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Biomedical subjects

C J Mulder

Publications and source records attributed to C J Mulder.

At least 91 records · Page 5Linked to original sources
PubMed1991

Endoscopic and histopathologic features of Degos' disease.

The case is reported of a 69-year-old female with atrophic papules on the skin who developed multiple spontaneous intestinal perforations of which she eventually died. The skin lesions in combination with lesions in the gastrointestinal tract are typical for Degos' disease or malignant atrophic papulosis. The characteristic histopathological and endoscopic features of this rare disease are reported. This case demonstrates the importance of routinely performing endoscopy in Degos' disease to detect silent perforation, even in patients without gastrointestinal complaints.

Aged↗
PubMed1991

Retrograde spread of mesalazine (5-aminosalicylic acid)-containing enema in patients with ulcerative colitis.

In order to investigate the retrograde spread in the colon and its relationship to the extent of the diseased area, the authors evaluated a 100ml enema of mesalazine (5-aminosalicylic acid, Pentasa') lg in a consecutive series of 30 patients with ulcerative colitis. The enema was labelled with 10 MBq 99mtechnetium-human serum albumin microcolloid. Sequential scintigraphic imaging was performed in all patients, and the results compared with the extension of the disease as found by colonoscopy. If the enema reached the entire affected area it was interpreted as 'topically adequate'. In 80% of the patients there was retrograde spread of the enema beyond the rectosigmoid, thus reaching the affected area in ulcerative colitis. No relationship was found between the extent of dispersion of the enema and the time of defecation prior to scintigraphy. The authors conclude that a 100ml 'Pentasa' enema may be adequate for treatment of ulcerative colitis extending up to the splenic flexure.

Adolescent↗
PubMed1990

Five-year cimetidine maintenance trial for peptic ulcer disease. A clinical and endocrinologic approach.

A multicentre maintenance trial was conducted in 63 peptic ulcer patients to investigate the efficacy and safety of continuous cimetidine maintenance therapy for up to 5 years. In Amsterdam the male patients were investigated yearly for possible endocrinologic changes and to monitor gastric acid secretory capacity. Patients with healed ulcers entered maintenance treatment with a 400-mg bedtime dose of cimetidine. The yearly relapse rates decreased from 20% to 6% from year 1 to year 4. Adverse reactions observed in this study were not different from those previously reported with cimetidine. Endocrinologic studies in 10 male patients showed a small but consistent increase in basal gastrin in the 3rd and 4th year, stabilizing in the 5th year. Prolactin levels showed a gradual increase during the first 3 years but remained well within the normal range. In the 4th and 5th year they decreased again; however, the changes noted were rather modest. It is concluded from this study that weak nocturnal acid inhibition with cimetidine maintenance treatment not only continues to be effective and safe beyond 1 year but also reduces the risk of relapse over time. No relevant endocrinologic abnormalities are to be expected with this regimen of modest nocturnal acid suppression.

Adult↗
PubMed1990

Omeprazole and ranitidine in duodenal ulcer healing. Analysis of comparative clinical trials.

Ten double-blind randomized studies with omeprazole versus ranitidine in duodenal ulcer healing have been published. The total number of patients in the trials amounted to 2225. To detect treatment differences, a meta-analysis was performed. After 2 and 4 weeks of treatment results have been evaluated. After 2 weeks of treatment omeprazole produced higher healing rates than ranitidine in nine studies. However, at 4 weeks numerical differences in favour of omeprazole were found in nine studies. Relief of ulcer symptoms occurred more rapidly with omeprazole than ranitidine. No major clinical or biochemical side effects were recorded. However, no data are available about maintenance therapy in double-blind randomized studies comparing both drugs or about rebleeding rates in bleeding duodenal ulcer treatment.

Duodenal Ulcer↗
PubMed1990

Absorption of oral mesalazine-containing preparations and the influence of famotidine on the absorption.

The mesalazine-containing preparations Asacol, Pentasa, and Salofalk (=Claversal) are frequently used in the treatment of inflammatory bowel disease. The release patterns of these formulations are time- and/or pH-dependent. The aim of this study was to investigate the patterns of absorption of these preparations and the influence of raised intragastric pH on absorption. Gastric pH was raised by simultaneous administration of famotidine. Absorption was determined by assaying with a high-performance liquid chromatography method the urinary excretion of acetylmesalazine, the major metabolite of mesalazine. A large intra- and inter-individual variability in absorption was found for all three formulations, both with and without concomitant famotidine administration. Asacol and Pentasa were significantly less absorbed than Salofalk. A significant lower absorption of mesalazine was seen when Asacol was combined with famotidine. Variations in gastric pH have negligible effect on the bioavailability of mesalazine in vivo.

Administration, Oral↗
PubMed1990

Anemia: monosymptomatic celiac disease. A report of 3 cases.

Patients with monosymptomatic celiac disease (CD) can escape diagnosis for a long period. Anemia is a common finding in CD, although anemia as the sole symptom is relatively unknown. We report on three patients who presented with iron deficiency anemia and no other symptom, in whom CD was considered and diagnosed several to many years after the anemia was documented.

Anemia, Hypochromic↗
PubMed1989

Formulation and stability of a beclomethasone dipropionate enema.

A beclomethasone dipropionate (BDP) enema and a BDP/mesalazine combination enema (containing 2 mg BDP and 1 g mesalazine and 2 mg BDP, respectively per 40 ml) were formulated. BDP and mesalazine were suspended in a carbomer-water gel. No degradation of BDP was measured during the storage period of the BDP enema (4 weeks at 20 degrees C) and of the BDP/mesalazine enema (44 days at 4 degrees C, 20 degrees C and 37 degrees C, respectively). Progressive darkening of colour occurred for the BDP/mesalazine enema during storage at 20 degrees C and at 37 degrees C, probably induced by mesalazine degradation products. Only very slight colouring was observed at 4 degrees C. Hardly any precipitation of BDP and mesalazine was seen during the storage period and the enemas could easily be resuspended.

Beclomethasone↗
PubMed1989

The effect of bisacodyl on whole-gut irrigation in preparation for colonoscopy.

The cleansing effect of whole-gut irrigation with a balanced electrolyte solution (BES), with or without pretreatment with bisacodyl, was compared, in order to establish whether bisacodyl reduces the duration and side effects of whole-gut irrigation. Bisacodyl at a dose of 20 mg in 2 days reduced the duration of the whole-gut irrigation procedure. No side-effects related to bisacodyl were demonstrated. We therefore consider bisacodyl to be a useful and inexpensive adjunt for colonic preparation of patients receiving whole-gut irrigation.

Bisacodyl↗
PubMed1989

Omeprazole (20 mg o.m.) versus ranitidine (150 mg b.d.) in duodenal ulcer healing and pain relief.

The object of this double-blind, multicentre study was to compare duodenal ulcer healing rates after 2 to 4 weeks of treatment with either 20 mg omeprazole o.m. or 150 mg ranitidine b.d. One hundred and eighty-one patients were randomized: 91 received omeprazole and 90 received ranitidine. In a per protocol analysis at 2 weeks, 63% of the patients were healed on omeprazole and 65% of the patients were healed on ranitidine (N.S.); at 4 weeks 91% were healed in the omeprazole group and 96% were healed in the ranitidine group. There were no differences in ulcer symptom relief between the two groups. There were no significant changes in laboratory values in either of the groups. Adverse events were few and mainly mild and transient. We conclude that both omeprazole (20 mg o.m.) and ranitidine (150 mg b.d.) result in rapid, ulcer healing rates.

Adult↗
PubMed1989

Comparison of beclomethasone dipropionate (2 and 3 mg) and prednisolone sodium phosphate enemas (30 mg) in the treatment of ulcerative proctitis. An adrenocortical approach.

Twenty-three patients with attacks of distal ulcerative colitis were treated randomly with either 2 or 3 mg of topically administered beclomethasone dipropionate (BDP) or 30 mg of prednisolone sodium phosphate (PP). The effect of the steroid enemas on adrenocortical function was assessed by ACTH tests, which were performed before and after treatment. Endoscopic, clinical and histological scores were comparable in the three treatment groups in this pilot trial. Fasting cortisol in the PP group decreased significantly from 0.47 +/- 0.12 mumol/l before to 0.22 +/- 0.14 mumol/l (P less than 0.05) after therapy; in the BDP group no significant changes were found. Urinary cortisol excretion in the PP group was not detectable after therapy; in the BDP group no changes were found. It is concluded that in the topical treatment of ulcerative colitis, BDP may be preferable to PP because it exerts a promising anti-inflammatory action without affecting adrenocortical function.

Adult↗
PubMed1989

Retrograde spread of therapeutic enemas in patients with inflammatory bowel disease.

Little is known about the factors that determine the extent of dispersion of enema solutions in the colon. To unravel some of the determinants we evaluated a consecutive series of patients with left-sided colitis. 40 ml enema solutions, viscosity 0.062 Pa.s (62 cP) at 37 degrees C were labelled with 10 MBq 99m-technetium human serum albumin microcolloid. Scintigraphic imaging was performed in 35 patients until 2 hours after administration of the enema. In 8 of the 16 patients with limited retrograde spread the study was repeated after doubling the volume (80 ml). We conclude that the extent of dispersion of an enema 0.062 Pa.s solution is highly variable. The basic fluid component for therapeutic 40 ml enemas (viscosity 0.062 Pa.s) reaches the affected area in patients with left sided colitis only in 40% of the cases. Increasing the volume of the enema can be an effective way to increase the retrograde spread up to the affected area in patients with limited retrograde spread. Scintigraphic imaging is a simple and reliable method of checking whether an enema conforms to the requirements of medical treatment. Scintigraphic imaging lasting for 1 hour after administration of the enema appears to suffice.

Adolescent↗
PubMed1988

Double-blind comparison of slow-release 5-aminosalicylate and sulfasalazine in remission maintenance in ulcerative colitis.

The results of a clinical trial comparing slow-release 5-aminosalicylic acid tablets (Pentasa) and enteric-coated sulfasalazine tablets (Salazopyrin) with regard to the efficacy of maintaining ulcerative colitis patients in remission for 12 mo and with regard to safety of treatment are reported. Seventy-five patients with ulcerative colitis in remission for between 1 mo and 5 yr were included for analysis. Forty-nine men and 26 women, aged between 18 and 79 yr, received either Pentasa t.i.d. (1500 mg) plus Salazopyrin placebo or Salazopyrin t.i.d. (3 g) plus Pentasa placebo daily. Patients were assessed clinically, endoscopically, and histologically before and 3, 6, 9, and 12 mo after the start of treatment. Life-table analysis showed ongoing remission after 6 and 12 mo for Pentasa to be 63% (26 of 41) and 54% (22 of 41) and for Salazopyrin 72% (22 of 31) and 46% (14 of 31). These differences were not statistically significant. Three patients treated with Salazopyrin were withdrawn because of severe erythrodermia, anxiety and backache, and pregnancy, respectively. One patient on Salazopyrin experienced transient rises in serum urea, creatinine, and lactic dehydrogenase and another patient in this group reported slight reversible loss of hair. In the Pentasa group no side effects were recorded. We conclude that Pentasa is a well-tolerated drug, equally effective as Salazopyrin in maintenance of remission of ulcerative colitis.

Actuarial Analysis↗
PubMed1988

Endoscopic lesions in Crohn's disease early after ileocecal resection.

Fifty patients with Crohn's disease were studied endoscopically 6 weeks to 6 months (median 9 weeks) after ileocecal or ileocolonic resection for evidence of non-resected abnormality. Only 8 of the 50 patients were endoscopically free of abnormalities. Microscopic examination of the surgical specimen revealed inflammatory pathology at the site of resection line in 30 patients. Of the latter, 27 had endoscopic lesions at the anastomosis or in the "neoterminal" ileum. Of the 42 patients with endoscopic lesions only 8 had minor biochemical abnormalities. This study suggests that the well known reappearance of inflammatory activity after resection, especially at and proximal to the anastomosis, develops from foci of remaining inflammation and should be considered as recrudescence of the disease rather than true recurrence.

Adult↗
PubMed1988

Comparison of 5-aminosalicylic acid (3 g) and prednisolone phosphate sodium enemas (30 mg) in the treatment of distal ulcerative colitis. A prospective, randomized, double-blind trial.

Twenty-nine patients with attacks of distal ulcerative colitis were treated randomly with 3 g 5-aminosalicylic acid (5-ASA) or 30 mg of prednisolone phosphate sodium (PP) enemas (40 ml). Endoscopic, clinical, and histologic improvement were comparable in the two treatment groups. Our study showed that topical treatment with 5-ASA is as efficacious as PP in improving distal ulcerative colitis.

Adult↗