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Biomedical subjects

C A Seldenrijk

Publications and source records attributed to C A Seldenrijk.

At least 19 recordsLinked to original sources
PubMed2006

Relationship between histological subtypes and clinical characteristics at presentation and outcome in biopsy-proven temporal arteritis. Identification of a relatively benign subgroup.

Temporal arteritis (TA) may offer major complications, whilst high dosage of prednisone may result in serious side effects. We tried to identify a subgroup of TA, which can be treated with a lower dosage of prednisone. Retrospectively, clinical and laboratory data were studied at presentation, as well as the outcome in 44 consecutive patients with biopsy-proven temporal arteritis. These data were related to three particular histological subgroups, (a) classical giant cell arteritis, (b) atypical arteritis, and (c) 'healed arteritis', defined according to Allsop and Gallagher (The American Journal of Surgical Pathology 5:317-332, 1981). At presentation in subgroup c, erythrocyte sedimentation rate was lower and the level of haemoglobin was higher than in the other two subgroups. During follow-up in the healed arteritis group, reactivation, recurrence, or early death were not observed, whilst prednisone dosage after 2 and 3 years was lower compared to subgroup b. Major complications (permanent blindness and cerebrovascular accident) were only observed in subgroups a and b. We believe that the healed arteritis subgroup represents a relatively benign subgroup with a mild clinical presentation and a good prognosis. Therefore, a much lower initial prednisone dosage (15 mg/day) is suggested for patients in subgroup c than in the other two subgroups (40-60 mg/day).

Aged↗
PubMed2006

[Oesophageal endoscopic ultrasound with fine-needle aspiration biopsy in the staging of non-small-cell lung carcinoma; results from 43 patients].

OBJECTIVE: To calculate the number of cervical mediastinoscopies that need not be carried out ifoesophageal endoscopic ultrasound and fine-needle aspiration biopsy (EUS-FNA) are included in the staging of patients with non-small-cell lung carcinoma (NSCLC). DESIGN: Retrospective, descriptive. METHOD: Patients referred to the St. Antonius Hospital in Nieuwegein, the Netherlands, with NSCLC from January to December 2003 routinely underwent EUS-FNA during the staging process. If mediastinal or distant metastases were found to be present then cervical mediastinoscopy was not carried out as the patient was not eligible for operation. If no metastases were demonstrated then cervical mediastinoscopy was carried out. The value of EUS-FNA was calculated. RESULTS: A total of 43 patients underwent EUS-FNA: 32 men and 11 women with an average age of 64 (range: 45-77). In 22 (51%) of them, cervical mediastinoscopy was not performed as EUS-FNA demonstrated malignant cells in the lymph nodes of the mediastinum or abdomen, in the left adrenal gland or in the primary tumour which had grown into the mediastinum. In 2 of the 21 other patients malignant cells were found on mediastinoscopy showing the EUS-FNA results in 2 of 43 patients (5%) to be false-negative. No complications occurred. CONCLUSION: Based on the findings from EUS-FNA, cervical mediastinoscopy was not performed in 51% of the patient group.

Aged↗
PubMed2005

[Haemoptysis as a complication of Behçet's disease].

Three patients, two Moroccan men aged 27 and 25 and a Turkish man aged 25, presented with haemoptysis caused by pulmonary aneurysm. The aneurysms had formed as a complication of Behçet's disease. Two of them were treated with high doses of corticosteroids. One man recovered and another died as a consequence of massive haemoptysis. The third man underwent emergency thoracotomy and pneumectomy due to massive haemoptysis. Postoperatively he was treated with cyclosporine resulting in full recovery. Behçet's disease is a multisystem vasculitis characterised by orogenital ulcerations and uveitis. In a minority of cases pulmonary aneurysms develop, often causing massive haemoptysis. Aneurysms are often accompanied by venous thrombosis. Treatment consists of immunosuppressive therapy. Nevertheless a considerable number of patients die following massive haemoptysis.

Adrenal Cortex Hormones↗
PubMed2004

[The adrenocortical carcinoma, a tumour of wide clinical diversity].

Over the course of a few years, an obese 52-year-old woman with a 23-year history of hypertension developed a number of abdominal complaints including gall stones. Her blood pressure became increasingly difficult to control and she developed diabetes mellitus and suffered palpitations and headaches. It became noticeable that she had a moon face. Laboratory tests revealed hypercortisolism. CT-scan showed a large inhomogeneous mass of nine centimetres in her left adrenal gland, which was subsequently removed surgically. The histopathological diagnosis was consistent with an adenoma. After a number of months the patient developed bone and liver metastases and the diagnosis was amended to carcinoma of the adrenal cortex. She then underwent radiotherapy and chemotherapy treatment. One year after surgery she developed a pancytopenia and died. Adrenocortical carcinomas are rare tumours with an incidence of about 1-2 cases per million of the population. Symptoms are heterogeneous since both functional (hormonal overproduction) and non-functional (mass effect) tumours exist. Surgical resection is the only curative therapy. It may be difficult to distinguish between benign and malignant cortical tumours.

Adrenal Cortex Neoplasms↗
PubMed2003

Update in pulmonary carcinoid tumors: a review article.

Pulmonary carcinoid tumors are neuroendocrine malignant tumors that make up 1% to 2% of all lung tumors. According to histopathologic criteria, carcinoids can be divided into typical (TC) and atypical (AC) carcinoids. Carcinoids can be placed in a spectrum of neuroendocrine tumors, ranging from low-grade malignant TC to intermediate AC to high-grade large-cell neuroendocrine carcinoma and small-cell lung carcinoma. Familial pulmonary carcinoids are rare. The most common symptoms are hemoptysis, cough, recurrent pulmonary infection, fever, chest discomfort and chest pain, unilateral wheezing, and shortness of breath. Paraneoplastic syndromes are rare and include carcinoid syndrome, Cushing's syndrome, and ectopic growth hormone-releasing hormone secretion. The diagnosis is usually established by flexible bronchoscopy and biopsy, although occasionally this can result in severe hemorrhage. Immunoscintigraphy by somatostatin analogs can also be useful in diagnosis. The treatment of choice is surgical resection, and prognosis is relatively good in TC, although it is worse in AC. The role of radiotherapy and chemotherapy as part of multimodality treatment or palliation is still debated.

Biopsy↗
PubMed2002

Vasculitis due to gemcitabine.

We report the first occurrence of gemcitabine-induced vasculitis. It concerns a 45-year-old man diagnosed with non-small lung cancer since 2 months. After the first cycle of chemotherapy, consisting of gemcitabine and cisplatin, he developed myalgia and swelling of arms and legs with impairment of movement. This re-occurred during the second cycle of chemotherapy. Further anemia, elevated ESR and increased creatininephosphokinase. A surgical biopsy showed leucocytoclastic vasculitis and necrosis of muscle tissue. The chemotherapy was stopped and the complaints disappeared and did not return.

Antimetabolites, Antineoplastic↗
PubMed2001

Does carditis have two different etiologies?

Carditis has become the subject of much study and discussion, although its etiology is still controversial. We wished to study the prevalence and possible pathogenetic mechanisms of carditis in a well-defined group of patients. In 664 patients biopsies were taken distal to the squamocolumnar junction (SCJ) and from the endoscopically defined cardia (2 cm below proximal margin of gastric folds). Specimens were stained with hematoxylin and eosin, Alcian blue, and modified Giemsa. Type of mucosa, inflammatory and metaplastic changes, and presence of Helicobacter pylori (Hp) were graded. Most of the patients had a normal appearing SCJ on endoscopy; 19.3% had short columnar segments (1-3 cm). In the first group cardiac/mixed mucosa was found in 71.9% of SCJ biopsies, and carditis (90.6%) was associated with Hp. In the second group, cardiac/mixed mucosa was present in 80.5%. There was a trend for an association between carditis (87.4%) and reflux esophagitis and hiatal hernia. Biopsies from the endoscopically defined cardia rarely contained cardiac/mixed mucosa (12.6%). These findings suggest two etiologies for carditis. In a normal-appearing SCJ carditis is associated with Hp, whereas in an irregular SCJ with short columnar segments/tongues carditis is associated with features of gastroesophageal reflux.

Biopsy↗
PubMed2001

Epidemiological, clinical, and histological characteristics of intestinal metaplasia at the oesophagogastric junction compared to short segments of columnar-lined oesophagus.

OBJECTIVE: Intestinal metaplasia (IM) close to the oesophagogastric junction (OGJ) has become a focus of research interest against a background of the rising incidence of malignancies in that area. Studies have focused on the presence of IM in short columnar segments (0-3 cm). Recently it has been suggested that IM at the OGJ and IM in short columnar segments may represent different entities. The objective of this current study was to determine the prevalence of IM in these areas and to assess clinical characteristics in order to test the hypothesis that IM at the OGJ and IM in short columnar segments are different entities. METHODS: Six hundred and fifty-eight patients referred for gastroscopy, in whom a columnar lining of 0-3 cm was found, participated in the study. Endoscopic oesophagitis was graded, distances to endoscopic landmarks were measured, and biopsies (antrum, corpus, 'cardia', and immediately distal to the squamocolumnar junction) were taken. Biopsies were stained with haematoxylin & eosin, Alcian Blue (pH 2.5), modified Giemsa for Helicobacter pylori (Hp), and immunohistochemistry in cases of a negative Giemsa. According to endoscopy, patients were categorized as having a normal OGJ (0-1 cm) or having a short columnar segment (1 -3 cm, tongues >1 cm). RESULTS: In this study 77.7% of patients had a normal OGJ (IM-positive 15.1%), and 22.3% had a short columnar segment (IM-positive 29.3%). In the first group, IM was correlated with Hp (P = 0.003) and antral IM (P = 0.002), in the second IM was associated with the presence of a hiatal hernia (P < 0.001) and reflux oesophagitis (P = 0.023). CONCLUSION: These findings suggest that IM at the OGJ is not the same entity as IM in short columnar segments.

Esophageal Neoplasms↗
PubMed2001

Prolonged measurement of lower oesophageal sphincter function in patients with intestinal metaplasia at the oesophagogastric junction.

BACKGROUND AND AIMS: It has been shown that gastro-oesophageal reflux plays a role in the pathogenesis of intestinal metaplasia (IM) limited to the oesophagogastric junction (OGJ), similar to the pathogenesis of IM in long segments of columnar lined oesophagus. The aim of this study was to examine lower oesophageal sphincter (LOS) function by means of prolonged recording in patients with IM limited to a normal appearing OGJ. PATIENTS AND METHODS: Eighteen patients with IM at the OGJ (five females, 13 males; mean age 55.4 years) and 22 patients without IM (nine females, 13 males; mean age 53.9 years) underwent conventional stationary oesophageal manometry. Thereafter, seven hour water perfused manometry with simultaneous pH measurement (probe 5 cm proximal to the LOS) was performed. Swallowing was monitored with a pharyngeal sidehole and LOS pressure was recorded with a Dent sleeve. Patients were studied in the fasted state (three hours) and after a standardised meal (four hours). LOS pressure was analysed using customised software, and the incidence of reflux episodes (pH <4 for at least five seconds) and transient LOS relaxations (TLOSRs) were examined. TLOSRs were judged to be accompanied by reflux if a decrease of 1 pH unit occurred during relaxation. RESULTS: Patients with IM at the OGJ had a higher prevalence of postprandial acid reflux compared with patients without IM. No differences were observed in LOS pressure (pre- and postprandially) or in the prevalence of TLOSRs. However, in the postprandial phase, the rate of TLOSRs accompanied by acid reflux was increased in patients with IM. CONCLUSION: Patients with IM at the OGJ have a higher prevalence of postprandial acid reflux. This is not associated with a higher prevalence of TLOSRs or a decreased LOS pressure but with a higher rate of TLOSRs accompanied by reflux.

Case-Control Studies↗
PubMed1999

Hodgkin's disease presenting as a parasternal chest wall mass.

A 53 year-old Moroccan woman presented with a tender parasternal mass. Computerized tomography showed a mediastinal mass protruding through the sternum. Cytologic examination of fluid collected from the mass repeatedly showed acute inflammation. Tuberculostatics were started. Since patient did not improve on tuberculostatics, a small supraclavicular lymph node was removed. Histologic examination showed Morbus Hodgkin of the nodular sclerosing type. Ultimately, cytologic examination of fluid from the parasternal mass showed atypical cells. Response on chemotherapy was excellent with complete disappearance of the parasternal mass. This is a very unusual extranodal presentation of Hodgkin's disease.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1999

Columnar lined oesophagus and intestinal metaplasia: current concepts.

Barrett's oesophagus is a condition where the distal oesophagus is lined with columnar epithelium. For the diagnosis intestinal metaplasia has to be found and a minimal length of 3 cm is required for the columnar-lined segment. It is well known that patients with the traditional Barrett's oesophagus have a higher risk of developing adenocarcinomas in the metaplastic segment. The clinical significance of shorter metaplastic segments and intestinal metaplasia at the gastro-oesophageal junction is much less certain. Different definitions are in use and the increasing number of studies dealing with these mucosal changes therefore may create confusion. In this article, the current knowledge concerning epidemiology, pathophysiology, clinical associations, diagnostic possibilities including endoscopy, pathology, measurement of differences in electrical potential, and treatment of columnar-lined oesophagus of any length and of intestinal metaplasia at the gastro-oesophageal junction is reviewed. Furthermore, the need for a consistent definition is emphasized.

Adenocarcinoma↗
PubMed1998

Primary thyroid lymphoma.

A 71-year-old woman presented with a rapidly growing goitre which was diagnosed as chronic autoimmune thyroiditis. Despite treatment with levothyroxine, she developed progressive airway obstruction. Biopsy revealed a primary thyroid lymphoma which was successfully treated with radiotherapy.

Aged↗
PubMed1998

CD44 splice variants as prognostic markers in colorectal cancer.

BACKGROUND: Splice variants of CD44 play a causal role in the metastatic spread of pancreatic carcinoma in the rat. In previous studies we have shown that homologues of these CD44 isoforms (CD44v6) are overexpressed during colorectal tumorigenesis in man and that CD44v6 overexpression is associated with an unfavorable prognosis in this disease. In the present study we have assessed the prognostic significance of CD44 variants containing exon v5. In addition, we have used a panel of different antibodies against CD44v6 and applied a combined scoring system to improve its value as prognosticator. METHODS: Expression of CD44 variants was studied by immunohistochemistry on frozen tissue sections, and the prognostic value of the CD44 variant expression was assessed using univariate and multivariate analysis. RESULTS: Our studies show that expression of CD44v6, but not CD44v5, has significant prognostic value. Analysis of CD44v6 expression by means of a combined scoring system, on the basis of a panel of three different monoclonal antibodies (mAbs), makes CD44v6 a highly significant prognostic marker that is independent of Dukes stage, tumor grade, or tumor localization. CONCLUSION: Assessment of CD44v6 expression by a combination of mAbs yields an independent prognosticator that may be of value in identifying patients with a high propensity to develop distant metastasis.

Adult↗
PubMed1997

Kikuchi's histiocytic necrotizing lymphadenitis.

Kikuchi's lymphadenitis was first recognized almost 25 years ago in Japan as a histopathologically specific reactive lymphadenitis without clear clinical correlates. The benign self-limiting clinical course and the notorious danger of misdiagnosis as malignant lymphoma together make it important to recognize this lymph node reaction type. We describe 2 typical case histories-young women with a cervical localisation.

Adult↗
PubMed1997

The prognostic value of neuroendocrine differentiation in adenocarcinoma of the prostate in relation to progression of disease after endocrine therapy.

PURPOSE: We evaluated the prognostic impact of neuroendocrine differentiation in prostate cancer with regard to the onset of endocrine therapy failure. MATERIALS AND METHODS: A retrospective study was performed on 72 transurethral resection specimens from patients who subsequently underwent endocrine therapy for prostate cancer and were followed for 44 to 95 months. Progression-free interval was recorded. Distribution pattern and proportion of neuroendocrine cells were examined in transurethral resection specimens. Neuroendocrine cells were identified based on immunoreactivity for chromogranin A. RESULTS: Of 32 patients with progressive disease 27 died of prostate cancer. Chromogranin A positive cells were found in 40 of the 72 prostate cancers (55%). In a Cox proportional hazards analysis neuroendocrine differentiation of the tumor showed a negative correlation with progression-free survival (p = 0.022), which proved to be independent of the Gleason score (p < 0.001). CONCLUSIONS: Our results support the view that neuroendocrine differentiation in prostatic adenocarcinomas is a prognostic factor for progressive disease under subsequent endocrine therapy. This prognosticator acts independently of tumor grade.

Adenocarcinoma↗