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Biomedical subjects

R Meijer

Publications and source records attributed to R Meijer.

At least 19 recordsLinked to original sources
PubMed2005

The Stroke Unit Discharge Guideline, a prognostic framework for the discharge outcome from the hospital stroke unit. A prospective cohort study.

OBJECTIVE: To investigate which factors during the subacute phase post stroke have predictive value for the discharge outcome from the hospital stroke unit. METHODS: In a prospective cohort of 338 patients admitted to a hospital stroke unit 26 potentially prognostic factors, arranged in clinical and social subdomains, were scored and analysed by binary logistic regression analysis. The outcome of the research consisted of the various discharge destinations. RESULTS: The overall predictive value of the discharge model is high (91%). Factors predictive of a poor discharge outcome are a low Barthel Index score (odds ratio (OR) 0.78 per point increase; p < 0.001), a poor sitting balance (OR 5.96; p < 0.001), a depression (OR 7.23; p < 0.001), poststroke cognitive disability (OR 3.51; p = 0.007) and older age (OR 1.05 per point increase; p = 0.008). If present, a personality disorder, premorbid cognitive disability and premorbid functional disability all show a tendency towards poor discharge outcome, but these factors did not reach statistical significance in this study, possibly due to their low prevalence. Readiness of the family circle to provide support was only significant in the univariate analysis. CONCLUSIONS: Somatic, biological and psychological factors predict the discharge outcome. Functional and cognitive factors play a decisive role in the future ability to live independently after a stroke. The prognostic importance of social factors could not be demonstrated. Urinary incontinence did not emerge as a prognostic factor. This is in contrast to scientific findings till now, but in accordance with clinical experience.

Age Factors↗
PubMed2003

Prognostic factors for ambulation and activities of daily living in the subacute phase after stroke. A systematic review of the literature.

OBJECTIVE: To identify evidence-based prognostic factors in the subacute phase after stroke for activities of daily living (ADL) and ambulation at six months to one year after stroke. DESIGN: Systematic literature search designed in accordance with the Cochrane Collaboration criteria with the following data sources: (1) MEDLINE, EMBASE, CINAHL, Current Contents, Cochrane Database of Systematic Reviews, Psyclit, and Sociological Abstracts. (2) Reference lists, personal archives, and consultation of experts. (3) Guidelines. METHODS: Inclusion criteria were: (1) cohort studies of patients with an ischaemic or haemorrhagic stroke; (2) inception cohort with assessment of prognostic factors within the first two weeks after stroke; (3) outcome measures for ADL and ambulation; and (4) a follow-up of six months to one year. Internal, statistical and external validity of the studies were assessed using a checklist with 11 methodological criteria in accordance with the recommendations of the Cochrane Collaboration. RESULTS: From 1,027 potentially relevant studies 26 studies involving a total of 7,850 patients met the inclusion criteria. Incontinence for urine is the only prognostic factor identified in three studies with a level A (i.e., a good level of scientific evidence according to the methodological score). The following factors were found in one level A study: initial ADL disability and ambulation, high age, severe paresis or paralysis, impaired swallowing, ideomotor apraxia, ideational apraxia, and visuospatial construction problems; as well as factors relating to complications of an ischaemic stroke, such as extraparenchymal bleeding, cerebral oedema and size of intraparenchymal haemorrhage. CONCLUSIONS: The present evidence concerning possible predictors in the subacute stage of stroke has insufficient quality to make an evidence-based prediction of ADL and ambulation after stroke because only one prognostic factor was demonstrated in at least two level A studies, our cut-off for sufficient scientific evidence.

Activities of Daily Living↗
PubMed2003

Prognostic factors in the subacute phase after stroke for the future residence after six months to one year. A systematic review of the literature.

OBJECTIVE: To identify evidence-based prognostic factors in the subacute phase after a stroke for future residence at six months to one year post stroke. DESIGN: Systematic literature search designed in accordance with the Cochrane Collaboration criteria with the following data sources: (1) MEDLINE, EMBASE, CINAHL, Current Contents, Cochrane Database of Systematic Reviews, PsycLIT and Sociological Abstracts. (2) Reference lists, personal archives and consultation of experts in the field. (3) Guidelines. METHODS: Inclusion criteria were: (1) cohort studies of patients with an ischaemic or haemorrhagic stroke; (2) inception cohort with assessment of prognostic factors within the first two weeks after stroke; (3) outcome measures for future residence; and (4) a follow-up of six months to one year. Internal, statistical and external validity of the studies were assessed using a checklist with 11 methodological criteria in accordance with the recommendations of the Cochrane Collaboration. RESULTS: From 1027 potentially relevant studies 10 studies involving a total of 3564 patients met the inclusion criteria. No prognostic factor was identified in at least two level A (i.e., a good level of scientific evidence according to the methodological score) studies, our standard for scientific proof. The following factors were found in at least one level A study: low initial ADL functioning, high age, cognitive disturbance, paresis of arm and leg, not alert as initial level of consciousness, old hemiplegia, homonymous hemianopia, visual extinction, constructional apraxia, no transfer to the stroke unit, nonlacunar stroke type, visuospatial construction problems, urinary incontinence and female gender. CONCLUSIONS: At present there is insufficient evidence concerning possible predictors in the subacute stage of stroke to make an evidence-based prediction of the future residence. In the scientific research until now social factors and their contribution to the possibility of living independently have not been investigated, or at least less well. None of the studies in this review described a conceptual framework as basis for the choice of the examined prognostic factors.

Activities of Daily Living↗
PubMed2002

Detection of intestinal drug containers by ultrasound scanning: an airport screening tool?

Our objective was to investigate the value of abdominal ultrasound for the detection of intestinal drug containers in air travelers suspected of intestinal drug trafficking. The study population consisted of 50 suspects charged with intestinal drug smuggling. All suspects, 7 women and 43 men, underwent an abdominal ultrasound scan immediately after detention in the prison hospital. A simple portable ultrasound unit (SonoSite 180) was used with a 2- to 4-MHz curved-array transducer. The images were digitally stored or recorded onto videotape. All suspects remained at the prison hospital to have their stool monitored for drug containers. The Customs officers who determined the presence or absence of containers in the stools were unaware of the ultrasound examination results. Of the suspects, 42 (84%) proved to have multiple intestinal drug containers as assessed by stool examination during detention. In 40 of 42 suspects abdominal ultrasound correctly identified the presence of containers. In 7 of 8 suspects ultrasound correctly identified the absence of containers. The positive predictive value of an ultrasound examination was 97.6%. In this group of suspects an abdominal ultrasound provided accurate information about the presence or absence of intestinal drug containers in 47 of 50 cases (94%).

Abdomen↗
PubMed2001

Targeting of liver tumour in rats by selective delivery of holmium-166 loaded microspheres: a biodistribution study.

Intra-arterial administration of beta-emitting particles that become trapped in the vascular bed of a tumour and remain there while delivering high doses, represents a unique approach in the treatment of both primary and metastatic liver tumours. Studies on selective internal radiation therapy of colorectal liver metastases using yttrium-90 glass microspheres have shown encouraging results. This study describes the biodistribution of 40-microm poly lactic acid microspheres loaded with radioactive holmium-166, after intra-arterial administration into the hepatic artery of rats with implanted liver tumours. Radioactivity measurements showed >95% retention of injected activity in the liver and its resident tumour. The average activity detected in other tissues was < or =0.1%ID/g, with incidental exceptions in the lungs and stomach. Very little 166Ho activity was detected in kidneys (<0.1%ID/g), thereby indicating the stability of the microspheres in vivo. Tumour targeting was very effective, with a mean tumour to liver ratio of 6. 1+/-2.9 for rats with tumour (n=15) versus 0.7+/-0.5 for control rats (n=6; P<0.001). These ratios were not significantly affected by the use of adrenaline. Histological analysis showed that five times as many large (>10) and medium-sized (4-9) clusters of microspheres were present within tumour and peritumoural tissue, compared with normal liver. Single microspheres were equally dispersed throughout the tumour, as well as normal liver parenchyma.

Animals↗
PubMed2001

Stress distribution changes in bovine vertebrae just below the endplate after sustained loading.

OBJECTIVE: To describe the pattern of stress distribution in the vertebral body just behind the endplate, and to document its changes due to sustained loading. METHODS: Twelve fresh bovine coccygeal motion segments were dissected and tested. Each specimen was axially loaded with a sustained compressive force of 50% of its estimated compressive strength. Before loading, after 1.5 h and after 3 h of loading, the distribution of the axial pressure under the bottom vertebra (i.e., just below its top endplate) was recorded at three force levels (25%, 37.5% and 50% of the estimated compressive strength), using pressure-sensitive film. RESULTS: Stress distribution over the endplate was found to be fairly uniform. At low compression forces, the stress was the highest centrally. With increased compression and after sustained compression the uniformity improved through a significant redistribution of stress to the periphery. No stress peaks were found to occur after sustained loading. CONCLUSION: Stress peaks after sustained loading cannot explain the occurrence of endplate fractures in sustained cyclic compression in non-degenerated discs. Competing explanations, such as creep, and fatigue failure, would appear more likely candidates. RELEVANCE: It has been hypothesised that compression induced fractures of the lumbar vertebral endplate constitute an important etiological factor for low back pain. Competing theories exist on the fracture mechanism in sustained loading and these would have different implications with respect to prevention. The present study evaluated one of these theories.

Analysis of Variance↗
PubMed2001

Validity and reproducibility of ultrasonography for the measurement of intra-abdominal adipose tissue.

OBJECTIVE: We studied the validity and reproducibility of a new abdominal ultrasound protocol for the assessment of intra-abdominal adipose tissue. MEASUREMENTS: Intra-abdominal adipose tissue was assessed by CT, MRI, anthropometry and ultrasonography on a single day. By ultrasonography the distance between peritoneum and lumbar spine was measured using a strict protocol, including the location of the measurements, pressure on the transducer and respiration. All measurements were repeated after 3 months. RESULTS: The study population consisted of 19 overweight patients with a body mass index (BMI) of 32.9 kg/m(2) (s.d. 3.7), intra-abdominal adipose tissue on CT 140.1 cm(2) (s.d. 55.9), and a mean ultrasound distance of 9.8 cm (s.d. 2.5). There was a strong association between the CT and ultrasonographic measures: Pearson correlation coefficient was 0.81 (P<0.001). The correlation between ultrasound and waist circumference was 0.74 (P<0.001), the correlation between CT and waist circumference was 0.57 (P=0.01). Ultrasound appeared a good method to diagnose intra-abdominal obesity: the area under the ROC curve was 0.98. During the follow-up period of 3 months, the patients lost on average almost 3 kg of body weight. The correlation coefficient between changes in intra-abdominal adipose tissue assessed by CT and ultrasound was 0.74 (P<0.001). The correlation coefficient of the mean ultrasound distance assessed by two different sonographers at baseline was 0.94 (P<0.001), the mean difference 0.4 cm (s.d. 0.9), and the coefficient of variation 5.4%, indicating good reproducibility of the ultrasound measurements. CONCLUSIONS: The results of this validation study show that abdominal ultrasound, using a strict protocol, is a reliable and reproducible method to assess the amount of intra-abdominal adipose tissue and to diagnose intra-abdominal obesity.

Abdomen↗
PubMed1999

Lumen reduction measurements of the internal carotid artery before and after Levovist enhancement: reproducibility and agreement with angiography.

Our aim was to assess reproducibility of three different lumen reduction measuring methods--North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial, and common carotid--using power Doppler and color Doppler sonography before and after Levovist enhancement. We included 20 symptomatic patients with mild or severe carotid disease. North American Symptomatic Carotid Endarterectomy Trial, European Carotid Surgery Trial, and common carotid measurements on longitudinal views and European Carotid Surgery Trial measurements on transverse views were performed. Examinations were repeated and the results compared to assess reproducibility of measurements. Correlation with angiography was obtained by calculating Pearson correlation coefficients. Reproducibility was significantly better (P < 0.05) for European Carotid Surgery Trial and common carotid measurements (95% limits of agreement between -10% to 10% and -19% to 17%) as compared to North American Symptomatic Carotid Endarterectomy Trial measurements (95% limits of agreement between -11% to 21% and -21% to 23%). Variability of measurements after enhancement increased slightly (not significant) for both power and color Doppler sonography. Additionally, European Carotid Surgery Trial measurements, using nonenhanced power Doppler or color Doppler sonography, did not correlate significantly with angiography, whereas North American Symptomatic Carotid Endarterectomy Trial and common carotid measurements correlated well with angiography, particularly in power Doppler mode after enhancement (r = 0.88 and r = 0.82, respectively). We conclude that for lumen reduction measurements of the internal carotid artery with power and color Doppler sonography, the common carotid method is the only method that is reproducible and has good correlation with angiography, which slightly improves after Levovist enhancement.

Aged↗
PubMed1994

[Compression under ultrasonic control as treatment of a pseudo-aneurysm following catheterization in the groin].

A false aneurysm is a well known complication after catheterisation. It is increasingly seen as a result of the increase of cardiological intervention treatment. In the past the classical treatment was surgery, nowadays a expectative management is the more frequently chosen alternative. A new treatment consists of compression under color Doppler ultrasonography control. This treatment frequently leads to direct thrombosis of the false aneurysm and can be carried out on an outpatient basis.

Aged↗
PubMed1994

Inflammation of the abdominal aortic aneurysm wall.

Inflammation and fibrosis do not only appear in an "inflammatory" aneurysm, but also in "ordinary" abdominal aortic aneurysms. In this study inflammatory changes in 130 abdominal aortic aneurysms were studied and related to patients' clinical records. According to histopathological criteria five different degrees of inflammation (Histological Inflammation Scale of Aneurysms) were found and patients were classified according to these criteria: grade A or mixed acute/chronic inflammation (4.5%); grade 0 or no inflammation (16.2%); grade 1 or mild chronic (57.7%); grade 2 or moderate chronic (16.2%); and grade 3 or severe chronic inflammation (5.4%) corresponding to an "inflammatory" aneurysm. Patients with grade 3 or an "inflammatory" aneurysm were younger (p = 0.013), were all symptomatic (p = 0.02), showed no associated iliac or femoral aneurysms (p = 0.03), were only recognised peroperatively and had elevated erythrocyte sedimentation rates (p = 0.0002). No other differences could be demonstrated between sex, risk factors, cardiovascular diseases, previous abdominal operations, bacterial culture, aneurysm diameter, white blood count, cholesterol level in-hospital mortality when compared to the degree of inflammation.

Adolescent↗
PubMed1992

Effects of lip adhesion and presurgical orthopedics on facial growth: an evaluation of four treatment protocols.

Differences in craniofacial morphology in uni and bilateral cleft lip and palate were studied by roentgenocephalometry: 35 American children, treated with a lip adhesion procedure, and 26 Dutch children treated with a preoperative orthopedic procedure, both followed by a lip and/or palatal repair, were compared. A multivariate statistical approach was used to study the effects of the surgical procedures and of the age of the child when operated upon. The variables affected by the type of operation were: the relative length of the maxilla (PNS-ANS); the SNA angle; and the relative length of the mandible (Go-Po). The length of the maxilla was on average longer for those treated with preoperative orthopedics and the maxilla was largest for children whose hard palate had yet to be closed. This was also the case for the SNA angle except for children treated with the combined lip-soft palate closure procedure. The mandible followed pattern displayed by the maxillary length; it was larger for those treated with preoperative orthopedics. Significant effects of the timing of the surgery on the variables studied were also found. Postponement of the definitive lip closure resulted in a reduction of the maxillary length, whereas delay of soft palatal closure resulted in an increase of the maxillary length.

Activator Appliances↗
PubMed1984

The relationship between indoor nitrogen dioxide concentration levels and personal exposure: a pilot study.

A small, personal monitoring study was performed in a subpopulation (14 families) of a case-control study on the relationship between indoor nitrogen-dioxide exposure and respiratory diseases of schoolchildren. Mothers, schoolchildren and pre-schoolchildren were asked to carry duplicate Palmes diffusion tubes during one week. Simultaneously nitrogen-dioxide concentrations were measured in the kitchen, living room, bedroom, outdoors and--for a few participants--at school and at work. Information on time activity patterns was gathered by means of a self administered diary. Several models for estimating exposure were constructed and tested against measured exposure. The personal exposure of the participants could well be explained by models containing indoor concentrations. Models with time-weighted average concentrations did not explain personal exposure better than models containing indoor concentrations. A calculated time-weighted average exposure was found to underestimate measured personal exposure by an average 20%, probably because the average concentration in a location does not necessarily reflect the actual exposure in that location. Personal exposure of mothers and children was very similar and highly correlated, indicating that the personal exposure of the mother might be a reasonable estimate for the exposure of the child.

Adult↗
PubMed1984

Indoor nitrogen dioxide pollution and respiratory symptoms of schoolchildren.

The influence of indoor nitrogen-dioxide exposure on respiratory symptoms of schoolchildren was investigated in a case-control study. The election method used was useful in obtaining symptomatic children, but insufficient in defining cases and controls without additional information. No relationship between indoor NO2 and respiratory symptoms was found. Bias may have been present, especially because of the high mobility of the study population. Attempts to estimate historical exposure were inaccurate. Therefore the results do not exclude that an association between indoor NO2 and respiratory symptoms exists.

Air Pollutants↗
PubMed1984

Secondary repair of the bilateral cleft lip deformity.

A wide prolabial segment with a "whistling" defect used to be a common deformity following bilateral cleft lip surgery when the muscle repair was ignored. Simply revising scars often will be followed by recurrence of the deformity. An adequate muscle repair is the basis for a successful and permanent correction. The operation described in this paper includes elevation of the prolabial skin and reconstruction of the orbicularis oris muscle.

Cicatrix↗
PubMed1978

Influences of different surgical procedures on growth of dentomaxillary complex in dogs with artificially created cleft palate.

Possible detrimental effects of palate repair on dentomaxillary growth have been reported before. In our study, two principally different surgical techniques were compared. Dogs with artificially created clefts of the palate were subjected to either a periosteal flap (Langenbeck) or to a bone flap (Dieffenbach) closure. Skull roentgenograms and upper jaw impressions were used to study the possible effects on growth. Definite abnormalities were found following both procedures; there are strong indications that the bone flap is the more detrimental one.

Animals↗