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Biomedical subjects

E J Dorhout Mees

Publications and source records attributed to E J Dorhout Mees.

At least 19 recordsLinked to original sources
PubMed2006

Long-term survival rates in haemodialysis patients treated with strict volume control.

METHODS: We analysed the survival of 218 patients (132 male, 86 female, age 48 +/- 15 years) who were treated in our dialysis units since we adopted the strategy of strict volume control without antihypertensive drugs. The mean observation period was 47 +/- 34 (6-140) months. Follow-up was ended because of death (57 patients), transfer to another center (35 patients), continous ambulatory peritoneal dialysis (CAPD) (15 patients) or transplantation (23 patients), while 88 were still under our treatment at the time of writing. RESULTS: Blood pressure (BP) decreased from a mean of 150 +/- 31/89 +/- 16 at the start to 121 +/- 14/75 +/- 8 mmHg at the end of observation (P < 0.001). Only nine patients needed a drug (enalapril) to reach this goal. Cardiothoracic index (CTI) dropped from 0.50 +/- 0.06 to 0.46 +/- 0.05 (P < 0.001). Interdialytic weight gain decreased from 1440 +/- 360 to 930 +/- 240 g/day (P < 0.001). Mortality rate was 68, 2 per 1000 patient-years, better than in most published series. There was a striking influence of age, but also of CTI and systolic BP on survival rate. Patients with CTI > or = 0.48 showed mortality 3.8 times higher than CTI < 0.48 (log rank P < 0.001). Consequently, the mean CTI of the deceased patients was much higher (0.50) than the average of the group (0.46) while their mean BP (123 +/- 16/75 +/- 9 mmHg) was not significantly different from the other patients. We found no increased mortality at low-normal pressure levels (systolic BP between 100 and 130 mmHg), but mortality was increased in small groups of patients whose pressures were lower or higher than these values. Thus, the curve, relating mortality to blood pressure was shifted markedly to the left. CONCLUSIONS: These results strongly suggest that the strategy of 'volume control', also when applied with conventional dialysis times, normalizes BP and increases survival of dialysis patients. Cardiomegaly, as evidenced on the chest X-ray despite normal BP, had a strong negative influence on survival. The large majority of the patients had low-normal BP after long periods of treatment and showed the lowest mortality, favouring the view that target BP should be lower than advised by most authors.

Adolescent↗
PubMed2005

[Haemodialysis in Turkey].

In Izmir, Turkey's third largest town, remarkably good treatment results have been achieved in haemodialysis patients. This success has been achieved by the formation of a close-knit and durable team of physicians and nurses at Ege University. This has enabled patients to be treated using a strict volume-control method and to be given individual attention and psychosocial support. This has been made possible by close collaboration with a producer of dialysis machines. Possible conflicts of interest were avoided as there were no personal connections between physicians and the production sector.

Humans↗
PubMed2000

[Physicians for Human Rights: a foreign observer at three trials against physicians in Turkey].

Physicians have a professional obligation to be among the first to defend human rights. Accordingly they have established organisations in many countries to that aim, which are united in the International Federation of Health and Human Rights Organisations (IFHHRO). The author was invited by this federation to attend several trials against members of the Turkish sister organisation. In one of them the doctor's duty to protect his patients' privacy was at stake. This physician has since been acquitted because of insufficient evidence. In Turkish society there are opposed conservative and liberal democratic forces: on the one hand people try to maintain the democratic and constitutional state, on the other some circles hold the opinion that undemocratic and inhuman measures are necessary to counter the dangers of terrorist movements. Even in the Netherlands the right of physicians not to reveal confidential information regarding 'illegal immigrants' has recently been challenged, and until now the medical organisations have not protested.

Civil Rights↗
PubMed1998

Dilated uremic cardiomyopathy in a dialysis patient cured by persistent ultrafiltration.

A patient is presented who after 2 years of hemodialysis showed all of the features of congestive cardiomyopathy to a very severe degree: dilation of all cardiac compartments, increased left ventricular mass, low ejection fraction, diastolic disturbances, third- to fourth-degree mitral and tricuspid regurgitation, ascites, and low blood pressure. All of these abnormalities gradually but completely disappeared during 5 months of persistent ultrafiltration during or between dialysis sessions. It was concluded that chronic fluid overload was a major factor in the cardiac disease of this patient. Unrecognized hidden fluid overload has long been known (but also neglected), and its prevention deserves top priority in chronic dialysis patients.

Adolescent↗
PubMed1998

Regression of left ventricular hypertrophy in haemodialysis patients by ultrafiltration and reduced salt intake without antihypertensive drugs.

BACKGROUND: Left ventricular hypertrophy (LVH) is very frequent in haemodialysis patients. Only few investigations have reported its regression, and only by the use of antihypertensive drugs. Because volume load is at least as important as pressure load, we investigated whether persistent strict volume control by ultrafiltration alone may be effective in improving LVH METHODS: Using blood pressure (BP) and cardiac dimensions as a guide, we treated all hypertensive patients in our dialysis unit during the 3 times weekly dialysis sessions for 4 h per session with as much ultrafiltration as they could stand. If they gained too much weight an extra isolated ultrafiltration (UF) session was applied. Special attention was given to dietary salt restriction. The study group of all 15 patients in whom echocardiographic assessment had been made at least 1.5 years previously was selected retrospectively, and we acknowledge that important confounding factors might not have been controlled for. Cardiothoracic index (CTI) was estimated on the chest X-ray. Diameters of left atrium (LA), left ventricle systolic (LVS) and diastolic (LVD), interventricular septum (IVS), posterior wall (PW), and left ventricular mass index (LVMI) were estimated by standard echocardiographic methods. RESULTS: Mean arterial pressure of the study group had been lowered by UF before the first echocardiogram from predialysis 136+/-11 to 101+/-14 and from postdialysis 119+/-8 to 92+/-12 mmHg. During a mean follow-up period of 37+/-11 months LVMI decreased from 175+/-60 to 105+/-11 g/m2. CTI decreased further from 48+/-3 to 43+/-4%, while significant decreases of LA (22.5+/-3 to 19.9+/-4 mm/m2), LVS (18.7+/-4 to 15.9+/-3 mm/m2) and LVD (28.3+/-4 to 24.0+/-3 mm/m2) were seen in all patients. There also was a further decrease in both pre- and postdialysis BP to 116+/-12/73+/-7 and 105+/-7/65+/-3 mmHg respectively. CONCLUSION: The results of this uncontrolled retrospective study suggest that good long-term BP control and a decrease of LVM can be achieved by continuous efforts to control hypervolaemia. The decrease in volume may be even more important than pressure reduction to achieve this goal.

Antihypertensive Agents↗
PubMed1998

Disappearance of mitral and tricuspid regurgitation in haemodialysis patients after ultrafiltration.

BACKGROUND: Doppler echocardiography has recently revealed frequent occurrence of valvular (in particular mitral) regurgitation in dialysis (HD) patients. We hypothesized that this may be in part 'functional' and related to the cardiac dilatation which is also frequently present. Thus it would be possible to improve it by ultrafiltration. METHODS: Mitral and tricuspid regurgitation was detected in 21 haemodialysis patients who had cardiomegaly but no manifest cardiac failure. They were treated by intensified ultrafiltration sessions, as much as they could tolerate, while all antihypertensive drugs were stopped. Doppler echocardiograms were then repeated. RESULTS: Mitral regurgitation disappeared in 13 and tricuspid regurgitation in 14 patients, while lesser degrees of either of them persisted in seven. This was accompanied by decreases of body weight (5.4 +/- 2.7 kg) mean arterial pressure (125 +/- 15 to 95 +/- 11 mmHg), cardiothoracic index (from 0.57 to 0.47), and left atrial (28 +/- 4 to 22 +/- 3 mm/m2), left ventricular systolic (25 +/- 5 to 21 +/- 55 mm/m2) and left ventricular diastolic (31 +/- 5 to 27 +/- 5 mm/m2), and mitral annular diameters (19.4 +/- 2 to 16.6 +/- 2 mm/m2). Ejection fraction increased but remained below 50% in 11 patients. CONCLUSION: Most of the mitral and tricuspid regurgitations seen in HD patients are partly or completely functional, due to dilatation of the mitral annulus which is related to volume overload. A more aggressive approach, while discontinuing antihypertensive drugs can correct or improve many of them and also ameliorate cardiac function.

Adolescent↗
PubMed1997

[Stranger in Turkey].

The author, a professor of nephrology, reports some impressions of his 7-year stay in Turkey. He worked at the Ege University in Izmir, traditionally one of the most 'western' cities. He and his wife, who gave unpaid assistance to dialysis patients, attempted to integrate into Turkish society as fully as possible. They traversed the country in weekends and holidays and introduced as many Dutch guests as they could to the unique archeological treasures, the magnificent nature and the extremely friendly population. Work at the university focused increasingly on cultivating a critical attitude with regard to the self, society and the trends and commercialization of medicine in Turkey and in the rest of the world. Self-reliance, also, had to be strengthened. Although this contravened the authority-based Turkish educational system, the efforts were clearly appreciated and even stirred enthusiasm in many of the younger people. There is no doubt that a foreign worker is regarded much more favourable in Turkey than in the Netherlands.

Acculturation↗
PubMed1997

[Medicine in Turkey, with special reference to nephrology].

The stormy development of Turkey in this century resulted in a drastic decrease of illiteracy and in a craving for knowledge among the younger generations. Qualitatively good students are admitted to universities. In the last 25 years, 47 new universities were founded (8 of them private ones), partly for political reasons. Teachers of medicine are underpaid, so that many earn extra money by working in a private practice. The results of medical teaching are adequate, owing in part to quality and motivation of students and interns. Much research is being subsidized by the Turkish Institute for Scientific and Technical Research, Tübitak, but bureaucracy inhibits originality. Research and postgraduate training are increasingly controlled by the pharmaceutical industry. Primary medical care is underdeveloped. The quality of medical treatment is technically adequate; modern diagnostic and surgical methods are available in all major centres. There is much private enterprise in health care (private clinics, private laboratories, research centres, universities and pharmacies). The latest drugs are available and given preference in prescribing. In Southeast Turkey, populated by Kurds, however, the economy has come to a complete standstill and there is an enormous shortage of physicians and hospitals. The prevalence of renal diseases differs from that in the Netherlands: fewer cystic kidneys, less diabetic nephropathy and nephropathy due to analgetics, but more acute glomerulonephritis and amyloidosis due to familial Mediterranean fever. Haemodialysis, is one of the fastest-growing methods of treatment; peritoneal dialysis is rapidly gaining ground. Kidney transplantations have been performed regularly since 1975.

Delivery of Health Care↗