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Biomedical subjects

F W Hazebroek

Publications and source records attributed to F W Hazebroek.

At least 37 records · Page 2Linked to original sources
PubMed1994

[3-week traction with 3-week spica-cast immobilization is as good as 6-week traction, and much cheaper].

OBJECTIVE: To gain insight into the clinical en economic results of the treatment of femoral shaft fractures in children by means of traction for 3 weeks and spica immobilization for 3 weeks as an outpatient in comparison with traction for 6 weeks. DESIGN: Retrospective. SETTING: Sophia children's hospital in Rotterdam. METHOD: Between 1981 and 1989, 278 children were admitted because of a femoral shaft fracture. This follow-up study concerned 229 children of whom 139 were treated by means of 6 weeks' traction (group 1) and 90 received the combination treatment (group 2). The two groups were comparable with regard to age, sex, cause, type and site of the fracture. RESULTS: All fractures healed, complications were rare and equally divided between the two groups. There was no significant difference between the two groups with regard to shortening and angulation of bone fragments. The mean duration of hospital stay was almost 47 days in group 1 as against 22 days in group 2, leading to a reduction of Dfl. 19,500.--in hospitalization costs per child. CONCLUSION: The results of treatment of femoral shaft fractures by means of traction in combination with spica immobilization equal those of 6 weeks' traction. The shortened duration of hospital stay leads to a considerable reduction in costs.

Adolescent↗
PubMed1994

[Limitations to care; evaluation of decision making concerning the death of 104 children in a surgical intensive care unit].

OBJECTIVE: To analyse the decision-making process concerning withholding and withdrawal of life-sustaining treatment in children who died in a paediatric surgical intensive care unit. DESIGN: Retrospective evaluation of medical and nursing records from the period 1988-1992. SETTING: Sophia Children's Hospital-University Hospital Rotterdam. METHOD: The evaluation concerned 104 children who died in the paediatric surgical intensive care unit during the study period. The causes of death were classified according to the classification proposed in a recent report issued by the Dutch Association of Paediatricians. A distinction was made between newborns and older children. RESULTS: In both newborns and older children, about half of the children had died because treatment was either withheld (4/104) or withdrawn (53/104). There were no cases of 'intentional termination of life in emergencies'. The remaining children had died in spite of medical treatment that had been considered worthwhile. CONCLUSION: The problems and guidelines suggested from the field of neonatology are applicable not only to newborns with severe congenital anomalies, but also to older children. Evaluation of the decision-making process should not be limited to medical-technical and nursing aspects, but should also include the experiences of the parents and the treatment team.

Child↗
PubMed1993

Radiographic evidence of bronchopulmonary dysplasia in high-risk congenital diaphragmatic hernia survivors.

Congenital diaphragmatic hernia is a congenital malformation associated with pulmonary hypoplasia. It often leads to respiratory failure, requiring artificial ventilation with high inflation pressures and high percentages of oxygen. We evaluated radiographic evidence of bronchopulmonary dysplasia (BPD) in survivors, who presented with respiratory distress within 6 hours after birth, by a radiographic scoring system measuring the severity of BPD by the Toce score and the degree of pulmonary hypoplasia by the Touloukian score. Fifteen of 45 survivors (33 percent) had clinical and radiological lung disease resembling BPD. As a group they had significantly higher Touloukian and Toce scores than survivors without BPD. Morbidity expressed as the duration of artificial ventilation, supplemental oxygen, and hospital stay was much higher in the BPD group. The hypoplastic lung in infants with congenital diaphragmatic hernia appears to be as susceptible to barotrauma and pulmonary oxygen toxicity as the lungs of prematurely born infants. To what extent BPD occurring in congenital diaphragmatic hernia survivors might influence the future development of lung function is not yet known.

Bronchopulmonary Dysplasia↗
PubMed1993

Withholding and withdrawal of life support from surgical neonates with life-threatening congenital anomalies.

We evaluated why and how life support was withheld or withdrawn in surgical neonates. During the study period, January 1988 through December 1991, 529 neonates were admitted, 52 of whom died (10%). Twenty-eight deaths were due to the underlying disease. The other 24 patients died because treatment was withheld or withdrawn. In 15 of 24 (group A, mean stay 9.2 +/- 9.1 days) treatment was initially started but later withdrawn (13/15) because of the severity of congenital anomalies alone (7/12) or congenital anomalies associated with chromosomal anomalies (5/12). In 9 of 24 (group B, mean stay 20.3 +/- 17.3 days) treatment was withdrawn because of serious complications. In all cases often lengthy discussions have led the doctors and nurses together with the parents to chose unanimously for withdrawal of treatment. Mechanical ventilation was the intervention most frequently withdrawn (10/15 group A, 9/9 group B). Vasoactive and other drugs were withheld in 5 patients of group A. Sedatives and analgetics were administrated as supportive care permitting the child to die in a humane way, 17 in the lap of a parent and 7 in the lap of a nurse. We conclude that life-sustaining care is withheld or withdrawn relatively frequently from patients at our ICU. Such decisions are ethical ones, taken in the light of professional and technical expertise. Evaluation of withholding or withdrawal of treatment is difficult but necessary to evolve appropriate decision-making procedures and to formulate humane standards of intensive care.(ABSTRACT TRUNCATED AT 250 WORDS)

Abnormalities, Multiple↗
PubMed1993

Persistent pulmonary hypertension in high-risk congenital diaphragmatic hernia patients: incidence and vasodilator therapy.

Survival of congenital diaphragmatic hernia patients depends on the gravity of pulmonary hypoplasia and persistent pulmonary hypertension (PPH). Many vasoactive drugs have been used in the treatment of PPH, but often they also lower peripheral resistance, leading to a significant drop in arterial blood pressure. The incidence of PPH in 52 high-risk diaphragmatic hernia patients and the results of treatment with tolazoline and prostacyclin were evaluated in a study lasting 52 months and involving 52 patients. High-risk patients require ventilatory support within 6 hours after birth. Study parameters were alveolar-arterial oxygenation difference (AaDO2), oxygenation index (OI), and mean arterial blood pressure (MABP), measured at set times before and after administration of tolazoline or prostacyclin. Twenty-one patients had documented episodes of PPH (46%), and 18 of them died. Tolazoline did not lower AaDO2 and OI values, but MABP dropped significantly. Prostacyclin caused a significant decrease of AaDO2 and OI values without an effect on MABP. We concluded: (1) PPH presented in 46% of our patients, associated with a high mortality rate; (2) tolazoline is not an effective dilator of the pulmonary vascular bed and lowers MABP; and (3) prostacyclin is an effective pulmonary vasodilator as reflected by ventilation parameters without systemic side effects; it does not affect overall outcome but can used as a "bridge" to extracorporeal membrane oxygenation.

Blood Pressure↗
PubMed1993

Surgical treatment of congenital bronchopulmonary disease in children.

From 1987 to 1992, 22 children (age 0 days-14 years) were operated for congenital bronchopulmonary disease. One patient had a hamartoma. Four children had a bronchogenic cyst, in 1 patient combined with an esophageal duplication. Intrapulmonary sequestration was diagnosed in 3 children; one of whom had an esophageal duplication as well. Four children had localized emphysema. In 1 patient histology showed rhabdomyosarcoma. A lobectomy was performed following chemotherapy but recurrence was not resectable at a third thoracotomy. Ten patients had cystic adenomatoid malformation, 6 were dependent on artificial ventilation before surgery. Three patients with cystic adenomatoid malformation died in hospital: 2 after pneumonectomy who were shown to have bilateral disease and 1 died after bilobectomy and was shown to have a hypoplastic contralateral lung. Hospital morbidity involved 1 patient with recurrent pneumothorax, 2 with atelectasis of the operated lung and 3 with prolonged artificial ventilation. Late mortality involved 1 patient due to pulmonary rhabdomyosarcoma. After 1-26 months of follow-up there were no late complications. Adequate multidisciplinary treatment allows acceptable mortality and low morbidity in surgery for congenital bronchopulmonary disease in children.

Adolescent↗
PubMed1993

Left and right ventricular diverticula, ventricular septal defect and ectopia cordis in a patient with Cantrell's syndrome.

A patient with Cantrell's syndrome is presented with ectopia cordis, ventricular septal defect and a left ventricular as well as a right ventricular diverticulum. One-stage correction was performed with resection of both diverticula. Closure of the ventricular septal defect was complicated due to exposure problems as a result of the malposition of the heart. Although the presentation of Cantrell's syndrome can be variable, one-stage repair is technically feasible and should be considered as the treatment of choice in this rare syndrome.

Diverticulum↗
PubMed1992

Avoidance of emergency surgery in newborn infants with trisomy 18.

Trisomy 18 (Edwards' syndrome) presents with characteristic external features as well as life-threatening abnormalities; many of these abnormalities require surgical correction during the neonatal period. Children with trisomy 18 have a very short life expectancy, and all long-term survivors have severe mental retardation. Difficult medical and ethical issues arise over whether or not to institute treatment when a newborn infant with suspected trisomy 18 has a life-threatening anomaly. We studied the policy of treatment in seven patients with clinical Edwards' syndrome. For three, the period of uncertainty was shortened because trisomy 18 was rapidly diagnosed by karyotyping of a bone-marrow aspirate. Four of the patients underwent surgery before the diagnosis of trisomy 18 was confirmed by routine karyotyping in lymphocytes; karyotyping in bone marrow might have allowed invasive treatment to be avoided in three of these. Rapid confirmation of clinically suspected Edwards' syndrome is very important because surgery may then be withheld. A newborn infant with trisomy 18 should be considered as a patient with a hopeless outlook who ought not to be subjected to invasive procedures. The decision to withdraw or withhold treatment should be discussed frankly with the parents. The period of uncertainty can be reduced to a minimum by the use of karyotyping in bone marrow.

Abnormalities, Multiple↗
PubMed1992

The management of the impalpable testis by surgery alone.

We evaluated 68 prepubertal boys with 84 impalpable testes who were operated upon without using any other diagnostic maneuvers. Of the testes 18 (22%) were absent (anorchism or 'vanished') and 38 (45%) could be placed in a scrotal position with standard orchiopexy. A staged, Fowler-Stephens or microvascular procedure was required for 28 testes (33%), involving orchiectomy in 2 cases, and succeeded in a scrotal position for another 24 testes. In 1 boy 2 testes were fixed outside the inguinal canal. Reexamination after 3 to 9 years showed that 42 of 55 operated testes (76%) were in scrotal position without atrophy, 10 had atrophied and 3 were removed at the second stage operation. We conclude that an exclusive surgical approach has the advantage of providing diagnosis and therapy, and, therefore, it is an effective method.

Child, Preschool↗
PubMed1991

[Results of prenatal echographic studies in the diagnosis of pediatric surgical abnormalities].

In 180 newborns with congenital anatomical anomalies, admitted to the Department of Paediatric Surgery, Sophia Children's Hospital, Rotterdam, we retrospectively determined whether ultrasound studies had been performed during the second and third trimesters of pregnancy. The correlation between prenatal and postnatal diagnoses was investigated as well. Ultrasound study had been performed in 86 if the 180 pregnant mothers (48%). In 41 cases the anomaly of the newborn had not been diagnosed prenatally. In 45 cases anomaly had been diagnosed prenatally. The ultimate diagnosis was the same as the prenatal diagnosis in 35 patients and was different in 10. We conclude that routine prenatal ultrasound study in the second or third trimester of pregnancy, aimed at detecting congenital anatomical anomalies to be treated by the (general) paediatric surgeon, provided little certainty about the health of the baby. Permanent education of obstetricians, and at the slightest doubt referral to one of the University Hospital Centres for specific ultrasound study, are mandatory in order to be able to correctly inform an increasing number of parents about the prospects of their unborn child.

Adult↗
PubMed1991

Evaluation of mortality in surgical neonates over a 10-year period: nonpreventable, permissible, and preventable death.

The mortality pattern and causes of death in surgical neonates were evaluated over the period of 1980 through 1990 in order to assess whether any deaths might have been prevented. In the study period 1,010 neonates were admitted, 104 of whom died (10%). These 104 neonates formed our study population. The Clinical Classification System (CCS) and the Therapeutic Intervention Scoring System (TISS) were used to assess the severity of illness. All 104 nonsurvivors were seriously ill (CCS 3 and 4; TISS greater than 20). The mortality pattern was classified in three groups. Group A (nonpreventable death) included 56 deaths, 48 of which were due to the underlying disease. The other 8 patients died of a nonpreventable complication of treatment. Eleven of the patients in group B (permissible death) had (multiple) congenital anomalies associated with chromosomal anomalies. Three of them were not treated and in the other 8 treatment was initially started but later withdrawn. In most of the other 14 patients further treatment was withdrawn because of serious postoperative complications or inoperable cardiac anomalies. Group C (preventable death) consisted of 23 patients. Six of 10 had irreversible brain damage due to prolonged hypoxemia. In the other 13 patients of group C, death was due to sepsis acquired in the postoperative period and treated inadequately. Staphylococcus epidermidis was the most frequent isolated pathogen (7/13).

Cause of Death↗