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Biomedical subjects

J W Groothoff

Publications and source records attributed to J W Groothoff.

At least 91 records · Page 5Linked to original sources
PubMed1998

Variation in measurements of range of motion: a study in reflex sympathetic dystrophy patients.

OBJECTIVE: To quantify the amount of variation attributed to different sources of variation in measurement results of upper extremity range of motion, and to estimate the smallest detectable difference (SDD) between measurements in reflex sympathetic dystrophy (RSD) patients. DESIGN: Two observers each measured in two sessions the range of motion of several upper extremity joints of RSD patients participating in an outcome study. SETTING: Department of Rehabilitation of a university hospital. SUBJECTS: Twenty-nine upper extremity RSD patients. MAIN OUTCOME MEASURES: The range of motion of forward flexion and external rotation of the shoulder, extension, flexion and supination of the elbow, palmar, dorsiflexion and ulnar, radial deviation of the wrist of affected and nonaffected sides, using a two-armed goniometer and an inclinometer. The measurement results were analysed using an analysis of variance according to the generalizability theory. RESULTS: The results indicate that observer and patient-observer were important sources of variation. The random error was the most important source of variation. Averaged over all ranges of motion the observer contributed 3.9% to the total variation, patient-observer interactions contributed 5.2% and the random error 20.3%. The SDD was smallest for elbow flexion, 7.1 degrees and 9.6 degrees and was largest for external rotation of the shoulder, 24.8 degrees and 28.7 degrees. The SDD was smaller for the nonaffected side as compared to the affected side for the majority of ranges of motion except elbow extension, wrist dorsiflexion, and radial and ulnar deviation. CONCLUSION: Clinically, our results indicate that range-of-motion measurements in RSD patients are subject to considerable variation and indicate that results of medical examinations in order to assess disability on the basis of range-of-motion measurements are subject to the same variation.

Arm↗
PubMed1998

Relationship between impairments, disability and handicap in reflex sympathetic dystrophy patients: a long-term follow-up study.

OBJECTIVE: To determine the relationship between impairments, disability and handicap in reflex sympathetic dystrophy (RSD) patients. DESIGN: A long-term follow-up study of upper extremity RSD patients. SETTING: A university hospital. SUBJECTS: Sixty-five patients, 3-9 years (mean interval 5.5 years) after RSD of the upper extremity (mean age 50.2 years). MAIN OUTCOME MEASURES: Impairments: range of motion, moving two point discrimination, muscle strength of the hand and pain were measured. Disability was assessed with the Groningen Activity Restriction Scale (GARS) and handicap was assessed with three subscales (social functioning, role limitations due to physical problems and role limitations due to emotional problems) of the RAND-36. RESULTS: After RSD of the upper extremity, 62% of the patients are limited in activities of daily living (ADL) and/or instrumental ADL (IADL). Pain and restrictions in forward flexion of the shoulder, thumb opposition and grip strength are the most important impairments limiting ADL and IADL. Patients with limitations in ADL and IADL are significantly more handicapped than patients without limitations. Pain is the most important factor contributing to handicap. CONCLUSION: The relationship between impairments and disability and between disability and handicap in RSD patients is weak to moderate. Pain is the most important factor leading to disability and handicap.

Activities of Daily Living↗
PubMed1998

Effects of day-hospital rehabilitation in stroke patients: a review of randomized clinical trials.

The purpose of this study was to review the literature on the effects of day-hospital rehabilitation (DHR) in stroke patients. In The Netherlands DHR concerns a multidisciplinary approach to decrease disability and handicap and to optimize quality of life in an outpatient setting. Data were collected by a computer-aided search of published randomized trials. Fifteen articles reporting on seven randomized controlled trials were selected. Data extraction included a score for quality of the methods, based on four categories: "study population", "interventions", "effects" and "data presentation and analysis". To each criterion a weight was attached and the maximum score was set at 100 points. In judging the methodological quality of the selected studies, one study proved insufficient. Of the remaining studies the sum score varied from 34 to 67, with a mean of 50. Comparison of the results of the studies is complicated by different definitions of DHR, different natures of the control group and the study population, and the variety of measurement instruments applied. Often instruments were applied whose reliability and validity was not proven. As of now it is not possible to prove that DHR for stroke patients is effective. In future research a standardized definition of DHR, a uniform control group, and acceptable research methodology and adequate measurement instruments must be applied.

Aged↗
PubMed1998

Reflex sympathetic dystrophy of the upper extremity--a 5.5-year follow-up. Part I. Impairments and perceived disability.

The aim of this retrospective and long-term follow-up study was to identify impairments resulting from reflex sympathetic dystrophy (RSD) of the upper extremity and to analyze the relationship between impairment and disability in RSD patients. The study group consisted of a referred sample of 65 RSD patients, with clinical signs in the upper extremity. RSD developed after fractures of the wrist or hand in 29 patients or after a carpal tunnel release in 9 patients. The mean interval between the RSD diagnosis and our evaluation was 5.5 (3-9) years (SD = 0.8). The main outcome measurements were the impairments assessed by standard physical examination. ADL and pain were quantified with a visual analogue scale (VAS). Pain was evaluated immediately before and after the physical examination and the perceived pain was determined in the week before the examination. Significant differences in impairments were found between the affected and the unaffected sides (p < 0.05). According to the AMA-guides, the impairments did not lead to disabilities. Significant correlations were found between VAS-ADL and VAS-pain in the last week prior to evaluation and full fist grip-strength. Pain seems to be the most disabling effect.

Activities of Daily Living↗
PubMed1998

Reflex sympathetic dystrophy of the upper extremity--a 5.5-year follow-up. Part II. Social life events, general health and changes in occupation.

The aim of this retrospective long-term follow-up study was to describe the psychosocial aspects, such as social life events (SLE), around the causative event of reflex sympathetic dystrophy (RSD) and the psychological history of 65 patients, 3-9 years after RSD of the upper extremity. General health and long-term changes in occupation were assessed by means of a general health questionnaire (RAND-36) and a structured interview, respectively. SLE, with a life-change unit rate more than 35, was present in 32 patients. A psychological (or psychiatric) history was found in 22 patients. In total, 60% of the patients had a SLE and/or a psychological history. The pain scores of the RAND-36 among RSD patients differed significantly from those of the control group. 17 patients changed occupation after RSD. Nearly 30% of the patients had to stop work for more than one year. The results show a high coincidence between RSD and associated psychosocial disorders and this may play a role in intensifying and prolonging the symptomatology of RSD.

Adolescent↗
PubMed1997

The clinical spectrum of humidifier disease in synthetic fiber plants.

In a synthetic fiber production site with recirculating cold water humidification systems and small-size-particle (> 0.1 mu < 1 mu) oil mist exposure, humidifier disease was diagnosed in several workers. The patients could be divided into three groups illustrating the clinical spectrum of humidifier disease: humidifier fever (toxic inhalation fever) (12 patients): an asthma-like syndrome (8 patients); and allergic alveolitis (4 patients). Natural challenge at the work place, monitored by parameters such as peak-flow, spirometry, blood leucocyte count, and body temperature, provided important diagnostic information. In patients with chronic allergic alveolitis, a gradual recovery during an exposure-free period indicated a work-related causation, more than changes during challenge in normal work. In some patients, the fungus Sporothrix schenckii, hitherto unknown as a sensitizer, may have been at least one of the causative antigens. Measured levels of viable fungi (< or = 100 CFU/m3) and endotoxin (64 pg/m3) in air samples were much lower than those at which health effects usually are reported. Small-size-particle oil mist exposure may have underestimated the exposure to microorganisms, but otherwise an adjuvant role to this type of co-exposure might also be postulated. In contrast to allergic alveolitis, the asthma-like syndrome appeared to be more common in patients with a history of atopy and of smoking.

Adult↗
PubMed1997

Clearance ratios of amylase isoenzymes and IgG subclasses: do they reflect glomerular charge selectivity?

The clearance ratios of endogenous plasma proteins with the same size but a different charge, such as the amylase isoenzymes and the immunoglobulin (Ig) G subclasses, have been used to assess glomerular charge selectivity in man. These proteins are, however, subject to tubular reabsorption. In this study we measured the IgG subclass/IgG clearance ratios for IgG1 (pI 8.0-9.5), IgG2 (pI 7.0-7.5) and IgG4 (pI < 6) in 6 healthy volunteers. Our results suggested a selective influence of tubular reabsorption: the IgG1/IgG clearance ratio was 0.68 +/- 0.14 (mean +/- SD) and lower than IgG2/IgG (2.02 +/- 1.06, p < or = 0.01). IgG4/IgG was 0.89 +/- 0.39. In addition, we studied the clearance ratios of pancreatic (PA, pI 7.0) and salivary amylase (SA, pI 5.9-6.4) and of IgG1 and IgG2 in 8 patients with minimal change nephrotic syndrome (MCNS), 11 patients recovering from acute tubular necrosis (ATN) and 9 healthy volunteers (controls). In MCNS glomerular charge selectivity is lost, while in recovering ATN tubular function is severely disturbed. The PA/SA clearance ratio was 3.25 +/- 0.89 in controls, reflecting intact glomerular charge selectivity. In MCNS patients the PA/SA clearance ratio had decreased to 1.21 +/- 0.23 (p < or = 0.001). In ATN patients the PA/SA clearance ratio was reduced as well: 1.55 +/- 0.41 (p < or = 0.001), although the aselective nature of the proteinuria and the modest albuminuria indicated intact glomerular charge selectivity. The IgG1/ IgG2 clearance ratio was 0.54 +/- 0.15 in controls, again suggesting preferential tubular reabsorption of IgG1. In MCNS patients the IgG1/IgG2 clearance ratio was 0.16 +/- 0.10 (p < or = 0.001); this probably reflects the relatively increased glomerular sieving of IgG2 when glomerular charge selectivity is lost. In ATN patients the IgG1/IgG2 clearance ratio was 1.07 +/- 0.47 (p < or = 0.001), which suggests a partial loss of preferential reabsorption of IgG1. It was concluded that the PA/SA clearance ratio is influenced by loss of tubular function and therefore does not reflect glomerular charge selectivity specifically. The IgG1/IgG2 ratio cannot be used to assess glomerular charge selectivity either because of the interference of selective tubular reabsorption of the subclasses. These findings put the assessment of glomerular charge using endogenous proteins in a new light and bring forward the necessity to interpret these ratios with the utmost cautiousness.

Adult↗
PubMed1997

Epidemiology of lower limb amputees in the north of The Netherlands: aetiology, discharge destination and prosthetic use.

The aim of this study was to give a retrospective review of all lower limb amputations performed in the 3 northern provinces of the Netherlands in 1991-1992. Assembled data were compared with the existing information in the National Medical Register (NMR) over the same period. With the participation of all regional hospitals, 473 lower limb amputations from transpelvic to transmetatarsal level were identified. Of the amputations 94% were performed for vascular pathology, 3% for trauma, and 3% for oncologic reasons. After surgery a prosthesis was provided to 48% of the amputees. The actual number of performed amputations exceeds the number of amputations registered by the NMR by 9%. Incidence rates of lower limb amputations in the Netherlands are 18-20/100,000 over the last 12 years. These numbers are lower than in other areas and no sharp decrease in frequency compared with other countries in Western Europe.

Adolescent↗
PubMed1996

Rehabilitation of patients with spinal cord lesions in The Netherlands: an epidemiological study.

Very little is known about the occurrence of spinal cord lesions and results of the rehabilitation of patients with such lesions in the Netherlands. This study was conducted to describe the process of rehabilitation in the Dutch situation, to assess the incidence of spinal cord lesions in a regional rehabilitation centre and to characterise differences between traumatic and non-traumatic spinal cord lesions regarding age, level and extent of lesion. In this study 293 patients were included who were admitted to the rehabilitation centre between 1982 and 1993. Sixty-six per cent of this group came from the university hospital. The mean length of stay in the rehabilitation centre was 154 days. After completing the rehabilitation programme 94% of patients went home. Sixteen new SCI patients per million per year were admitted to the rehabilitation centre. Of our group 52% had a non-traumatic lesion, which concerned older patients with more incomplete lesions. In our opinion close collaboration between the university hospital and the rehabilitation centre is needed for optimal rehabilitation. Attention to independent living programmes and appropriate housing facilities can shorten the length of stay and increase the number of discharges of patients to their own environment. For patients with non-traumatic spinal cord lesions special programmes should be made available.

Adult↗
PubMed1996

Clinical rehabilitation of the amputee: a retrospective study.

The aim of this study was to determine the rehabilitation outcome of lower limb amputee patients after clinical rehabilitation. Altogether 183 amputee patients admitted for clinical rehabilitation in the years 1987-1991 were reviewed by retrospective analysis of medical record data. Three groups of amputee patients were identified by reason for amputation. The vascular group: (N = 132), mean age 67 years, mean admission time 119 days, 85% prosthetic fitting. The oncology group (N = 15), mean age 55 years, mean admission time 77 days, 60% prosthetic fitting. The traumatic amputee group: (N = 14), mean age 41 years, mean stay 134 days and 100% prosthetic fitting. Some 22 patients were bilateral amputees and were assessed separately. The most important reasons for not fitting a prosthesis were oncological metastases, stump and wound healing problems. After rehabilitation 86% of all patients could be discharged home. These results are more favourable than those seen in previous studies.

Adolescent↗
PubMed1996

A placebo-controlled, double-blind trial of growth hormone treatment in prepubertal children after renal transplant.

Sustained growth retardation in spite of a successful renal transplantation (RTx) is a serious problem for many pediatric allograft recipients. Biosynthetic growth hormone (GH) was given to 11 prepubertal children with severe growth retardation after RTx in a placebo-controlled double-blind study, assessing its effect on height velocity (HV), bone maturation, renal function, plasma IGF-I and IGF-II, serum IGF-binding proteins (IGFBP), and lipid and carbohydrate metabolism. Six months of GH (4 IU/m2/day s.c.) was either preceded or followed by six months of placebo. The patients underwent a full examination every three months. All children completed the study. Mean HV improved significantly with GH therapy (P < 0.0001), but there was also some improvement with placebo (P = 0.06). The GH-induced HV increment exceeded that of placebo by 2.9 cm/six months. Bone maturation was not accelerated. Acute renal graft rejection did not occur in any of the patients. 125I-thalamate and 131I-hippuran tests showed that mean glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) did not change significantly during GH therapy. GH caused a significant increase in IGF-I (P < 0.0001), which was far greater than the insignificant increase in serum IGFBP-3 levels (P = 0.16). Mean serum levels of total cholesterol, low density lipoprotein, apolipoprotein-A1 and -B, which are elevated at the start of the study compared with that of controls, did not change significantly during GH therapy. GH induced a significant increase in mean integrated plasma insulin levels during oral glucose tolerance test, without changing plasma glucose levels. Serum fructosamine and parathyroid hormone levels remained constant. Impressive HV increment can be achieved with GH therapy in children with growth retardation after RTx, without significant changes in renal function. Bone maturation appears unaffected, suggesting an improve final height.

Adolescent↗
PubMed1996

Use of recombinant human growth hormone (rhGH) in pubertal patients with CRI/dialysis/post-transplant: Dutch data. Dutch Study Group on Growth in Children with Chronic Renal Disease.

In the intermediate term, recombinant human growth hormone (rhGH) therapy in a dose of 28-30 i.u./m2/week accelerates growth significantly in most pubertal patients with growth retardation secondary to chronic renal insufficiency (CRI), dialysis and after renal transplantation (RTx), without evidence of adverse effects or acceleration of bone maturation. Therefore, rhGH therapy may well improve the final height of these patients.

Adolescent↗
PubMed1995

[What determines waiting time for cataract surgery, knee arthroscopy and total hip arthroplasty and how satisfied are the patients?].

OBJECTIVE: To gain an insight into the waiting periods for cataract, arthroscopic knee and total hip operations and the patients' opinion on this subject. DESIGN: Retrospective study. SETTING: The district of Groningen, the Netherlands. METHOD: A study population of 300 national health insurants who underwent a cataract operation (100), an arthroscopic knee operation (100) or a total hip operation (100) in 1992 and 50 private insurants who underwent a cataract operation in 1992, was obtained by a select sampling. By a structured questionnaire, information about basic variables (age, gender, education, occupation, perceived urgency and form of insurance), waiting periods and opinions on the waiting periods was gathered. RESULTS: The waiting periods between the specialist consultation and the operation were 5.2 and 7 months for eye, knee and hip patients respectively. The waiting period per hospital varied from 4-7 months for an eye operation, 1-4 months for a knee operation and 2.5-12 months for a hip operation. The waiting period was not affected by basic variables, except the waiting period for hip operation which benefited from a high urgency declaration by the specialist. 60% of the eye patients, 45% of the knee patients and 47% of the hip patients were satisfied about the waiting period. 15% of all patients were dissatisfied about it. CONCLUSION: Waiting periods for operations in this study were not determined by patient-specific basic variables, varied strongly between hospitals and did not cause discontent among the majority of the patients, despite durations of mostly several months.

Adult↗
PubMed1994

[Determinants of medical consumption in older subjects covered by national health insurance].

OBJECTIVE: Investigating to what extent the medical consumption of persons aged 50-80 yr covered by the Dutch National Health Service is explained by their health condition and sociodemographic factors like age, gender, marital status and education. DESIGN: Questionnaire. SETTING: 15 general practices (3 in each of 5 municipalities) in the provinces Drenthe and Overijssel, the Netherlands. METHOD: A one-time prestructured health questionnaire (in writing) was sent to 1875 persons aged 50-80 yr covered by the Dutch National Health Service (125 randomly selected persons from each practice). The response was 55% (n = 1022). The objective and subjective health conditions and the sociodemographic factors were tested in relation to the medical consumption (visiting a general practitioner, a specialist, or hospitalization) with a type of regression analysis with which both direct and indirect relations with medical consumption could be calculated. RESULTS: The medical consumption was explained for 17% by the health condition, the age and the level of education of patients. Elderly, single women with little education had the highest medical consumption. This was mainly determined by the higher probability of health problems in this group. Apart from this there was an age-related increase in medical consumption. CONCLUSION: Only part of the medical consumption can be explained by the main literature determinants of medical consumption. Refinement in research can be achieved by relating the care demand to research into referral behaviour of general practitioners and specialists, which can result in supplementary knowledge on determinants of medical consumption.

Age Factors↗
PubMed1994

Growth hormone treatment in growth-retarded adolescents after renal transplant.

Growth failure is a psychosocial problem for many patients who have undergone renal transplantation. 18 adolescents (mean age 15.6, range 11.3-19.5) with severe growth retardation after renal transplantation were treated with biosynthetic growth hormone (GH) for 2 years. All received prednisone, administered daily or on alternate days, with azathioprine and/or cyclosporin A. 16 were blindly assigned to one of two GH doses (4 vs 8 IU per m2 per day). Growth, bone maturation, renal graft function, plasma insulin-like growth factors, serum binding proteins, and other biochemical parameters were checked regularly. Glomerular filtration rate and effective renal plasma flow were tested with 125I-Thalamate and 131I-Hippuran. Data on growth and glomerular filtration rate during GH treatment were also compared with those of matched non-GH-treated controls. Mean (standard deviation) increment in height after 2 years of GH was 15.7 (5.1) cm, significantly greater (p < 0.0001) than in matched controls, 5.8 (3.4) cm. Results were similar for the two GH dosage groups. Bone maturation was not accelerated. Glomerular filtration rate and effective renal plasma flow did not change significantly. The incidence of a > 25% reduction in glomerular filtration rate over 2 years was not significantly higher in GH-treated patients than in non-GH-treated controls (39% vs 32%, p = 0.97). Although a few patients had deterioration of graft function, we could not find a relation with GH treatment. Our results show that sustained improvement of height can be achieved with GH in severely growth-retarded adolescents after renal transplantation.

Adolescent↗
PubMed1994

[Incidence and prevalence of genetically-determined disorders in The Netherlands; a literature study].

OBJECTIVE: To analyse if data now available on frequencies of genetic disorders are sufficient to be used in future as indicators when an evaluation of new developments is desired for policy-making purposes. DESIGN: Literature study. SETTING: The Netherlands. METHOD: Using automated literature search systems, papers published before October 1991 were surveyed and an inventory of incidence and prevalence of genetic disorders in the Netherlands was made. RESULTS: Depending on the pattern of heredity differences in available data and their validity were found. Valid data on most of the II congenital anomalies investigated were available from the EUROCAT registration in the northern Netherlands. This method of data collecting is also suitable for the evaluation of prevalence development. On the 29 multifactorial diseases occurring later in life that were investigated many data were available, although the varying sources made comparison difficult. These data were often out of date and had a highly varying validity. Of 3 chromosomal abnormalities the prevalence at birth was known. Of only 22 out of 650 monogenic disorders, described in the Netherlands up to 1991, the prevalence at birth and(or) in the population was known. CONCLUSION: Data on frequency of genetic disorders can be collected but the information now available is insufficient to serve as an indicator for government policy. Frequencies should also be considered in relation to the impact of the disease on the individual, his environment and society.

Adolescent↗