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Biomedical subjects

F G Van der Meché

Publications and source records attributed to F G Van der Meché.

12 recordsLinked to original sources
PubMed2001

Changes in referral pattern and its effect on outcome in patients with Guillain-Barré syndrome.

The authors assessed the referral pattern and outcome in patients with Guillain-Barré syndrome (n = 266) after the introduction of intravenous immunoglobulin (IVIg). Fewer patients were transferred from small to large hospitals after the introduction of IVIg (p = 0.05). This did not result in a worse outcome in patients treated in small centers. The introduction of IVIg has led to a better use of different levels of health care facilities.

Guillain-Barre Syndrome↗
PubMed2001

Serratus anterior paralysis as an occupational injury in scaffolders: two case reports.

BACKGROUND: Shoulder complaints in scaffolders are very common and may result in permanent disability. METHODS: We present two case reports of patients who developed acute shoulder complaints. After lifting weights up to 50 kg both patients suffered an isolated lesion of the long thoracic nerve resulting in serratus anterior paralysis. RESULTS: Physical signs are unilateral winging of the scapula and loss of strength in the arm. A combined effect of pressure and stretching of the nerve resulted in an occupational injury with a different prognosis of reversibility in both patients. CONCLUSION: Shoulder pads in the overall and limiting the weight to carry may prevent future injuries.

Adolescent↗
PubMed2001

Diagnostic and classification criteria for the Guillain-Barré syndrome.

BACKGROUND: Diagnostic criteria for the Guillain-Barré syndrome (GBS) have been available since 1978. Since then, several variants have been described. More recently, a distinction has been made between pure motor forms, severe sensory forms, primary axonal and primary demyelinating varieties. Associations of clinical characteristics, and specific infections and the presence of antiganglioside antibodies have been found. For further studies on GBS, it is therefore necessary to reconsider the available diagnostic criteria and add additional criteria for subclassification. METHODS: A panel of (20) experts was formed. The literature representing the recent developments in GBS subclassification was reviewed. Following a consensus protocol, diagnostic and classification criteria were formulated. RESULTS: The diagnosis of GBS can usually be made on clinical characteristics. A schedule for subclassification has been made to cover also the clinical variants in a systematic manner.

Autoantibodies↗
PubMed2000

Mild forms of Guillain-Barré syndrome in an epidemiologic survey in The Netherlands.

OBJECTIVE: Assessment of incidence rates of Guillain-Barré syndrome (GBS) in the Netherlands over a 10-year period; investigation of a relationship between possible seasonality in GBS and the occurrence of preceding infections; and determination of distinctive characteristics in patients with GBS who are only mildly affected (able to walk unaided at nadir). METHOD: Records of patients with GBS admitted between 1987 and 1996 from all 45 hospitals in the southwest Netherlands were evaluated, covering a population of 4.2 million inhabitants. RESULTS: A total of 476 patients met National Institute for Neurological and Communicative Disorders and Stroke criteria for GBS. This resulted in a crude incidence rate (IR) of 1.18/100,000 inhabitants. This IR increased linearly with age (p < 0.001). Men were more frequently affected than women (p < 0.001). No seasonal preponderance for GBS, nor for any of the preceding infections, was found. Patients under 50 years of age (p < 0.001) and men (p = 0.01) were more frequently found in the mildly affected group. In both groups a preceding infection was reported in 70% of the cases. In the severely affected group, serologic evidence for infection with Campylobacter jejuni, cytomegalovirus, Epstein-Barr virus, or Mycoplasma pneumoniae was found more frequently than in the mildly affected group (41% versus 16%, p = 0.001). CONCLUSIONS: Overall IR in the Netherlands are similar to those found in other studies. The incidence increases linearly with age and men are more frequently affected than women. Distinctive characteristics for mildly and severely affected patients were found regarding age, sex, and preceding infections. This suggests that other infectious agents or host factors may be involved in mild forms of GBS.

Data Collection↗
PubMed1997

Binocular saccadic eye movements in multiple sclerosis.

We attempted to increase the sensitivity for detection of abnormal binocular saccadic eye movements, particularly of the internuclear ophthalmoplegia (INO) type associated with multiple sclerosis (MS). Saccades of 10 and 20 degrees were binocularly recorded with scleral sensor coils in 10 normal control subjects and 26 patients with definite or probable MS, seven of whom had a clinically manifest INO in one or both directions. In the cases in which this was accompanied by a dissociated nystagmus of the abducting eye, our recordings showed that such secondary saccades were also expressed, in a strongly reduced form, by the adducting eye. The patients with manifest INO showed lower average peak velocities and peak accelerations, especially for adduction of the eye on the affected side, but the distribution of these parameters overlapped with the normal distribution. A much sharper distinction between normals and patients with INOs was found by considering the ratios between peak accelerations and velocities of saccade pairs (abducting eye/adducting eye). These ratios, which eliminate much intra- and inter-individual variability, had a narrow range in normals, and all values for INOs were outside this range. On this basis, the 19 patients without clinically manifest INO were easily separated into subgroups of 14 patients with completely normal interocular ratios and five patients with elevated peak velocity and acceleration ratios, identified as sub-clinical (uni- or bilateral) INOs. Measurements of vertical saccades and of interocular timing differences provided no useful criteria for disturbances of binocular coordination in MS. We conclude that in particular, the acceleration of the adducting eye is strongly reduced in patients with an INO, and that this reduction is best identified by interocular comparison between binocular pairs of saccades.

Adult↗
PubMed1997

Uvulopalatopharyngoplasty for the obstructive sleep apnoea syndrome: value of polysomnography, Mueller manoeuvre and cephalometry in predicting surgical outcome.

Sixty consecutive patients with the obstructive sleep apnoea syndrome (53 men and seven women) were analysed by questionnaire, polysomnography, röntgenographic cephalometry and the Mueller manoeuvre before and 6 months after uvulopalatopharyngoplasty (UPPP), to assess the surgical outcome and the prognostic value of preoperative evaluation. Seventy-three per cent of patients reported improvement of snoring and 55% reported improvement of excessive daytime sleepiness. Thirty-five per cent showed a decrease of at least 50% in the desaturation index, and 13% had a postoperative desaturation index below 5. Although the improvement of desaturation parameters was marked in some patients, the overall change was not significant. Neither the Body Mass Index (BMI), nor any of the cephalometric variables were significantly correlated to surgical outcome. Increased difference in collapsibility between the soft palate and the base of the tongue showed a close to significant relation with the improvement of desaturation index. High desaturation index, low mean saturation and deep lowest saturation were found to be slightly predictive of improvement in nocturnal desaturation. In a multivariate analysis however no significant predictors could be identified. It is concluded that UPPP is effective in reducing snoring and daytime sleepiness over a 6-month follow-up period, but that the overall improvement in nocturnal desaturation is limited and difficult to predict. Further research is needed to evaluate the long-term efficacy of UPPP.

Body Mass Index↗
PubMed1996

Breathing pattern awake and asleep in myotonic dystrophy.

Because myotonic dystrophy patients show marked irregularities of breathing both awake and asleep, variables related to breathing pattern under both conditions were measured in 11 patients, together with pulmonary function indices, ventilatory CO2 response and maximal mouth pressures. The aim of the study was to detect and explain a possible interrelationship between daytime and nocturnal irregularity. Awake, patients demonstrated significantly more variability in tidal volume and respiratory cycle time than controls. Asleep, periodic breathing occurred during up to 100% of the time spent in light sleep, but not during deep sleep. A strong correlation was found with age (r = 0.73, p = 0.01). No relationship was found between disturbed breathing awake and asleep. There was a tendency for increased variability of tidal volume awake in cases with a decreased ventilatory CO2 response (p = 0.1). The results indicate that different mechanisms may be involved in daytime and nocturnal irregularity. It is hypothesized that brain stem integrative functions may be impaired in myotonic dystrophy.

Adolescent↗
PubMed1995

Guillain-Barré syndrome without sensory loss (acute motor neuropathy). A subgroup with specific clinical, electrodiagnostic and laboratory features. Dutch Guillain-Barré Study Group.

We analysed data obtained from 27 out of a group of 147 patients with Guillain-Barré syndrome, who did not have sensory loss during a follow-up period of 6 months (motor Guillain-Barré syndrome). These patients had a distinctive clinical pattern compared with the other 120 Guillain-Barré syndrome patients. The clinical course was marked by a more rapid onset of weakness (3.9 versus 6.1 days, P = 0.002), an earlier nadir (6.3 versus 9.1 days, P < 0.001), an initially predominant distal weakness (67% versus 27%, P < 0.001), sparing of the cranial nerves (26% versus 68%, P < 0.001) and the disease was more often preceded by a gastro-intestinal illness (41% versus 13%, P = 0.001) often caused by a Campylobacter jejuni infection (67% versus 28% in the other Guillain-Barré syndrome patients, P < 0.001). High titres of anti-GM1 antibodies were also significantly more common in motor Guillain-Barré syndrome patients (42% versus 5%, P < 0.001). Electromyographic data of the motor Guillain-Barré syndrome patients at nadir revealed little or no evidence for demyelination. Abundant denervation activity was present in half of the patients. The response to immune globulin treatment was good but with plasma exchange significantly fewer motor Guillain-Barré syndrome patients reached the stage of independent locomotion after a follow-up period of 6 months especially if the acute motor neuropathy occurred after a C.jejuni infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1977

Reversal of sign of long spinal reflexes dependent on the phase of the step cycle in the high decerebrate cat.

Reversal of the sign of long ascending and descending spinal reflexes dependent on the phase of the step cycle has been shown in the high decerebrate cat. Electrical stimuli were applied to the skin over the dorsum of the metacarpals and metatarsals and the effects were recorded in the corresponding hindlimb or forelimb of the same side. Stimulation generally evoked an increase in activity of flexor or extensor muscles shortly before, and during, activity of the muscle. Inhibition of a muscle occurred when its activity overlapped with the activity of an antagonist muscle. From the latencies it was concluded that at least the early components of the long reflex responses are due to spinal mechanisms. In the stimulated limb the activity of flexor and extensor muscles was also modulated in a phase dependent manner. No consistent long spinal responses to skin stimulation were obtained in high spinal cats during stepping. Electrical stimulation of cutaneous nerve trunks in decerebrate preparations during stepping gave variable though phase dependent long spinal reflex effects.

Animals↗