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G J Gelpke

Publications and source records attributed to G J Gelpke.

10 recordsLinked to original sources
PubMed1989

[Effect of surgery on neurological involvement caused by a lumbosacral radicular syndrome].

Results of neurological assessment one year after surgical treatment of herniated lumbar intervertebral disc and lumbar stenosis are reported in 443 patients. Follow-up was performed during one year after operation. Preoperatively, surgeons found motor loss more frequently than patients, (28 and 12% respectively) and, postoperatively, motor loss was still present in 25% and 24%, respectively, of these cases. The operation had caused motor loss in 5% and aggravated motor loss in 3%. Sensibility was reported as abnormal one year after surgery by both patients and surgeons in one-third of the cases. Sensory loss, considered by the patient to have been caused or aggravated by the operation, occurred in 15% of the cases and in 12% of these the surgeons agreed. Preoperatively, unilaterally diminished knee and Achilles tendon reflexes were found in 9% and 42% respectively; one year after surgery, these had recovered in 65% and 57%, respectively. Surgery caused or aggravated unilaterally diminished knee or ankle jerks in 3% and 10%, respectively.

Adult↗
PubMed1988

Changes in radicular function following low-back surgery.

Results of neurological assessment 1 year following surgical treatment of herniated lumbar intervertebral discs and lumbar stenosis are reported in 443 patients. The data were collected using separate series of questionnaires to be completed by the patient and the surgeon. Preoperatively, motor loss was reported by 12% of patients, while surgeons found motor weakness in 28%. Postoperative motor loss was still present in 24% and 25% of these cases, respectively; the operation had caused or aggravated motor loss in 5% and 3% of cases, respectively. Sensory phenomena were reported by 53% of the patients, while surgeons found sensory loss in 45%. Sensation was reported as abnormal 1 year after surgery both by patients and by surgeons in one-third of these cases. Sensory loss, considered by the patient to be caused or aggravated by operation, occurred in 15% of cases and in 12% of cases the surgeons agreed. Preoperatively, unilaterally diminished knee and Achilles tendon reflexes were found in 9% and 42%, respectively; at 1 year after surgery, these had recovered in 65% and 57% of cases, respectively. Surgery caused or aggravated unilaterally diminished knee or ankle jerks in 3% and 10% of cases, respectively.

Humans↗
PubMed1987

Prognostic significance of pretreatment variables in patients with invasive cervical cancer.

In 119 consecutive patients with invasive cervical cancer 92 variables of potential significance in predicting recurrence were determined before treatment. In 49 patients recurrent disease was diagnosed during follow-up after therapy. The investigated variables include: clinical data, routinely performed hematological and biochemical tests, histopathological data, oncofetal antigens, placental and pregnancy associated substances, serum levels of acute phase reactants, complement components, immunoglobulins and circulating immune complexes, and assays measuring the general immune competence of the patient. Thirty-three of the variables appeared to give statistically significant differences between values of future recurrence and non-recurrence patients. Further selection was carried out by stepwise forward discriminant analysis. This selection resulted in a prognosis rule using a subset of 7 variables. Carcino-embryonic antigen and the complement component C3PA appeared to be the most powerful variables. Although the stage of disease was the third most important single variable, it did not add prognostic information, once CEA and C3PA were used. By applying the prognosis rule a probabilistic prediction is obtained for each patient. In about 60% of the future recurrences and 40% of the future non-recurrence patients, these predictions reached a high level of accuracy. It was argued that the prediction of non-recurrence does not warrant to change the treatment protocol at present. Whether the prediction of recurrence is clinically useful remains to be clarified.

Adult↗
PubMed1986

Prognosis and prediction of outcome in comatose head injured patients.

Recent studies on the prognosis of comatose head injured patients have identified single powerful prognostic features at various time points during the first month after onset of coma. Using appropriate statistical methods even more powerful combinations of prognostic features can be selected. At each time point, optimal prediction requires sets of only 3 to 5 features. These features include depth and duration of coma as assessed by the Glasgow Coma Scale, pupil reactivity to light, age in decades, and spontaneous and reflex eye movements. In individual new patients, bedside predictions are now possible, e.g. using a booklet with prognosis tables like the one used in Rotterdam. Doctors actually learn by using these tables as they retain some of the information. However, the main application is that these tables permit one to evaluate whether differences in survival rates in different centres with different management regimes are due to a difference in management efficacy or to a difference in initial severity of injury.

Coma↗
PubMed1983

Comparison of outcome in two series of patients with severe head injuries.

A comparison is made between the outcome distributions of two Dutch series of patients with severe head injuries. Both series are taken from the same study and cover the same period (1974 to 1977). There is a large difference in survival rate between the series: 45% versus 63%. The authors present a possible method for assessing the influence of differences in initial severity of injury on outcome. It is estimated that, of the 18% difference in survival rate, 10.5% is due to differences in severity of injury on admission. The remaining 7.5% difference in survival rate is not explained, but may have been caused by unmeasured variations in the initial determination of severity of injury or by differences in effectiveness of management. The higher survival rate was achieved at the center with the more conservative management regimen. An evaluation of recent literature suggests that reports that do not find aspects of "aggressive" management beneficial are more reliable in comparing series than are those that claim improved outcome after aggressive therapy.

Brain Injuries↗
PubMed1983

The prognostic value of computerized tomography in comatose head-injured patients.

In a series of 121 comatose head-injured patients, computerized tomography (CT) scans were obtained at various intervals after onset of coma. The scans were classified without knowledge of previous scans or of the patient's clinical state, and predictions as to outcome at 1 year were made based on clinical features and CT findings. The state of the basal cisterns as seen on CT scans proved to be a very powerful prognosticator. Subsets of features with the greatest prognostic weight were selected systematically for CT features, clinical features, and for a combination of CT and clinical features. With these features, probability statements were made about death or survival at 1 year. The quality of the predictions was established by comparing them with actual outcome. The percentage of accurate predictions was markedly higher with a combination of clinical and CT features than with clinical or CT features alone.

Adolescent↗
PubMed1980

Systematic selection of prognostic features in patients with severe head injury.

In this study small sets of clinical features were identified that, when combined, yield high quality predictions of long term outcome. The study is based on a series of 305 consecutive head-injured Dutch patients, all of whom had been in coma for at least 6 hours. The overall social outcome was assessed after 6 months using the Glasgow outcome scale. Predictions of outcome were made by assigning probabilities to each possible outcome category. The prognostically most promising features recorded during the early post-traumatic course were identified, and powerful combinations of prognostic features were selected on admission and 1, 3, 7, 14, and 28 days after the start of coma by an appropriate statistical method. At each time point, optimal prediction required sets of only three to five features, typically including age in decades, depth and duration of coma as assessed by the Glasgow coma scale, pupil reactivity to light, and spontaneous and reflex eye movements. The method described allows bedside predictions in individual patients and provides a tool for comparing the severity of injury between series of patients.

Adolescent↗
PubMedDate not supplied

A computer program for selection of variables in diagnostic and prognostic problems.

The computer program INDEP-SELECT has been developed for selection of an optimal subset from a set of possibly informative diagnostic or prognostic variables. But the program is equally useful for other discriminant analysis or pattern recognition problems involving variable selection. The approach is probabilistic; i.e., diagnostic probabilities are assigned to a patient on the basis of the values observed on the diagnostic variables. The statistical model used is largely based on the assumption of independency between the variables, but one model-parameter, the so-called 'global association factor', is added in order to take dependency into account. The stepwise forward selection strategy of adding in each selection step a new variable to the set of already selected variables, is used. The user may choose between a number of selection criteria. Such a criterion is used in order to decide in each selection step which variable should be added. All criteria are based on measures of diagnostic or prognostic performance. INDEP-SELECT is able to handle a large number of variables, also with missing data, and a large number of patients. The program is written in ANS Standard FORTRAN, and takes relatively little computation time.

Bayes Theorem↗