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R Brand

Publications and source records attributed to R Brand.

At least 145 records · Page 8Linked to original sources
PubMed1991

Is it correct to correct? Developmental milestones in 555 "normal" preterm infants compared with term infants.

To determine whether correction for preterm birth should be applied during developmental assessment, we conducted a prospective national survey of very premature infants (born at less than 32 weeks of gestation); neurodevelopment in the first 2 years was studied with the Dutch child health care developmental assessment. In 555 preterm children who had no evidence of handicap at 2 years of age, the age at which developmental milestones were reached was established. The results were compared with the results of the same assessment in Dutch children born at term. During the first year, the development of the very premature children equaled the development of normal children when full correction was applied. At 2 years of age, development was equal to or better than normal children's development without correction. We conclude that full correction for prematurity should be applied in the first year to avoid overreferral for developmental stimulation, whereas at 2 years of age correction is not necessary.

Age Factors↗
PubMed1991

Computerised vascular data management: a flexible modular registry suitable for the evaluation of long-term results in patients subjected to multiple interventions.

We have designed a computerised vascular registry (CVR) combining storage of complete patient histories in minute detail, including reoperations and long-term follow-up, with clinical applicability. The basic concept of this registry is the storage of data in a structure of cycles (one cycle per treatment episode), modules (clusters of logistically correlated data) and data-chapters (clusters of clinically correlated data). The registry was designed to minimally interfere with routine clinical practice, for instance by collecting the data step-by-step at the wards and out-patient clinics, quite similar to traditional record keeping. The CVR enables production of inventories of all stored data. More importantly, and in addition to other registries, the structure of our registry adequately enables analyses of data of patients with multiple interventions and patients with long-term follow-up. A microcomputer was used for the input of data, which were stored in a structure enabling effortless transportation of the data to a mainframe computer. Standard software programs were used. Simple inventories and analyses were performed on a microcomputer, and a mainframe computer was used for more complex analyses. The performance and applicability of the newly designed CVR was thoroughly tested in comprehensive retrospective studies. On the basis of these experiences several adjustments were carried out after which the CVR was introduced into clinical practice.

Computer Systems↗
PubMed1991

Popliteal artery aneurysms. Long-term follow-up of aneurysmal disease and results of surgical treatment.

The natural history of aneurysmal disease was analyzed in 50 patients who were treated for 71 popliteal aneurysms. No patients were lost to follow-up (mean, 5.0 years). Initially, 25 popliteal aneurysms (25/71; 35%) were treated nonsurgically, and 46 (46/71; 65%) were treated surgically. Complications developed in 12 of the 21 asymptomatic popliteal aneurysms (57%) and in 2 of the 4 symptomatic popliteal aneurysms (50%), which were treated nonsurgically. The probability of developing complications increased with time to 74% within 5 years. When reconstruction of a popliteal aneurysm was performed, graft patency and foot salvage were 64% and 95% at 10 years, respectively. Particularly acute arterial thromboembolism was a severe presenting complication. Another important finding was the development of 23 arteriosclerotic aneurysms at other locations during follow-up in 16 patients (32%). The probability of developing these new aneurysms increased to 49% 10 years after repair of the initial popliteal aneurysm. The presence of multiple isolated aneurysms at the initial examination was the most significant risk factor limiting the survival of these patients. Consequently patients at risk could be identified early. This study confirms the limb-threatening potential of popliteal aneurysms when left untreated. Therefore prophylactic reconstructive surgery should be undertaken. Moreover, this study demonstrates that patients with a popliteal artery aneurysm have an increased risk of new aneurysm formation, both in the popliteal artery and at other locations. Therefore these patients should be followed and, in the event that new aneurysms develop, should be considered for elective reconstructive surgery to prevent limb-threatening or life-endangering complications.

Aged↗
PubMed1991

The use of health services in the first 2 years of life in a nationwide cohort of very preterm and/or very low birthweight infants in The Netherlands: rehospitalisation and out-patient care.

In a prospective collaborative survey on very preterm (less than 32 weeks) and/or very low birthweight (VLBW) infants (less than 1500 g) in The Netherlands, the use of health services was studied by examining the incidence of and reasons for rehospitalisation and the use of out-patient care, i.e. visits to medical specialists and physical therapists. Out of 1338 liveborn infants originally enrolled in the survey, 998 survived the initial hospital stay. Their use of health services was studied during four period: discharge-3 months, 3-6, 6-12 and 12-24 months corrected for expected date of delivery. A total of 320 infants (34%) was readmitted on 481 occasions. The main reasons for rehospitalisation were surgical procedures, of which inguinal herniorrhaphy was the most prominent, and respiratory tract disorders: 149 admissions (31%) and 147 (31%) admissions respectively. The remaining reasons for rehospitalisation occurred less frequently. In a multivariate analysis, both sex and the length of the initial hospital stay were shown to be significantly associated with an increased risk of rehospitalisation. During the study period, 671 children (67%) attended a medical specialist other than their paediatrician, and 313 children (31%) attended a physical therapist. The use of out-patient services was higher in the first than in the second year of follow-up. The use of health services depended very much on the neurodevelopmental status of the child. In the second year of life, a similar rehospitalisation rate and use of out-patient services was found in the non-impaired children as in children from the general Dutch population.

Ambulatory Care↗
PubMed1991

Cognitive function after spinal or general anesthesia for transurethral prostatectomy in elderly men.

Cognitive functions in 53 elderly men who underwent a transurethral prostatectomy were assessed pre-operatively and 4 days and 3 months post-operatively. Thirteen patients had a preference for one particular type of anesthesia, and the remaining 40 were randomly allocated to receive either spinal or general anesthesia. Cognitive function was not different between the groups receiving different types of anesthesia at either time point and did not decrease post-operatively. No pre- or perioperative variable could distinguish the subgroup of patients who had a post-operative decrease of 2 points or more on the Mini-Mental State Examination. No difference in post-operative performance was found in the patient groups with pre-operative Mini-Mental State Examination scores above or under their age-specific norm. It is concluded that neither hospitalization nor the two forms of anesthesia investigated cause a decrease in cognitive function in elderly men.

Aged↗
PubMed1991

Tissue reaction to suture materials revisited: is there argument to change our views?

Tissue reactivity to ten different suture materials (silk, plain catgut, chrome catgut, tevdek, ticron, ethibond, vicryl, dexon, maxon and prolene) was evaluated on the basis of conventional microscopic assessment of eight histologic parameters at 7 days following surgery in the rat. Each suture material was placed at different localizations in the abdominal facial layer of 6 rats, thus a total of 60 rats were operated on. A completely standardized and reproducible system of microscopic assessment was used. Weighed discriminant sum values of these parameters showed no systematic differences between tissue reaction to these sutures. The computed addition of all possible magnitudes of weighing factors to the tissue reactivity parameters did not change this negative result. Discriminant analysis showed that it is unlikely that conventional histologic parameters of tissue reaction constitute a single concept like 'tissue reactivity'. It is concluded that at 7 days after surgery the effect of surgical trauma still nullifies the possible differences between suture materials with respect to tissue reaction. Minimizing surgical trauma should, therefore, be reappraised as more important for physiologic wound healing than the use of biocompatible sutures.

Animals↗
PubMed1991

Hearing loss in facioscapulohumeral muscular dystrophy.

The coincidence of facioscapulohumeral muscular dystrophy (FSHD) with sensorineural hearing loss and retinal abnormalities might imply genetic heterogeneity of FSHD. We performed screening audiometry in 56 patients with autosomal dominant FSHD and in 72 healthy family members, and found that the difference in hearing level between 4,000 Hz and 6,000 Hz was significantly greater in FSHD patients than in controls, independently both for the left and right ear. We conclude that this change of hearing function is part of the disease and may lead to severe hearing loss in some patients. The fact that it was present in all families is another argument against genetic heterogeneity.

Adolescent↗
PubMed1991

Long-term prognosis after partial gastrectomy for benign conditions. Survival and smoking-related death of 2633 Amsterdam postgastrectomy patients followed up since surgery between 1931 and 1960.

Decreased life expectancy may occur after remote peptic ulcer surgery, but the cause of shortened survival is unclear. A 50-year follow-up study of an Amsterdam cohort of postgastrectomy patients who underwent ulcer surgery between 1931 and 1960 showed a statistically significant decrease in survival after a postoperative interval of 12 years or more compared with the general population. The shortened life expectancy mainly reflected decreased survival in men. In women, no significant difference in survival compared with the general population was observed. The excess mortality in men was predominantly due to a statistically significant increase in cancer-related deaths. Carcinoma of the lung accounted for the majority of excess mortality. No time relationship between lung cancer death and interval since surgery was observed. Thus, smoking, primarily in men who had undergone surgery for gastric ulcers, seems an important factor contributing to excess mortality and shortened life expectancy. Excess mortality due to tobacco use has also been observed in postmarketing surveillance of H2-receptor antagonists. Therefore, smoking cessation may provide the greatest improvement in the long-term prognosis of peptic ulcer patients, regardless of the treatment.

Adult↗
PubMed1990

Comparison of ovarian stimulation regimens for in vitro fertilization (IVE) with and without a gonadotropin-releasing hormone (GnRH) agonist: results of a randomized study.

In order to diminish the cancellation rate due to a premature endogeneous LH surge and/or to a poor ovarian response and thus increasing the pregnancy rate, a GnRH agonist (Buserelin) was applied in patients starting their first ovarian stimulation with gonadotropins for IVF. All patients suffered from tubal infertility and were not older than 40 years. Each woman was allocated randomly to one of three groups: the conventional treatment with hMG alone (group I), patients from group II started the hMG treatment shortly after the LH rise caused by the GnRH agonist and patients in group III commenced the hMG treatment when an hypogonadotropic state was achieved after a long treatment of Buserelin. All male partners had a normal spermiogram. A reduction of poor responders to the superovulation is seen in the short-term group (6%), compared with the other two groups (14%). In some cases from group III ovarian cyst formation led to the cancellation of the treatment. The long-term group differs significantly from the other two in the duration of the gonadotropin stimulation and the number of ampoules hMG used. A severe ovarian overstimulation syndrome was not observed. There is no difference in the number of retrieved oocytes and the fertilization rate among the three groups. The pregnancy rate per cycle or per patient in the group with a short-term GnRH-agonist regimen is significantly higher compared to that of the group using the conventional hMG treatment.

Administration, Intranasal↗
PubMed1990

Prenatal risk factors for cot death in very preterm and small for gestational age infants.

In a nationwide prospective survey on very preterm and very-low-birthweight infants in The Netherlands, the incidence of cot death in infants discharged alive was 15%. The postnatal age at death in these infants did not differ significantly from age at death in other cot death infants. Using a case-control design, possible risk factors associated with cot death were identified: lower maternal age at first pregnancy; maternal smoking during pregnancy; hypothermia of the infant immediately after birth; decreased number of white blood cells and thrombocytes in the infant on the first day of life. Intrauterine hypoxia is hypothesized as the entity common to these factors.

Case-Control Studies↗
PubMed1990

Neonatal seizures in very preterm and very low birthweight infants: mortality and handicaps at two years of age in a nationwide cohort.

In a nationwide, prospective survey on very preterm and/or very low birthweight infants (less than 32 weeks of gestational age and/or less than 1500 g birthweight) we studied the outcome at the corrected age of two years of children with neonatal seizures. Of the 1338 infants, originally enrolled in the study, 72 had neonatal seizures; of these 44 died and 11 developed a major handicap. Using a multivariate statistical method, a significantly increased risk of death as well as handicap was found in infants with seizures compared to infants without seizures. Nevertheless, 16 of the 28 survivors with neonatal seizures were considered normal at the corrected age of two years.

Gestational Age↗
PubMed1990

Neonatal neurological dysfunction in a cohort of very preterm and/or very low birthweight infants--relation to other perinatal factors and outcome at 2 years.

Neonatal neurological dysfunction was found in only a small part of 1192 infants enrolled in an epidemiologic survey on very preterm (less than 32 weeks) and very low birthweight (less than 1500 gram) infants. A routine neurological examination was performed in the neonatal period by the attending paediatrician throughout all levels of care. The incidence of obvious neurological dysfunction was 8.1% and incidence of suspect neurological dysfunction was 6.1%. Multivariate analysis showed that gestational age, birthweight, low Apgar score, IRDS and, most of all, ICH were significantly associated with neonatal neurological dysfunction (N.D.). The mortality rate was very high in obvious and suspect ND infants (81.1% and 35.6% respectively) compared to neurologically normal infants (17.8%). This phenomenon was also found regarding the handicap rate at two years of age. Only 6% (n = 6) of the 96 infants with obvious ND survived without handicap. Using routine physical examination, a quarter of the very preterm or VLBW infants with later neurological disturbances were identified. A more standardized neurological examination, incorporated in the routine examination of newborns in all levels of care, might improve early identification of infants at risk for handicaps.

Brain Diseases↗
PubMed1990

Degradation of aggregates of activated C3 (C3b) by monocytes of patients with rheumatoid arthritis is related to vasculitis.

We investigated whether a decreased complement receptor expression or function of monocytes isolated from peripheral blood of 52 patients with rheumatoid arthritis (RA) and rheumatoid vasculitis (RV) could account for the previously observed diminished degradation of immune complexes by monocytes of patients with RA and RV. On average, monocytes from all patients expressed significantly less CR1, and degraded significantly less AC3b when compared with monocytes of healthy controls. In addition, monocytes from RV patients degraded significantly less AC3b when compared with monocytes from patients with RA. The expression of both CR1 and CR3 on monocytes of RV patients was lower compared with RA patients but this difference was only significant for CR3. No differences were found between AC3b degradation and the expression of CR1 and CR3 between patients with active and inactive RA. Using linear discriminant analysis on the variables AC3b, CR1 and CR3, 94% of the patients could be classified correctly as healthy controls, RA or RV, suggesting a true multi-variate relationship between these parameters and patients groups. Our results suggest that the diminished capacity of monocytes from RA patients to degrade AC3b is due partly to a decreased expression of CR1 and CR3.

Adult↗
PubMed1990

Using logistic regression in perinatal epidemiology: an introduction for clinical researchers. Part 1: Basic concepts.

Logistic regression is a statistical modelling technique which may be applied to estimate the simultaneous effect of a set of predictors (e.g. gestational age, birthweight) on the risk of a certain outcome variable (e.g. neonatal death) which can take either one of two possible values (yes/no, alive/dead) or in the situation where one wants to estimate the effect of a particular risk factor (e.g. sex) while adjusting (correcting) for the effect of other risk factors (e.g. gestational age). Since this situation often occurs both in medical or epidemiological research and in daily practice it is important to have a flexible and readily interpretable technique to predict risk of mortality and morbidity. Since the logistic regression technique is a powerful and widely applicable tool which is appearing more and more often in the epidemiological literature, a basic understanding of this technique becomes necessary for the clinical researcher. In this paper we explain logistic regression to medical researchers who do not have any particular statistical background. Part 1 covers the basic concepts. Part 2 will describe the actual representation of the basic concepts in a logistic framework.

Epidemiologic Methods↗
PubMed1990

Using logistic regression in perinatal epidemiology: an introduction for clinical researchers. Part 2: The logistic regression equation.

In Part 1 basic concepts were introduced as a preparation for an introductory explanation of logistic regression. Logistic regression is a statistical modelling technique, designed for the estimation of the simultaneous effects of predictors on the risk of a certain dichotomous outcome variable where each effect is estimated while adjusting for the effect of the other factors considered. The basic concepts--odds, odds ratio, confounding and interaction--were introduced in such a way that they naturally lead to the concept of logistic regression. In Part 2 the concepts are 'translated' into simple equations. By studying these equations the equivalence between such mathematical expressions and the underlying clinical assessment of risk will become clear.

Female↗
PubMed1990

Serum CK-BB activity in the preterm infant and outcome at two and four years of age.

The relationship between serum creatine kinase brain-specific isoenzyme (CK-BB) activity immediately after birth and neurodevelopmental outcome at two and four years corrected age was studied prospectively in 45 preterm infants (less than 34 weeks gestation). Nine infants died during the neonatal period and one was lost to follow-up. Of the 35 children available for follow-up, seven had motor disabilities: four severe diplegia, two mild to moderate diplegia and one hemiplegia. No relationship existed between these motor disabilities and serum CK-BB activity after birth. There seemed to be a relationship between increased serum CK-BB after birth and low scores on the Bayley Scales of Mental Development, but this did not reach statistical significance. At the age of four years, four of the five survivors with high serum CK-BB activity after birth (greater than 25U/L) needed special schooling because of mental retardation. Increased serum CK-BB activity after birth may be associated with delayed mental development, but further study is needed, especially of asphyxiated infants.

Brain Diseases↗
PubMed1990

Elevated insulin receptor content in human breast cancer.

The growth of breast cancer cells is under the regulation of hormones, growth factors, and their receptors. In the present study, we have employed a new, sensitive, and specific radioimmunoassay for the direct measurement of insulin receptors in surgical specimens of breast cancers. In 159 specimens the insulin receptor content was 6.15 +/- 3.69 ng/0.1 mg protein. This value was more than sixfold higher than the mean value found in both 27 normal breast tissues obtained at total mastectomy (0.95 + 0.68, P less than 0.001) and in six normal specimens obtained from reduction mammoplasty (0.84 +/- 0.78, P less than 0.001). The insulin receptor content in breast cancer tissues was also higher than in any normal tissue investigated including liver (Pezzino, V., V. Papa, V. Trischitta, A. Brunetti, P.A. Goodman, M.K. Treutelaar, J.A. Williams, B.A. Maddux, R. Vigneri, and I.D. Goldfine, 1989. Am. J. Physiol. 257:E451-457). The insulin receptor in breast cancer retained its ability to both bind insulin and undergo insulin-induced tyrosine kinase activation. Immunostaining of the specimens revealed that the insulin receptor was present in malignant epithelial cells, but was not detected in stromal and inflammatory cells. Univariant analysis revealed that the insulin receptor content of the tumors correlated positively with tumor size (P = 0.014), histological grading (P = 0.030), and the estrogen receptor content (P = 0.035). There were no significant correlations between insulin receptor content and the age, body weight, menopausal status, and nodal involvement of the patients. These studies indicate, therefore, that the insulin receptor content is increased in breast cancers and raise the possibility that the insulin receptor may have a role in the biology of these tumors.

Binding, Competitive↗