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Biomedical subjects

J Hermans

Publications and source records attributed to J Hermans.

At least 289 records · Page 16Linked to original sources
PubMed1994

Prevalence of blindness and low vision of people over 30 years in the Wenchi district, Ghana, in relation to eye care programmes.

A population based survey on the prevalence of major blinding disorders was conducted in the Wenchi district in central Ghana between March and May 1991. In 10 villages, 1425 people of 30 years and older were screened, using the WHO eye examination record. The prevalence of bilateral blindness above 30 years proved to be 1.7% (best acuity < 3/60): the prevalence of low vision above 30 years was 2.0% (best visual acuity 6/18 to 3/60). The causes of blindness were determined as cataract (62.5%), onchocerciasis (12.5%), corneal opacity (non-trachomatous) (8.2%), refraction anomalies (4.2%), phthisis bulbi (4.2%), optic atrophy (4.2%), and vascular retinopathy (4.2%). In the Wenchi district, 1.0% of the population over the age of 30 years was found to need a cataract extraction because of blindness of both eyes. Another potential 1.0% needs a cataract extraction because of low vision. A minor second study (n = 149) was undertaken in the same district, but in a village in an area near the Black Volta river in which onchocerciasis is endemic. The prevalence of blindness (8.1%) and low vision (3.4%) caused by onchocerciasis and cataract both proved to be higher. The survey provided the basis for a preventive and curative eye care programme.

Adult↗
PubMed1994

Changes in tumor perfusion induced by chemotherapy in bone sarcomas: color Doppler flow imaging compared with contrast-enhanced MR imaging and three-phase bone scintigraphy.

PURPOSE: To prospectively evaluate color Doppler flow imaging (CDFI) with spectral analysis versus dynamic gadolinium-enhanced magnetic resonance (MR) imaging and three-phase bone scintigraphy in monitoring the effect of chemotherapy on bone sarcomas. MATERIALS AND METHODS: Seventeen osteosarcomas and five Ewing sarcomas were examined with these imaging techniques before and after chemotherapy. Results were compared with the histopathologic response. RESULTS: Before chemotherapy, high systolic Doppler frequency shifts (DFSs) and/or low-impedance Doppler signals were found in all but one tumor. Resistive indexes (RIs) in tumor-feeding arteries were substantially lower than in contralateral normal arteries. After chemotherapy, DFSs disappeared in five of seven good respondents and remained substantial in all but one poor respondent. RIs increased substantially in all good respondents and decreased or showed minor changes only in all but one poor respondent. CONCLUSION: CDFI with spectral analysis has an advantage over the other two techniques in monitoring the efficacy of chemotherapy in bone sarcomas because of its superior accuracy, noninvasive nature, availability, and low cost.

Adult↗
PubMed1994

Persistent cervical intraepithelial neoplasia after incomplete conization: predictive value of clinical and histological parameters.

In a group of 316 conizations performed from January 1984 to July 1991, 68 patients (22%) revealed no free margins of cervical intraepithelial neoplasia (CIN). They were divided into two groups with: 'negative follow-up' [normal cytology or less than two smears suggesting CIN I (class IIIa)] and 'positive follow-up' [at least two smears suggesting CIN I or one smear suggesting CIN II (class IIIb) or worse]. Forty-five patients (66%) fulfilled the criteria of negative follow-up. All patients with CIN I at the cone margin (18) were found in this group. The other 23 patients were in the positive follow-up group. Patients with positive follow-up were significantly younger (p = 0.04). Intervention after incomplete cone biopsy was necessary in approximately 10% (7/68) of cases. Cytology was thereby a reliable indicator for residual disease. Higher grade of CIN involved at the cone margin predicted a higher chance of positive follow-up. Semiquantitative measurement of CIN in the cone specimen showed a severe involvement of CIN II and CIN III in the positive follow-up group. In sum, our study showed that CIN I at the margin of the cone biopsy has no clinical significance. However, CIN II or III at the margin needs a careful cytologic follow-up, and appropriate action should be taken in case of cytologic abnormalities.

Adult↗
PubMed1994

Evaluation of the extent of lymphadenectomy in a randomized trial of Western- versus Japanese-type surgery in gastric cancer.

PURPOSE: In the context of a prospective, randomized trial of gastric cancer treatment, comparing Western surgical resection with limited lymphadenectomy (R1) versus Japanese surgical resection with extended lymphadenectomy (R2), we analyzed adherence to the specified surgical-pathologic guidelines. PATIENTS AND METHODS: Following evaluation of 389 patients, we quantified noncompliance (ie, performance of less dissection than specified) and contamination (ie, performance of more extensive dissection than specified). Of 389 patients, pathologic data permitted identification of 237 eligible patients treated with curative intent. RESULTS: Noncompliance occurred in 84% of R1 and R2 cases, with magnitude significantly (P < .001) higher in R2 cases versus R1 cases. Contamination occurred in 48% of R1 cases and 52% of R2 cases, with the magnitude of contamination moderate and equally distributed between the two groups. The contamination in R1 resections and the noncompliance in R2 resections lead to a partial homogenization of the groups, undermining the likelihood of detecting any potential therapeutic advantage to R2 dissection. CONCLUSION: The observed tendency to perform R1 resections combined with insufficient retrieval of lymph nodes underlines the need for increased surgical-pathologic standardization in this trial. Potential remedies are discussed. Proper conduct of clinical trials requires reliable means of standardizing performance of the surgical-pathologic team, an elusive but important goal.

Adenocarcinoma↗
PubMed1994

[Comparison of azathioprine and methotrexate in rheumatoid arthritis: an open-randomized clinical study].

Thirty-eight patients with active rheumatoid arthritis (RA) were entered in an open randomized 24-week study comparing azathioprine (AZA; initial daily dose 1 mg/kg) with methotrexate (MTX; initial weekly dose 7.5 mg). The patients had previously been treated with antimalarials, gold salts and/or D-penicillamine. The groups were well balanced in baseline characteristics. There were three premature withdrawals in each group, all of which were due to toxicity. The present study did not show any significant differences between AZA and MTX in ability to reduce activity in RA after 24 weeks of treatment.

Adult↗
PubMed1994

EBMT survey on bone marrow transplant activity in Europe: regional differences.

In the years 1991 and 1992, 203 teams in 26 European countries performed 11026 BMT procedures: 4841 allografts and 6185 autografts; 10263 (93%) were performed in those 12 countries which did at least 100 transplants in total and five transplants per 1 million inhabitants per year during this 2-year period. Indications for these 10263 BMT were leukemia in 5080 patients (3294 allo-BMT, 1786 auto-BMT), lymphopro-liferative disorders in 3177 patients (329 allo-BMT, 2848 auto-BMT), solid tumors in 1236 patients (18 allogeneic-BMT), 1218 autologous-BMT), aplastic anemia in 305 patients and hemoglobinopathies or inborn errors of disease in 465 patients (456 allogeneic-BMT, 9 autologous-BMT). The proportion of allogeneic- and autologous-BMT, the main indications and the timing (first complete remission versus later stages) were compared between these 12 countries. Differences and similarities can be observed in all three aspects. They underline previously described differences in Europe which can partially be ascribed to different patient populations but may also be caused by divergent medical opinions.

Anemia, Aplastic↗
PubMed1994

An analysis on the effect of blood transfusion on recurrence and survival in patients undergoing extended lymphadenectomy for colorectal cancer.

In a retrospective study data were collected from 644 patients with cancer of the colon or rectum undergoing curative surgery with extended lymphadenectomy to evaluate a possible effect of blood transfusion, given perioperatively, on tumor recurrence and patient survival. Univariate analysis showed depth of bowel wall invasion, number and level of lymph node metastases to be of highly significant prognostic factors. After 5 years the overall recurrence rate was 16.6% for the non-transfused (n = 223) and 26.1% for the transfused (n = 421; p < .01) patients, and survival rates showed borderline significance favoring the non-transfused patients (90.5% vs. 80.0% after 5 years; p < 0.05). However, after stratification for the prognostically important factors, in a multivariate analysis a possible detrimental effect of perioperative blood transfusions could not be demonstrated.

Adenocarcinoma↗
PubMed1994

Bone marrow transplantation activity in Europe 1992: report from the European Group for Bone Marrow Transplantation (EBMT).

In the year 1992, 203 teams in 26 countries in Europe performed a total of 6065 bone marrow transplantations (BMT). Transplant source in 2666 cases (44%) was an allogeneic donor, in 2171 cases an HLA-identical sibling donor, in 170 a non-identical family donor, in 29 a twin donor and in 296 cases an unrelated volunteer donor. There were 3399 autologous transplants (56%): 2494 autologous BMT, 644 autologous peripheral blood stem cell transplants and 261 combined autologous BM and peripheral blood stem cell transplants. Indications for transplant were leukemias in 2963 patients (49%; 1987 allogeneic, 976 autologous), lymphoproliferative disorders in 1890 patients (31%; 201 allogeneic, 1689 autologous), solid tumors in 739 patients (12%; 10 allogeneic, 739 autologous), aplastic anemia in 194 patients (3%; 193 allogeneic, 1 autologous), thalassemia in 128 patients (2%; allogeneic), inborn errors in 115 patients (2%; allogeneic) and miscellaneous disorders in 36 patients (32 allogeneic, 4 autologous). Compared with an EBMT survey 2 years ago, there was an increase in the number of participating institutions and in the number of transplants performed from all sources. If the 142 teams reporting in 1990 and 1992 are compared alone, there is an increase in unrelated allogeneic BMT and in autologous BMT. There was an increase in autologous transplants for myeloma and lymphoma. These data confirm a continuing trend to apply BMT as a therapeutic modality.

Bone Marrow Transplantation↗
PubMed1994

Autosomal recessive osteopetrosis: variability of findings at diagnosis and during the natural course.

OBJECTIVE: To determine the variability and the natural course of children suffering from autosomal recessive osteopetrosis to allow optimal counseling and decision making with respect to therapeutic intervention. DESIGN: Retrospective and longitudinal evaluation of clinical symptoms and natural course with emphasis on survival and sensoneurologic and hematologic findings. SETTING: Two large referral-based pediatric bone marrow transplantation units in Europe. PATIENTS: Thirty-three patients with autosomal recessive osteopetrosis admitted to units in Paris and Leiden between 1972 and 1988 were analyzed until last follow-up or the time at which bone marrow transplantation was performed. The great number of patients and unprecedented amount of data make this report one of the single largest clinical studies on autosomal recessive osteopetrosis. MAIN RESULTS: Ocular involvement occurring at a median age of 2 months was the symptom at initial examination in half of the patients. A striking variability between patients was found. Retinal degeneration was present in three patients and associated generalized neurodegeneration was present in two. The probability of survival until the age of 6 years was about 30% for the group as a whole. The cumulative risk of developing visual or hematologic impairment in the first year of life was about 75% and leveled off afterward. Patients with early hematologic impairment, ie, before 3 months of age, especially when combined with early visual impairment, had a very poor prognosis regarding life expectancy. CONCLUSIONS: Autosomal recessive osteopetrosis seems to be a variable disorder with a poor prognosis, especially in children with early visual and hematologic impairment. Allogenic bone marrow transplantation remains the only curative approach.

Bone Marrow Transplantation↗
PubMed1994

Effects of doxycycline in patients with acute cough and purulent sputum: a double blind placebo controlled trial.

BACKGROUND: Acute cough with purulent sputum is a common complaint presented to general practitioners. AIM: A randomized, double blind, placebo controlled clinical trial was undertaken to determine the efficacy of doxycycline in persons aged 18 years and over presenting to 22 general practices in the Netherlands with acute cough and purulent sputum. METHOD: Patients were excluded if they were pregnant, had an allergy or intolerance to tetracyclines, had severe dyspnoea and fine crackles on auscultation, purulent rhinitis together with maxillary tenderness, chronic airways disease, or had taken antibiotics in the previous two weeks. Patients entered in to the study were given oral doxycycline for 10 days, 200 mg on the first day, followed by 100 mg on the next nine days, or placebo. RESULTS: Duration of frequent daytime cough after entry was a mean of 1.5 days shorter in the group of 71 patients receiving doxycycline than in the group of 69 patients on placebo (4.7 days versus 6.2 days, respectively). In patients aged 55 years and over the mean duration of frequent day-time cough after entry was 4.1 days shorter in the group taking doxycycline than in the placebo group. Patients with a very frequent cough and who also felt ill at entry regained their normal daily activities 2.1 days earlier when using doxycycline than the control group. CONCLUSION: Doxycycline has small beneficial effects in patients with acute cough and purulent sputum. These beneficial effects are more prominent, and probably clinically relevant, in patients aged 55 years and over and in patients who cough very frequently and who also feel ill.

Acute Disease↗
PubMed1993

Fosfomycin trometamol in a single dose versus seven days nitrofurantoin in the treatment of acute uncomplicated urinary tract infections in women.

In general practice acute uncomplicated urinary tract infections in women are treated with different courses of antibiotics. In this study the efficacy and tolerability of a single dose of 3 g fosfomycin trometamol and the conventional treatment with nitrofurantoin 50 mg four times daily for seven days were compared. In a randomized, double-blind, double-dummy trial in 31 general practices in the Netherlands 231 patients with symptoms of acute dysuria, stranguria and/or urinary frequency received treatment. Evaluation was based on resolution of symptoms, dipslide results and side-effects at 4, 9 and 42 days after starting the treatment. The clinical cure rates and bacteriological cure rates were not significantly different between the treatment groups. Side-effects were reported at day 4 by 43% of the women receiving single-dose treatment, compared with 25% of the women in the seven-day treatment group, a significant difference. At day 9 the groups did not significantly differ in the number of patients with side-effects. Almost all side-effects were mild and gastro-intestinal complaints were reported most. Taking into account the convenience of taking a single dose we conclude that fosfomycin trometamol is a reasonable alternative to 7 days nitrofurantoin 50 mg four times a day in the treatment of women with symptoms of acute uncomplicated urinary tract infections in general practice.

Acute Disease↗
PubMed1993

Postoperative local radiotherapy in rectal cancer: treatment results with limited radiation fields.

PURPOSE: The purpose of this study is to determine the treatment results and complication rates of postoperative local radiotherapy, with doses per fraction of 2.25 to 2.50 Gy, in patients with rectal carcinoma who have received macroscopically radical surgery. METHODS AND MATERIALS: A retrospective analysis was done of the records of all consecutive patients (N = 147) with rectal carcinoma Dukes' Stage B or C who have received postoperative local radiotherapy in our institution in the years 1981 through 1989. All patients have been treated on a limited target area covered by only local radiation fields. Locoregional fields covering the whole iliac node chains have not been given. In our treatment protocol doses per fraction were from 2.25 to 2.50 Gy and total doses from 50 to 55 Gy. The minimum follow-up was 24 months; eight patients have been lost to follow-up. RESULTS: The overall 5-year survival rate for the whole group of patients was 39%. The actuarial 2- and 5-year pelvic recurrence rates were 14% and 22% respectively for Dukes' B patients and 30% and 38% respectively for Dukes' C patients. The difference between the pelvic recurrence rates of Stage B and Stage C patients was statistically significant (p = 0.009). No other factors with prognostic significance for pelvic recurrence were found. The interval between surgery and radiotherapy especially had no influence on pelvic recurrence rates. The 35 pelvic recurrences were classified as follows: 17 in-field, 5 marginal, 1 out-of-field, and 9 peritoneal seeding; in three patients there was not enough information for classification. Of the 32 classified pelvic recurrences, the five marginal recurrences were probably geographical misses, only the one out-of-field recurrences, the five marginal recurrences were probably geographical misses; only the one out-of-field recurrence might have been prevented with locoregional radiotherapy. Serious complications caused by the radiotherapy have occurred in 3% of the patients. CONCLUSION: We conclude that the results of postoperative local radiotherapy alone are comparable with the published results of locoregional radiation. Even when relatively high doses per fraction are given low complication rates are seen.

Adenocarcinoma↗
PubMed1993

Free energies for refolding of the common beta turn into the inverse-common beta turn: simulation of the role of D/L chirality.

Quantitative estimates of the Gibbs free-energy change (delta G) for refolding of one beta-turn conformation into another would assist rational protein design. For beta-turn models, we studied a chirally representative set of nine peptides of the form CH3CO-L1-L2-NHCH3, where loop residues L1 (i + 1) and L2 (i + 2) are achiral Gly (G), L-Ala (A), or D-Ala (a). The stabilities of their common (type I) and inverse-common (type I') beta-turn conformers (GGI is the type-I GG conformer, etc.) were estimated by free-energy simulations using explicit water molecules. An alpha-hydrogen atom of a Gly residue at L1 or L2 was replaced by a methyl group by slow growth. The resulting conformers were less stable than GGI and GGI' by about 1-3 kcal/mol (delta G = 0.9 kcal/mol for AGI and aGI', 1.0 kcal/mol for GAI and GaI', 2.1 kcal/mol for aGI and AGI', and 2.8 kcal/mol for GaI and GAI'; 1 kcal = 4.18 kJ). The delta G value for simultaneous growth of one methyl group at L1 and another at L2 was the sum of the two component delta G values. The delta G values for I-->I' refolding of the common beta-turn conformer into the inverse-common beta-turn conformer ranged over 6 kcal/mol (-3.0 for aa, -1.8 for Ga, -1.1 for aG, -0.7 for Aa, 0 for GG, 0.7 for aA, 1.1 for AG, 1.8 for GA, and 3.0 for AA). Thus, replacing L-Ala by D-Ala at both L1 and L2 of a common beta turn may contribute as much as 6 kcal/mol toward its refolding as an inverse-common beta turn.

Amino Acid Sequence↗
PubMed1993

Randomized double-blind study of nabumetone and piroxicam in the treatment of osteoarthritis in Dutch general practice: efficacy and tolerability.

To study nabumetone (1,000 mg once daily) by comparison with piroxicam (20 mg once daily) in patients with osteoarthritis, a randomized, double-blind trial was set up in 40 general practices. Evaluation was based on clinical outcome in 198 patients. There was some evidence that nabumetone is associated with a lower and less severe occurrence of gastric pain, and with more withdrawals due to lack of efficacy. Although the differences between nabumetone and piroxicam were small in this study, these were clinically relevant. The general practitioner should balance the respective benefits of greater safety and tolerance against greater efficacy in meeting the requirements of an individual patient with osteoarthritis.

Adult↗
PubMed1993

Prognostic factors in well-differentiated early-stage epithelial ovarian cancer.

BACKGROUND: The prognosis of patients with early ovarian cancer is good as compared with that of patients with advanced disease. However, there are no methods for predicting prognosis of early ovarian cancer, on which treatment decisions can be based. METHODS: The prognostic significance of DNA flow cytometric and morphometric analysis was evaluated in 64 surgically treated patients with well-differentiated early-stage (International Federation of Gynecology and Obstetrics [FIGO] Stage IA, IB, IC, and IIA) epithelial ovarian cancer. The extent of the well-defined staging procedure was assessed strictly in every patient. RESULTS: Only five patients died of recurrent ovarian cancer; all of these patients belonged to the inaccurately staged group. No significant relationship was found between clinicopathologic characteristics, such as menopausal status, FIGO stage, histologic cell type, and 5-year disease-free survival rate. Forty-two of the tumors had a mitotic activity index (MAI) of less than 30, and 43 of the tumors showed a volume percentage epithelium (VPE) of less than 65. Neither as a single parameter nor in combination did MAI and VPE correlate significantly with disease-free survival. Thirty-two tumors (50%) were DNA diploid, 15 were considered wide-CV-diploid, and 17 were aneuploid. Nearly 90% of the tumors showed DNA indices (DI) of 1.40 or less. The 5-year disease-free survival rate was significantly lower (61%) for patients with DI greater than 1.40 than for those with DI of 1.40 or less (96%) (P < 0.005). From the total number of five patients who died of their disease, three had tumors with DI in the tetraploid range.

Adult↗
PubMed1993

Human papillomavirus type 16 in tumor tissue of low-stage squamous carcinoma of the uterine cervix in relation to ploidy grade and prognosis.

BACKGROUND: The relationship among the presence of human papillomavirus (HPV) in tumor cells, DNA ploidy, and the prognosis of squamous cell carcinoma of the uterine cervix was studied. METHODS: HPV 16 was detected using the polymerase chain reaction on paraffin-embedded material from 69 patients with Stage IB and IIA carcinoma of the uterine cervix. The presence or absence of HPV was related to age, survival, and ploidy status as measured by DNA flow cytometry. All patients were treated by radical surgery. RESULTS: Thirty-four patients had HPV 16, and 35 did not. The mean age of the patients differed statistically significantly between the HPV-positive group (51.1 years) and the HPV-negative group (45.1 years, P = 0.015). No difference was found in the mean DNA index (1.21 versus 1.22, P = 0.85) or 5-year survival rate (85% versus 86%, P = 0.87) between the two groups. CONCLUSIONS: The high prevalence of HPV 16 in cervical cancer, which appeared to be correlated with age (in combination with its presence in diploid and aneuploid tumors), indicated the important role of HPV 16 in the evolution of cervical cancer. However, using stepwise Cox regression analysis, the presence of HPV 16 had no additional prognostic value over lymph node metastases findings.

Adult↗
PubMed1993

[The value of cytological studies in nodular goiter: results in 495 patients].

The accuracy of clinical diagnosis and fine-needle aspiration biopsy (FNAB) was evaluated in a total of 495 patients of whom 183 were operated upon within 6 months after FNAB and 312 were not. Operated patients were divided into three subgroups with high, moderate or low suspicion of malignant neoplasms on clinical grounds. Histological examination revealed an overall malignant neoplasm rate of 23%. The rate, i.e. the positive predictive value, was 74% for the subgroup with high clinical suspicion, vs 14% and 10% respectively for the subgroups with moderate and low clinical suspicion. The sensitivity of a high clinical suspicion was 60% and the specificity 93%. The overall sensitivity of FNAB was 93% in the operated group and probably not less than 87% in all patients studied; specificity was 71% and 84% respectively for these groups. The overall positive predictive value of a positive cytology result (malignant or uncertain) was 48%. In the subgroups with moderate or low clinical suspicion which are more representative of a non-university setting, the average predictive value was 27%. In our opinion all patients in the group with high clinical suspicion need surgical treatment, regardless of the FNAB result; those with lower degrees of clinical suspicion and malignant or uncertain FNAB result should also undergo diagnostic surgical exploration.

Adolescent↗