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Biomedical subjects

R S Breederveld

Publications and source records attributed to R S Breederveld.

At least 19 recordsLinked to original sources
PubMed2004

Investigation of computed tomographic scan concurrent criterion validity in doubtful scaphoid fracture of the wrist.

BACKGROUND: Rapid diagnosis of scaphoid bone fracture in the wrist is important so that appropriate treatment can be started. If a fracture is clinically suspected without being visible on radiography, further investigation has to be conducted to reveal a fracture or to rule it out. The objective of this study was to investigate the validity of computed tomographic (CT) scanning and bone scintigraphy compared with the clinical fracture rate during follow-up of 1 year for examining patients with a suspected scaphoid fracture. METHODS: Bone scintigraphy and CT scanning were performed in 29 patients with persistent clinical suspicion of a scaphoid bone fracture 5 to 10 days after trauma. RESULTS: The sensitivity, specificity, and positive and negative predictive values of the CT scan were 100%. The sensitivity, specificity, and positive and negative predictive values of bone scintigraphy were 78%, 90%, 78%, and 90%, respectively. Seven patients showed a fracture on both CT scanning and bone scintigraphy. Eighteen patients showed no fracture on both CT scanning and bone scintigraphy. A false-positive bone scintigram showed up in two patients and a false-negative bone scintigram in another two patients. CONCLUSION: CT scanning is a rapid, simple, valid method for demonstrating or ruling out a scaphoid fracture and is superior to bone scintigraphy.

Adult↗
PubMed1999

Effect of vitamin C on frequency of reflex sympathetic dystrophy in wrist fractures: a randomised trial.

BACKGROUND: The pathogenesis of reflex sympathetic dystrophy (RSD) is not clear, nor is there a definitive treatment for this syndrome. The morbidity, costs in health care, and loss of work time justify the search for a means to prevent post-traumatic dystrophy. Although the role of toxic oxygen radicals has not yet been clarified, we investigated vitamin C (ascorbic acid) as a prophylactic antioxidant drug. METHODS: 123 adults with 127 conservatively treated wrist fractures were randomly allocated in a double-blind trial to take a capsule of 500 mg vitamin C or placebo daily for 50 days. Each participant's sex, age, side of fracture, dominance, fracture type, dislocation, reduction, and complaints with the plaster cast were recorded, and they were clinically scored for RSD. The follow-up lasted 1 year. FINDINGS: Eight patients were withdrawn after randomisation. 52 patients with 54 fractures (male 22%, female 78%; mean age 57 years) received vitamin C and 63 patients with 65 fractures (male 20%, female 80%; mean age 60 years) received placebo. RSD occurred in four (7%) wrists in the vitamin C group and 14 (22%) in the placebo group 15% (95% CI for differences 2-26). Other significant prognostic variables for the occurrence of RSD were complaints while wearing the cast (relative risk 0.17 [0.07-0.41]) and fracture type (0.37 [0.16-0.89]). INTERPRETATION: This prospective, double-blind study shows that vitamin C was associated with a lower risk of RSD after wrist fractures. Our hypothesis is that this beneficial effect of prophylaxis would be useful in other forms of trauma.

Adult↗
PubMed1994

[Bariatric surgery using an adjustable gastric band for morbid obesity: initial 30 patients in The Netherlands].

OBJECTIVE: Early evaluation of efficacy and safety of Adjustable Silicone Gastric Banding (ASGB) in the treatment of morbid obesity. DESIGN: Descriptive. SETTING: Red Cross Hospital, Beverwijk, the Netherlands. METHOD: In the period September 1991-September 1993, 30 eligible patients (5 men and 25 women, median age 37 years (range 22-60), median excessive weight 63 kg (18-94), median body mass index (BMI) 43 kg/m2 (28-53)) were operated. A horizontal gastroplasty was performed resulting in a pouch of 25 ml and a new stomach outlet with a diameter of 12 mm. The volume of the band may be increased in order to diminish the diameter of the outlet according to clinical needs postoperatively. RESULTS: The follow-up was 10 months in 13 of the 30 patients. After 6 months median BMI was 33 kg/m2 (23-38) and median loss of excessive weight 53% (27-94), after 10 months these 28 kg/m2 (23-38) and 67% (27-98) respectively. No patients died perioperatively; 52 gastric band adjustments were necessary in 17 patients. Complications consisted of: band dislocation (1 patient), functional stenosis (2), gastric perforation (2) and wound infection (1). Four patients needed reoperation. CONCLUSION: In this short term follow-up ASGB gave a good weight reduction. Advantages of ASGB are the reversibility of the operation and the adjustable outlet.

Adult↗
PubMed1992

Digital gangrene after accidental intra-arterial injection of phenytoin (epanutin).

A case is described in which inadvertent intra-arterial injection of phenytoin led to digital gangrene, with arteriography showing occlusion of the digital arteries, necessitating amputation of fingers. The high alkalinity of phenytoin is strongly irritant to vessel walls. Intravenous injection of phenytoin should be given only with great care and in emergencies, preferably avoiding the cubital fossa.

Accidents↗
PubMed1992

Misleading cause of acute arterial insufficiency: ergotamine intoxication. Case report.

In a woman arteriographically indicated spasm of the iliac, femoral and popliteal arteries did not respond to intra-arterial tolazoline. At operation groin pulsations were normal. Bilateral lumbar sympathectomy was performed. Subsequently it emerged that she had been using ergotamine. Surgery could have been avoided if nitroprusside had been given.

Adult↗
PubMed1991

Exertional (march) haemoglobinuria.

The case history is presented of two patients with attacks of cherry-red urine after strenuous exercise. Both had varicosity of the long saphenous veins. Haemoglobinuria disappeared after crossectomy of the long saphenous vein and resection of the convolutes. After one and two years, they have no recurrence.

Adult↗
PubMed1989

Surgical treatment of bronchopulmonary carcinoid tumours.

Based on histopathological characteristics bronchopulmonary carcinoid tumours can be divided into a typical and an atypical variant. Atypical carcinoid tumours often have regional lymph node metastases. A differentiation between the two types of tumours cannot be made preoperatively. A total of 23 patients underwent resectional therapy for carcinoid tumours of the lung. Eleven underwent pneumonectomy, eight patients lobectomy and three patients had bilobectomy. Segmental resection was performed in one patient. One patient died in the postoperative period. During the follow-up period, ranging from 5 to 22 years (median 11 years), neither local recurrences nor metastatic spread was observed. In eight patients the tumour was classified as the atypical variant. There was no correlation between the size of the tumour and the presence of regional lymph node metastases. All tumours with lymph node metastases were classified as atypical carcinoids. As in other studies, our data suggest that treatment based on standard resectional procedures is to be preferred for bronchopulmonary carcinoids since a preoperative distinction between the typical and atypical variants is as yet not possible.

Adult↗
PubMed1989

Results of dynamic hip-screw osteosynthesis for intracapsular fractures of the femoral neck.

Dynamic hip-screw osteosynthesis was carried out in 121 patients with fractures of the proximal femur and intracapsular fractures of the femoral neck. Five patients died (4%). The mean age of the 121 patients was 66.4 years, in the subcapital fracture group of 48 patients, the mean age was 58 years. In the 48 patients, treated for an intracapsular femoral neck fracture, good functional results were achieved in 36 patients (75%). Partial femoral head necrosis was seen in six patients. Fast and proper anatomic reduction and dynamic fixation with a central positioned hip-screw (sliding nail) for intracapsular femoral neck fractures, result in good fracture healing with a low incidence of segmental femoral head necrosis.

Adolescent↗
PubMed1988

Immediate or delayed operative treatment of fractures of the ankle.

This study presents the results of the treatment of 92 unilateral fractures of the ankle. Of these, 72 patients were operated on immediately after the injury and 20 patients had delayed operations. Both groups are comparable in age, injury, fracture type and treatment. From the results it can be concluded that delayed open reduction and internal fixation 5-8 days after injury will give similarly good functional results. However, postoperative immobilization and the time spent in hospital by patients treated by delayed operation is significantly longer.

Adult↗
PubMed1988

Fractures of the sternum.

The records of 71 patients treated for sternal fracture were reviewed: 52 patients sustained isolated sternal fracture, 19 patients had a sternal fracture in combination with multiple other injuries, with in 12 patients only rib fractures. Forty-one patients were involved in a car accident, 29 of them used safety belts. Three patients (3/71, 4%) died, two multitrauma patients, in whom artificial ventilation was necessary, died of multiple organ failure. One patient with a sternal fracture and bilateral multiple rib fractures died of cardiac contusion and myocardial infarction. Three patients (3/71, 4%) showed signs of myocardial contusion. The morbidity in the patients with an isolated sternal fracture was very low. The prognosis of an isolated sternal fracture is good. Cardiac contusion was an uncommon complication of sternal fracture. Clinical observation for only a short period is advised.

Accidents, Traffic↗
PubMed1988

Bronchopulmonary carcinoids and regional lymph node metastases. A quantitative pathologic investigation.

Bronchopulmonary carcinoid tumors are tumors with a low malignant potential. They metastasize in 5-15% of cases. Accurate histologic preoperative prediction of the presence of regional lymph node metastases is not possible at this time. A retrospective quantitative pathologic analysis was performed to investigate the possibility of predicting the presence or absence of regional lymph node metastases in 24 patients with bronchopulmonary carcinoid tumors. The results of univariate analysis showed that large tumor size was associated significantly more frequently with regional lymph node metastases than small tumor size (P less than 0.01). The other quantitative features, ie, a larger mean nuclear area, higher standard deviation of the nuclear area and the presence of an aneuploid DNA index, were frequently associated with regional lymph node metastases, but this tendency was not significant. In multivariate analysis the combination of tumor size and mean nuclear area predicted the presence or absence of regional lymph node metastases correctly in 80 and 94% of the cases, respectively. These results indicate that the combination of tumor size and mean nuclear area may serve as a guideline to predict the presence of regional lymph node metastases.

Adult↗
PubMed1987

Shoulder injury caused by electric shock.

Shoulder injury and more in particular bilateral dislocation of the shoulder joint after electric shock is rare. Three patients are presented with dislocation and fracture of the shoulder and serious muscle contraction. After an accident involving electric current potential shoulder injuries should be considered. Early diagnosis improves the functional results of adequate treatment.

Adult↗
PubMed1986

Leiomyoblastoma of the gastric wall.

A patient with leiomyoblastoma of the gastric wall is reported. The manifestations of the tumor are described and guidelines for therapy and prognosis are provided, based on a review of literature.

Adult↗
PubMed1985

Refractures of the femoral shaft.

A retrospective analysis of refracture in 148 femoral shaft fractures is presented. Nineteen (13%) refractures occurred, mostly after plate fixation. Based on the outcome of this analysis and on the literature, recommendations are given to prevent refracture of the femoral shaft after primary therapy by a plate-osteosynthesis. If possible external compression should be used in the treatment of femoral fractures. Cancellous bone grafting should be carried out in all fractures with medial cortical bone defects, or if there is devascularization of bone fragments. Furthermore, a delayed cancellous bone graft (8-12 weeks after primary surgery) is advocated in some of these fractures.

Adolescent↗