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Biomedical subjects

Macé M Schuurmans

Publications and source records attributed to Macé M Schuurmans.

15 recordsLinked to original sources
PubMed2007

Content comparison of health-related quality of life instruments for COPD.

BACKGROUND: Due to the increasing importance of quality of life assessments in chronic obstructive pulmonary disease (COPD) patients, and the increased use of the International Classification of Functioning, Disability and Health (ICF) for comparative purposes it is essential to understand the relationship between health-related quality of life (HRQL) instruments and the ICF. OBJECTIVE: The objective of this study was to compare the content of recommended COPD-specific HRQL instruments using the ICF as reference. COPD-specific instruments mentioned in widely accepted guidelines were linked to the ICF using standardized linking rules. The degree of agreement between various health professionals was assessed by calculating the kappa statistic. RESULTS: Eleven instruments were included. They varied strongly in the number of concepts contained and the number of ICF categories used to map these concepts. A total of 548 concepts were identified and linked to 60 different ICF categories. Only the single category 'dyspnea' was covered by all instruments, whilst 21 categories were unique to specific instruments. The relationships of the measures with the ICF were identified. CONCLUSIONS: This study may aid researchers and clinicians to choose the most appropriate instrument for a specific purpose as well as help compare studies that have used different instruments for HRQL assessment.

Activities of Daily Living↗
PubMed2005

Time to spirometric and exercise response in 4-week oral corticosteroid trial for stable COPD patients.

OBJECTIVE: Little evidence supports the commonly recommended 2-week duration for an oral corticosteroid trial in stable COPD patients. We aimed to assess the time to spirometric and exercise responses in stable COPD patients undergoing an oral corticosteroid trial. METHODS: In a pilot study a 28-day trial with prednisone 0.5 mg/kg bodyweight was performed in all outpatients meeting entry criteria during one calendar year. Response was assessed by spirometry (twice weekly) and 6-minute walk distance (6MWD, weekly). Of 36 moderate to severe COPD patients started on prednisone, 30 completed the study according to the protocol. RESULTS: The mean post-bronchodilator forced expiratory volume in 1 second (FEV1) was 49.5% predicted and the 6MWD was 444 m at baseline. On the basis of spirometry (post-bronchodilator FEV1 > or = 15% and > or = 200 ml) 12 patients were responders. Five additional patients improved their 6MWD by > or = 55 m (exercise responders). Of all 17 responders six (35%) responded between day 17 and 28 (4 spirometric and 2 exercise responders). Responders and non-responders showed a maximum FEV1 increase from baseline on day 24 of 264 ml and 70 ml, respectively. CONCLUSION: An oral corticosteroid trial of only 2 weeks' duration may miss a clinically significant number of corticosteroid-responsive stable COPD patients.

Administration, Oral↗
PubMed2005

Moderate-to-severe blood pressure elevation at ED entry: hypertension or normotension?

PURPOSE: It is controversial whether arterial hypertension (AHT) can be diagnosed in the emergency department (ED). We sought to prospectively investigate the natural time course of blood pressure (BP) to define an optimal period for AHT screening in ED patients with an elevated initial BP. PROCEDURES: Patients with a BP greater than 160/100 mm Hg upon ED admission underwent repeated BP measurements every 5 minutes for 2 hours using an automated device. Arterial hypertension was confirmed using 12-hour ambulatory BP measurement or repeated office BP measurement according to the Joint National Committee VII guidelines by the primary care physician after discharge from the hospital. MAIN FINDINGS: Systolic BP decreased significantly during the first 10 to 20 minutes of ED stay in hypertensive and normotensive patients without further significant changes thereafter. Diastolic BP remained stable in both hypertensive and normotensive patients. Discrimination between hypertensive and normotensive patients was best between minutes 60 and 80 after ED admission. An average BP of 165/105 mm Hg or higher during this period strongly suggests AHT whereas a BP of less than 130/80 mm Hg excludes AHT with high sensitivity. CONCLUSIONS: Screening for AHT in the ED is possible with high specificity and sensitivity. Blood pressure measurements between minutes 60 and 80 after entry into the ED yield the highest diagnostic value.

Blood Pressure Determination↗
PubMed2005

Transbronchial needle aspirates: comparison of two preparation methods.

STUDY OBJECTIVES: Transbronchial needle aspiration has evolved as a key bronchoscopic sampling method. Specimen handling and preparation are underrated yet crucial aspects of the technique. This study was designed to identify which of two widely practiced sample preparation methods has a higher yield. DESIGN: Prospective comparison of two diagnostic methods. SETTING: Tertiary academic hospital. PATIENTS: Consecutive patients undergoing transbronchial needle aspiration. INTERVENTIONS: Transbronchial aspirates were obtained pairwise. One specimen was placed directly onto a slide and smears were prepared on site (ie, the direct technique), and the other specimen was deposited into a vial containing 95% alcohol and further prepared in the laboratory (ie, the fluid technique). In total, 282 pairs of samples were aspirated from 145 target sites (paratracheal, 10 sites; tracheobronchial, 101 sites; hilar, 17 sites; endobronchial or peripheral, 17 sites). MEASUREMENTS AND RESULTS: The measured outcome was the presence of diagnostic material at the final laboratory assessment. At least one diagnostic aspirate was obtained in 66% of 86 investigated patients (small cell lung cancer, 18 patients; non-small cell lung cancer, 47 patients; other diagnoses, 21 patients). The direct technique had a better yield overall than the fluid technique (positive aspirates, 36.2% vs 12.4%, respectively; p < 0.01), as well as after stratification for tumor type and for anatomic site. CONCLUSION: The direct technique is superior to the fluid technique for the preparation of transbronchial needle aspirates.

Adolescent↗
PubMed2004

Intrapleural streptokinase for empyema and complicated parapneumonic effusions.

We conducted a single-center, randomized, placebo-controlled trial to determine whether streptokinase instillations adjunctive to chest tube drainage reduce the need for surgery and improve outcome in patients with pleural empyema. Fifty-three patients (frank pus aspirated, 81%; microbiological agent cultured, 62%; mean effusion pH, 6.6 +/- 0.4) received antibiotic treatment, chest tube drainage, and once-daily pleural rinses with either normal saline or normal saline with streptokinase (250,000 IU). Nine patients were excluded for various reasons before pleural rinses were started. Streptokinase (n = 22) was instilled over 4.5 +/- 2 days and saline (n = 22) was instilled over 3 +/- 1.3 days. One patient in each group died during treatment. Clinical treatment success and need for referral to surgery were the main outcome measures. No difference was observed after 3 days. After 7 days, streptokinase-treated patients had a higher clinical success rate (82 vs. 48%, p = 0.01) and fewer referrals for surgery (45 vs. 9%, p = 0.02). No significant radiologic or functional differences were observed between groups during follow-up over 6 months. We conclude that intrapleural streptokinase adjunctive to chest tube drainage reduces the need for surgery and improves the clinical treatment success in patients with pleural empyema.

Adult↗
PubMed2004

Effect of pre-treatment with nicotine patch on withdrawal symptoms and abstinence rates in smokers subsequently quitting with the nicotine patch: a randomized controlled trial.

AIMS: To determine whether 2-week pre-treatment with transdermal nicotine influences withdrawal symptoms or success rate of subsequent smoking cessation using nicotine patches. DESIGN: Randomized controlled trial. SETTING: Smoking cessation clinic. PARTICIPANTS: Healthy smokers (n = 200, 45% female) were allocated randomly to either active nicotine-patch (AP, 15 mg daily, n = 100) or placebo-patch (PP, n = 100) pre-treatment. Baseline characteristics were well balanced except for daily cigarette consumption: mean (+/- SD) 23.1 (8) and 26.4 (11) for AP and PP groups, respectively (P = 0.021). INTERVENTION: At the screening visit (-2 weeks) subjects were counselled and started pre-treatment with daily patches (AP or PP). From the quit date (week 0) onwards all subjects received active nicotine patches for 12 weeks (15 mg daily for 8 weeks, 10 and 5 mg daily for 2 weeks each) and counselling. MEASUREMENTS: Follow-up visits included measurement of exhaled carbon monoxide at the quit date, 2, 6, 10 and 26 weeks. Subjects documented daily cigarette consumption and severity of withdrawal symptoms (Wisconsin scale) from -2 weeks to week 2. Outcome measures were withdrawal symptoms composite score and abstinence rates. FINDINGS: There was no significant difference in withdrawal symptoms, but more subjects in the AP group were smoke-free during the 6-month study period. Overall sustained abstinence was documented in 17% of subjects at 6 months; 22% and 12% for AP and PP, respectively (P = 0.03). Retrospective subgroup analysis showed for subjects smoking >16 cigarettes/day sustained cessation rates were 22% and 9% for AP and PP, respectively (P = 0.01). No difference in adverse event rates was observed. CONCLUSIONS: Nicotine patch pre-treatment before cessation did not reduce early withdrawal symptoms but increased sustained abstinence rates at 6 months. The nicotine pre-treatment was equally effective in light and heavy smokers.

Administration, Cutaneous↗
PubMed2003

Paraneoplastic bilateral proptosis in a case of non-small cell lung cancer.

We report the case of a 51-year-old woman with a large cell bronchial carcinoma with neuroendocrine differentiation (T3N0M0, stage IIB) and bilateral exophthalmos. A CT of the orbitae was compatible with Graves ophthalmopathy, but neither abnormalities in thyroid function nor thyroid antibodies could be found. The proptosis normalized 10 days after tumor resection. We conclude that the most likely cause of the reversible proptosis in this patient is paraneoplastic, a condition not previously described in the English-language literature.

Carcinoma, Large Cell↗
PubMed2003

Use of an ultrathin bronchoscope in the assessment of central airway obstruction.

STUDY OBJECTIVE: To assess the utility of an ultrathin bronchoscope (UB) in the assessment of central airway obstruction (CAO). DESIGN: Prospective evaluation SETTING: Tygerberg Hospital, a tertiary teaching hospital. PATIENTS: Consecutive patients referred to the Lung Unit with CAO. INTERVENTIONS: Fiberoptic bronchoscopy (FOB) was performed with a prototype UB (Olympus BF XP40; Olympus Europe; Hamburg, Germany; outer diameter, 2.8 mm; working channel, 1.2 mm). The UB was used whenever a standard bronchoscope (SB) could not pass the obstruction or could not be tolerated by the patient. MEASUREMENTS AND RESULTS: Data relating to indication and performance of FOB, patient demographics, utility in establishing a diagnosis, and planning definitive management were documented. Twenty-four patients (17 men; mean age, 46 years) were studied. Twelve patients (50%) had malignant CAO, 8 patients (33%) had benign tracheal stenosis, 3 patients (12.5%) had stent occlusion, and 1 patient (4%) had bilateral vocal cord paralysis. In 42% of patients, an initial attempt at passing the obstruction with an SB had failed. Vocal cords or trachea were involved in 62% of patients. The mean luminal occlusion was 84% of the total airway lumen (range, 50 to 100%). One complication (desaturation) led to early termination of FOB. In all but three patients with complete obstruction, the UB was able to pass the CAO and allowed assessment of the obstruction and the distal airways (87%). CONCLUSION: UB-FOB was useful and safe in the assessment of patients with CAO from both benign and malignant disease. It aided in establishing a diagnosis and/or planning of definitive management in all patients examined.

Adult↗
PubMed2003

Comparison of a new desktop spirometer (Spirospec) with a laboratory spirometer in a respiratory out-patient clinic.

BACKGROUND: The performance of spirometers is often evaluated under ideal conditions with computer-generated waveforms or in vivo testing with healthy subjects. Real-life conditions are less ideal because of comorbidities, age of the subjects, and a variety of air flow limitations. Evaluation of new spirometry equipment can also be performed under these less favorable conditions. The Spirospec is a new desktop spirometer that is commercially available, but its accuracy has not been evaluated in a clinical setting. OBJECTIVE: Test the Spirospec with subjects with normal and pathologic pulmonary function. METHODS: A group of 45 patients (mean age 38.4 years, 27 male) booked for evaluation in the pulmonary function laboratory of a tertiary care university hospital were tested with both a Spirospec and a standard Jaeger Masterlab 4.0 spirometer, according to the guidelines of the American Thoracic Society. Three subgroups (normal spirometry, obstructive air flow limitation, and restrictive air flow limitation) of 15 consecutive subjects each underwent spirometry. RESULTS: Pulmonary function measurements from the Spirospec correlated closely (r = 0.95-0.99) with those from the Masterlab 4.0, showing good limits of agreement and differences between the 2 devices: forced vital capacity 0.03 L, forced expiratory volume in the first second (FEV(1)) -0.01 L, peak expiratory flow -0.41 L/s, peak inspiratory flow 0.43 L/s, forced expiratory flow at 50% of total lung capacity 0.13 L/s, and forced expiratory flow at 75% of total lung capacity 0.12 L/s. With the exception of forced vital capacity and FEV(1), these differences were statistically significant (p < 0.05). CONCLUSION: The Spirospec is comparable to the Masterlab 4.0, with high accuracy for FEV(1) and forced vital capacity and clinically acceptable differences in the measured flow variables.

Adult↗
PubMed2002

Functional evaluation before lung resection.

Advances in operative technique and perioperative care have reduced surgical morbidity and mortality considerably after pulmonary resections. Various single and combined parameters of functional operability have been proposed to assess the surgical risk. Patients with normal or only slightly impaired pulmonary function (FEV1 and DLCO > or = 80% predicted) and no cardiovascular risk factors can undergo pulmonary resections up to a pneumonectomy without further investigation. For others, exercise testing, pulmonary split-function studies, or a combination of these methods are recommended. Cardiopulmonary exercise testing, most frequently performed as a symptom-limited test with the measurement of VO2max, assesses the pulmonary and cardiovascular reserves. A VO2max of less than 10 mL/kg/minute generally is considered prohibitive for any resection, a value of greater than 20 mL/kg/minute or greater than 75% predicted normal, safe for major resections. Split-function studies are radionuclide-based estimations of the ppo values of various parameters. The currently used ppo parameters are FEV1-ppo, DLCO-ppo, and VO2max-ppo. Suggested cutoff values for safe resection are: FEV1-ppo and DLCO-ppo 40% or greater than predicted, and V(r)O2max-ppo 35% or greater than predicted, combined with an absolute value of greater than or equal to 10 mL/kg/minute. The lowest acceptable ppo values remain to be confirmed by additional prospective studies. Resections involving not more than one lobe usually lead to an early functional deficit followed by recovery. The permanent loss in pulmonary function is small (approximately 10%) and exercise capacity is reduced only slightly or not at all. Pneumonectomy leads to an early permanent loss of about 33% in pulmonary function and approximately 20% in exercise capacity. Pulmonary function tests alone therefore overestimate the functional loss after lung resection.

Algorithms↗
PubMed2002

Ancestral founder of mutation W283X in the porphobilinogen deaminase gene among acute intermittent porphyria patients.

Acute intermittent porphyria (AIP) is a low-penetrant autosomal dominant disorder caused by mutations in the porphobilinogen deaminase gene (PBGD). Nearly 60% of all Swiss AIP patients carry a nonsense mutation W283X (G(7916)-->A). In France, the prevalence of W283X is <5%. To determine whether W283X was a founder mutation or originated from multiple de novo events, we studied 25 apparently unrelated W283X families and index patients, 21 of Swiss and 4 of French origins. In the absence of sufficient genealogical data to verify the ancestral background of these W283X families/patients, we identified haplotypes of seven intragenic single nucleotide polymorphisms (SNPs) in the PBGD gene as well as eight microsatellites flanking the PBGD gene covering 9.88 cM in chromosome 11. Molecular cloning and sequencing experiments were required in order to completely resolve the intragenic haplotypes in this study cohort which mainly consisted of single index patients and families with limited members. Thirteen of the 25 W283X families/patients carry a SNP haplotype [C-A-A-A-G-C-W283X-G] and 12 (including four French families) carry a [T-G-G-G-G-C-W283X-G] haplotype. A less conserved microsatellite haplotype was identified among the 25 W283X alleles which allowed us to estimate the age of the mutation. Since W283X is not explained by a methylcytosine mutation, we favor the hypothesis of a single mutational event which took place on the [T-G-G-G-G-C-G] background at approximately 40 generations or 1000 years ago. Around 550 years ago, a recombination event occurred between intron 3 and 10 of the PBGD gene which resulted in the [C-A-A-A-G-C-W283X-G] haplotype only found in a restricted region.

Amino Acid Substitution↗
PubMedDate not supplied

Utility of rapid on-site evaluation of transbronchial needle aspirates.

BACKGROUND: Rapid on-site evaluation has been proposed as a method to improve the yield of transbronchial needle aspiration. OBJECTIVES: This study investigated whether on-site analysis facilitates routine diagnostic bronchoscopy in terms of sampling, yield and cost. METHODS: Patients with lesions accessible for transbronchial needle aspiration on computed tomography were investigated. A cytopathologist screened the needle aspirates on site for the presence of diagnostic material. The bronchoscopic sampling process was adjusted according to the results. In 90 consecutive patients with neoplastic disease (n=70; 78%), non-neoplastic disease (n=16; 18%) or undiagnosed lesions (n=4; 4%) we aspirated 162 lung tumours or lymph node sites (mediastinal: 7%; tracheobronchial: 68%; other: 25%). In 90 consecutive patients with neoplastic disease (n=70; 78%), non-neoplastic disease (n=16; 18%) or undiagnosed lesions (n=4; 4%) we aspirated 162 lung lesions (paratracheal tumours or lymph nodes: 7%; tracheobronchial lymph nodes: 68%; other: 25%). RESULTS: The diagnostic yield of needle aspiration was 77 and 25% in patients with neoplastic and non-neoplastic lesions, respectively. Sampling could be terminated in 64% of patients after needle aspiration had been performed as the only diagnostic modality, and on-site analysis identified diagnostic material from the first site aspirated in 50% of patients. Only in 2 patients (2%) diagnostic aspirates were not recognized on site. On-site analysis was cost effective due to savings for disposable diagnostic tools, which exceeded the extra expense for the on-site cytology service provided. CONCLUSIONS: Rapid on-site analysis of transbronchial aspirates is a highly useful, accurate and cost-effective addition to routine diagnostic bronchoscopy.

Adolescent↗