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Biomedical subjects

G A Bruyn

Publications and source records attributed to G A Bruyn.

At least 37 records · Page 2Linked to original sources
PubMed1994

Pneumocystis carinii pneumonia associated with low dose methotrexate treatment for rheumatoid arthritis.

Since 1983 there have been several reports on Pneumocystis carinii pneumonia (PCP), complicating low dose methotrexate (MTX) therapy for rheumatoid arthritis (RA). Two additional cases of this opportunistic infection are reported and a review of the literature on the complication is presented. It is concluded that PCP is a serious complication of low dose MTX therapy for RA and should always be ruled out when a patient presents with pulmonary symptoms. Several factors may play a role in the occurrence of this opportunistic infection, but the exact mechanism has not yet been elucidated.

Adult↗
PubMed1993

Double-blind comparison of efficacy and gastroduodenal safety of diclofenac/misoprostol, piroxicam, and naproxen in the treatment of osteoarthritis.

OBJECTIVES: To compare the efficacy and gastroduodenal safety of a fixed-dose combination of diclofenac sodium 50 mg and misoprostol 200 micrograms twice daily with those of piroxicam 10 mg twice daily and naproxen 375 mg twice daily in patients with osteoarthritis. METHODS: A 4 week, randomised, double-blind, parallel-group, multicentre study was conducted in 643 patients with symptomatic osteoarthritis of the hip and/or knee, who required continuous non-steroidal anti-inflammatory drug therapy for 4 weeks and who were without significant upper gastrointestinal damage as confirmed by endoscopy. RESULTS: For patients who had pre- and post-treatment endoscopic examinations, gastroduodenal ulcers developed in 3 (1.5%) of 200 patients treated with diclofenac/misoprostol, 21 (10.3%) of 204 piroxicam-treated patients, and 17 (8.6%) of 198 patients receiving naproxen (Chi square = 13.771, p = 0.001). The improvement in the osteoarthritis severity index was greater in the diclofenac/misoprostol group than in the piroxicam group (p = 0.004). Changes in physician and patient global assessments showed no significant differences between treatment groups. The incidences of diarrhoea and abdominal pain were higher in the diclofenac/misoprostol group than in the piroxicam and naproxen groups. CONCLUSIONS: Diclofenac/misoprostol at twice daily dosing is associated with significantly fewer gastroduodenal ulcers than either piroxicam or naproxen. The efficacy of diclofenac/misoprostol in treating the signs and symptoms of osteoarthritis is at least comparable to that of piroxicam and naproxen.

Adult↗
PubMed1992

Mechanisms of host defense against infection with Streptococcus pneumoniae.

Various aspects of the host's response to infection by Streptococcus pneumoniae are reviewed. First, the structure of the bacterium is described, with a focus on those elements that are related to its immunogenicity and pathogenicity. The epidemiology of the pneumococcal serotypes, which are differentiated by the molecular structure of the capsule, is considered briefly, and several key points are emphasized--for example, that some pneumococcal types are more pathogenic than others; that variations in biological behavior are based on differences in the chemical composition of the capsule, although the particular factors determining virulence are not known; and that cell wall peptidoglycan, a structure common to all pneumococci, plays an important role in the inflammatory reaction in the tissues. Next, current views on the pathogenesis of pneumococcal infections are discussed. Finally, the roles of type-specific antibodies to the capsular polysaccharide and of complement in the opsonization of pneumococci and the clearance of these bacteria from the bloodstream by the spleen and liver are reviewed.

Animals↗
PubMed1991

Pneumococcal polysaccharide vaccines: indications, efficacy and recommendations.

Streptococcus pneumoniae is the primary cause of community-acquired pneumonia, meningitis in adults and otitis media in infants and children and the third cause of meningitis in infants and children. Despite the availability of effective therapeutic agents against this pathogen, mortality has remained high, particularly for infections complicated by bacteremia. For many years, there has been a plea for vaccination. The first steps, using whole bacterial vaccines, were taken during the early decades of this century in the gold mining camps of South Africa, where pneumonia was endemic. The efficacy of purified pneumococcal polysaccharide vaccines has since been demonstrated in young adults, such as gold miners and military recruits, as well as for several other groups at risk, such as institutionalized elderly, patients with sickle cell anemia or those who have undergone a splenectomy, and elderly patients with underlying conditions such as chronic obstructive pulmonary disease and chronic cardiovascular disease, but not in infants and severely immunocompromised patients. Serological studies on the immune response to inoculation of pneumococcal polysaccharide antigens have demonstrated a severely impaired antibody response in the last two groups. Therefore, development of more highly immunogenic vaccines, e.g. by linking pneumococcal polysaccharides or parts of them to protein carriers, should be continued in an attempt to offer adequate protection to those who are insufficiently protected by the current 23-valent polysaccharide vaccine. Opportunities to immunize other patients who are at risk for pneumococcal infection and are capable of responding to the current vaccine should not be missed.

Antibodies, Bacterial↗
PubMed1990

Pneumococcal anticapsular antibodies in patients with chronic cardiovascular and obstructive lung disease in The Netherlands.

Differences in pneumococcal anticapsular antibody concentrations were assessed among patients with various chronic disorders and among young (25-35 years of age) and older adults (55-65 years). Antibody concentrations were determined by ELISA, using the whole 23-valent pneumococcal polysaccharide vaccine as antigen. No differences in mean or distribution of serum antibody concentrations were found among young adults (either healthy or asthmatic) or among older adults (healthy or with chronic obstructive pulmonary or chronic cardiovascular disease). Each group included individuals with low antibody levels. Therefore, the enhanced susceptibility to pneumococcal infections reported for some groups at risk, that is, elderly individuals and patients with chronic obstructive pulmonary or chronic cardiovascular disease, cannot be attributed solely to low anticapsular antibody concentrations.

Adult↗
PubMed1990

Pneumococcal endocarditis in adult patients. A report of five cases and review of the literature.

A retrospective survey of patients with pneumococcal infective endocarditis at the University Hospital, Leiden, over a 10-year period (1976-1986) yielded five cases. Applying strict case definitions, four patients had definite and one patient possible pneumococcal endocarditis. The commonest presenting signs and symptoms were malaise, fever, and congestive heart failure. Predisposing conditions were previous splenectomy in one case and a valve prosthesis in another. The aortic valve was the most common site of infection. In four of the five patients the diagnosis of endocarditis was made during life. These patients were treated appropriately, i.e. with antibiotics to which S. pneumoniae is sensitive. In three patients, surgical intervention was performed in the acute phase because of progressive heart failure. Paravalvular abscesses were observed at surgery in all these cases. The four patients treated in our series recovered fully; the single fatal case constituted an unrecognized case of pneumococcal endocarditis. If recognized and treated appropriately (particularly with early selective surgery) endocarditis can be cured. In a statistical analysis of 36 patients with pneumococcal endocarditis reported during the past five years, we found a significantly higher occurrence and mortality in men than in women; no other clinical features were associated with a poor outcome of illness.

Adolescent↗
PubMed1990

Sweet's syndrome.

Two women are reported both of whom exhibited, after an episode of an upper respiratory tract infection, painful, erythematous, sharply demarcated plaque-like lesions on the extremities, in combination with fever. In addition, one woman also had acute polyarthritis and episcleritis. The histological features of the lesions showed a perivascular neutrophilic infiltration in the dermis without signs of vasculitis, pathognomonic of Sweet's syndrome. One patient was successfully treated, initially with aspirin and later prednisone, the other with potassium iodide. Recognition of this syndrome is important in view of the dramatic response to treatment, particularly corticosteroids.

Adult↗
PubMed1989

Clinical evaluation of pneumococcal meningitis in adults over a twelve-year period.

A retrospective study was performed to review the clinical features and outcome of 39 episodes of pneumococcal meningitis in 36 adult patients over a 12-year period. Overall mortality was 33.3%. Only a few of the deaths were directly related to the central nervous system disease and most of them were due to cardiorespiratory failure. Univariate analysis showed that death was more likely to occur in patients with advanced age, an absence of neck stiffness, a high pulse rate, an associated pneumonia, internal complications, or a long duration of the disease (greater than 7 days) before treatment was started. Patients who died had a higher erythrocyte sedimentation rate and serum bilirubin level and a lower serum sodium level than those who survived. Discriminant analysis showed the development of internal complications to be the strongest predictive factor of a poor outcome of illness. Two other important predictors of a poor outcome were the absence of neck stiffness and associated pneumonia. The history of a skull fracture or head surgery was significantly correlated with a better than average prognosis. The incidence of sequelae in survivors at the time of discharge amounted to 72%. None of the clinical features were significantly correlated with the development of sequelae, except a higher cerebrospinal fluid protein content.

Adolescent↗