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Biomedical subjects

E J Mulder

Publications and source records attributed to E J Mulder.

At least 19 recordsLinked to original sources
PubMed2005

Drug utilisation by children and adolescents with mental retardation: a population study.

OBJECTIVE: Little is known about the utilisation of drugs by mentally retarded children; population studies are even more sparse. In this study the chronic drug utilisation in children aged 4-18 years with mental retardation in a large population in the Netherlands was investigated. METHODS: Throughout all special schools and (day) care facilities for children with mental retardation in Friesland, parents/representatives were approached requesting participation of their children. Participants were interviewed about a number of aspects including medication use. For 921 of the 1,057 participants, information was available on medication use for those physical and psychiatric illnesses that bothered them or was expected to bother them for at least 3 months per year; 912 of the participants were within the age category under study: 4-18 years. RESULTS: About 22% of the 912 participants used chronic medication, 47% of whom used two or more drugs. The prevalence of drug use increased with severity of mental retardation from about 17% to 49%. The exception was the 6% of children with borderline intellectual functioning: their medication prevalence was 27%. Overall, 17% of the study population used a nervous system drug, 4% used a respiratory system drug and 3% used an alimentary tract drug. Of the drugs for the nervous system, alimentary tract and respiratory tract, 32% was prescribed off-label. For 3%, we were unable to establish on/off-label use. CONCLUSIONS: Chronic drug utilisation patterns in children and adolescents with mental retardation are different from those in the general paediatric population. These different patterns suggest the need for additional research.

Adolescent↗
PubMed2001

Restrictive dermopathy and fetal behaviour.

We report three siblings from consecutive pregnancies affected with restrictive dermopathy (RD). During the second pregnancy, fetal behavioural development and growth were studied extensively using ultrasound at 1-4 week intervals. Dramatic and sudden changes occurred in fetal body movements and growth but not until the end of the second trimester of pregnancy. Prominent at that time were prolonged periods of fetal quiescence and very low heart rate variability, together with abnormally executed body movements of short duration. Retarded femoral development and jerky abrupt fetal body movements (abnormal movement quality) were already present in the early second trimester of pregnancy. Facial anomalies emerged despite the presence of fetal mouth movements. The clinical features of RD were only partly explained by present knowledge of skin development and the fetal akinesia deformation sequence hypothesis. Quantitative assessment of fetal movements proved to be a poor early marker for antenatal diagnosis of this disorder.

Adult↗
PubMed2001

Salivary cortisol levels and anxiety are not increased in women destined to develop preeclampsia.

OBJECTIVE: To compare salivary cortisol levels and maternal anxiety (general and pregnancy-specific) in the early and late second trimester of pregnancy between women who developed preeclampsia (PE) and women who remained normotensive. DESIGN: Nested case-referent study. In a prospectively studied cohort of 250 pregnant women, nine women developed PE in late pregnancy. These nine patients were matched and compared with nine controls. Diurnal cortisol levels were obtained by collecting saliva samples at 17-18 and 27-28 weeks gestation. Salivary cortisol levels were determined by radioimmunoassay. Maternal anxiety was determined by Spielberger's State-Trait Anxiety Inventory (STAI) and a pregnancy-specific stress questionnaire. RESULTS: For both patients and controls, a similar pattern of salivary cortisol excretion was observed. Salivary cortisol levels and anxiety scores (general and pregnancy-specific) did not differ significantly between patients and controls. CONCLUSIONS: Our findings do not lend support to a role for maternal anxiety or second trimester increases in circulating stress hormones in the pathogenesis of PE.

Analysis of Variance↗
PubMed2001

Fetal akinesia deformation sequence: behavioral development in a case of congenital myopathy.

OBJECTIVE: To monitor behavioral development in a fetus affected by the Pena-Shokeir phenotype due to fetal akinesia deformation sequence of myogenic origin. METHODS: Fetal behavioral development was studied sonographically in a fetus suspected of having fetal akinesia deformation sequence, between 15 and 35 weeks of gestation at 1-4-week intervals. RESULTS: Fetal body movements were quantitatively and qualitatively abnormal from 28 weeks onwards. Behavioral deterioration coincided with the observation of structural anomalies such as club feet. Fetal heart rate and its variation remained within normal limits and showed normal ultradian cyclicity, but the temporal linkage between body movements and heart rate pattern worsened with advancing gestation. Breathing movements, although present until the end of pregnancy, became increasingly shallow. CONCLUSION: Our results provide sound evidence that the trajectory of behavioral development with fetal akinesia deformation sequence, which has been hypothesized to occur in man exclusively on the basis of retrospective analyses and animal experiments, does indeed take place.

Abnormalities, Multiple↗
PubMed2001

Doppler studies on the fetal renal artery in the severely growth-restricted fetus.

OBJECTIVES: To examine changes with time in the fetal renal circulation by Doppler sonography in the severely growth-restricted preterm fetus during the period of gradual deterioration prior to delivery, and to examine the relationship between Doppler measurements, amniotic fluid index, birth weight and fetal condition at birth. METHODS: This was a prospective observational study in 16 preterm growth-restricted fetuses between 26 and 35 weeks of gestational age. Serial Doppler measurements were made of the renal artery, umbilical artery, middle cerebral artery and ductus venosus. RESULTS: The pulsatility index in the renal artery did not show any correlation with cord blood pH, birth weight or amniotic fluid index corrected for gestational age (Delta/SDAFI). However, peak systolic velocities in the renal artery showed a significant reduction with time (n = 7, P < 0.05) and a significant correlation with: venous cord pH at delivery (n = 12, r = 0.84, P < 0.001), Delta/SDAFI (n = 16, r = 0.67, P < 0.01), and birth weight (n = 16, r = 0.61, P < 0.02). Birth weight correlated significantly with: Delta/SDAFI (n = 15, r = 0.57, P < 0.05), pulsatility index values of the middle cerebral artery (n = 15, r = -0.61, P < 0.02), and pulsatility index values of the ductus venosus (n = 16, r = 0.55, P < 0.05), and Delta/SDAFI correlated significantly with: pulsatility index values of the ductus venosus (n = 15, r = 0.51, P < 0.05) and arterial cord pH values at delivery (n = 8, r = 0.78, P < 0.05). CONCLUSIONS: Progressive redistribution of the circulation occurs with deterioration of the fetal condition in the growth-restricted preterm fetus. On spectral Doppler this is reflected by changes in peak systolic velocities, but not by changes in pulsatility values of the fetal renal artery waveforms.

Amniotic Fluid↗
PubMed2001

Effects of medication use on health state in postictal migraineurs.

We investigated whether headache-free patients with migraine report a lower health state compared with healthy controls, and whether health state is differently affected during the postattack period after using sumatriptan versus habitual nonvasoactive medication. Mood, health state, and personality questionnaires were administered once during an interictal period and twice within 30 hours after different migraine attacks treated with sumatriptan or habitual nonvasoactive medication. Twenty migraineurs without aura, 10 migraineurs with aura, and 30 matched and headache-free controls participated in this study. During an interictal period, patients with migraine reported more problems regarding social activities and pain compared with healthy controls. During the postictal period, mood (fatigue and emotional state) was negatively affected by an attack that was treated with habitual medication, whereas health state (physical pain, social activities, current pain) was similar to the migraine-free period. Sumatriptan treatment had beneficial effects on aspects of health state and mood during the postictal period.

Adult↗
PubMed2001

Interictal and postictal contingent negative variation in migraine without aura.

Cortical hyperexcitability is thought to explain the more enhanced contingent negative variation (CNV) amplitudes and impaired CNV habituation that have been found during the interictal period in migraine without aura. These CNV characteristics have been shown to normalize to the level of healthy controls during an attack. This study aimed to replicate the interictal findings, and additionally examine whether migraineurs show reduced CNV amplitudes during the postattack period. Of 12 patients with migraine without aura and their sex- and age-matched healthy controls, CNV characteristics were recorded once in an interictal period, once during the postattack period within 30 hours after an attack that was treated with sumatriptan, and once after an attack that was treated with habitual nonvasoactive medication (counterbalanced). The present results did not confirm the enhanced CNV early and late wave amplitudes or impaired habituation, and cortical hyperexcitability that have previously been reported in the interictal period in patients with migraine without aura. During the postattack period, a decrease in CNV early and late amplitudes was found but only after sumatriptan use. This reduction in CNV amplitudes was most prominent over the frontal cortex and could reflect cortical hypoexcitability, possibly related to a suppression of central catecholaminergic activity by sumatriptan.

Adult↗
PubMed2001

Effects of morphine and naloxone on fetal heart rate and movement in the pig.

To test the hypothesis that an increasing opioid tonus is involved in decreases in fetal heart rate (FHR) and movement (FM) during late gestation, we studied the effects of intravenous bolus injections of morphine (1 mg) and naloxone (1 mg) on FHR and FM in the fetal pig. Twenty-one fetuses (1 per sow) were catheterized at 90-104 days of gestation (median 100 days). Recordings of FHR (electrocardiograph or Doppler-derived signals) and FM (ultrasonography) were made from 15 min before to 45 min after treatment. Morphine administration significantly decreased FHR, but it increased FHR variation and forelimb movements (LM). LM were clustered, and this stereotyped behavior has never before been observed in any mammalian fetus. Naloxone administration increased gross body movements and FHR without significant changes in FHR variation. It is concluded that FHR and motility are under opioidergic control in the pig fetus. Both morphine and naloxone induce hypermotility, suggesting that naloxone does not act as a pure opioid antagonist in the fetal pig.

Analgesics, Opioid↗
PubMed2000

Fetal heart rate in relation to its variation in normal and growth retarded fetuses.

OBJECTIVES: (1) to assess the relationship of basal fetal heart rate (FHR) with both long term (LTV) and short term (STV) FHR variation in low-risk pregnancies, longitudinally from 24 weeks gestation onwards and (2) to investigate the relationship of FHR with LTV and STV in intrauterine growth retarded (IUGR) fetuses. STUDY DESIGN: Computerised FHR recordings were made in twenty-nine uncomplicated pregnancies (n=224) and in twenty-seven IUGR fetuses who were selected retrospectively from three databases (n=135). Nomograms of FHR variation with FHR and GA were constructed using multilevel analysis. RESULTS AND CONCLUSIONS: There was a strong negative relationship of FHR with both LTV and STV in the control group (R2=53% and 52%, respectively). In the IUGR fetuses, FHR was generally higher than in normal fetuses whereas LTV and STV were lower. The relationship of FHR with LTV and STV in the IUGR group was less strong (for both: R2=18%). Correction of FHR variation for basal FHR in the IUGR fetuses only resulted in a slight reduction in the number of recordings with a variation below the normal range. As it does not improve the recognition of fetuses being considered at the highest risk, such a correction of FHR variation for basal FHR is therefore not necessary. Intrafetal consistency, known to be present in healthy fetuses, was also present in the IUGR fetuses with a low FHR variation.

Female↗
PubMed1999

Temporal organization of fetal behavior from 24-weeks gestation onwards in normal and complicated pregnancies.

Developmental aspects of behavioral organization were investigated in 29 healthy fetuses from 24-weeks gestation onwards: (a) short-term association between body (GM) and eye (EM) movements; (b) linkage of pairs of the three state variables [fetal heart rate pattern (FHRP), GM, and EM]; and (c) sequence of change of state variables during transitions. Linkage and sequence were also studied in complicated pregnancies. Short-term association between GM and EM was well established after 28 weeks. Linkage of state variables improved considerably after 32-34 weeks. FHRP was the first variable to change during synchronized transitions from 1F to 2F between 28-39 weeks, and the last variable during 2F to 1F transitions between 32-39 weeks. Although clear developmental patterns could be recognized, the interfetal variability was such that identification of the abnormal fetus is still difficult. Only transitions were significantly different in growth-restricted fetuses, as they showed no specific sequence of change. Assessing the temporal organization of fetal behavior seems, therefore, until now, not of great clinical value.

Adult↗
PubMed1999

Quantitative analysis of fetal general movements: methodological considerations.

OBJECTIVES: We studied the effects of gestational age and various smoothing procedures on four incidence parameters of fetal general movement, to evaluate reported variation in previous studies and to establish the optimal way of smoothing. SUBJECTS AND METHODS: General movements were studied longitudinally between 24 and 40 weeks of gestation in 29 healthy fetuses. The number of movement bursts per hour, burst duration, onset-onset interval between successive bursts (OOI) and the percentage incidence were analysed in detail. RESULTS: Advancing gestation was characterised by a proportional increase in OOI's lasting > 60 s and a decreased number of bursts, whereas burst duration remained relatively stable (unsmoothed data). Smoothing resulted in an exaggerated decrease in the number of bursts and in increases in burst duration, OOI and percentage incidence. These changes occurred in a gestational age specific manner and could largely explain the variation in results between previous studies. CONCLUSIONS: The temporal patterning of fetal general movements undergoes developmental change, as shown by differential effects of smoothing between mid and late pregnancy. A smoothing procedure is to be preferred which includes short intervals (1-3 s) between the elements composing a burst, since small changes in movement generation can still be recognised this way.

Adult↗
PubMed1999

Interictal and postictal cognitive changes in migraine.

The question whether symptom-free migraine patients show cognitive impairments compared to matched control subjects is addressed, and also whether migraine patients show transient cognitive impairments induced by an attack. The Neuropsychological Evaluation System (NES2) was administered once in an interictal period and twice within 30 h after different migraine attacks. Since cognitive impairments could be related to attack duration or severity, cognitive performance was compared during a postictal period after sumatriptan use and during a postictal period after habitual nonvasoactive medication use. Twenty migraineurs without aura, 10 migraineurs with aura, and 30 matched headache-free controls participated in the study. During a headache-free period, migraineurs without aura responded as quickly as controls, while migraineurs with aura were slower than controls during all tasks specifically requiring selective attention. These effects were not aggravated by a preceding migraine attack, irrespective of medication use and attack duration.

Adult↗
PubMed1998

Hourly fetal urine production rate in the near-term fetus: is it really increased during fetal quiet sleep?

Fetal bladder volume and hourly fetal urine production (HFUPR) is calculated on the assumption that the fetal bladder is ellipsoid in shape. A recent validation study demonstrated a progressive overestimation at increasing bladder volumes. This may be due to changes in shape of the fetal bladder at increasing volumes. Two independent papers have shown increased HFUPR during fetal behavioural state 1F (S1F) when compared with S2F. The aim of the present study was to assess whether this increase of HFUPR during S1F, previously observed by others, could be the result of an error introduced by the method of volume calculation. A retrospective evaluation was performed in a series of 208 HFUPR measurements in 123 normal near term pregnant women attending a low-risk atenatal clinic. Adequate bladder filling in both states was identified in 43 recordings. Maximum fetal bladder volumes were greater (> 10 ml) during S1F in comparison to S2F in 56% of these recordings and HFUPR was significantly greater during S1F only in these cases. Bladder volumes are usually lower during S2F as a result of fetal voiding, which occurred in association with 22 of 36 transitions from S1F to S2F, and only 1 of 13 transitions from S2F to S1F (P < 0.001). When disregarding calculated bladder volumes in excess of 20 ml for the purpose of calculating HFUPR, eleven recordings remained. HFUPR calculated in this way was significantly lower in comparison to measurements where larger bladder volumes were included and no difference was observed between states. This implies that the differences observed are the result of the greater error in calculating bladder volumes and HFUPR during S1F, where volumes are usually greater and that calculation of fetal bladder volume should not be performed on the assumption that the bladder is ellipsoid in shape. Alternative techniques include limiting measurements to a maximum volume of approximately 20 ml, when the bladder is usually ellipsoid in shape or basing volume calculation on the surface area of a series of sagittal views as suggested by Hedriana and Moore [Hedriana HL, Moore TR. Ultrasonographic evaluation of human fetal urinary flow rate: accuracy of bladder volume estimations. Am J Obstet Gynecol 1994;170:1250-1254; Hedriana HL, Moore TR. Accuracy limits of ultrasonographic estimation of fetal urinary flow rate.

Female↗
PubMed1998

Morbidity and mortality of reconstructive surgery of noninfected false aneurysms detected long after aortic prosthetic reconstruction.

OBJECTIVE: To determine the morbidity and mortality of surgical treatment of false (anastomotic) aneurysms, we analyzed the results of 158 consecutive surgical procedures for repair of false aneurysms that were detected as a result of a surveillance program after aortic reconstruction with a prosthesis. DESIGN: Retrospective analysis of patient data from a vascular registry that included information on the long-term follow-up of our patients. SETTING: A university hospital (tertiary referral center) in the Netherlands that has been performing vascular reconstructive surgery since 1958. PATIENTS: We performed 158 surgical procedures on 135 patients with 220 noninfected false aneurysms. Using a yearly surveillance program, the false aneurysms were detected at a mean interval of 8 years after the initial reconstruction. Most patients (60%) were asymptomatic. The operation was performed as an emergency in 25 instances (16%). RESULTS: The mortality rate of patients receiving nonsurgical treatment was very high (61%) owing to documented rupture (11 of 18 patients). The intraoperative death rate was 7.6% per procedure. This was higher for emergency (24%) than for elective procedures (4.5%). CONCLUSIONS: Conservative follow-up carries a very high mortality rate, as does emergency surgery for a false aneurysm. However, the intraoperative mortality rate of elective reconstruction of a false aneurysm can be in the same range as that of elective primary aortic reconstruction. Therefore, we advocate a surveillance program, including yearly ultrasound studies, after prosthetic aortic reconstruction for the timely detection and elective repair of all false aneurysms.

Adult↗
PubMed1998

Effects of maternal alcohol intake on fractal properties in human fetal breathing dynamics.

Fractal methods have been found to be useful in characterizing biomedical signals. The use of fractal estimation requires the estimation of parameter H, which is directly related to the fractal dimension D. Here, we propose a new approach which is a combination of the wavelet transform and fractal estimators to characterize the human fetal breathing signals before and after the intake of two glasses of wine by a mother. This study was performed on 26 fetuses. The variances of the wavelet coefficients were estimated at each scale. The slope of the representation on a logarithmic plot from the scales 5 to 1 was found to be increased after alcohol intake. Our results suggested that fetal breathing rates have a rough structure before the alcohol intake and a smooth structure after alcohol intake.

Alcohol Drinking↗
PubMed1998

The influence of betamethasone and dexamethasone on motor development in young rats.

Synthetic corticosteroids such as dexamethasone and betamethasone are widely used in clinical practice of the perinatal period to enhance lung maturation. However, indications emerged both on the basis of investigations in humans and in experimental animals that such treatment leads to abnormal brain development. In the present study, the neurologic development and the development of locomotion were studied in two groups of rats injected either with dexamethasone or with betamethasone on their 3rd and 4th d, and this was compared with development in a group of control rats injected with saline. Each group consisted of 12 rats. Neurologic reflexes were tested daily and the rat's physical development (body weight and age at eye opening) was noted from the 4th until the 21 st d. Locomotion was recorded on videotape and analyzed during playback runs. Results indicated a growth retardation in both groups of rats treated with corticosteroids, but remarkably, the opening of the eyes was advanced by about 1 d in the dexamethasone group compared with control rats and rats treated with betamethasone. Several reflexes showed normal development, but the negative geotaxis and free-fall righting responses developed retarded. Locomotion in both experimental groups was characterized by a postural tremor and an abnormal posture during walking from the 9th until the 15th d. Although the walking pattern after this age became fluent, the gait width remained abnormally increased until the 20th d. Our results indicate that both dexamethasone and betamethasone interfere with the development of vestibular and cerebellar functions involved in complex motor patterns.

Aging↗
PubMed1998

Acute maternal alcohol consumption disrupts behavioral state organization in the near-term fetus.

Disturbed sleep regulation is often observed in neonates of women who drank heavily during pregnancy. It is unknown if (and how) an occasional drink affects fetal sleeping behavior. In 28 near-term pregnant women we examined the effects on fetal behavioral state organization of two glasses of wine (0.25 g of ethanol/kg of maternal body weight). Simultaneous 2-h recordings of fetal heart rate and body, eye, and breathing movements were made on two successive days, once without alcohol exposure and once during maternal alcohol consumption. The study was standardized for time of day and fetal sleep state, i.e., the start of recording was either during quiet sleep (n = 16) or during active sleep (n = 12). Alcohol intake reduced fetal eye movements, disorganized behavioral state organization (rapid eye movement sleep was affected in particular), and suppressed fetal breathing activity almost completely. Modest maternal alcohol intake affects fetal behavioral state organization, which reflects an immediate effect on fetal brain function.

Ethanol↗