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Biomedical subjects

E R Hammacher

Publications and source records attributed to E R Hammacher.

At least 19 recordsLinked to original sources
PubMed2003

Surfer wipe out by predator fish.

Needlefish injuries, commonly reported in the Indo-Pacific region, have not been previously reported along the European coastlines. This case report describes a penetrating injury to the heel of a professional surfer during competition off the Portuguese coast. Diagnostic as well as therapeutic recommendations are made.

Adult↗
PubMed2002

Recognising vascular causes of leg complaints in endurance athletes. Part 1: validation of a decision algorithm.

Flow limitations in the iliac arteries of endurance athletes during exercise were previously ascribed solely to intravascular lesions. We postulate that functional kinking of the arteries can also result in flow limitations. However, the diagnostic tools in routine practice are not effective in diagnosing such flow limitations in a substantial proportion of athletes, mainly because these diagnostic tools do not measure in the provocative situations. Ninety-two symptomatic legs in 80 endurance athletes were examined with newly developed, sports-specific vascular tests. Thirty-five asymptomatic cyclists matched for working capacity served as the control subjects. Legs were classified as vascular or non-vascular following a decision algorithm, based upon the results of these diagnostic tests, excluding orthopaedic causes by the effects of specific treatment. Independently of this clinical classification, an alternative method was applied to find stable characteristics in the total patient group using factor analysis. This characterisation was based on scores on 14 test variables deriving from diagnostic tests that were not used in the decision algorithm, thus avoiding dependency between the clinical categorisation and the statistical categorisation. The hypothesis was that these characteristics were sufficiently sensitive to classify patients with vascular and non-vascular complaints. If so, these characteristics should correspond with the one derived from the decision algorithm. Following the decision algorithm, 58 legs (63%) were classified as vascular, 29 (32%) as non-vascular and 5 (5%) as inconclusive. The latter were considered non-vascular. In a substantial proportion of the vascular patients, kinking of the iliac arteries was identified as the major cause of flow limitation. The characteristics derived from factor analysis proved to classify 87% in agreement with the decision algorithm (kappa 0.56). The agreement is sufficient for validation of the clinical classification. The algorithm can therefore be applied in clinical situations to diagnose endurance athletes with flow limitations due to both intravascular lesions and kinking of the arteries.

Adult↗
PubMed2002

Recognising vascular causes of leg complaints in endurance athletes. Part 2: the value of patient history, physical examination, cycling exercise test and echo-Doppler examination.

UNLABELLED: Leg complaints at maximal exercise in endurance athletes may have many causes, including arterial flow limitations in the iliac arteries. Such flow limitations can evolve into serious health problems due to increasing intravascular obstruction or even complete obstruction as a result of dissection or thrombosis. Early detection is therefore of clinical importance, but conventional diagnostic tools often prove inadequate. In the current study simple sports-specific tests are examined for their diagnostic power. Test variables derived from patient history, physical examination, cycling exercise testing followed by arterial pressure measurements at the ankle, and echo-Doppler examination with provocative manoeuvres were tested in 92 symptomatic legs (80 patients). A validated clinical classification acted as a reference. Several test variables proved useful. However, no single test variable combined a high sensitivity with a high specificity. Multivariate testing resulted in the correct classification of 91 % of patients, reaching a sensitivity of 0.90 and specificity of 0.93 (kappa 0.76). Four patients wrongly classified as non-vascular suffered from kinking in the common iliac artery that could not be visualised using the diagnostic tools currently available in this study. IN CONCLUSION: simple sports-specific tests accurately diagnose iliac artery obstruction in endurance athletes.

Adult↗
PubMed2000

[Patients without referral treated in the emergency room: patient characteristics and motives].

OBJECTIVES: To determine the motives of patients to directly visit the Emergency Department for medical treatment without seeing their family practitioner first and to establish the characteristics of this group. DESIGN: Prospective, descriptive. METHOD: Of the surgical patients attending the Emergency Room (ER) of Utrecht University Hospital, the Netherlands, between 1st April and 25th June 1997, the demographic and diagnostic data of the non-referred patients were compared with those of patients referred by the general practitioner (GP). The non-referred patients were asked about their reasons to attend without referral. RESULTS: A total of 1026 patients visited the ER at their own initiative: 603 males and 423 females. The most frequent reasons for the direct visits were 'had not thought of their family practitioner' (48%) and 'wants help that can only be provided in a hospital' (30%). The self-referring patients differed from the 962 referred patients in severity of the trauma: 76% versus 39% had a relatively minor trauma; sort of trauma: 19% versus 4% had a sport trauma; place of residence: 57% versus 45% lived in the near vicinity of the hospital. Of the self-referring patients 57% visited the hospital out of office hours, versus 39% of the referred patients. CONCLUSION: A large part of the non-referred patients visited the ER unnecessarily and should actually have consulted their GP. These were mainly young adults with minor injuries or sports injuries who lived close to the hospital. Important factors were unfamiliarity with or lack of understanding of the existing regulations.

Adolescent↗
PubMed2000

Recurrent traumatic dislocation of the hip joint at the age of 13 and 17 years. A case report.

We report a case of a recurrent traumatic dislocation of the hip joint in a young man at the age of 13 and 17. The patient had retroversion of the femoral neck, instead of a physiological anteversion. We found no consensus about the management of a recurrent traumatic dislocation of the hip joint in the literature. The various therapeutic options are discussed. We advised posterior capsulorraphy with femoral rotation osteotomy. The patient refused surgery.

Adolescent↗
PubMed1999

[Injuries missed in diagnosing severely injured accident victims in the emergency room].

OBJECTIVE: To determine the incidence of injuries missed in the emergency room (ER) and the factors involved. DESIGN: Retrospective. METHOD: Of patients with an Hospital trauma index-injury severity score (HTI-ISS) > or = 14 who were treated in 1996 in the ER of the Academic Hospital Utrecht, the Netherlands, it was studied in the computerized database whether injuries had been missed. A missed injury was defined as an injury not identified during assessment in the Emergency department, but identified later in the hospital or rehabilitation centre. The groups of patients with and without missed injuries were compared with each other regarding possible risk factors for missing injuries. RESULTS: Of 376 severely injured patients in 1996, 329 patients had sufficient follow-up documentation. In 37 patients (11%) of these 329 patients 47 injuries were missed. Fractures were the injuries most frequently missed (n = 25), followed by nerve tissue injuries (n = 14). There were consequences for the treatment in 13 of these patients (35%). Patients with missed injuries had a higher HTI-ISS, were more often primarily referred to the ER and arrived more often at night compared with patients without missed injuries. The two patient groups did not differ at to experience of the physicians.

Adult↗
PubMed1998

Improved results in treatment of femoral shaft fractures with the unreamed femoral nail? A multicenter experience.

OBJECTIVES: The first studies of intramedullary nailing with the Arbeidsgemeinschaft fur Osteosynthesefragen (AO) unreamed femoral nail in selected clinics showed favorable results. Daily practice, however, is that femoral fractures are treated in a variety of clinics by a mixture of surgeons. To evaluate whether similar results could be obtained in general practice, a prospective multicenter trial was undertaken, involving a variety of university and general hospitals in one country. METHODS: Between August of 1994 and June of 1996, 122 patients with 129 traumatic femoral shaft fractures treated with the unreamed femoral nail in eight hospitals were included in this study. Patients who had a reoperation with an unreamed femoral nail or patients with a pathologic fracture of the femur were excluded from this part of the study. Of these patients, 58 patients had multiple injuries, and 33 of the fractures had open soft-tissue injury. RESULTS: Postoperative infection occurred in four patients; the nail broke in one patient. In total, nine patients (6.6 %) sustained general complications, five of which developed adult respiratory distress syndrome (3.6%). Non-union occurred in seven patients (5.1%) and delayed union occurred in four cases (2.9%) with a reintervention rate of 6.6%. CONCLUSION: In this study, a decrease in the number of patients who develop adult respiratory distress syndrome through the use of a thin unreamed nail could not be demonstrated. The promising early callus formation and good consolidation mentioned in previous studies could not be confirmed. We find that the technical and clinical results in this study of unreamed femoral nailing in a mixture of clinics and by a variety of surgeons are comparable to the results of reamed nailing in the literature and are not as favorable as in the previous reports.

Adolescent↗
PubMed1996

[Outpatient sports clinic, first impressions].

OBJECTIVE: To review the first year of the outpatient sports clinic in Utrecht University Hospital (AZU), and to demonstrate the feasibility of such a sports clinic. DESIGN: Retrospective study (period: April 1993-March 1994). SETTING: University Hospital Utrecht, the Netherlands. METHODS: The patients attended the sports clinic either on referral or on their own initiative. The specialist directly entered the patients' data onto a registration form. RESULTS: Over a period of one year 461 consultations where given to 271 patients. The patients' average age was 31 years. The commonest sports were soccer, running and tennis. The lower limb was the commonest site of injury (79%) and overuse injuries predominated. For 57% of the patients therapy was instituted, which consisted in 67% of the cases of physiotherapy and in 13% of operative intervention. CONCLUSION: The outpatient sports clinic appears to be visited in particular by senior athletes with chronic complaints caused by surmenage injuries or with residual complaints following acute injuries. Future intramural sports medicine will have to deal not only with treatment of injuries as presented at the sports clinic, but also with prevention of chronic complaints resulting from acute injuries in this group of athletes.

Adult↗
PubMed1996

[Reasonably good results of Hansson's pins in elderly patients with a medial femoral neck fracture].

OBJECTIVE: To establish the result of treatment of medial femoral neck fractures in patients aged 70 years and older using Hansson pins introduced percutaneously. DESIGN: Descriptive. SETTING: Department of Surgery, University Hospital Utrecht, the Netherlands. METHOD: Ninety-two patients aged 70 years and older with a medial femoral neck fracture were treated in the period 1986-1994 with osteosynthesis using Hansson pins. The case histories and X-rays of these patients were analysed. All fractures were classified according to Garden and Pauwels, with Singh classification of bone quality. The result of the operation was evaluated with the aid of postoperative X-rays. RESULTS: The patients' mean age was 80 years. There were 16 non-dislocated Garden grades I or II and 71 dislocated Garden III and IV fractures. Four patients died within 30 days after the operation. At the time of the follow-up (after an average of 4.5 years), 45 patients had died. Thirty-three patients in all developed a fracture-related complication; 27 of them underwent reoperations during which 19 (21%) were fitted with a head-neck prosthesis or a total hip prosthesis. All reoperations which included implantation of a prosthesis were performed in dislocated Garden grades III and IV fractures. In fractures of this type in which postoperative repositioning proved inadequate, more reoperations were performed than in the Garden grades III and IV fractures with correct posture. CONCLUSION: Treatment of a medial femoral neck fracture in elderly patients by means of internal fixation with percutaneously introduced Hansson pins gives results similar to those of other types of internal fixation. This is a good operation for Garden grades I and II fractures, whereas in Garden grades III and IV fractures in which repositioning is impossible, internal fixation should be refrained from and a head-neck prosthesis should be implanted in one session.

Aged↗
PubMed1996

Radial head fractures: operative or conservative treatment? The Greek temple model.

An important point in any communication on fracture treatment is agreement on classification of the fracture to be discussed. for fractures of the radial head there are several useful classification systems. The well-recognized Mason classification is particularly useful in the treatment of radial head fractures. It is however important to realize that the usefulness of this classification system is limited to radial head fractures without associated injury. In deciding on operative or conservative treatment it is therefore essential to subdivide fractures of the radial head into simple or complex fractures. As stated, the Mason classification system is most useful in deciding on treatment of simple fractures, that is to say fractures without an additional fracture or ligamentous injury. Type I fractures should be treated conservatively because of their excellent prognosis. The treatment of type II fractures is still controversial. The decision for osteosynthesis is not only based on the fracture configuration but certainly also on the talent of the surgeon involved. Immediate resection is not considered acceptable in this type of fracture. In type III fractures however, immediate excision is an acceptable method of treatment as long as there is no associated fracture or ligamentous injury. In deciding whether or not there is a complex injury the "Greek Temple" model is very useful. In this model the ulna and radius are seen as two "pillars" which support the "roof" of the distal humerus. The connection between the roof and the pillar on the ulnar side is formed by a ligament, on the radial side there is only the tension of the muscles. With this model it is easy to memorize which associated injuries form the basis of a complex injury, in which excision of the radial head or conservative treatment can cause ulnohumeral subluxation or late radioulnar instability. Treatment in these complex injuries should therefore in principle consist of reconstruction or temporary fixation of the radial pillar, and if necessary temporary stabilization of the ulnar pillar.

Elbow Joint↗
PubMed1988

Brachial artery lesions after cardiac catheterisation.

In a prospective study the incidence of brachial artery injury after cardiac catheterisation and the factors involved were examined. The main aim of the study however was to determine whether immediately after the injury it was possible to predict if long-term ischaemic symptoms would occur if conservative treatment was used. Five-hundred and two patients were seen pre- and post-catheterisation. Examination included inspection, palpation, segmental blood pressure measurements before and after exercise, Doppler score evaluation and in selected cases, angiography. Twenty-nine patients (5.8%) had postcatheterisation complaints of pain, pallor, hypoaesthesia or paraesthesia. A postcatheterisation wrist blood pressure index of less than 0.85, was found in 97 patients (19%). This included 22 occlusions confirmed by angiography (4.5%). Cardiac valve disease and previous catheterisations were a risk factor. All brachial artery injuries, that is to say those patients with a postcatheterisation wrist index of less than 0.85, were treated conservatively and reviewed at 6 months. Nineteen of the 72 patients seen at follow-up still had ischaemic symptoms on effort. Postinjury complaints of pain and paraesthesia had no value in predicting whether or not ischaemic symptoms would persist, whilst angiography, wrist pulse palpation, capillary refill time and the wrist pressure index at rest had very little predictive value. The Doppler score, pallor and coldness of the hand all had some value. The best predictor of long-term ischaemic symptoms was the wrist pressure index after exercise. Brachial artery injury occurs frequently after cardiac catheterisation and ischaemic symptoms thereafter are usually mild.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1988

The dynamic condylar screw in subtrochanteric fractures of the femur.

Early experience with the AO dynamic condylar screw in subtrochanteric fractures of the femur showed a solid and stable osteosynthesis in 19 patients. The ease of insertion of the dynamic condylar screw, the firm proximal fixation, the increased strength and resistance to stress failure should, in our opinion, make this technique a favoured form of treatment for this particular type of fracture.

Adult↗
PubMed1986

Minimal osteosynthesis of lateral malleolar fractures.

An oblique fracture of the lateral malleolus caused by a supination-external rotation injury (Danis-Weber type B) is the most common ankle fracture and is preferably treated operatively. Interfragmentary compression and lateral plating are generally used as the method of osteosynthesis. As an alternative two posteriorly inserted lag screws in the antero-posterior direction were used in 18 patients. In all but one good to excellent results as regards pain, function and radiographic appearance were achieved. The advantages of less extensive dissection, smaller amounts of foreign material and shorter operation time tend to make this the technique of choice for this type of fracture.

Adult↗