[Trends in emergency admissions in Amsterdam. Fifteen years of emergency psychiatry in an increasingly crowded city]. / Trends in acute opnames in Amsterdam; 15 jaar acute psychiatrie in een steeds vollere stad.

BACKGROUND: The Temporary Holding Department (toa) is a link between the 7/24 service and the admissions departments. We examined the make-up of the admission cohorts and the use of isolation between 2001 and 2017 in the context of demographic developments and changes in the mental healthcare sector.
METHOD: Comparison of patient data in four cohorts who came in during four consecutive periods.
RESULTS: The number of admissions rose from 408 a year in the period 2001-2003 to 728 in the period 2013-2016. The proportion of voluntary admissions increased from 4 to 33%, while emergency compulsory admissions (ibs) fell from 83 to 54%. The proportion of admissions of Dutch people from outside Amsterdam and of people from other countries rose from 11 to 23%. The percentage of patients with schizophrenic disorder rose from 25 to 32%, the percentage with mood disorder from 14 to 20% and the percentage with drug-related disorders from 3 to 7%. Assessment at a police station and the classification psychotic disorder were predictors of compulsory admissions (under the terms of the Dutch bopz act). Men under the age of 45 who were admitted compulsorily were more likely to be isolated. The percentage of patients isolated during admission fell from 37% to 20%, and the length of the periods of isolation also declined. CONCLUSIONS The increase in the annual number of admissions to the toa indicates, in the context of population growth and the rise in tourism, that there is a shortage of available beds in regular admissions departments in Amsterdam. Over the course of fifteen years, the number of Dutch nationals from outside Amsterdam and foreigners doubled. Due to policy and/or as a result of the increased proportion of patients admitted voluntarily, the use of isolation decreased.

Arteriographic evaluation of small coronary arteries.

The purpose of this study was to determine the accuracy of imaging small coronary arteries with current radiographic equipment. Phantom assessments were performed using a phantom that comprises a large array of circular objects of varying diameter and contrast density. More objects could be identified in the moving cinearteriogram than in single cine frames. Using the largest object as the calibration standard, diameters less than 1 mm were markedly overestimated. A simple morphometric method showed that arteriographic visualization of small vessels was better by digital processing than by cine recording. However, there was no statistically significant difference in the average size of the smallest identifiable vessel by either method (0.5 versus 0.51 mm). After correcting for overestimation and the inaccurate imaging of the smallest detectable vessels, the practical arteriographic threshold is approximately 0.5 mm. Parametric imaging holds promise, but its significance for evaluating small vessel disease has yet to be determined.

Prolonged dilation with an autoperfusion balloon catheter for refractory acute occlusion related to percutaneous transluminal coronary angioplasty.

OBJECTIVES: Efficacy and safety of redilation by an autoperfusion balloon catheter over several hours were investigated in this retrospective and observational study. BACKGROUND: Acute occlusion, refractory to redilation, is a serious complication of coronary angioplasty. METHODS: Of 1,123 patients who underwent angioplasty, 83 had a refractory acute occlusion. Thiry-five patients were treated with extended dilation. Seven had stable, 19 unstable and 6 postinfarction angina and 3 had an acute infarction at the time of angioplasty. The duration of dilation was (mean +/- SD) 17 (+/- 6) h. RESULTS: Angiographically successful redilation, with a mean residual percent diameter stenosis of 13.5% (+/- 11.6%), was achieved in 22 (67.7%) of 34 patients. Five patients underwent bypass surgery. Three patients, who were poor surgical candidates, died. There was one new Q wave infarction and one death that occurred during extended dilation; one death and four operations were related to reocclusion immediately (< or = 30 min) after catheter withdrawal; and one death and one operation were related to in-hospital reocclusion. Overall success, defined as angiographic success and freedom from major events, was obtained in 20 (57%) of 35 patients (95% confidence interval 41% to 73%). Of the variables studied, only multilesion dilation was significantly (p = 0.018) associated with an unfavorable outcome. During a mean follow-up period of 13.8 (+/- 6.1) months, two patients underwent repeat angioplasty, one sustained an infarction and three underwent elective bypass surgery. CONCLUSIONS: In approximately half of the patients (20 [57%] of 35), an initial angioplasty failure due to refractory occlusion could be reverted to a successful procedure by prolonged dilation with an autoperfusion balloon catheter.

Balloon angioplasty in the treatment of pulmonary hypertension caused by pulmonary embolism.

We present a 30-year-old man with pulmonary hypertension after pulmonary embolism. Pulmonary angiography showed multiple stenoses in the pulmonary vascular tree. We treated four of these stenoses by balloon angioplasty in three sessions. Pulmonary artery pressure was reduced from 90/25 mm Hg (mean 46) to 78/13 mm Hg (mean 35) with concomitant increase of aortic pressure from 105/60 mm Hg (mean 75) to 134/68 mm Hg (mean 90). Pulmonary perfusion scintigraphy showed increase of perfusion in the treated segments. Two procedures were followed by transient segmental pulmonary edema, but no other complications were noted. We conclude that balloon angioplasty is a promising method of lowering pulmonary artery pressure and improving pulmonary perfusion in suitable cases of pulmonary hypertension secondary to pulmonary embolism.

Comparative trial of Omnipaque 350 (iohexol) and Telebrix 350 (sodium-meglumine-ioxithalamate) in left ventriculography and coronary arteriography.

In a double-blind randomized trial, the hemodynamic and electrophysiologic effects of the low-osmolar nonionic contrast medium iohexol (Omnipaque) and the standard high-osmolar ionic monomer sodium-meglumine-ioxithalamate (Telebrix) at left ventricular angiography and selective coronary arteriography were evaluated. Sixty patients were divided into two groups of 30 patients; one group received Omnipaque in a dosage of 350 mgI/ml and the other group received Telebrix in a dosage of 350 mgI/ml. The Omnipaque showed significantly less effects on heart rate and myocardial contractility, and induced less electrophysiological changes than did Telebrix. However, there was a significant increase of 10% in the diameter of the left coronary artery following selective coronary injection with Telebrix, while Omnipaque induced practically no change in vessel diameter. All hemodynamic and electrophysiologic effects proved to be short-lasting. We conclude that ionic and nonionic agents are similarly efficacious in providing adequate images with minimal risk to the patient. However, the nonionic agents exert slightly more alterations in cardiac hemodynamics and in electrocardiographic intervals. The vasodilatory effect on coronary artery diameter by Telebrix may entail a more rapid clearance of contrast medium from the coronary circulation, which might be of some advantage over nonionic contrast media.

IgG subclasses in CAPD patients.

OBJECTIVE: To make a comparison of serum levels of immunoglobulin G (IgG) subclasses in adult continuous ambulatory peritoneal dialysis (CAPD) patients with those in age- and sex-matched hemodialysis patients and healthy volunteers, and to analyze the contribution of removal of these proteins in peritoneal effluent to their plasma values. DESIGN: A cross-sectional study. SETTING: A renal unit of a university hospital. PATIENTS: Twenty-three CAPD patients, 21 hemodialysis patients, and 21 healthy volunteers. Peritoneal transport studies were done in 8 of the 23 CAPD patients. METHODS: IgG subclasses were measured in serum by nephelometry. For the peritoneal transport studies an ELISA method on ethylenediamine tetracetic acid plasma was used. The same method was used in seven-to-ten-fold concentrated peritoneal dialysate. RESULTS: CAPD patients had lower IgG2 and IgG4 levels than hemodialysis patients and healthy volunteers (p < 0.01). IgG2 values below 1.5 g/L were present in 43% of the CAPD patients (p < 0.001 compared to healthy volunteers). Peritonitis incidence was not different between CAPD patients with low or normal IgG2 plasma levels. Peritoneal clearance of IgG3 was lower than that of the other subclasses. Evidence was obtained for a depressed synthesis of IgG2 and IgG4 in CAPD patients. The hypothesis that interleukin-2 may be involved in the low synthesis rate of IgG2 is discussed. CONCLUSION: Low serum IgG2 and IgG4 levels are present in stable, adult CAPD patients. These were not caused by increased peritoneal loss, but by decreased synthesis.

Three-dimensional densitometric reconstruction and visualization of stenosed coronary artery segments.

In this paper we report results from an ongoing study about the diagnostic benefits of three-dimensional (3D) visualization and quantification of stenosed coronary artery segments. Biplane angiographic images do not provide enough information for the exact reconstruction of the coronary arteries. Therefore, a priori information about the 3D shape to be reconstructed must be incorporated into the reconstruction algorithm. One approach is to assume a circular cross-section of the coronary artery. Hence, the diameter is estimated from the contours of the vessel in both projections. Another approach is based on densitometry and searches for a solution of the reconstruction problem close to the previously reconstructed adjacent slice. In this paper we apply contour information as well as the densitometrical profiles of the two orthogonal vessel projections. We present a new probabilistic densitometric reconstruction algorithm, which extends the correct handling of the stochastic properties of the density profiles into the network flow based reconstruction algorithm. The reconstructed coronary segment is visualized in three dimensions. In order to assess the accuracy of the reconstruction, the method is applied to tubes with artificial obstruction of known geometry, modeling coronary artery stenoses. These catheter tubes are filled with normal iodine contrast material. The results of the reconstruction and visualization are discussed with respect to clinical usefulness.

Coronary arterial mapping in hypertrophic cardiomyopathy.

The diameters of the coronary arteries and their peripheral branches were measured on coronary angiograms obtained from 9 patients with hypertrophic obstructive cardiomyopathy (HOCM), 6 patients with hypertrophic non-obstructive cardiomyopathy, and 6 normal controls. There was a marked increase in the diameters of the main coronary arteries in the patients suffering from cardiomyopathy but no significant difference in the peripheral branches between the three groups. This discrepancy between the 'run-in' and 'run-off' components of coronary circulation could explain anginal symptoms during exercise in HOCM, but in the absence of direct coronary flow measurements this theory remains to be tested. HOCM was associated with the widest arteries whereas hypertrophic non-obstructive cardiomyopathy occupied an intermediate position between HOCM and the control group.

Isolated chylopericardium due to lymphangiomatous dysplasia of the thymus.

In this paper we present the case of an 18-year old asymptomatic woman whose routine chest radiograph revealed an enlarged cardiac silhouette which was caused by a chylopericardium due to a lymphangioma of the thymus.

Cholesterol embolism as a complication of left heart catheterisation. Report of seven cases.

Cholesterol embolism after left heart catheterisation by the femoral approach was diagnosed in seven men (mean age 59.6 years) out of a total of 4587 catheterisations. Diabetes was present in four patients, systemic hypertension in three, and signs of extensive atherosclerosis in six; five patients were taking anticoagulant drugs. Acute pain in the legs or abdomen occurred in six patients, two of whom had abdominal angina; renal failure was present in six patients, cutaneous manifestations in five, and a cholesterol embolus was seen in the retina in one. Six out of six patients had an appreciable increase in the erythrocyte sedimentation rate and five out of five had eosinophilia within a week of catheterisation. Renal failure was progressive in five patients, one of whom required haemodialysis. Three patients required amputation of the toes because of gangrene. Four patients died within four and a half months of catheterisation from causes not directly related to cholesterol embolism. At necropsy cholesterol emboli were found in all four patients. Cholesterol embolism is a rare but serious complication of left heart catheterisation.

Pulsatile coronary flow determination by digital angiography.

A new angiographic method to calculate absolute coronary arterial blood flow and its cyclic variations as a function of time, has been designed and evaluated. The method combines densitometric analysis of spatial and temporal aspects concerning the contrast propagation through the arterial system from digital images, and is based on applying the concept of conservation of contrast material in successive images. It requires a standard arteriographic procedure. In simulations with both constant as well as pulsatile flow through a coronary arterial phantom, an excellent agreement with electromagnetic flow measurements was demonstrated (r = 0.993 and r = 0.982, respectively). Preliminary clinical results show, that the method yields reproducible assessment of coronary flow patterns after repeated injections in a patient. In a coronary artery bypass graft, coronary flow patterns in a baseline and a drug-induced hyperemic state were obtained. A consistent coronary flow reserve value was determined after repeated examinations. The method has been shown to be feasible in clinical applications, uncomplicated and fast, but requires further animal and clinical validation in order to determine the possible applications, limitations and accuracy.

Association of cholesterol concentrations in low-density lipoprotein, high-density lipoprotein, and high-density lipoprotein subfractions, and of apolipoproteins AI and AII, with coronary stenosis and left ventricular function.

We examined the association of cholesterol levels in serum lipoprotein fractions, as well as of serum apolipoprotein-AI (apo-AI) and apo-AII levels, with coronary artery stenosis (CAS) and left ventricle function in a group of 43 patients with angina pectoris (33 men and 10 women) subjected to angiography. Cholesterol level in VLDL, LDL, HDL2, and HDL3 fractions was determined after separation of these fractions by density gradient ultracentrifugation. HDL-cholesterol is the sum of cholesterol in HDL2 and HDL3. Cineangiography yielded scores for CAS and for left ventricle ejection fraction (LVEF). On univariate regression CAS was correlated weakly with LDL-cholesterol (positive) and with HDL3-cholesterol and HDL-cholesterol (negative), and more strongly with LDL-cholesterol/HDL-cholesterol (positive), but not with HDL2-cholesterol. LVEF was correlated positively with HDL3-cholesterol, HDL-cholesterol, apo-AI, and apo-AII. Of other "risk factors," none was correlated with CAS, and a history of previous myocardial infarction (PMI) was the only one significantly correlated with LVEF. CAS itself was also correlated negatively with LVEF. In multiple regression analysis with two or three independent variables, the relation of HDL(3)-cholesterol with CAS remained significant when other risk factors were taken into account. LVEF remained related positively with HDL(3)-cholesterol, apo-AI, or apo-AII, when either of them was tested in combination with other risk factors; of these only PMI made a significant independent contribution. Conclusions for this patient group (with low HDL-cholesterol): HDL3-cholesterol, and not HDL2-cholesterol, is informative for CAS; HDL(3)-cholesterol, apo-AI, or apo-AII, as well as CAS and PMI, are associated with LVEF.(ABSTRACT TRUNCATED AT 250 WORDS)

Unclassified familial cardiomyopathy with ventricular dysrhythmia.

The case is described of a boy with some right ventricular dysplasia and episodes of ventricular tachycardia of left bundle branch block pattern who had symptoms from the age of 1 month. Angiography and cardiac biopsy demonstrated major involvement of the left ventricular myocardium. A sister of the patient presented at the age of 2 months with predominantly left ventricular cardiomyopathy; clinical signs and angiography suggested the presence of right ventricular dysplasia as well. She died suddenly at the age of 9 years. Her brother, now aged 14 years, is being treated with antiarrhythmic drugs. The hypothesis of this cardiomyopathy being a variant of "arrhythmogenic right ventricular dysplasia syndrome" is discussed.

Relations between ejection fraction and ventricular volume, and their alteration by chronic beta-blockade.

This study describes the newly discovered relation between ejection fraction and end-systolic volume index (ESVI) of the left ventricle as obtained by angiography at the time of cardiac catheterisation. Linear regression analysis shows that ejection fraction (%)=82.0-0.62 ESVI (ml/m2) but the correlation for patients receiving beta-adrenergic blocking drugs is significantly lower compared with the untreated group. Non-linear analysis, applied to cover also the asymptotic range for ejection fraction less than 20%, shows similar results. The good relation between the two indices indicates that the index ejection fraction may derive its clinical importance directly from the more fundamental index end-systolic volume index by virtue of the operation of the beta-adrenergic system on the heart.