Intravenous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy.

Background: Chronic inflammatory demyelinating polyradiculoneuropathy is an immune mediated disorder characterised by progressive or relapsing symmetrical motor or sensory symptoms and signs in more than one limb, developing over at least two months. It may cause prolonged periods of disability and even death. Several uncontrolled studies have suggested a beneficial effect of intravenous immunoglobulin.

High risk of acute deterioration in patients harboring symptomatic colloid cysts of the third ventricle.

Object: Patients harboring colloid cysts of the third ventricle can present with acute neurological deterioration, or the first indication of the lesion may appear when the patient suddenly dies. The risk of such an occurrence in a patient already identified as harboring a colloid cyst is unknown. The goal of this study was to estimate the risk of acute deterioration in patients with colloid cysts.

Direct costs of modern treatment of aneurysmal subarachnoid hemorrhage in the first year after diagnosis.

Background And Purpose: The purpose of this study was to investigate the current direct costs of modern management of patients with aneurysmal subarachnoid hemorrhage in the first year after diagnosis.

Methods: During a 1-year period, we studied all admitted patients with subarachnoid hemorrhage from a population of 2 million people. We calculated the direct costs of treatment, which included the costs of medical and nursing care and the related travel expenses of patients.

Measuring quality of life in children with inflammatory bowel disease: the impact-II (NL).

Inflammatory bowel disease (IBD) is a chronic debilitating disorder. Measures of quality of life are only available for adult patient populations. We developed a new disease-specific health-related quality of life instrument in Dutch for pediatric patients with IBD, called Impact-II (NL).

Disease severity in multifocal motor neuropathy and its association with the response to immunoglobulin treatment.

Disease progression in multifocal motor neuropathy (MMN) was studied by comparing severity and duration of disease. We assessed disease severity by determining muscle weakness, disability, conduction block (CB), and distal and proximal compound muscle action potential (CMAP)-amplitude in 38 patients with MMN in whom disease duration ranged from 6 months to 34 years. As indicator for an ongoing immune-mediated process, the response to one course of IVIg treatment was measured in 34 patients and associated with disease severity.

Comparison of electrodiagnostic criteria for demyelination in patients with chronic inflammatory demyelinating polyneuropathy (CIDP).

This study compared sensitivity, specificity, positive and negative likelihood ratios (LR) of four previously published sets of electrodiagnostic criteria for demyelination in 64 patients whose history and physical examination indicated that chronic inflammatory demyelinating polyneuropathy was a possible diagnosis. Sensitivity of the sets of criteria ranged from 56-70 % and specificity from 85-98 %. Positive LRs ranged from 4.

[Measuring the functional status of patients in clinical trials using modern clinimetric methods].

In clinical medicine numerous measurement instruments have been developed to assess the functional outcome of patients in clinical trials. The majority are questionnaires with multiple-choice items. The responses of the patients are used to calculate a sum score.

Morbidity and mortality following pallidotomy in Parkinson's disease: a systematic review.

Objective: To study the frequency of morbidity and mortality associated with pallidotomy.

Method: The authors searched the MEDLINE electronic database for pallidotomy articles reported between January 1992 and December 2000. They selected studies by the following criteria: original clinical data, unequivocal description of morbidity and mortality, and unselected consecutive cases.

Beyond disability: perceived participation in people with a chronic disabling condition.

Objective: To describe the impact of a chronic disabling condition on participation and to identify variables that may explain perceived restrictions in participation.

Study Design: Cross-sectional.

Setting: People were recruited from the outpatient clinics of two rehabilitation centres and the rehabilitation department of an academic hospital.

Biomimetic calcium phosphate coatings on Polyactive 1000/70/30.

Precalcification of Polyactive 1000/70/30 with a biomimetic calcium phosphate coating is expected to enhance the bioactivity of this biodegradable polymer for the application as bone filler or scaffold of bone tissue engineering. This study presents a 1-day one-step incubation method to obtain either amorphous or bone-like apatitic calcium phosphate coating on Polyactive 1000/70/30. Either dense plates or three-dimensional porous blocks of the polymer were incubated in a simplified but concentrated simulated body fluid-derived solution at 37 degrees C.

Systematic review of prediction of poor outcome in anoxic-ischaemic coma with biochemical markers of brain damage.

Objective: To investigate whether accurate prognostic rules can be derived from the combined results of studies concerning prediction of poor prognosis in anoxic-ischaemic coma with biochemical markers of brain damage in cerebrospinal fluid (CSF) or serum.

Design: A meta-analysis of prognostic studies in anoxic-ischaemic coma, selected from Medline and EMBASE databases, according to predefined criteria.

Subjects: Twenty-eight studies, with a total of 802 unselected, consecutive patients, in which tests, sampling time and outcome measures were described unequivocally and results were described using clear cut-off values or raw data.

Nimodipine in animal model experiments of focal cerebral ischemia: a systematic review.

Background And Purpose: Based on the results of animal experiments, clinical trials were performed with nimodipine, which did not demonstrate a beneficial effect on outcome after stroke. The aim of this study was to determine whether the evidence from animal experiments with nimodipine supported the use of nimodipine in clinical trials.

Methods: - We performed a systematic review of animal experiments with nimodipine in focal cerebral ischemia.

Outcome of unilateral pallidotomy in advanced Parkinson's disease: cohort study of 32 patients.

Objectives: In a randomised trial to study the efficacy of unilateral pallidotomy in patients with advanced Parkinson's disease, patients having pallidotomy within 1 month after randomisation were compared with patients having pallidotomy 6 months after the primary outcome assessment. Of the 37 patients enrolled 32 had a unilateral pallidotomy. The follow up study of these patients is presented to report (1) clinical outcome; (2) adverse effects; (3) cognitive and behavioural effects; (4) relation between lesion location and outcome; and (5) preoperative patient characteristics predictive for good outcome.

The Critical Nursing Situation Index for safety assessment in intensive care.

Objective: The assessment of critical nursing situations can be a valuable tool in the detection of weak elements in the safety of patients and the quality of care in the ICU. A critical nursing situation can be defined as any observable situation, which deviates from good clinical practice and which may potentially lead to an adverse event. The aim of our study was to establish the feasibility, reliability and validity of the Critical Nursing Situation Index (CNSI) as a tool for assessing the safety and the quality of nursing in the ICU.

Impact of stroke type on survival and functional health.

In a cohort 760 consecutive stroke patients (23 hospitals in the Netherlands), we studied prognosis in relation to stroke type and focused on (a) short-term and long-term mortality, and (b) long-term functional health. Based on clinical and CT data, we distinguished infratentorial strokes from supratentorial strokes (lacunar infarctions, (sub)cortical infarctions and intracerebral hemorrhages). Cumulative mortality for all stroke patients was 34% at 6 months, 51% at 3 years, and 62% at 5 years.

Interobserver and intraobserver reproducibility of peripheral blood and oxygen pressure measurements in the assessment of lower extremity arterial disease.

Introduction: Peripheral blood pressure measurements play a prominent role in the diagnosis and follow-up of patients with peripheral vascular diseases. Toe pressure of the hallux (TP1) and second toe (TP2) and transcutaneous oxygen pressure (TCPO2) measurements are becoming more important. The ankle/brachial pressure index (ABPI) is known to be a reliable parameter, but the toe pressure and TCPO2 are evaluated less thoroughly.

Psychometric properties of the Impact on Participation and Autonomy Questionnaire.

Objective: To examine the homogeneity, test-retest reliability, construct validity, and concurrent validity of the Impact on Participation and Autonomy Questionnaire (IPAQ).

Design: Cross-sectional study with a test-retest subsample.

Patients: One hundred twenty-six persons from 5 diagnostic groups recruited from the outpatients clinics of 2 rehabilitation centers and the rehabilitation department of an academic hospital.

Very Early Nimodipine Use in Stroke (VENUS): a randomized, double-blind, placebo-controlled trial.

Background And Purpose: The Very Early Nimodipine Use in Stroke (VENUS) trial was designed to test the hypothesis that early treatment with nimodipine has a positive effect on survival and functional outcome after stroke. This was suggested in a previous meta-analysis on the use of nimodipine in stroke. However, in a recent Cochrane review we were unable to reproduce these positive results.

Clinical features and prognostic factors of cerebral venous sinus thrombosis in a prospective series of 59 patients. For The Cerebral Venous Sinus Thrombosis Study Group.

The prognosis of cerebral venous sinus thrombosis (CVST) is variable, and outcome may range from complete recovery to death. Prognostic factors to predict outcome in the acute phase of CVST have not been analysed in a prospective study. Prognostic factors in patients enrolled in a clinical treatment trial were prospectively investigated.

The usefulness of a laser Doppler in the measurement of toe blood pressures.

Objective: The purpose of this study was to evaluate the clinical value and reproducibility of laser Doppler (LD) versus photoplethysmography (PPG) in the measurement of the systolic toe blood pressure.

Methods: Toe blood pressure was measured in 60 patients in different stages of peripheral vascular disease with simultaneous digital sampling of PPG and two LD signals, each with a different filter setting (3 second [LD(3)] and 0.03 second [LD(0.

Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume.

Objective: To perform a two-part study of pancreaticoduodenectomy in the Netherlands, focusing on the effects of risk factors on outcomes in a single high-volume hospital and the effect of hospital volume on outcomes.

Summary Background Data: Hospital volume and surgeon caseload can be related to the rates of complications and death, and the influence of risk factors can be volume-dependent. Provision of regionalized care should take this into account.

Prediction of poor outcome in anoxic-ischemic coma.

Most patients who are comatose a few hours after a period of global cerebral ischemia have a poor prognosis. In a series of studies selected with strict criteria for study design, the median prevalence of death or survival in a vegetative state was 78% (range, 56-90%) (Zandbergen et al., 1998).