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Rob J. M. Groen

Bio: Rob J. M. Groen is an academic researcher from University Medical Center Groningen. The author has contributed to research in topics: Subarachnoid hemorrhage & Medicine. The author has an hindex of 30, co-authored 126 publications receiving 3757 citations. Previous affiliations of Rob J. M. Groen include University of Groningen & Katholieke Universiteit Leuven.


Papers
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Journal ArticleDOI
TL;DR: The authors have the opinion that the posterior internal vertebral venous plexus plays an important part in the etiology of the SSEH.

341 citations

Journal ArticleDOI
TL;DR: The critical factors for recovery after spontaneous spinal epidural hematoma are the level of preoperative neurological deficit and the operative interval, which suggests that local compression, rather than vascular obstruction, is the main factor in producing neurological deficit.
Abstract: OBJECTIVE: We clarify the factors affecting postoperative outcomes in patients who have suffered spontaneous spinal epidural hematomas. METHODS: We review 330 cases of spontaneous spinal epidural hematomas from the international literature and three unpublished cases of our own. Attention was focused on sex, age, medical history, mortality, size and position of the hematoma, vertebral level of the hematoma, preoperative neurological condition, operative interval, and postoperative result. RESULTS: Sex, age, and size and position of the hematoma did not correlate with postoperative outcome. Mortality correlated highly with cervical or cervicothoracic hematomas, especially in patients with cardiovascular disease and those undergoing anticoagulant therapy. Incomplete preoperative sensorimotor deficit correlated highly with favorable outcomes (P < 0.0005), and recovery was significantly better when decompression was performed in < or = 36 hours in patients with complete sensorimotor loss (P < 0.05) and in < or = 48 hours in patients with incomplete sensorimotor deficit (P < 0.005). CONCLUSION: The critical factors for recovery after spontaneous spinal epidural hematoma are the level of preoperative neurological deficit and the operative interval. The vertebral level of the hematoma did not correlate with postoperative results, which suggests that local compression, rather than vascular obstruction, is the main factor in producing neurological deficit.

329 citations

Journal ArticleDOI
TL;DR: In this article, the authors investigated prospectively in an unselected series of patients with an aneurysmal subarachnoid haemorrhage what at present the complications are, what the outcome is, how many of these patients have modern treatment, what factors cause a delay in surgical or endovascular treatment, and what the estimated effect on outcome will be of improved treatment.
Abstract: OBJECTIVE The aim of this study was to investigate prospectively in an unselected series of patients with an aneurysmal subarachnoid haemorrhage what at present the complications are, what the outcome is, how many of these patients have “modern treatment”—that is, early obliteration of the aneurysm and treatment with calcium antagonists—what factors cause a delay in surgical or endovascular treatment, and what the estimated effect on outcome will be of improved treatment. METHODS A prospective, observational cohort study of all patients with aneurysmal subarachnoid haemorrhage in the hospitals of a specified region in The Netherlands. The condition on admission, diagnostic procedures, and treatments were recorded. If a patient had a clinical deterioration, the change in Glasgow coma score (GCS), the presence of focal neurological signs, the results of additional investigations, and the final diagnosed cause of the deterioration were recorded. Clinical outcome was assessed with the Glasgow outcome scale (GOS) at 3 month follow up. In patients with poor outcome at follow up, the cause was diagnosed. RESULTS Of the 110 patients, 47 (43%) had a poor outcome. Cerebral ischaemia, 31 patients (28%), was the most often occurring complication. Major causes of poor outcome were the effects of the initial haemorrhage and rebleeding in 34% and 30% of the patients with poor outcome respectively. Of all patients 102 (93%) were treated with calcium antagonists and 45 (41%) patients had early treatment to obliterate the aneurysm. The major causes of delay of treatment were a poor condition on admission or deterioration shortly after admission, in 31% and 23% respectively. CONCLUSIONS In two thirds of the patients with poor outcome the causes of poor outcome are the effects of the initial bleeding and rebleeding. Improved treatment of delayed or postoperative ischaemia will have only minor effects on the outcome of patients with subarachnoid haemorrhage.

270 citations

Journal ArticleDOI
TL;DR: In this paper, the authors identify factors that favour spontaneous recovery in patients who suffered a spontaneous spinal epidural hematoma (SSEH) in non-operative cases of SSEH.
Abstract: Objective To identify factors that favour spontaneous recovery in patients who suffered a spontaneous spinal epidural hematoma (SSEH) Methods The literature was reviewed reguarding non-operative cases of SSEH (SSEHcons) Sixty-two cases from the literature and 2 of our own cases were collected, focusing on sex, age, medical history, position of the hematoma, segmental distribution and length of the hematoma, diagnostic imaging, neurological condition and outcome Those data were analysed and compared with the data from a literature review of 474 cases operated on because of a SSEH (SSEHoper) Results The mean length of the hematoma was significantly higher in SSEHcons, compared to SSEHoper (54 versus 42 vertebral segments; [standard error of the difference (SED) is 038 vertebral segments; 95% confidence limits for the difference are 045 to 195]) Also after exclusion of patients with coagulopathy, mean length of the hematoma was significantly higher in SSEHcons (47 versus 39 vertebral segments [SED is 039 vertebral segment; 95% confidence limits for the difference are 004 to 156]) Neurological signs and symptoms in SSEHcons were significantly less severe (P<0005) and diagnosis was based on Magnetic Resonance Imaging (MRI) in the majority of cases (P<00005), when compared to SSEHoper All other patient characteristics showed no correlation with spontaneous recovery Conclusion The recent increase of publications of SSEHcons has to be explained by the introduction of MRI in daily medical practice As a result, more patients with a mild or benign clinical course are being diagnosed In earlier times those patients would have escaped medical attention The mean length of the hematoma in SSEHcons appears to be significantly higher compared to SSEHoper This suggests that spontaneous regression of neurological symptoms may result from decompression of the neural structures by spreading of the (liquid) hematoma along the spinal epidural space in the early stages after haemorrhage Based on the present review, there appear to be no factors which promote conservative treatment in SSEH In the majority of cases with SSEH, the mainstay of treatment will remain surgical decompression of the neural structures and removal of the hematoma The decision for conservative treatment has to be based on the severity of the neurological deficit and on the clinical course Retrospectively, the length of the hematoma seems to give a clue to the spontaneous recovery which occurs in some cases of SSEH Nevertheless, hematoma-length can not be used as a guide to treatment

229 citations

Journal ArticleDOI
TL;DR: In this paper, the results of different surgical procedures for chronic subdural hematoma (CSDH) were evaluated using MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other databases.
Abstract: Object In this paper the authors systematically evaluate the results of different surgical procedures for chronic subdural hematoma (CSDH). Methods The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other databases were scrutinized according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement, after which only randomized controlled trials (RCTs) and quasi-RCTs were included. At least 2 different neurosurgical procedures in the management of chronic subdural hematoma (CSDH) had to be evaluated. Included studies were assessed for the risk of bias. Recurrence rates, complications, and outcome including mortality were taken as outcome measures. Statistical heterogeneity in each meta-analysis was assessed using the T2 (tau-squared), I2, and chi-square tests. The DerSimonian-Laird method was used to calculate the summary estimates using the fixed-effect model in meta-analysis. Results Of the 297 studies identified, 19 RCTs were included. Of them, 7 ...

225 citations


Cited by
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Journal ArticleDOI
01 Jun 2012-Stroke
TL;DR: Evidence-based guidelines are presented for the care of patients presenting with aneurysmal subarachnoid hemorrhage and offer a framework for goal-directed treatment of the patient with aSAH.
Abstract: Purpose—The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods—A formal literature s...

2,713 citations

Journal Article
TL;DR: Definition: To what extent does the study allow us to draw conclusions about a causal effect between two or more constructs?
Abstract: Definition: To what extent does the study allow us to draw conclusions about a causal effect between two or more constructs? Issues: Selection, maturation, history, mortality, testing, regression towrd the mean, selection by maturation, treatment by mortality, treatment by testing, measured treatment variables Increase: Eliminate the threats, above all do experimental manipulations, random assignment, and counterbalancing.

2,006 citations

Journal Article
TL;DR: The book will undoubtedly be considered a classical contribution to medical literature and is strongly recommended, not only because of the general interest of its topic, but as a reference book on penicillin therapy of hitherto unequalled excellence.
Abstract: MEDICAL LITERATURE has been deluged during the past few years with books and papers on penicillin; but a book which has been produced under the general editorship of Sir Alexander Fleming himself represents a complete and authoritative summary of penicillin therapy as it stands today.' The book contains a series of independent contributions by \"experienced and eminent men who have worked with penicillin in Great Britain\". Their opinions and practical methods differ slightly, and there is some overlapping; but these are not disadvantageous, comparison and contrast lending interest to the reading. In the first or general section of the book Fleming contributes two chapters, one on the history and development of penicillin, introducing some interesting sidelights in the romance of discovery, the other on the bacteriological control of penicillin therapy. In both chapters the information is set out in meticulous detail and with a clarity and simplicity which can be enjoyed by all readers. Fleming also gives the right perspective to the place of penicillin amongst the antibiotics and lays down the principles of treatment. Both chapters are well illustrated and are the most outstanding in the book. Included in this first section also are chapters on the chemistry and manufacture of penicillin and its pharmacy, pharmacology and methods of administration. The second section of the book is entirely clinical, giving each author's view on the use of penicillin therapy in a disease or an infection of some particular region of the body. The entire range of peniCillin-sensitive conditions is considered in twenty authoritative and clearly written chapters; these contain many references and illustrations. Dental and veterinary diseases are also given fairly full consideration. The final section is a condensed resume of much of the preceding chapters and is written for. the general practttioner. This chapter is superttuous: it does not contain enough detall to be of much practical value. The book as a Whole, however, will undoubtedly be considered a classical contribution to medical literature and is strongly recommended, not only because of the general interest of its topic, but as a reference book on penicillin therapy of hitherto unequalled excellence. The typography, although conforming to war economy standards, is clear and the paper is good. There is an excellent list of references and the index is satisfactory.

1,657 citations

Journal ArticleDOI
TL;DR: The ASRA consensus statements represent the collective experience of recognized experts in the field of neuraxial anesthesia and anticoagulation and are based on case reports, clinical series, pharmacology, hematology, and risk factors for surgical bleeding.

1,319 citations