ABSTRACT De behandeling van een aan appendicitisgerelateerd intra-abdominaal abces bij kinderen b... more ABSTRACT De behandeling van een aan appendicitisgerelateerd intra-abdominaal abces bij kinderen bestaat in principe uit chirurgische of radiologische drainage. Dit is echter vaak technisch moeilijk uitvoerbaar en geassocieerd met morbiditeit. Op grond van literatuurgegevens en door de risico's van drainage af te wegen tegen de voordelen van conservatieve therapie behandelden wij zeven opeenvolgende kinderen met een appendiculair abces succesvol met breedspectrumantibiotica. Individueel zal steeds de keuze gemaakt moeten worden voor conservatieve behandeling dan wel chirurgische drainage, maar er tekent zich een trend af naar een conservatieve benadering. Het adagium ubi pus, ibi evacua kon in de door ons beschreven gevallen van een intra-abdominaal abces bij kinderen worden vervangen door de aanbeveling ubi pus, ibi antibiotica. Summary The treatment of an intra-abdominal abscess related to an appendicitis in children is primarily surgical or radiological drainage. However, this is often technically difficult to perform and associated with morbidity. According to the literature and comparing the risk of drainage against the benefits of conservative therapy we treated seven consecutive children successfully with an appendicular intra-abdominal abscess with broad spectrum antibiotics. Looking at every patient individually a choice must be made for either conservative treatment of surgical drainage, but a trend emerges towards a conservative approach. The maxim ubi pus, ibi evacua could be replaced in the above described cases of intra-abdominal abscesses in children by the recommendation ubi pus, ibi antibiotics.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2008
We report a case of intercostal pulmonary hernia through a defect in the wall of the thoracic cav... more We report a case of intercostal pulmonary hernia through a defect in the wall of the thoracic cavity which occurred after blunt thoracic trauma. Diagnosis of pulmonary herniation was confirmed radiologically by chest X-ray and computed tomographic scan. After initial inspection by video-assisted thoracoscopy which also revealed a diaphragmatic rupture, a postero-lateral thoracotomy was performed. The defect of the thoracic wall was repaired with two reconstruction plates. The hernia was successfully repaired with prosthetic mesh. Review of the literature shows that when required, surgical repair of pulmonary herniation is the treatment of choice.
We report a case of intercostal pulmonary hernia through a defect in the wall of the thoracic cav... more We report a case of intercostal pulmonary hernia through a defect in the wall of the thoracic cavity which occurred after blunt thoracic trauma. Diagnosis of pulmonary herniation was confirmed radiologically by chest X-ray and computed tomog r a p h i cscan. After initial inspection by video-assisted thoracoscopy which also revealed a diaphragmatic rupture, a postero-lateral thoracotomy was performed. The defect of the thoracic wall was repaired with two reconstruction plates. The hernia was successfully repaired with prosthetic mesh. Review of the literature shows that when required, surgical repair of pulmonary herniation is the treatment of choice.
Daily administration of vitamin D is important for maintaining bone homeostasis. The orthopedic c... more Daily administration of vitamin D is important for maintaining bone homeostasis. The orthopedic community has shown increased interest in vitamin D supplementation and patient outcomes after fracture. The current study used data from a large hip fracture trial to determine the proportion of patients who consistently used vitamin D after hip fracture surgery and to determine whether supplementation was associated with improved health-related quality of life and reduced reoperation rates. The FAITH study is a multicenter trial of elderly patients with femoral neck fracture treated with internal fixation. The current study asked a subset of patients included in the FAITH study about vitamin D supplementation and categorized them as consistent users, inconsistent users, or nonusers. This study also evaluated whether supplementation was associated with improved quality of life and reduced reoperation rates. The final analysis included 573 patients (mean age, 74.1 years; female, 66.3%; no...
Background High rates of re-operations after initial hip fracture fixation, the associated morbid... more Background High rates of re-operations after initial hip fracture fixation, the associated morbidity, mortality, and costs motivated the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) randomised controlled trial. Methods We randomised 1,079 patients with a low-energy femoral neck fracture fracture requiring fracture fixation in 81 centres to a single large diameter screw with a side-plate (sliding hip screw) or the current standard, multiple small diameter cancellous screws (Clinical Trials Identification Number: NCT01908751). The primary outcome was hip re-operation within 24 months. Health-related quality of life (HRQL) was measured by the SF-12, EQ-5D, and WOMAC score. Findings Re-operations did not convincingly differ by type of surgical fixation: 107 of 542 patients (19•7%) in the sliding hip screw group and 117 of 537 patients (21•8%) in the cancellous screws group (hazard ratio, 0•83; 95% CI, 0•63 to 1•09; p=0•18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9•2%] vs. 28 patients [5•2%]; hazard ratio, 1•78; 95% CI, 1•09 to 2•91; p=0•02). The three HRQL instruments were consistent in showing no important difference by treatment group at 24 months. A priori subgroups suggested lower reoperation rates with sliding hip screws in patients with displaced fractures (interaction p=0•04), base of femoral neck fractures (interaction p=0•04), and current Page 3 of 33 smokers (interaction p=0•02); current smoking appeared the dominant effect modifier in an analysis that included all three variables. Interpretation Among patients with a femoral neck fracture fracture there was no convincing difference in hip re-operations or HRQL among patients allocated to sliding hip screw compared to cancellous screws. Avascular necrosis was higher with sliding hip screws.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2008
We report a case of intercostal pulmonary hernia through a defect in the wall of the thoracic cav... more We report a case of intercostal pulmonary hernia through a defect in the wall of the thoracic cavity which occurred after blunt thoracic trauma. Diagnosis of pulmonary herniation was confirmed radiologically by chest X-ray and computed tomographic scan. After initial inspection by video-assisted thoracoscopy which also revealed a diaphragmatic rupture, a postero-lateral thoracotomy was performed. The defect of the thoracic wall was repaired with two reconstruction plates. The hernia was successfully repaired with prosthetic mesh. Review of the literature shows that when required, surgical repair of pulmonary herniation is the treatment of choice.
Since the original Baux score was outdated and inhalation injury was recognized as an important c... more Since the original Baux score was outdated and inhalation injury was recognized as an important contributor to mortality, Osler et al. developed a revised Baux score for the prediction of mortality of burn patients in an American population. The aim of this study was to validate the revised Baux score with data of patients admitted to the Rotterdam Burn Center (RBC) in the Netherlands.
infection in the first month was 10·2% with placebo and 2·3% with ceftriaxone (p<0&... more infection in the first month was 10·2% with placebo and 2·3% with ceftriaxone (p<0·001, Pearson &khgr;2-test). Grampositive bacteria were found in 74·5% of wound infections and 13·4% of nosocomial infections.
The Journal of Trauma: Injury, Infection, and Critical Care, 1993
The cytotoxicity of commonly used antimicrobial and antiseptic agents to cultured human keratinoc... more The cytotoxicity of commonly used antimicrobial and antiseptic agents to cultured human keratinocytes was investigated, combining a morphologic assay with a quantitative neutral red (NR) spectrophotometric assay. Main outcome criteria of response were the initial cytotoxicity (NR 90) and midpoint cytotoxicity (NR 50) and the highest tolerated dose (HTD), a concentration causing the first observed morphologic alterations. These values were compared with commonly administered clinical doses or calculated doses. Thirty-five agents were evaluated; five agents were also subjected to an assay for cell morphologic alterations, and HTD and percentage of cells taking up trypan blue and annihilation dose were assessed. These studies show that in clinical concentrations many, but not all, agents exert profound cytotoxic effects. The results suggest that under certain conditions cultured epithelial grafts may be exposed to clinical concentrations of neomycin, clindamycin, framycetin, erythromycin, gentamicin, and 0.1% solutions of povidone-iodine. Tetrachlorodecaoxygen anion complex (TCDO) should be further evaluated as a likely effective cleansing agent before culture grafting.
The Journal of Trauma: Injury, Infection, and Critical Care, 2004
The introduction of the ATLS course in The Netherlands in 1995 provided for an opportunity to com... more The introduction of the ATLS course in The Netherlands in 1995 provided for an opportunity to compare data of trauma patients between a pre-ATLS and a post-ATLS period. Over a 3-year period (May 1996 - September 1997 pre ATLS; December 1997-April 1999 post ATLS) 63 trauma patients with an AIS-ISS &amp;amp;amp;amp;amp;amp;gt; or = 16 (n = 31, pre-ATLS and n = 32, post-ATLS) were prospectively studied in two community residency training (ACS Level III) hospitals. All diagnostic and therapeutic procedures were recorded by a video-camera and evaluated by a neutral faculty of six experienced ATLS trained specialists. Ten out of 14 interventions were performed qualitatively better in the post-ATLS group, while also the overall score was highly significantly better (4.2 pre-ATLS and 5.8 post-ATLS, p &amp;amp;amp;amp;amp;amp;lt; 0.0001). Using the opinion of an expert team, this study identified a significantly lower number of patients with inadequate management.
The American Burn Association/Shriners Hospital for Children Burn Outcomes Questionnaire (BOQ) is... more The American Burn Association/Shriners Hospital for Children Burn Outcomes Questionnaire (BOQ) is a self-administered questionnaire to monitor functional outcome after burns in children and adolescents. This study aimed to assess feasibility, reliability, and validity of the Dutch BOQ. The BOQ was adapted into Dutch and tested in a population of children and adolescents aged 5 to 15 years who were primary admissions to a Dutch or Belgian burn center (n = 6) during the period of March 2001 through February 2004. To assess validity, the Child Health Questionnaire (CHQ) and the EuroQol-5D (EQ-5D) were included. Response rate was 53% among parents (n = 145) and 48% among adolescents (n = 52). Internal consistency of the BOQ scales was good (Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alpha &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.7 in all but one scale). Test and retest results were similar; there were no significant differences between parents and adolescents in this respect. Expected high correlations between BOQ scales and conceptually equivalent CHQ and EQ-5D scales were found in eight of 12 comparisons. Eleven scales showed significant differences in the expected direction between children with a long length of stay versus those with a short length of stay. The Dutch BOQ can be used to evaluate functional outcome after burns in children aged 5 years and older. Our study showed that the Dutch BOQ is a feasible instrument with good reliability and validity.
Background: The Advanced Trauma Life Support (ATLS®) course teaches procedures for administering ... more Background: The Advanced Trauma Life Support (ATLS®) course teaches procedures for administering initial trauma care. This study attempts to document changes that occurred in institutions after ATLS® training had been introduced. Patients and Methods: Prospective analysis by videotape review of trauma resuscitations in two community training hospitals was performed. The major outcome measure was the time to accomplish procedures defined in the ATLS® curriculum. Results: There was a significant post-ATLS® improvement in frequency of the following diagnostic and therapeutic activities: obtaining arterial blood samples, hypothermia management, ultrasound examination of the abdomen and rectal examination. The median time to obtain the neurologic status decreased from 6 to 2 min (p = 0.019). The hospital trauma resuscitation time (TRT) was 49 min in both groups. Conclusion: ATLS® training significantly improves a number of qualitative and quantitative aspects of acute trauma resuscitation.
European Journal of Surgical Oncology (EJSO), 1996
In a retrospective study 37 patients were surgically treated for 38 fractures (27 actual and 11 i... more In a retrospective study 37 patients were surgically treated for 38 fractures (27 actual and 11 impending) caused by metastatic lesions of the humerus shaft. A comparison between plate osteosynthesis with bone cement (20 cases) and intramedullary nailing (18 cases) was made. There was no mortality related to the surgical procedure. The patients' survival rate was 61% after 3 months and 44% after 6 months; six were alive after 1 year. Overall, a subjective and objective relief of pain was achieved in 92% and 79%, respectively. Restoration of arm function was improved in 95%.
ABSTRACT De behandeling van een aan appendicitisgerelateerd intra-abdominaal abces bij kinderen b... more ABSTRACT De behandeling van een aan appendicitisgerelateerd intra-abdominaal abces bij kinderen bestaat in principe uit chirurgische of radiologische drainage. Dit is echter vaak technisch moeilijk uitvoerbaar en geassocieerd met morbiditeit. Op grond van literatuurgegevens en door de risico&#39;s van drainage af te wegen tegen de voordelen van conservatieve therapie behandelden wij zeven opeenvolgende kinderen met een appendiculair abces succesvol met breedspectrumantibiotica. Individueel zal steeds de keuze gemaakt moeten worden voor conservatieve behandeling dan wel chirurgische drainage, maar er tekent zich een trend af naar een conservatieve benadering. Het adagium ubi pus, ibi evacua kon in de door ons beschreven gevallen van een intra-abdominaal abces bij kinderen worden vervangen door de aanbeveling ubi pus, ibi antibiotica. Summary The treatment of an intra-abdominal abscess related to an appendicitis in children is primarily surgical or radiological drainage. However, this is often technically difficult to perform and associated with morbidity. According to the literature and comparing the risk of drainage against the benefits of conservative therapy we treated seven consecutive children successfully with an appendicular intra-abdominal abscess with broad spectrum antibiotics. Looking at every patient individually a choice must be made for either conservative treatment of surgical drainage, but a trend emerges towards a conservative approach. The maxim ubi pus, ibi evacua could be replaced in the above described cases of intra-abdominal abscesses in children by the recommendation ubi pus, ibi antibiotics.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2008
We report a case of intercostal pulmonary hernia through a defect in the wall of the thoracic cav... more We report a case of intercostal pulmonary hernia through a defect in the wall of the thoracic cavity which occurred after blunt thoracic trauma. Diagnosis of pulmonary herniation was confirmed radiologically by chest X-ray and computed tomographic scan. After initial inspection by video-assisted thoracoscopy which also revealed a diaphragmatic rupture, a postero-lateral thoracotomy was performed. The defect of the thoracic wall was repaired with two reconstruction plates. The hernia was successfully repaired with prosthetic mesh. Review of the literature shows that when required, surgical repair of pulmonary herniation is the treatment of choice.
We report a case of intercostal pulmonary hernia through a defect in the wall of the thoracic cav... more We report a case of intercostal pulmonary hernia through a defect in the wall of the thoracic cavity which occurred after blunt thoracic trauma. Diagnosis of pulmonary herniation was confirmed radiologically by chest X-ray and computed tomog r a p h i cscan. After initial inspection by video-assisted thoracoscopy which also revealed a diaphragmatic rupture, a postero-lateral thoracotomy was performed. The defect of the thoracic wall was repaired with two reconstruction plates. The hernia was successfully repaired with prosthetic mesh. Review of the literature shows that when required, surgical repair of pulmonary herniation is the treatment of choice.
Daily administration of vitamin D is important for maintaining bone homeostasis. The orthopedic c... more Daily administration of vitamin D is important for maintaining bone homeostasis. The orthopedic community has shown increased interest in vitamin D supplementation and patient outcomes after fracture. The current study used data from a large hip fracture trial to determine the proportion of patients who consistently used vitamin D after hip fracture surgery and to determine whether supplementation was associated with improved health-related quality of life and reduced reoperation rates. The FAITH study is a multicenter trial of elderly patients with femoral neck fracture treated with internal fixation. The current study asked a subset of patients included in the FAITH study about vitamin D supplementation and categorized them as consistent users, inconsistent users, or nonusers. This study also evaluated whether supplementation was associated with improved quality of life and reduced reoperation rates. The final analysis included 573 patients (mean age, 74.1 years; female, 66.3%; no...
Background High rates of re-operations after initial hip fracture fixation, the associated morbid... more Background High rates of re-operations after initial hip fracture fixation, the associated morbidity, mortality, and costs motivated the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) randomised controlled trial. Methods We randomised 1,079 patients with a low-energy femoral neck fracture fracture requiring fracture fixation in 81 centres to a single large diameter screw with a side-plate (sliding hip screw) or the current standard, multiple small diameter cancellous screws (Clinical Trials Identification Number: NCT01908751). The primary outcome was hip re-operation within 24 months. Health-related quality of life (HRQL) was measured by the SF-12, EQ-5D, and WOMAC score. Findings Re-operations did not convincingly differ by type of surgical fixation: 107 of 542 patients (19•7%) in the sliding hip screw group and 117 of 537 patients (21•8%) in the cancellous screws group (hazard ratio, 0•83; 95% CI, 0•63 to 1•09; p=0•18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9•2%] vs. 28 patients [5•2%]; hazard ratio, 1•78; 95% CI, 1•09 to 2•91; p=0•02). The three HRQL instruments were consistent in showing no important difference by treatment group at 24 months. A priori subgroups suggested lower reoperation rates with sliding hip screws in patients with displaced fractures (interaction p=0•04), base of femoral neck fractures (interaction p=0•04), and current Page 3 of 33 smokers (interaction p=0•02); current smoking appeared the dominant effect modifier in an analysis that included all three variables. Interpretation Among patients with a femoral neck fracture fracture there was no convincing difference in hip re-operations or HRQL among patients allocated to sliding hip screw compared to cancellous screws. Avascular necrosis was higher with sliding hip screws.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2008
We report a case of intercostal pulmonary hernia through a defect in the wall of the thoracic cav... more We report a case of intercostal pulmonary hernia through a defect in the wall of the thoracic cavity which occurred after blunt thoracic trauma. Diagnosis of pulmonary herniation was confirmed radiologically by chest X-ray and computed tomographic scan. After initial inspection by video-assisted thoracoscopy which also revealed a diaphragmatic rupture, a postero-lateral thoracotomy was performed. The defect of the thoracic wall was repaired with two reconstruction plates. The hernia was successfully repaired with prosthetic mesh. Review of the literature shows that when required, surgical repair of pulmonary herniation is the treatment of choice.
Since the original Baux score was outdated and inhalation injury was recognized as an important c... more Since the original Baux score was outdated and inhalation injury was recognized as an important contributor to mortality, Osler et al. developed a revised Baux score for the prediction of mortality of burn patients in an American population. The aim of this study was to validate the revised Baux score with data of patients admitted to the Rotterdam Burn Center (RBC) in the Netherlands.
infection in the first month was 10·2% with placebo and 2·3% with ceftriaxone (p<0&... more infection in the first month was 10·2% with placebo and 2·3% with ceftriaxone (p<0·001, Pearson &khgr;2-test). Grampositive bacteria were found in 74·5% of wound infections and 13·4% of nosocomial infections.
The Journal of Trauma: Injury, Infection, and Critical Care, 1993
The cytotoxicity of commonly used antimicrobial and antiseptic agents to cultured human keratinoc... more The cytotoxicity of commonly used antimicrobial and antiseptic agents to cultured human keratinocytes was investigated, combining a morphologic assay with a quantitative neutral red (NR) spectrophotometric assay. Main outcome criteria of response were the initial cytotoxicity (NR 90) and midpoint cytotoxicity (NR 50) and the highest tolerated dose (HTD), a concentration causing the first observed morphologic alterations. These values were compared with commonly administered clinical doses or calculated doses. Thirty-five agents were evaluated; five agents were also subjected to an assay for cell morphologic alterations, and HTD and percentage of cells taking up trypan blue and annihilation dose were assessed. These studies show that in clinical concentrations many, but not all, agents exert profound cytotoxic effects. The results suggest that under certain conditions cultured epithelial grafts may be exposed to clinical concentrations of neomycin, clindamycin, framycetin, erythromycin, gentamicin, and 0.1% solutions of povidone-iodine. Tetrachlorodecaoxygen anion complex (TCDO) should be further evaluated as a likely effective cleansing agent before culture grafting.
The Journal of Trauma: Injury, Infection, and Critical Care, 2004
The introduction of the ATLS course in The Netherlands in 1995 provided for an opportunity to com... more The introduction of the ATLS course in The Netherlands in 1995 provided for an opportunity to compare data of trauma patients between a pre-ATLS and a post-ATLS period. Over a 3-year period (May 1996 - September 1997 pre ATLS; December 1997-April 1999 post ATLS) 63 trauma patients with an AIS-ISS &amp;amp;amp;amp;amp;amp;gt; or = 16 (n = 31, pre-ATLS and n = 32, post-ATLS) were prospectively studied in two community residency training (ACS Level III) hospitals. All diagnostic and therapeutic procedures were recorded by a video-camera and evaluated by a neutral faculty of six experienced ATLS trained specialists. Ten out of 14 interventions were performed qualitatively better in the post-ATLS group, while also the overall score was highly significantly better (4.2 pre-ATLS and 5.8 post-ATLS, p &amp;amp;amp;amp;amp;amp;lt; 0.0001). Using the opinion of an expert team, this study identified a significantly lower number of patients with inadequate management.
The American Burn Association/Shriners Hospital for Children Burn Outcomes Questionnaire (BOQ) is... more The American Burn Association/Shriners Hospital for Children Burn Outcomes Questionnaire (BOQ) is a self-administered questionnaire to monitor functional outcome after burns in children and adolescents. This study aimed to assess feasibility, reliability, and validity of the Dutch BOQ. The BOQ was adapted into Dutch and tested in a population of children and adolescents aged 5 to 15 years who were primary admissions to a Dutch or Belgian burn center (n = 6) during the period of March 2001 through February 2004. To assess validity, the Child Health Questionnaire (CHQ) and the EuroQol-5D (EQ-5D) were included. Response rate was 53% among parents (n = 145) and 48% among adolescents (n = 52). Internal consistency of the BOQ scales was good (Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alpha &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.7 in all but one scale). Test and retest results were similar; there were no significant differences between parents and adolescents in this respect. Expected high correlations between BOQ scales and conceptually equivalent CHQ and EQ-5D scales were found in eight of 12 comparisons. Eleven scales showed significant differences in the expected direction between children with a long length of stay versus those with a short length of stay. The Dutch BOQ can be used to evaluate functional outcome after burns in children aged 5 years and older. Our study showed that the Dutch BOQ is a feasible instrument with good reliability and validity.
Background: The Advanced Trauma Life Support (ATLS®) course teaches procedures for administering ... more Background: The Advanced Trauma Life Support (ATLS®) course teaches procedures for administering initial trauma care. This study attempts to document changes that occurred in institutions after ATLS® training had been introduced. Patients and Methods: Prospective analysis by videotape review of trauma resuscitations in two community training hospitals was performed. The major outcome measure was the time to accomplish procedures defined in the ATLS® curriculum. Results: There was a significant post-ATLS® improvement in frequency of the following diagnostic and therapeutic activities: obtaining arterial blood samples, hypothermia management, ultrasound examination of the abdomen and rectal examination. The median time to obtain the neurologic status decreased from 6 to 2 min (p = 0.019). The hospital trauma resuscitation time (TRT) was 49 min in both groups. Conclusion: ATLS® training significantly improves a number of qualitative and quantitative aspects of acute trauma resuscitation.
European Journal of Surgical Oncology (EJSO), 1996
In a retrospective study 37 patients were surgically treated for 38 fractures (27 actual and 11 i... more In a retrospective study 37 patients were surgically treated for 38 fractures (27 actual and 11 impending) caused by metastatic lesions of the humerus shaft. A comparison between plate osteosynthesis with bone cement (20 cases) and intramedullary nailing (18 cases) was made. There was no mortality related to the surgical procedure. The patients' survival rate was 61% after 3 months and 44% after 6 months; six were alive after 1 year. Overall, a subjective and objective relief of pain was achieved in 92% and 79%, respectively. Restoration of arm function was improved in 95%.
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