14 research outputs found
Clinical applications of infant lung function testing
The studies in this thesis show that research in the field of lung function
testing in infants has moved from methodological issues towards clinical applications.
This development is mainly the result of publications of guidelines for
infant lung function testing and standardization of the equipment used, by the
European Respiratory Society en de American Thoracic Society (ERS/ATS)
(7-10). As a result, normative data have become available for different lung
function methods, allowing comparison of data from different centers. In
addition, several biomedical engineering companies have marketed equipment
with specifications according to the guidelines given by the ERS/ATS. These
developments are a necessity for wide applications of infant lung function
testing in a clinical setting, such as collaborative studies and multicenter drug
trials in infants with airway disease (II). On the other hand, there are high costs
for buying complete recording systems and training the staff. In addition, most
methods require sedation of the infant. Therefore, infant lung function
measurements will probably be established primarily in larger, mostly academic,
centers. The forthcoming challenges for those involved in this field will
be to develop methods that are cheap to buy and simple to use, still providing
essential information. These methods should be applicable in infants without
sedation. When this has been achieved, infant lung function testing may even move out of the clinic (II)
Blue rubber-bleb naevus syndrome: report of a case with consumption coagulopathy complicated by manifest thrombosis
Abstract
Blue rubber-bleb naevus (BRBN) syndrome is a rare disorder characterized by subcutaneous and gastrointestinal haemangiomas. The latter may lead to bleeding complications. A case is reported in which a process of chronic intravascular coagulation resulted in serious thrombotic complications. In the presence of a chronic consumption coagulopathy, it remains uncertain whether antiplatelet drugs are of prophylactic antithrombotic value
Exhaled nitric oxide predicts asthma relapse in children with clinical asthma remission
BACKGROUND: Nitric oxide in exhaled air (FE(NO)) is a marker of
eosinophilic airway inflammation. A study was undertaken to determine
whether FE(NO) predicts asthma relapse in asymptomatic asthmatic children
in whom inhaled corticosteroids are discontinued. METHODS: Forty children
(21 boys) of mean age 12.2 years on a median dose of 400 mug budesonide or
equivalent (range 100-400) were included. FE(NO) was measured before and
2, 4, 12, and 24 weeks after withdrawal of steroids. A relapse was defined
as more than one exacerbation per month, or need for beta agonist
treatment on 4 days per week for at least 2 weeks, or diurnal peak flow
variability of >20%. FE(NO) measurements were performed online with an
expiratory flow of 50 ml/s. RESULTS: Nine patients relapsed. Two and 4
weeks after withdrawal of steroids geometric mean FE(NO) in children who
were about to relapse was higher than in those who did not relapse: 35.3
ppb v 15.7 ppb at 2 weeks (ratio 2.3; 95% CI 1.2 to 4.1; p = 0.01) and
40.8 ppb v 15.9 ppb at 4 weeks (ratio 2.6; 95% CI 1.3 to 5.1). An FE(NO)
value of 49 ppb at 4 weeks after discontinuation of steroids had the best
combination of sensitivity (71%) and specificity (93%) for asthma relapse.
CONCLUSION: FE(NO) 2 and 4 weeks after discontinuation of steroids in
asymptomatic asthmatic children may be an objective predictor of asthma
relapse
Exhaled nitric oxide measurements with dynamic flow restriction in children aged 4-8 yrs
Fractional exhaled nitric oxide concentration (FENO) depends on exhalation
flow; however, children often are unable to perform controlled flow
procedures. Therefore, a device was developed for off-line FENO sampling,
with dynamic flow restriction (DFR). The authors compared off-line w
Compliance, hysteresis, and collapsibility of human small airways
We tested the hypothesis that airway wall dimensions are important
determinants for the mechanical properties of airways. Lung tissue was
obtained from 31 smokers with different degrees of chronic obstructive
pulmonary disease (COPD) who were operated on for a solitary lung lesion.
Segments of small airways (n = 35) were mounted on cannulas in an organ
bath and inflated and deflated cyclically between +15 and -15 cm H(2)O.
For each airway this was done at baseline, after methacholine, and after
isoprenaline. Specific compliance (sCdyn), specific hysteresis (seta), and
pressure at which the airways collapsed (Pcol) were calculated from each
recording. Airway wall dimensions were measured morphometrically. Lung
function parameters of airflow obstruction were correlated to sCdyn, seta,
and Pcol. At baseline, after methacholine, and after isoprenaline sCdyn
was 0.059, 0.052, and 0. 085 cm H(2)O(-)(1), seta was 13.5, 12.9, and
7.1%, and Pcol was -3.4, -3.5, and -1.9 cm H(2)O, respectively.
Differences between sCdyn, seta, and Pcol after methacholine and after
isoprenaline were highly significant (p < 0.001). Of all dimensions
studied, smooth muscle area, but not total wall ar
Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine
[This corrects the article DOI: 10.1186/s13054-016-1208-6.]
Serous endometrial intraepithelial carcinoma (SEIC): Current clinical practice in The Netherlands
Introduction: Serous endometrial intraepithelial carcinoma (SEIC) is a rare diagnosis, defined as an intraepithelial lesion with cells identical to serous type endometrial carcinoma. SEIC is considered to be potentially metastatic, however clear and robust data on prognosis are lacking, potentially leading to variability in clinical management. Objective: The aim is to establish the opinion of gynecologists on the optimal management of patients with SEIC. Methods: An online questionnaire with 15 multiple choice questions was sent to all gynecologists with expertise in gynecological oncology in 19 expert centers in The Netherlands. Results: A total of 24 gynecologists participated. The majority of respondents (n = 18/24, 75%) do not consult a guideline regarding the treatment of SEIC. In current practice, 14 of the 24 respondents perform surgical staging in women with SEIC (58.3%) while seven choose hysterectomy with bilateral salpingo-oophorectomy (29.2%), and three (12.5%) have no firm preference. Eleven of the 14 respondents who perform a surgical staging procedure believe that this is certainly the optimal treatment. The majority of respondents have no firm opinion on whether lymph node sampling or lymph node dissection is preferable during surgical staging (n = 15/23, 65.2%). Most respondents do not give adjuvant therapy (n = 15/24, 62.5%), 25.0% recommend brachytherapy (n = 6/24). Follow-up is for 5 years in almost all cases (n = 23/24). Conclusion: There is no consensus on the optimal surgical treatment and the use of adjuvant therapy for patients with SEIC. Our research team is therefore conducting a nationwide cohort study in which treatment modality, morbidity and survival will be evaluated
Cost-effectiveness of laparoscopy as diagnostic tool before primary cytoreductive surgery in ovarian cancer
Objective. To evaluate the cost-effectiveness of a diagnostic laparoscopy prior to primary cytoreductive surgery to prevent futile primary cytoreductive surgery (i.e. leaving >1 cm residual disease) in patients suspected of advanced stage ovarian 'cancer. Methods. An economic analysis was conducted alongside a randomized controlled trial in which patients suspected of advanced stage ovarian cancer who qualified for primary cytoreductive surgery were randomized to either laparoscopy or primary cytoreductive surgery. Direct medical costs from a health care perspective over a 6-month time horizon were analyzed. Health outcomes were expressed in quality-adjusted life-years (QALYs) and utility was based on patient's response to the EQ-5D questionnaires. We primarily focused on direct medical costs based on Dutch standard prices. Results. We studied 201 patients, of whom 102 were randomized to laparoscopy and 99 to primary cytoreductive surgery. No significant difference in QALYs (utility = 0.01; 95% CI 0.006 to 0.02) was observed. Laparoscopy reduced the number of futile laparotomies from 39% to 10%, while its costs were (sic) 1400 per intervention, making the overall costs of both strategies comparable (difference (sic) - 80 per patient (95% CI - 470 to 300)). Findings were consistent across various sensitivity analyses. Conclusion. In patients with suspected advanced stage ovarian cancer, a diagnostic laparoscopy reduced the number of futile laparotomies, without increasing total direct medical health care costs, or adversely affecting complications or quality of life
Laparoscopy to Predict the Result of Primary Cytoreductive Surgery in Patients With Advanced Ovarian Cancer:A Randomized Controlled Trial
Purpose To investigate whether initial diagnostic laparoscopy can prevent futile primary cytoreductive surgery (PCS) by identifying patients with advanced-stage ovarian cancer in whom . 1 cm of residual disease will be left after PCS. Patients and Methods This multicenter, randomized controlled trial was undertaken within eight gynecologic cancer centers in the Netherlands. Patients with suspected awdvanced-stage ovarian cancer who qualified for PCS were eligible. Participating patients were randomly assigned to either laparoscopy or PCS. Laparoscopy was used to guide selection of primary treatment: Either primary surgery or neoadjuvant chemotherapy followed by interval surgery. The primary outcome was futile laparotomy, defined as a PCS with residual disease of.1 cm. Primary analyses were performed according to the intention-To-Treat principle. Results Between May 2011 and February 2015, 201 participants were included, of whom 102 were assigned to diagnostic laparoscopy and 99 to primary surgery. In the laparoscopy group, 63 (62%) of 102 patients underwent PCS versus 93 (94%) of 99 patients in the primary surgery group. Futile laparotomy occurred in 10 (10%) of 102 patients in the laparoscopy group versus 39 (39%) of 99 patients in the primary surgery group (relative risk, 0.25; 95% CI, 0.13 to 0.47; P , .001). In the laparoscopy group, three (3%) of 102 patients underwent both primary and interval surgery compared with 28 (28%) of 99 patients in the primary surgery group (P , .001). Conclusion Diagnostic laparoscopy reduced the number of futile laparotomies in patients with suspected advanced-stage ovarian cancer. In women with a plan for PCS, these data suggest that performance of diagnostic laparoscopy first is reasonable and that if cytoreduction to , 1 cm of residual disease seems feasible, to proceed with PCS