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Biomedical subjects

R Brand

Publications and source records attributed to R Brand.

At least 163 records · Page 9Linked to original sources
PubMed1989

[Inter-hospital comparison of perinatal intensive care in academic hospitals].

Data on infants born in 1983 with a gestational age of less than 32 weeks and a birth weight under 1500 g were collected in the Project on Preterm and Small for gestational age infants (POPS). It was found that the mortality odds of these neonates were lowest when they were born in one of the eight departments of obstetrics in university hospitals and subsequently admitted to the neonatal intensive care units (PICUs). Comparison of the eight PICUs revealed considerable differences in crude mortality but this was due to differences between the groups of patients. After correction for this variability by means of a multivariate analysis technique (logistic regression), no statistically significant differences in mortality were found. The actual mortality rates in all PICUs virtually equalled the mortality to be expected on the basis of the abnormalities in the patient groups in question.

Academic Medical Centers↗
PubMed1989

[Mortality risk after intrauterine and after neonatal transport].

In a Dutch national collaborative study of 1338 newborn infants born in 1983 with a gestational age of less than 32 weeks and (or) a birth weight of less than 1500 g, a comparison was made of maternal transport to university perinatal centres and delivery in local general hospitals on the one hand, and neonatal transport to those centres and treatment in regional general hospitals on the other. The mortality risk was investigated by means of logistic regression analysis. The results show that maternal transport was accompanied by a statistically significantly lower mortality risk. The mortality risk after neonatal transport, compared with that after treatment in regional hospitals, was also lower although not significantly. Mortality risk after neonatal transport was significantly associated with increasing transportation distance. The results of the study confirm that referral by maternal transport offers the best prospects for high risk preterm babies.

Female↗
PubMed1989

Morbidity of very low birthweight infants at corrected age of two years in a geographically defined population. Report from Project on Preterm and Small for gestational age infants in The Netherlands.

In a nationwide prospective survey on very preterm and very-low-birthweight infants in the Netherlands, a neurodevelopmental assessment was made at the corrected age of two years in a virtually complete population. The study achieved a 97.4% follow-up rate. A major handicap was found in 59 children and a minor handicap in 111 children (4.4% and 8.3% of liveborn infants, respectively). Unlike mortality, handicap was apparently unrelated to gestational age or birthweight.

Age Factors↗
PubMed1989

The male disadvantage in very low birthweight infants: does it really exist?

In a nationwide collaborative study in the Netherlands, perinatal and follow up data were collected on 1338 liveborn very preterm (less than 32 weeks) and/or very low birthweight (VLBW) infants (less than 1500 g). In this group, the mortality risk was similar for both male and female infants. The handicap risk, however, was significantly greater for boys than for girls. This finding could not be explained as being due to the well-known delay in lung maturation in male infants as in idiopathic respiratory distress syndrome and need of assisted ventilation.

Birth Weight↗
PubMed1989

False aneurysms after prosthetic reconstructions for aortoiliac obstructive disease.

Several aspects of false aneurysm development after prosthetic resconstruction for aortoiliac obstructive disease were studied. For this purpose the long-term results (up to 20 years of follow-up) of 518 patients with implanted arterial prostheses in the aortoiliofemoral tract were retrospectively evaluated. Completeness of follow-up data was 83.2% 15 years after operation. A total of 101 false aneurysms (21 aortic, 53 iliac, and 27 femoral) were detected in 69 patients and verified by operation. The incidence per patient was 69 of 518 patients (13.3%). The incidences per anastomosis were: aortic, 21 of 438 anastomoses (4.8%); iliac, 53 of 835 anastomoses (6.3%); and femoral, 27 of 198 anastomoses (13.6%). Almost one half (47.5%) of all the false aneurysms were asymptomatic and were detected by angiography or ultrasonography. Chances for late survivors to develop a false aneurysm during follow-up were calculated by the life-table method. The chance to be free of a false aneurysm at any site was 77.2% 15 years after operation. These chances were 92.3%, 84.5%, and 76.2% for aortic, iliac, and femoral anastomoses, respectively. Analyses of subgroups showed that the development of a false aneurysm was significantly correlated with the presence of hypertension, multilevel disease, the type of suture material, and the type of anastomosis. These results indicate unexpectedly high chances for the development of false aneurysms in long-term survivors after aortoiliac or aortofemoral prosthetic reconstructions. We advocate the use of a life-long follow-up schedule with periodic angiography and ultrasonography for these patients.

Anastomosis, Surgical↗
PubMed1989

A prospective survey of necrotising enterocolitis in very low birthweight infants.

Necrotising enterocolitis is the most common gastrointestinal complication of pre-term infants. In order to determine the strength of the association of hypoxia/ischaemia and infection as causative factors in necrotising enterocolitis, we evaluated all liveborn pre-term infants with a birthweight less than 1500 g and/or gestational age less than 32 weeks in The Netherlands in 1983. The factors related to hypoxia/ischaemia included: asphyxia, respiratory distress syndrome, ventilatory assistance, persistent fetal circulation, persistent ductus arteriosus, apnoea, bradycardia, exchange transfusion and peri/intraventricular haemorrhage; those related to infection were: congenital infections, pneumonia, sepsis and meningitis. Of the 1338 infants enrolled, 1187 survived for more than 24 hours and had complete data. Mean (+/- s.d.) birthweight was 1278 (+/- 297) g and mean (+/- s.d.) gestational age 30.7 (+/- 2.6) weeks. Seventy-three (6.1%) infants developed necrotising enterocolitis: 46 (63.0%) stage I disease (clinically very suspect), 11 (15.1%) stage II (pneumatosis intestinalis) and 16 (21.9%) stage III (intestinal perforation). Mean +/- s.d. birthweight of the infants with necrotising enterocolitis (1197 +/- 284 g) was lower (P less than 0.02) than in those without necrotising enterocolitis (1283 +/- 297 g). Gestational ages were comparable. Mortality in the group with necrotising enterocolitis was 21.9% versus 15.8% in the non-necrotising enterocolitis group (NS). Stepwise logistic regression analysis indicated that among those factors studied, only sepsis and birthweight were truly associated with the occurrence of necrotising enterocolitis.

Enterocolitis, Pseudomembranous↗
PubMed1989

Hyperbilirubinemia in preterm infants and neurodevelopmental outcome at 2 years of age: results of a national collaborative survey.

As part of a prospective national survey of preterm and small for gestational age infants in the Netherlands, the relationship between maximal serum total bilirubin concentration in the neonatal period and neurodevelopmental outcome at the corrected age of 2 years was studied. Initially, 1,338 infants with a gestational age of less than 32 completed weeks and/or a birth weight of less than 1,500 g were enrolled in the study; 146 were subsequently excluded because of congenital malformations and 361 died during the study period. At the corrected age of 2 years, 831 children were available for follow-up. Children with minor and major handicaps had significantly greater maximal serum total bilirubin concentrations than children with a normal neurodevelopmental outcome (P = .02). A consistent increase in prevalence of handicaps was found for each 50-mumol/L (2.9 mg/dL) increase of maximal serum total bilirubin concentration. The handicaps consisted mainly of cerebral palsy. Logistic regression analysis involving seven suspected confounding factors (gestational age, birth weight, seizures, intracranial hemorrhage, respiratory distress syndrome, ventriculomegaly, and bronchopulmonary dysplasia) revealed that the odds ratio was 1.3. This indicates that, on a multiplicative scale, the risk of a handicap increased by 30% for each 50-mumol/L (2.9 mg/dL) increase of maximal serum total bilirubin concentration (P = .02). Further analysis treated bilirubin as a categorized exposure. A striking systematic increase was found, suggesting a causal relationship between maximal serum total bilirubin concentration and neurodevelopmental outcome.

Bilirubin↗
PubMed1989

Tissue reaction and surgical knots: the effect of suture size, knot configuration, and knot volume.

Tissue reaction surrounding surgical knots was assessed histologically using a semiquantitative scoring system in 40 male Wistar rats. We tested sizes 2/0 and 4/0 (United States Pharmacopeia [USP]) coated polyglycolic acid and coated polyglactin-910 sutures, and two different knots. In addition, we measured the volume of the different knots and the total volume of tissue reaction surrounding the knots. Multivariate analysis showed only suture material and suture size to be independent factors determining tissue reaction. An increase of suture size resulted in a more than four- to sixfold increase in knot volume and a more than two- to threefold increase in the amount of the tissue-reaction sheath; however, the addition of extra throws to the knot enlarged the knot body by a factor of ony 1.5 and the tissue-reaction sheath by a factor of 1.0-1.9. These findings suggest that the use of thick-gauge suture material adds much more to the total amount of foreign body and tissue reaction in the wound than the addition of extra throws to the knot and might, therefore, be deleterious to optimum wound healing.

Animals↗
PubMed1989

Vision screening of school age children in Missouri.

In this report, vision screenings conducted by schools in the state of Missouri are reviewed. Data were generated by the 127 participating schools in 38 school districts that responded to four research questions. In general, many inadequacies exist in schools regarding vision screening. Recommendations include greater participation in the public school arena by vision specialists and the development of consistent criteria for vision screening in school districts.

Adolescent↗
PubMed1989

Age differences in corneal hydration control.

Dynamic changes in corneal thickness were measured in eight young and eight older normal subjects (mean ages 24.4 +/- 4.3 years and 71.9 +/- 7.3 years, respectively) to provide data for quantitative assessment of corneal hydration control and thereby provide information for studying age differences in this important aspect of corneal function. For each subject, pachometry data were obtained by (A) monitoring corneal recovery following hypoxic stress, and by either (B1) measuring recovery after sleep or (B2) by measuring corneal thickness in the late afternoon. The combined data from A and B1 or A and B2 were analyzed through an exponential model to provide information on the: (1) percent recovery per hour (PRPH) following induced corneal hydration; (2) open-eye steady-state (OESS) corneal thickness; (3) residual corneal swelling just before the hypoxic stress test; (4) amount of corneal edema induced by hypoxic stress; and (5) time to reach 95% recovery back to the OESS thickness level (T95%). The results show that between the two age groups, there are substantial differences in some characteristics of corneal hydration while other aspects are similar. For example, the mean PRPH values (58.9 +/- 7.8% and 34.2 +/- 6.4%/hr) were significantly higher in the younger subjects (P = 0.0002) and the mean time for 95% recovery to OESS thickness (207 +/- 42 min and 452 +/- 117 min) was significantly lower in the younger vs. the older group (P = 0.0002).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

For debate: pet birds as an independent risk factor for lung cancer.

To find out whether keeping birds in the home is an independent risk factor for lung cancer a case-control study was carried out in four main hospitals in The Hague, The Netherlands. Forty nine patients under 65 years of age with lung cancer each were matched for age and sex with two control subjects who attended the same general practice. Data were collected on social class, cigarette smoking, intake of beta carotene and vitamin C, and alcohol consumption. It was found that smoking, birdkeeping, and a low intake of vitamin C were significantly and independently related to the incidence of lung cancer. The odds ratio for lung cancer among people who keep birds as pets was estimated to be 6.7 after adjusting for smoking and vitamin C intake. The results of this study suggest that keeping pet birds is an independent risk factor for lung cancer.

Adult↗
PubMed1988

Assessment of tissue reaction at suture knots; an adaptation of Sewell's scoring system.

From a theoretical point of view and from reported animal work the knot side should be considered the most relevant part of the suture loop for studying inflammatory foreign body reaction. In the present study a semi-quantitative histological assessment of inflammatory tissue reaction around the knots of implanted sutures is presented. To test the reliability of this method an animal model was used in which two suture materials with well-known differences in tissue reactivity were studied. Differences in tissue response around the knots between these materials proved to be highly significant statistically (tissue reactivity score (TRS) 44.17 vs. 58.71: p less than 0.001). No differences in TRS could be demonstrated between different localizations in the anterior abdominal wall of male Wistar rats. Implications of these findings with respect to future studies are discussed.

Abdominal Muscles↗
PubMed1988

Outcome of periventricular-intraventricular hemorrhage at 2 years of age in 484 very preterm infants admitted to 6 neonatal intensive care units in The Netherlands.

Of 484 newborn infants with a gestational age of less than 32 weeks and admitted to 6 neonatal intensive care units in the Netherlands, 294 survived and were available for follow-up at the corrected age of two years. The total incidence of impaired neurodevelopmental outcome was 23.1%. Sixty-nine children had a periventricular-intraventricular hemorrhage (PIVH) in the neonatal period: 31 grade I, 21 grade II, 12 grade III, 5 grade IV. Children with grade I and II PIVH had significantly more handicaps than children without PIVH (36.5% vs 17.8%, p less than 0.01). This held even true after the data were adjusted for possible confounding factors (odds ratio [OR] 2.1, confidence interval [1.3, 3.3], p less than 0.01). Children with grade III and IV PIVH had also more handicaps than children without PIVH (52.9% vs 17.8%, p less than 0.001); after adjustment for confounding factors the OR was 3.0, confidence interval [1.6, 5.5], p less than 0.01. The difference between children with grade I and II PIVH and children with grade III and IV PIVH was not significant.

Cerebral Hemorrhage↗
PubMed1988

Patent ductus arteriosus in a cohort of 1338 preterm infants: a collaborative study.

As part of a prospective national survey on morbidity and mortality of all infants born at less than 32 weeks and/or weighing less than 1500 g in the Netherlands we studied the incidence of symptomatic patent ductus arteriosus (PDA) in infants surviving at least 24 hours. In 1252 of the 1338 infants the presence or absence of PDA could be established. The incidence of PDA was 10.7%. Logistic regression analyses revealed that idiopathic respiratory distress syndrome (IRDS) was the most predictive factor, followed in order of importance by septicaemia, birthweight, prolonged rupture of membranes and gestational age. None of the other maternal and perinatal factors showed any association with the occurrence of PDA. Furthermore, bronchopulmonary dysplasia (BPD) and necrotising enterocolitis (NEC) were found to be sequelae of PDA. The combination of IRDS, very pre-term birth and septicaemia should be considered as high risk for the development of PDA.

Ductus Arteriosus, Patent↗
PubMed1988

Total parenteral nutrition and sepsis.

In 1279 very premature or very low birthweight infants the use and duration of treatment with total parenteral nutrition were associated with short gestational age and low birth weight. Infants treated with total parenteral nutrition had a higher risk of sepsis usually caused by Staphylococcus epidermidis or Staphylococcus aureus.

Bacterial Infections↗