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Biomedical subjects

J E Nagtegaal

Publications and source records attributed to J E Nagtegaal.

12 recordsLinked to original sources
PubMed2006

[No advantage to referring patients with acute myocardial infarction from a general hospital to an intervention clinic for percutaneous coronary intervention; comparison of mortality rates in 2000 and 2003 in the Meander Medical Centre, Amersfoort].

OBJECTIVE: To evaluate whether implementation of the 2000 Netherlands Society of Cardiology guideline 'ST-elevation acute coronary syndromes', which recommends the use ofpercutaneous coronary intervention (PCI), has reduced mortality and complication rates in a general hospital, and whether patient characteristics and outcomes are comparable to those reported in the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT) 2 and 3 trials. DESIGN: Retrospective outcomes study. METHOD: Data from 2003 were compared with data from 2000 regarding patients with acute myocardial infarction who received thrombolysis at the Meander Medical Centre in Amersfoort, the Netherlands, or percutaneous transluminal coronary angioplasty (PTCA) after referral to an intervention clinic. Data included baseline characteristics, type of treatment, outcomes and complications. Age, sex and mortality ofall patients were compared to data from the ASSENT 2 and 3 trials. RESULTS: Data were included from 130/132 patients treated in 2003 and 145/145 patients treated in 2000. Baseline characteristics were comparable, except age: there were significant more elderly patients in 2003 (p = 0.006). After implementation of the guideline, significantly more patients underwent PTCA (odds ratio (OR) 4.41 (95% CI: 2.51-7.75)). After adjusting for confounding factors there was no significant difference in in-hospital mortality (adjusted OR 1.11 (95% CI: 0.48-2.60)), 30-day mortality and 1-year mortality. Significantly more minor complications were reported (OR 2.58 (95% CI: 1.07-6.19)). Significantly more women and patients older than 75 years were treated compared with the ASSENT 2 and 3 trials. The 30-day mortality rate was significantly higher compared with ASSENT 2 (OR 1.60 (95% CI: 1.07-2.41)) and ASSENT 3 (OR1.74 (95% CI: 1.14-2.66)). CONCLUSION: The implementation of new guidelines 'ST-elevation acute coronary syndromes' did not result in lower mortality or fewer complications.

Age Factors↗
PubMed2000

Effects of melatonin on the quality of life in patients with delayed sleep phase syndrome.

OBJECTIVE: The purpose of this study was to compare health-related quality of life of delayed sleep phase syndrome (DSPS) patients with a random Dutch sample and four samples of patients with other chronic conditions. We also investigated the effectiveness of treatment with 5 mg of melatonin on the quality of life of DSPS patients. METHODS: Forty-three DSPS patients completed a quality-of-life questionnaire (Medical Outcome Study Short Form-36 [MOS SF-36] health survey) just before and 2-9 months after participation in a clinical trial involving the administration of melatonin. Scores were compared with responses to the same survey by a random Dutch sample and by patients with sleep apnea, clinical depression, migraine, and osteoarthritis. RESULTS: MOS SF-36 scales scores were significantly lower in DSPS patients relative to age- and gender-adjusted norms for the Dutch sample. Some health dimensions were more affected, and others less affected, by DSPS compared with the other chronic conditions. Melatonin treatment improved all scales except the scale "role due to emotional problems." CONCLUSION: DSPS has a unique significant quality-of-life burden that seems to be improved by treatment with melatonin.

Adult↗
PubMed1998

Delayed sleep phase syndrome: A placebo-controlled cross-over study on the effects of melatonin administered five hours before the individual dim light melatonin onset.

In a double-blind placebo-controlled cross-over study, 30 patients with Delayed Sleep Phase Syndrome (DSPS) were included, of whom 25 finished the study. Melatonin 5 mg was administered during two weeks in a double-blind setting and two weeks in an open setting successively or interrupted by two week of placebo. The study's impact was assessed by measurements of the 24-h curves of endogenous melatonin production and rectal temperature (n = 14), polysomnography (n = 22), actigraphy (n = 13), sleep log (n = 22), and subjective sleep quality (n = 25). Mean dim light melatonin onset (DLMO) (+/- SD), before treatment, occurred at 23.17 hours (+/- 138 min). Melatonin was administered five hours before the individual DLMO. After treatment, the onset of the nocturnal melatonin profile was significantly advanced by approximately 1.5 hour. Body temperature trough did not advance significantly. During melatonin use, actigraphy showed a significant advance of sleep onset and polysomnography, a significant decreased sleep latency. Sleep architecture was not influenced. During melatonin treatment patients felt significantly more refreshed in the morning. These results show that analysis of DLMO of patients suffering from DSPS is important both for diagnosis and therapy. These results are discussed in terms of the biochemistry of the pineal.

Adult↗
PubMed1998

Melatonin-responsive headache in delayed sleep phase syndrome: preliminary observations.

The occurrence of headache and its change after treatment with melatonin 5 mg were studied in 30 patients with delayed sleep phase syndrome. The medication was taken 5 hours before the endogenous nocturnal plasma melatonin concentration had reached 10 pg/mL. Three women (aged 14, 14, and 23 years) suffered from chronic tension-type headache. Their headache disappeared within 2 weeks after the start of treatment with melatonin. One 54-year-old man suffered from disabling migraine attacks without aura, twice a week. After starting melatonin treatment, only three migraine attacks were reported in 12 months. Ever since his 40s, a 60-year-old man complained of cluster headache episodes lasting about 2 months, twice a year. In the year since starting melatonin treatment, only one 5-day cluster episode occurred. Nocturnal melatonin secretion in the patients with delayed sleep phase syndrome and headache did not differ significantly from that in the patients with the sleep disorder but without headache. Melatonin may be helpful in patients with headache who are suffering from delayed sleep phase syndrome. Its effectiveness may be due to modification of vascular and nociceptive systems or to its chronobiological action which adjusts the patient's biological clock to his/her life-style.

Adolescent↗
PubMed1995

Pancuronium masks the prejunctional muscarinic autoreceptor in guinea pig tracheal smooth muscle.

The effect of pancuronium pretreatment on the function of the prejunctional muscarinic receptor in guinea-pig trachea was studied by using electrical field stimulation (EFS). The effects of cumulative doses of the muscarinic M2 receptor antagonist gallamine were investigated in tracheal smooth muscle strips from guinea-pigs after addition of pancuronium in vitro and in strips from guinea-pigs which had been pretreated with doses of pancuronium that caused 100% neuromuscular blockade. The results of both types of experiments were compared to those of control groups of the same size. In all strips a dose response curve with cumulative doses of methacholine was made before EFS was switched on. No differences were found between the mean pD2 value and slope of the concentration-response curves of untreated guinea-pigs and animals treated with anaesthetics and pancuronium. The animals showed variable responses to pancuronium. The bath concentration of pancuronium which decreased the EFS-induced contraction to half the original value varied between 14-61 microM. The intravenous dose necessary to paralyze the muscles, varied among the different guinea-pigs from 0.017-0.085 mg.kg-1. The EFS-induced contraction for the concentration range of gallamine 0.32 microM-0.32 mM was found to differ significantly between the strips treated with pancuronium in the organ bath and their control group. For the guinea-pigs anaesthetized and pretreated with pancuronium a significant difference with control was observed at gallamine concentrations ranging from 0.032-0.32 mM. These results show that pancuronium, added to the organ bath as well as administered intravenously to the guinea-pig, masked the inhibitory muscarinic receptor.

Animals↗
PubMed1991

Prejunctional muscarinic receptors on cholinergic nerves in guinea pig airways are of the M2 subtype.

Prejunctional inhibitory muscarinic receptors in guinea pig tracheal strips were investigated by electrical field stimulation. Pilocarpine and methacholine caused, in a similar way, a dose-dependent increase in baseline with a concomitant decrease in twitch response. We showed by using selective muscarinic antagonists, such as pirenzepine (M1-selective), methoctramine (M2-selective), AF-DX 116 (11-[[2-[diethylamino)methyl]-1-piperidinyl]-acetyl]-5,11-dihydro- 6H-pyrido[2,3-b] [1,4]benzodiazepine-6-one, M2-selective), gallamine (M2-selective) and 4-DAMP (4-diphenylacetoxy-N- methylpiperidinemethiodide, M3-selective), that the prejunctional inhibitory muscarinic receptor is of the M2 subtype.

Animals↗
PubMedDate not supplied

The search for prejunctional inhibitory muscarinic receptors in human bronchus.

The purpose of our study was to search for and classify prejunctional inhibitory muscarinic receptors in human bronchus with a wide range of muscarinic antagonists. Human bronchial airway smooth muscle strips, collected at thoracotomy from 54 subjects, 31 patients with chronic airway obstruction and 23 control subjects, were suspended in organ baths and stimulated by electrical field stimulation. The stimulation parameters were: frequency: 32 Hz; Grass reading voltage: 70 V (voltage between the electrodes: 15 V); pulse duration: 0.5 msec and train duration: 10 sec, every minute. Twitch responses of smooth muscle strips of 27 subjects (14 with and 13 without chronic airway obstruction) were sufficiently stable to search for the effects of M1-, M2- and M3-selective antagonists. All antagonists were added to the bath in a cumulative manner and decreased twitch contraction. No convincing evidence was found for the presence of prejunctional inhibitory muscarinic receptors of the M2-subtype, reasons for this obvious absence are discussed. Anaesthetical drugs for example, may mask the prejunctional inhibitory muscarinic receptors. The question remains whether the used electrical field stimulation experiments are suitable to point out prejunctional inhibitory muscarinic receptors. It is concluded that additional experiments with other experimental methods and in patients with different anaesthetical treatment are needed.

Airway Obstruction↗
PubMedDate not supplied

Traumatic brain injury-associated delayed sleep phase syndrome.

A 15-year-old girl developed a prominent delayed sleep phase syndrome (DSPS) following traumatic brain injury. Several physiological markers of the sleep-wake rhythm: plasma melatonin, body temperature, wrist activity and sleep architecture (EEG) were delayed almost half a day, returning to normal after treatment with 5 mg melatonin. This report suggests an association between traumatic brain injury and DSPS. Awareness of this phenomenon may result in better possibilities for treatment of patients with brain injury.

Adolescent↗