PubMed Health⌕ Search

Biomedical subjects

J Feenstra

Publications and source records attributed to J Feenstra.

27 records · Page 2Linked to original sources
PubMed1997

A nested case-control study on mortality in users of ibopamine.

BACKGROUND: A recent interim analysis of the PRIME II placebo-controlled study showed a significantly higher mortality in the group treated with ibopamine than in the control group. The objective was to study mortality in patients on ibopamine, and to assess risk factors for death. METHODS: All 2147 drug-dispensing outlets (DDO) in the Netherlands were asked to provide a printout of the complete medication history of users of ibopamine. A reaction was received from 92% of the DDO. From the 14,024 identified former or current users of ibopamine, a sample of 3148 patients (22%) was enrolled in the follow-up study. All general practitioners (GP) of these patients received an enquiry pertaining to the vital status of their patient, cause of death, primary cause and NYHA classification of heart failure, echo- and electrocardiographic data, serum creatinine, admissions and the effects of ibopamine. Cases were defined as patients who died during the follow-up period which ended on the day of return of the questionnaire or the day of decease (index date). Two random controls were obtained for each case from the non-deceased patients at the index date. The design was a follow-up study with risk factor assessment in a nested case-control design. RESULTS: Questionnaires were returned regarding almost 70% of the sample. Mortality in this group was 25%. A case-control analysis was performed with the first 104 cases and 208 random controls. Patients with NYHA class IV had a 3-times increased risk of dying. In patients with a serum-creatinine level in the highest quartile the risk of dying was increased threefold. Higher doses of ibopamine seemed to have a protective effect. Significantly more cases than controls used amiodarone. Also, opioids were used more often, which may be related to their use in terminal cardiac failure. CONCLUSION: NYHA classification and serum-creatinine levels were independent risk factors for death in patients with heart failure on ibopamine. Although there were increased risk estimates for current use of ibopamine and amiodarone, these did not reach statistical significance. This may be related, however, to the fact that this analysis was restricted to the first 20% of cases.

Aged↗
PubMed1997

Adverse cardiovascular effects of NSAIDs in patients with congestive heart failure.

Congestive heart failure (CHF) is a complex clinical syndrome, especially in the elderly, which results from cardiac dysfunction. Epidemiological studies have shown a gradual increase in age-adjusted hospitalisation rates for CHF and overall population prevalence of CHF during the last 2 decades in Western countries. The healthcare costs associated with CHF are considerable and are likely to increase in the near future. Hence, identification of risk factors which could induce or exacerbate CHF is of major importance. NSAIDs are frequently prescribed in elderly patients for several rheumatological and nonrheumatological indications. Numerous adverse reactions, mainly related to the gastrointestinal tract and kidney function, have been described for NSAIDs. In addition, some case reports have suggested a causal relation between the use of NSAIDs and the onset of CHF. The pathophysiology of CHF and the pharmacological properties of NSAIDs support this hypothesis. In particular, the inhibition of prostaglandin synthesis may adversely affect cardiovascular homeostasis in patients with a propensity to develop CHF. Notwithstanding the adverse effects, however, the prescription of NSAIDs in elderly patients is often desirable and justifiable. Therefore, further pharmaco-epidemiological research is needed to quantify the risk for CHF attributable to the use of NSAIDs and to identify patients who are particularly susceptible to the adverse cardiovascular effects of these agents. In these patients, it may be advisable to avoid the use of NSAIDs.

Aging↗
PubMed1993

Psychosocial effects of two years of human growth hormone treatment in Turner syndrome. The Dutch Working Group: Psychologists and Growth Hormone.

Thirty-eight girls with Turner syndrome were treated for 2 years with human growth hormone. Both parents and patients carried out assessments of the effects of treatment on various aspects of psychosocial functioning. The children used the Piers-Harris Self-Concept Scale and the Social Anxiety Scale for children, while parents were interviewed and filled in the Child Behavior Checklist. Both parents and children used the Therapy Evaluation Scale and the Silhouette Apperception Technique. Teachers completed the Teacher Rating Form. Results showed no significant changes with treatment in self-concept or social anxiety, or in behavioural problems, though immature behaviour was less common after the treatment period. Therapy was evaluated positively, and improvements were apparent in both social and emotional functioning; about a quarter of the patients became more independent, happier and more involved in social interactions. Unrealistic perceptions of present height and expectations of future height were expressed by a large proportion of both children and parents.

Anxiety↗
PubMed1988

[Fraud in medicine with the child as victim. Munchausen syndrome by proxy. A review of the literature].

In a review of the literature on the subject 'Münchhausen syndrome by proxy' the authors try to give an impression of the history of diagnosis and treatment of this special kind of child abuse. Particularly aspects of confrontation are discussed. They consider features of the chief actors in this very dramatic play. The authors point to problems in differential diagnosis in the framework of other subjects like 'non-accidental poisoning', 'doctor-shopping' and 'filicide'. They discuss ethical and legal consequences.

Adult↗
PubMed1988

[A case of Munchausen syndrome by proxy].

In this paper the case is described of a one-year-old girl who was diagnosed as to have the Münchhausen syndrome by proxy. There had been a single-sided, chronic parotitis, followed by a single-sided orbita-cellulitis. In the pathological-anatomical matter derived from the parotid a substance was found that does not belong to the human body (most likely to be alum), and which contained aluminium, silica, and iron. Based on pediatric, psychological, and child psychiatric diagnoses, the conclusion was that in all probability the matter was injected by the patient's grandmother, who acted as foster-mother. The grand-mother herself appeared to be a patient with the Münchhausen syndrome. After the girl was separated from her grand-parents, she soon recovered. Following after a total stay of 18 months in three different hospitals, the girl could be placed in a therapeutic foster home.

Cellulitis↗
PubMedDate not supplied

Combined therapy with somatostatin analogues and weekly pegvisomant in active acromegaly.

Pegvisomant monotherapy once daily returns concentrations of insulin-like growth factor I (IGF-I) to normal in most patients with acromegaly, but is very costly. In a 42-week dose-finding study, we assessed the efficacy of the combination of long-acting somatostatin analogues once monthly and pegvisomant once weekly in 26 patients with active acromegaly. Dose of pegvisomant was increased until IGF-I concentration became normal or until a weekly dose of 80 mg was reached. IGF-I reached normal concentrations in 18 of 19 (95%) patients who completed 42 weeks of treatment, with a median weekly dose of 60 mg pegvisomant (range 40-80). No signs of pituitary tumour growth were noted, but mild increases in liver enzymes were observed in ten patients (38%). This combined treatment is effective, might increase compliance, and could greatly reduce the costs of medical treatment for acromegaly in some patients.

Acromegaly↗