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Biomedical subjects

R Braakman

Publications and source records attributed to R Braakman.

At least 55 records · Page 3Linked to original sources
PubMed1988

Pitfalls in diagnostic stereotactic brain surgery.

Some of the problems and dangers inherent to stereotaxis are discussed in a series of 243 procedures. Neurological deterioration, either due to haemorrhage or to traumatic oedema, was rare. One fatal accident occurred. Infections were not present although the patient's head was not shaved. Provided he can manipulate the proper instruments accurately stereotaxis can nowadays be performed by any surgeon who can make a burr hole and perform simple arithmetic calculations. This procedure can be considered to lie within the scope of any neurosurgeon.

Biopsy↗
PubMed1988

Chemonucleolysis or discectomy? Results of a randomized multicentre trial in patients with a herniated lumbar intervertebral disc (a preliminary report).

A randomized trial was carried out to compare the results of discectomy and chemonucleolysis in 151 patients, suffering from lumbar disc herniation L4-L5 or L5-S1. All patients fulfilled strict entry criteria. Seventy eight patients underwent surgical discectomy, 73 were treated with chemonucleolysis. Within one year of follow-up 18 patients (25%) required surgery after chemonucleolysis, whereas 2 patients (3%) in the surgery group underwent re-operation. Increase of radicular pain within 30 days after treatment was encountered in 16 patients (22%) in the chemonucleolysis group, as compared to none in the surgery group. The results of open surgery after preceding chemonucleolysis was successful in 44% and unsuccessful in 56%. The final result of chemonucleolysis, including second treatment, was still slightly less favourable (73%) the result of primary surgery (79%).

Adolescent↗
PubMed1988

Non-corresponding radiological and surgical diagnoses in patients operated for sciatica.

One hundred and nine patients with radicular leg-pain underwent both computer-tomography and myelography and were subsequently operated upon. The diagnoses on computer-tomogram, myelogram and surgery failed to correspond in 41 cases. Stenosis of the bony spinal canal, scar formation, and an intra- or extraforaminal herniation were the most frequent causes of discrepancy in the diagnoses. In cases of spinal stenosis and previous disc surgery both computer-tomography and myelography have to be performed. Certain precautions taken during computer-tomography and myelography may reduce the number of discrepant findings.

Adolescent↗
PubMed1988

Prognosis of the posttraumatic vegetative state.

Of 1373 patients who, following severe brain injury had been comatose for over 6 hours, 140 (10%) were in a vegetative state one month later. Fifty-nine regained consciousness but none of those aged over 40 became independent during the first year. Of those still in a vegetative state after 3 months, none became independent irrespective of age. Of all patients comatose for over 6 hours after severe brain injury, only 1% was in a vegetative state after one year. Certain scores for features such as age, pupillary reactions, eye-opening and eye movements indicate either a favourable prognosis, a fatal outcome or irreversible coma. It is only in some 10% of all patients in coma or in a vegetative state during the first two weeks after the accident that it is possible to predict with a high degree of probability (p greater than 0.95), an unfavourable outcome (death or irreversible coma) within one year. At no time after the onset of coma is it possible to predict or distinguish, with a fair degree of probability (e.g. p greater than 0.80), those patients who will remain in a vegetative state from those who will die.

Adult↗
PubMed1988

Changes in radicular function following low-back surgery.

Results of neurological assessment 1 year following surgical treatment of herniated lumbar intervertebral discs and lumbar stenosis are reported in 443 patients. The data were collected using separate series of questionnaires to be completed by the patient and the surgeon. Preoperatively, motor loss was reported by 12% of patients, while surgeons found motor weakness in 28%. Postoperative motor loss was still present in 24% and 25% of these cases, respectively; the operation had caused or aggravated motor loss in 5% and 3% of cases, respectively. Sensory phenomena were reported by 53% of the patients, while surgeons found sensory loss in 45%. Sensation was reported as abnormal 1 year after surgery both by patients and by surgeons in one-third of these cases. Sensory loss, considered by the patient to be caused or aggravated by operation, occurred in 15% of cases and in 12% of cases the surgeons agreed. Preoperatively, unilaterally diminished knee and Achilles tendon reflexes were found in 9% and 42%, respectively; at 1 year after surgery, these had recovered in 65% and 57% of cases, respectively. Surgery caused or aggravated unilaterally diminished knee or ankle jerks in 3% and 10% of cases, respectively.

Humans↗
PubMed1987

Interobserver agreement in assessment of vestibulo-ocular responses.

In 30 comatose head injured patients vestibulo-ocular responses were elicited by caloric stimulation. Inter- and intra-observer agreement of these responses was studied. The responses were shown in the form of a film to ten doctors who classified them into four categories: no reaction, tonic reaction, paradoxical nystagmus and nystagmus. The level of the coefficient Kappa (a chance-corrected measure of interobserver agreement) was 0.50; this is within the range of levels for most components of clinical examination reported in the literature.

Cold Temperature↗
PubMed1987

Lumbar disk herniation: diagnosis with CT or myelography.

The value of computed tomography (CT) and myelography as single investigations in the diagnostic evaluation of patients with radiating leg pain probably due to lumbar disk herniation (LDH) has been adequately demonstrated. However, the extent to which CT can replace myelography and the conditions in which the examinations should be combined and in which order are still uncertain. Results of CT scans and myelograms from 461 patients with symptoms of lumbar root compression, probably due to LDH, were evaluated and compared with surgical results, if available. The sensitivity of myelography exceeded that of CT (82% vs. 73%), but its specificity was lower (67% vs. 77%). The positive predictive value of myelography only slightly differed from that of CT (93% vs. 94%). These results were used to establish a sequential diagnostic workup for patients with radiating leg pain. If, in this population with a high prior probability for surgery, CT had been the investigation of first choice in patients suspected of having LDH, the number of myelographic procedures performed could have been reduced by two-thirds.

Adult↗
PubMed1987

Hyperflexion sprain of the cervical spine. Follow-up of 45 cases.

A long-term follow-up study of a series of 45 consecutive patients with a hyperflexion sprain causing anterior subluxation of the cervical spine shows that conservative management is successful in more than 50 per cent of children and adults. In patients under 16 years of age, usually with involvement of the C2-C4 level, kyphosis may persist for months, but later realignment is common. Primary surgical treatment should be restricted to children with a kyphotic angulation of more than 20 degrees. In adults with injuries commonly at the C4-C7 level, the failure rate of conservative management indicates that primary surgical treatment should be preferred unless kyphotic angulation is less than 10 degrees. Kyphosis may progress during conservative management and may even result in unilateral interlocking. However, none of the patients with a persisting kyphotic angulation had neck complaints. Neurologic involvement when present was mild and reversible. Posterior wiring and fusion may entail inadvertent inclusion of adjacent segments without, however, causing major residual symptoms.

Adolescent↗
PubMed1986

Prognosis and prediction of outcome in comatose head injured patients.

Recent studies on the prognosis of comatose head injured patients have identified single powerful prognostic features at various time points during the first month after onset of coma. Using appropriate statistical methods even more powerful combinations of prognostic features can be selected. At each time point, optimal prediction requires sets of only 3 to 5 features. These features include depth and duration of coma as assessed by the Glasgow Coma Scale, pupil reactivity to light, age in decades, and spontaneous and reflex eye movements. In individual new patients, bedside predictions are now possible, e.g. using a booklet with prognosis tables like the one used in Rotterdam. Doctors actually learn by using these tables as they retain some of the information. However, the main application is that these tables permit one to evaluate whether differences in survival rates in different centres with different management regimes are due to a difference in management efficacy or to a difference in initial severity of injury.

Coma↗
PubMed1986

Pressure-flow relationships of the canine iliac periphery and systemic hemodynamics: effects of sodiumnitroprusside and adenosine.

It has been reported that sodiumnitroprusside (SNP) decreases mean systemic pressure and simultaneously increases pressure pulse amplification towards the iliac periphery (Kenner and van Zwieten 1982). This unexpected finding was suggested to be due to a decrease in iliac peripheral resistance but an increase in iliac differential resistance. In order to investigate this apparent contradiction, the iliac periphery was hemodynamically isolated from the rest of the circulation and perfused with the dog's own blood by means of a pump. Perfusion pressure (P) and flow (F), femoral venous pressure (Pv), systemic pressure (Ps) and cardiac output (CO) were measured. Steady state pressure-flow relations of the isolated bed were obtained during control and during various i.v. infusion rates of SNP and adenosine (ADS) and were found to be straight (mean r = 0.99). Their slope (delta P/delta F) was defined as differential resistance (Rd). Peripheral resistance (Rp) of the iliac bed was defined as Rp = (P-Pv)/F, calculated at the flow value where perfusion pressure equalled the prevailing systemic pressure. Total peripheral resistance (TPR) was defined as TPR = Ps/CO. The changes of Rd, Rp, Ps, CO and TPR with respect to control show that during low SNP infusion rates Rd and Rp were both increased while TPR was decreased. During all infusion rates of SNP CO did not change while Ps decreased. During low infusion rates of adenosine CO increased while Ps, Rd and Rp did not change and TPR decreased.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗
PubMed1986

Influence of transsphenoidal hypophysectomy on visual deficit due to a pituitary tumour.

The effect of transsphenoidal hypophysectomy is presented in 60 patients with visual impairment due to a pituitary adenoma, derived from a total series of 194 patients. The preoperative visual acuity and visual fields were compared with those one year after operation. The visual field loss was estimated using a semi-quantitative method. Seventy-two eyes had diminished visual acuity, and this improved in 45 eyes (63%). Visual field loss was present in 102 eyes and this improved in 71 eyes (70%). Improvement of either visual acuity and/or visual field was found in 84 eyes (78%). In 16 patients (27%) vision became normal after operation. Improvement of the visual acuity was usually accompanied by an improvement in the visual fields.

Adenoma↗
PubMed1986

The value of more aggressive management in traumatic paraplegia.

In the last decade, operative decompression of cord and cauda, internal fixation with rods, bony fusion and early ambulation, have become more popular in the management of thoracolumbar injuries with neurological deficit. Computer-tomography, CT myelography and peroperative ultrasonography provided direct evidence, that, without surgical decompression, reduction of displaced bone and disc fragments, propelled into the spinal canal, is often incomplete, not only after postural reduction, but also after rod instrumentation. The percentage of patients with incomplete paraplegia who show improvement of neurological deficit after surgical reduction and stabilization, is probably greater than that noted with postural management. There are, however, shortcomings in the classification of neurological deficit, which hamper adequate comparison. Further research in this field is necessary. The value of the surgical approaches is mainly in immediate stabilization, which diminishes pain, facilitates nursing care and allows more rapid mobilization. This results in a shorter stay in hospital and earlier active rehabilitation. That decompression of the neural elements provides improved neurological recovery seems likely, but has so far not been proven. Management of these patients, preferably admitted to specialized units, should be carried out by an orthopedic surgeon and a neurosurgeon in cooperation. The orthopedic surgeon is mainly concerned with management of the spine; the neurosurgeon with management of the paraplegia, operations being carried out by both.

Fractures, Bone↗
PubMed1986

Decision analysis of the management of incidental intracranial saccular aneurysms.

We used decision analysis to approach the dilemma "surgery or not?" in patients with incidental intracranial saccular aneurysms. To decide if a patient should undergo surgery, the following factors are of primary importance: age and general health of the patient, chance of rupture of the aneurysm, surgical mortality and morbidity, and patient preference for immediate and long-term risks. In a fictitious patient (a woman of 45 with migraine, otherwise healthy), surgery was the option with the greatest expected utility. Sensitivity analysis showed the influence of different factors. Other patients are also discussed, and "break-even" points for age versus surgical results are given.

Decision Making↗