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R Vonk

Publications and source records attributed to R Vonk.

12 recordsLinked to original sources
PubMed2001

The relevance of placental location at 20-23 gestational weeks for prediction of placenta previa at delivery: evaluation of 8650 cases.

OBJECTIVE: To determine the correlation between placental position at 20-23 weeks and incidence of birth complications caused by placental position. SUBJECTS AND METHODS: In an ongoing prospective study, placental position was determined by transabdominal sonography as part of anomaly scanning at 20-23 gestational weeks, followed by transvaginal sonography in uncertain or suspicious situations. Examination was performed in 9532 cases; feedback was obtained from 8650 patients (90.7%). RESULTS: Transabdominal sonography was followed by transvaginal scan in 363 of 8650 cases (4.2%). In 8551 cases (98.9%), we found normal placental position, with the placenta not reaching the internal os and a Cesarean section rate of 17.1% (1458/8551). The incidence of 'low placental position', with the placenta reaching the internal os was 0.66% (57/8650), with a Cesarean section rate of 21% (12/57). In 0.49% (42/8650) of cases, the placenta overlapped the internal os at 20-23 weeks; Cesarean section because of placenta previa or bleeding was performed in 28 of 8650 cases (0.32%). Vaginal delivery was possible in 43% of cases (13/30), when the overlap did not exceed 25 mm. If the overlap exceeded 25 mm (12 cases), no vaginal delivery was reported. There was no reported case of placenta previa missed at the 20-23-week scan. CONCLUSION: At 20-23 weeks, a combination of routine transabdominal and indication-based transvaginal location of placental position is a powerful tool in predicting placenta previa at delivery. The advantage of determining placental position at this stage of pregnancy is a low false-positive rate compared to at earlier stages of pregnancy. We conclude that an overlapping placenta at 20-23 weeks has the consequence of a high probability of placenta previa at delivery. An overlap of 25 mm or more at 20-23 weeks seems to be incompatible with later vaginal delivery.

Adult↗
PubMed1999

Variability of human hepatic UDP-glucuronosyltransferase activity.

The availability of a unique series of liver samples from human subjects, both control patients (9) and those with liver disease (6; biliary atresia (2), retransplant, chronic tyrosinemia type I, tyrosinemia, Wilson's disease) allowed us to characterize human hepatic UDP-glucuronosyltransferases using photoaffinity labeling, immunoblotting and enzymatic assays. There was wide inter-individual variation in photoincorporation of the photoaffinity analogs, [32P]5-azido-UDP-glucuronic acid and [32P]5-azido-UDP-glucose and enzymatic glucuronidation of substrates specific to the two subfamilies of UDP-glucuronosyltransferases. However, the largest differences were between subjects with liver disease. Glucuronidation activities toward one substrate from each of the UDP-glucuronosyltransferases subfamilies, 1A and 2B, for control and liver disease, respectively, were 1.7-4.5 vs 0.4-4.7 nmol/mg x min for hyodeoxycholic acid (2B substrate) and 9.2-27.9 vs 8.1-75 nmol/mg x min for pchloro-m-xylenol (1A substrate). Microsomes from a patient with chronic tyrosinemia (HL32) photoincorporated [32P]5-azido-UDP-glucuronic acid at a level 1.5 times higher than the other samples, was intensely photolabeled by [32P]5-azido-UDP-glucose and had significantly higher enzymatic activity toward p-chloro-m-xylenol. Immunoblot analysis using anti-UDP-glucuronosyltransferase antibodies demonstrated wide inter-individual variations in UDP-glucuronosyltransferase protein with increased UDP-glucuronosyltransferase protein in HL32 microsomes, corresponding to one of the bands photolabeled by both probes. Detailed investigation of substrate specificity, using substrates representative of both the 1A (bilirubin, 4-nitrophenol) and 2B (androsterone, testosterone) families was carried out with HL32, HL38 (age and sex matched control) and HL18 (older control). Strikingly increased (5-8-fold) glucuronidation activity was seen in comparison to HL18 only with the phenolic substrates. The results indicate that one or more phenol-specific UDP-glucuronosyltransferase 1A isoforms are expressed at above normal levels in this tyrosinemic subject.

Adolescent↗
PubMed1999

Nuchal cord.

Explore the source record for details and available documents.

Female↗
PubMed1998

Kappa-like indices of observer agreement viewed from a latent class perspective.

It is common practice to assess consistency of diagnostic ratings in terms of 'agreement beyond chance'. To explore the interpretation of such a term we consider relevant statistical techniques such as Cohen's kappa and log-linear models for agreement on nominal ratings. We relate these approaches to a special latent class concept that decomposes observed ratings into a class of systematically consistent and a class of fortuitous ratings. This decomposition provides a common framework in which the specific premises of Cohen's kappa and of log-linear models can be identified and put into perspective. As a result it is shown that Cohen's kappa may be an inadequate and biased index of chance-corrected agreement in studies of intra-observer as well as inter-observer consistency. We suggest a more critical use and interpretation of measures gauging observer reliability by the amount of agreement beyond chance.

Adult↗
PubMed1997

[Referral to a clinical-genetic center for genetic counseling in mental disorders].

OBJECTIVE: Evaluation of the genetic counselling for psychiatric disorders in a clinical genetic service. DESIGN: Retrospective. SETTING: Clinical Genetic Service Rotterdam, the Netherlands. METHOD: Evaluation of the psychiatric genetic counselling during the period 1985-1992 (n = 49). RESULTS: Psychiatric disorders were the indication for genetic counselling in 1%. A minority of the consultants were referred by the psychiatrist. The most common question was the risk of future children becoming affected by a psychiatric disorder already present in the family. The male-female ratio was about one for the whole group of consultants. Affected relatives were significantly more frequent in the woman's family than in the man's. The average number of affected individuals in a family was 3.6. CONCLUSION: Genetic counselling for psychiatric disorders in a clinical genetic service is requested infrequently considering the frequency of these problems. This may be related to a lack of need for information and counselling in potential consultants or to adequate information by treating physicians, but also to insufficient recognition by general practitioners and psychiatrists of questions patients and their family have.

Adult↗
PubMed1997

History of syringe sharing in prison and risk of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus infection among injecting drug users in Berlin.

BACKGROUND: Injecting drug users (IDU) are at risk of parenterally transmitted diseases such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infection. We investigated whether a history of syringe sharing in prison is a risk factor for these infections. In the longitudinal part of the study, HBV, HCV, and HIV seroincidence rates were determined. METHODS: The participants were recruited by multisite-sampling at different agencies for IDU. Data on risk behaviour were obtained by a standardized questionnaire. Serological markers for HBV, HCV, and HIV were determined. Logistic regression analysis was performed to adjust for confounding effects. RESULTS: A history of syringe sharing in prison was significantly associated with HBV (adjusted prevalence odds ratio [POR] = 3.9, 95% confidence interval [CI]: 2-10), HCV (POR = 9.7, 95% CI: 3-33), and HIV infection (POR = 10.4, 95% CI: 4-29). The HIV seroincidence rate was 5.9 per 100 person-years. None of the IDU receiving methadone maintenance treatment (MMT) seroconverted whereas the HIV incidence was 8.5 among IDU not in MMT (P = 0.01). CONCLUSIONS: The increased risk of HBV, HCV, and HIV infection among IDU who had shared syringes in prison warrants specific preventive action. The longitudinal data suggest that IDU in MMT have a lower risk of HIV infection.

Adult↗
PubMed1997

Knowledge-based system ADNEXPERT to assist the sonographic diagnosis of adnexal tumors.

ADNEXPERT is a knowledge-based system for the computer-assisted ultrasound diagnosis of adnexal tumors. In a case-based approach, ADNEXPERT used histopathologic and sonographic data from 2,290 adnexal tumors. After an ultrasound examination, the gynecologist interacts with the system. A maximum of 15 questions are posed; all but one question (age) relate to the sonographic findings. The help system gives online access to an ultrasound image library. Once the dialogue is complete, ADNEXPERT assesses the adnexal tumor pathology and makes a histological classification. A certainty factor (CF) model is used for knowledge representation. The CFs of the knowledge base are computed from the case database. During system evaluation, the accuracy of ADNEXPERT was tested by 69 new adnexal tumor cases, for which verified histopathological diagnoses were available. ADNEXPERT accurately assessed pathology in 49 cases (71%); in 10 cases (14%) correct indications to pathology were given; no diagnostic hints were attained in 2 cases (3%); and 8 cases (12%) were falsely diagnosed. Based on the positive results of the evaluation, ADNEXPERT will be tested under clinical conditions.

Adolescent↗
PubMed1995

Characterization of human liver microsomal UDP-glycosyltransferases using photoaffinity analogs.

The photoaffinity analogs [beta-32P]5-azido-UDP-glucuronic acid ([32P]5N3UDP-GlcUA) and [beta-32P]5-azido-UDP-glucose ([32P]5N3UDP-Glc) were used to characterize UDP-glycosyltransferases of microsomes prepared from human liver. Photoincorporation of both probes into proteins in the 50- to 56-kdalton range, known to contain UDP-glucuronosyl transferases (UGTs), was concentration dependent, and photolabeled proteins were susceptible to trypsin digestion only in the presence of detergent. The latter was demonstrated by the appearance on Western blots of the trypsin-treated, detergent-disrupted microsomes of a protein band of slightly lower molecular mass than, and presumably derived from, the UGTs. However, a labeled cleavage product was found only in samples photolabeled with [32P]5N3UDP-GlcUA and not in those labeled with [32P]5N3UDP-Glc. In detergent-treated microsomes, all of the nucleotide sugars that were tested protected better against photoinsertion of [32P]5N3UDP-GlcUA than of [32P]5N3UDP-Glc, with UDP-glucose being the most effective, followed by UDP-GlcUA and UDP-galactose. The pattern of inhibition of a series of uridinyl analogs toward photolabeling by the two probes was quite different: one inhibitor that was ineffective in blocking photoincorporation of [32P]5N3UDP-GlcUA (L-DPASiU) was one of the most potent inhibitors of photolabeling with [32P]5N3UDP-Glc. A similar dichotomy was seen with several inhibitors in enzymatic assays measuring hyodeoxycholic acid 6-O glucuronidation and glucosidation activities; the most potent inhibitors of HDCA glucosidation were not as effective against glucuronidation. The results indicate a lumenal orientation for human microsomal UGTs and provide substantial evidence that two distinct enzyme systems are involved in 6-O glucuronidation and 6-O glucosidation of HDCA.

Affinity Labels↗
PubMed1993

Growth of under five-year-old children in Kyeni, Kenya.

During a three-months period a cross-sectional study of the measurements of head circumference, mid-upper-arm circumference (MUAC) and weight was performed in 515 under five-year-old children in Kyeni, Kenya. Growth of Kyeni children seems to develop according to international standards for weight-for-age, MUAC-for-age and head circumference and for all parameters the average remains above minus 2 SD of the standard. Despite the presence of anthropometric malnutrition and downward trend in weight-for-age, MUAC-for-age and to a lesser degree the head circumference-for-age, the average growth of the Kyeni children in Kenya is within normal limits of international references.

Age Factors↗