Biomedical subjects

J Hermans

Publications and source records attributed to J Hermans.

At least 325 records · Page 18Linked to original sources

PubMed1993

Frejka pillow and Becker device for congenital dislocation of the hip. Prospective 6-year study of 104 late-diagnosed cases.

During the period 1974-1986, 107 consecutive 1-9 month-old children with late-diagnosed congenital dislocation of the hip (CDH) were treated with a Frejka pillow primarily, followed by a Becker device. Treatment was initially successful in 96 cases with 2 not reduced, 4 failed stabilization, 4 persisting dysplasia, and 1 avascular necrosis. No correlation was found between age at the time of diagnosis or the severity of the dislocation and the duration or the result of treatment. In those initially successful, 14 percent had slight dysplasia 6 months later. The last follow-up, at the mean age of 7 years, excluding the 11 children needing supplementary treatment, showed that 84 percent had normal hips on radiography, based on measurements of the acetabular angles and the center-edge angles. The clinical findings were normal.

Female↗

PubMed1993

[Determination of thyroid peroxidase antibodies in common thyroid pathology. Methodological and clinical approach].

Thyroid peroxidase antibody levels were measured in 409 patients who came to the thyroid pathology consultation of our Institution between September, 1990, and November, 1991, and were compared with a reference population. In the first 231 patients, we compared the results obtained with two commercial kits. The correlation coefficient between both populations of results was assessed to be 0.919. Only one of the kits was selected later ("Immutest anti-TPOR", Henning, Germany) because normal and pathological values overlapped to a lesser extent. In a population of controls (reference population). 4 cases out of 82 (4.8%) had values exceeding 100 U/ml (arbitrary units), this value being regarded as the boundary of normal conditions. Out of the 409 assays made in patients examined during the thyroid pathology consultation, 137 (33.5%) had pathological values ranging from 100 to 5000 U/ml and even more. Peroxidase antibodies are mainly found in patients with primary hypothyroidism (positive in 82% of cases) and graves' hyperthyroidism (positive in 81%). We have also observed the highest levels in these two conditions. In addition, we have demonstrated a group of patients with normal thyroid conditions who were positive for peroxidase antibodies, sometimes in a family with a history of thyroid pathology. These may be at higher risks to develop hypothyroidism in the future than the general population. A TRH test in some subjects and the clinical evolution of these patients lead us to advocating TPO antibody assay for screening on the first consultation. Endocrine surveillance is advisable in case of positive results.

Antibodies↗

PubMed1993

[Can benign and malignant thyroid nodules be differentiated with thallium 201?].

The merits of Thallium 201 radionuclide scanning of the thyroid mentioned as soon as 1976 by PALERMO have been confirmed in the 16 last studies published in the international literature. Over 1601 examinations, authors showed that any cold nodule (Tc 99 m or I 123) which preferentially fixes Thallium 201 as compared to surround thyroid tissue must be operated since some of them are thyroid cancer carriers, some others are carriers of a traditional follicular adenoma or Hurthle-cell adenoma, or a follicular adenoma associated with varied cell atypisms which make difficult the diagnosis between benign and malignant nodules. The analysis of the results published show a 91.3% sensitivity of this diagnosis test, all analysis methods being considered. In case of negative test, it allows eliminating the cancer risk by more than 97% (negative predictive value). Such an examination--as opposed to a cytology test on the isolated nodule only--is valid for any type of nodule, being isolated, multiple or a multinodular goitre where the degeneration risk is close to, or even higher than, that of isolated nodules (4, 22).

Adenoma↗

PubMed1993

[Economic analysis of diagnostic and therapeutic methods in cases of cold thyroid nodules].

This article studies how two diagnostic tests (cytological puncture and 201thallium scanning) can be combined to obtain a more efficient approach of cold thyroid nodules. Diagnostic and therapeutic approaches are compared on the basis of four criteria: financial cost (immediate and delayed), number of labelled cancers, pre- and postoperative death rates and number of complications.

Biopsy, Needle↗

PubMed1993

Bone marrow transplantation for chronic myeloid leukemia: long-term results. Chronic Leukemia Working Party of the European Group for Bone Marrow Transplantation.

The data on 1480 bone marrow transplants for chronic myeloid leukemia (CML), performed between 1979 and 1990 were reported to the registry of the European Group for Bone Marrow Transplantation (EBMT). Of these, 1082 patients were transplanted in first chronic phase, 88 in subsequent chronic phase, 251 in accelerated phase and 59 during blast crisis. For these four disease stages leukemia-free survival (LFS) at 5 years is 39%, 22%, 22% and 0%, respectively. A more detailed analysis was performed for 947 patients receiving a first transplant in first chronic phase of their disease from an HLA-identical sibling donor. Survival at 8 years is 47%. At 5 years, relapse incidence (RI) is 33% and the transplant-related mortality rate (TRM) is 42%. The major prognostic factors are patient age (LFS, TRM), T cell depletion (LFS, RI), time from diagnosis to transplant (LFS, TRM), white blood cell count (RI) and donor-recipient sex combination (LFS, TRM). This first report on long-term results of a large cohort of transplanted CML patients confirms and extends previous findings. Stage of disease at time of transplant is the most important prognostic factor. Fifty per cent of all patients transplanted for CML in chronic phase can be expected to be alive at 8 years post-transplant, 40% alive and free of the disease. This number increases to > 60% for patients given cyclosporin and methotrexate without T cell depletion as GVHD prophylaxis. However, there is no plateau phase and late relapses and late transplant-related deaths occur in all subcategories.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Cosmetic result of lower midline laparotomy wounds: polybutester and nylon skin suture in a randomized clinical trial.

OBJECTIVE: To compare the cosmetic outcome of lower midline laparotomy scars using either nylon or polybutester suture for skin closure. METHODS: A randomized clinical trial compared polybutester skin suture with nylon for lower midline laparotomy wounds in 50 women undergoing gynecologic surgery. Scar hypertrophy, scar width, scar color, the presence of cross-hatching marks, and a total score were assessed in all patients at 18 months following surgery and compared by nonparametric statistical tests. RESULTS: The wounds closed with polybutester suture were significantly less hypertrophic than those closed with nylon. Regardless of the suture material used, the lower part of the laparotomy scar showed an inferior cosmetic result compared with the upper part underneath the umbilicus for scar hypertrophy, scar width, and the total scar score. CONCLUSIONS: Polybutester skin suture diminishes the risk of hypertrophic scarring because of its special properties allowing it to adapt to changing tensions in the wound. Increased closure tension of the skin in the midline region above the pubic bone may be caused by a relative immobility of the skin. Scar cosmetics in this area may be improved by extra subcuticular suture support.

Cicatrix↗

PubMed1993

Symptomatology of Graves' disease and Plummer's disease in relation to age and thyroid hormone level.

In order to relate the clinical expression of Graves' disease and Plummer's disease to age and thyroid hormone level, we prospectively studied 39 patients with Graves' disease and 26 patients with Plummer's disease using a standardized clinical score. Multiple regression analyses were performed with the clinical score as dependent variable and FT4I, age and diagnosis as independent variables. Our results show that patients with Graves' disease tend to have more signs and symptoms than patients with Plummer's disease. In addition, we found a positive correlation between the clinical score and FT4I. We did not find an age dependence of the clinical score, after controlling for diagnosis and FT4I. The age dependence reported by other authors is mainly due to the higher prevalence of Graves' disease among younger age groups in contrast to Plummer's disease.

Adult↗

PubMed1993

Frequency and indication of unrelated bone marrow transplants in Europe. European Group of Bone Marrow Transplantation (EBMT).

In 1991, 4,961 bone marrow transplants (BMT) were performed in Europe by 171 teams in 21 countries. 217 were from an unrelated donor. Two years ago, this number was 99, five years ago less than ten. Main indications for unrelated BMT were CML (115), AML (32), ALL (24), SAA (19), MDS (10). Major differences exist in the European countries with regard to the number of BMT performed per number of inhabitants and with regard to indications. The present study documents the marked increased in the use of unrelated BMT in Europe. It illustrates the need for health care strategies and for clearer definitions of indications.

Acute Disease↗

PubMed1992

Hereditary protein C-deficiency: laboratory values in transmitters and guidelines for the diagnostic procedure. Report on a study of the SSC Subcommittee on Protein C and Protein S. Protein C Transmitter Study Group.

A multicenter study on protein C-antigen and -activity values was carried out in transmitter patients with hereditary protein C deficiency (diagnosis established by pedigree analysis) and in normal controls in order to (1) establish the range of protein C levels in genetically determined heterozygotes and (2) to evaluate the usefulness of statistical procedures to discriminate between protein C deficient patients and controls. In transmitters absolute protein C activity values ranged from 19 to 82% and antigen values from 22 to 88.5%. Most transmitter patients could clearly be differentiated from the control group. However, in some transmitter patients values of protein C were within the range of the control group. The discrimination between transmitters and controls could be improved by statistical procedures. Using tolerance ellipses the overlapping area of the two groups was smallest when (factor II antigen+factor X antigen)/2 was plotted against protein C antigen. To specify the degree of uncertainty likelihood ratios were calculated to obtain the posterior probability for an individual for being deficient or not. In quadratic discriminant analysis the best discrimination between transmitters and controls was obtained using protein C activity versus factor X antigen and protein C antigen versus factor X antigen. Based on these analysis an equation was derived, which allows the calculation of the likelihood ratio favouring deficiency or non-deficiency in an individual.

Antigens↗

PubMed1992

Effect of preservation solution on results of cadaveric kidney transplantation. The European Multicentre Study Group.

University of Wisconsin (UW) preservation solution has been reported to be beneficial for canine organ transplants and for human liver and pancreas transplants. To examine whether it affects renal graft survival, a randomised multicentre trial was conducted to compare its effect with that of EuroCollins solution on delayed graft function, renal function, and patient and graft survival in 695 recipients of cadaveric renal transplants. 352 kidneys were preserved with UW and 343 with EuroCollins solution. Delayed graft function occurred in 23% of the UW group and in 33% of the EuroCollins group (p = 0.003). Three factors other than type of preservation fluid were associated with a higher incidence of delayed graft function: older donor age, intracerebral haemorrhage in the donor, and oliguria in the donor. Renal function as indicated by serum creatinine concentration was better in the UW than in the EuroCollins group. Patient survival in the UW and EuroCollins groups after 1 year was 95% and 94%, respectively. In both groups, delayed graft function reduced 1-year graft survival by 15% (p = 0.0001). 1-year graft survival of UW-preserved kidneys was 6% higher than that of controls (88.2% vs 82.5%, p = 0.04). Delayed graft function is significantly associated with a reduction in 1-year graft survival. The preservation solution is the most important factor influencing development of delayed graft function, and UW solution is superior to EuroCollins solution in reducing occurrence of delayed graft function, improving graft function, extending graft survival.

Adolescent↗

PubMed1992

Differential helix propensity of small apolar side chains studied by molecular dynamics simulations.

A series of oligoalanine molecules with single amino acid replacements in the middle of the chain has been studied by molecular dynamics simulations. Differences in stability of the alpha-helix (as free energies delta delta G degrees) were estimated for the following series of residues: alpha-aminoisobutyric acid, alanine, alpha-amino-n-butyric acid, valine, glycine, D-alanine, t-leucine (= alpha-amino-beta,beta-dimethyl-n- butyric acid), and proline, arranged here in decreasing order of helix-forming potential. (The results for proline and valine had been reported earlier.) No experimental results were available for alpha-amino-n-butyric acid, D-alanine, and t-leucine at the time these calculations were done. The values of delta delta G degrees, including the three predictions, are in striking agreement with recent experimental results. A combination of free dynamics, dynamics with forced conformational change, and dynamics with forced molecular replacement was used. Conformational distributions were calculated for the peptide backbone of the dipeptides and, where appropriate, for the side chains of the dipeptide and the alpha-helix. The results demonstrate an unexpected level of accuracy for the all-atom model used to represent atomic interactions in the simulations. The simulations permit a detailed analysis of different factors responsible for conformational preferences and differences in stability. These conclusions drawn from this analysis agree with accepted qualitative explanations and allow these explanations to be quantitated to an extent not heretofore possible.

Alanine↗

PubMed1992

[Non-urgent patients in a non-traumatology Emergency Service; general aspects and screening for psychiatric disorders].

The Emergency Department is used by a rather large number of patients with a non-urgent condition. It is unknown whether the request for medical assistance for non-urgent conditions is partly due to the presence of a mental disorder. We conducted a cross-sectional study of 711 patients of a non-traumatic Emergency Department. The prevalence and determinants of non-urgent conditions and of mental disorders of non-urgent patients were studied. Of all patients, 31% had a non-urgent condition. Self-referrals and young adults more often had a non-urgent condition. However, in our study only 17% of all patients were self-referred. The prevalence of a score greater than or equal to 5 on the general health questionnaire (GHQ), an indication of the presence of a mental disorder, in the non-urgent patients was 59%. Non-acute symptoms, life events, the use of psychotropic drugs and alcoholism were determinants for a high GHQ score, but their specificity was low. It is advised to include questions concerning mental disorders in the medical interview of non-urgent patients.

Academic Medical Centers↗

PubMed1992

The value of aspiration cytologic examination of the breast. A statistical review of the medical literature.

The decision to perform surgery in patients with a breast mass usually is made on the basis of combined diagnostic information, with fine-needle aspiration cytologic examination (FNAC) playing a central role. To determine and compare the quality of FNAC of the breast, a search was performed of the English literature for articles with quantitative information about their results. Twenty-nine such articles, containing 31,340 aspirations, were identified and summarized. Required data were extracted from these articles. These numbers were analyzed with the use of a two-by-four contingency table to relate the FNAC result (definitely malignant, suspect, benign, or unsatisfactory cytologic material) with the final diagnosis (malignant or benign breast disease). Test characteristics such as sensitivity, specificity, and the likelihood ratios for the four different FNAC results were derived for each study and compared. There was a striking difference between studies with regard to the probability of a particular FNAC upshot (e.g., in patients with breast cancer, the chance of obtaining definitely malignant cytologic material ranged from 0.35 to 0.92), the sensitivity (range, 0.65 to 0.98), the specificity (range, 0.34 to 1.0), and likelihood ratios. In the opinion of the authors, it is virtually impossible to infer general test characteristics of FNAC of the breast from the medical literature because of differences in methods and different biases. At best, the maximum attainable performance of this test can be described. For the development of a policy for breast mass management, the local test characteristics of this highly operator-dependent test should be established.

Biopsy, Needle↗

PubMed1992

Fractional allelic imbalance in human breast cancer increases with tetraploidization and chromosome loss.

We have previously reported a complete allelotype study of 86 primary breast carcinomas, in which each non-acrocentric chromosome arm was studied with at least one polymorphic DNA-marker for the presence of allelic imbalance (AI, allelic loss or allelic gain) in the tumor. Here we report the statistical analysis of this data set, investigating the relationships between AI, DNA aneuploidy and several clinico-pathological parameters of tumor progression. AI on 13 different chromosome arms, including 3p, 11p, and 17p, correlated significantly with the total number of AI events at other sites, suggesting that they are progression-related events. AI at 1q and 16q did not show such a correlation and may thus represent earlier events. Mean fractional allelic imbalance (FAI) was significantly higher in flow cytometrically aneuploid tumors than in diploid tumors (0.27 vs. 0.17, p = 0.007), and was highest in hypotetraploid tumors (0.37). This suggests that tetraploidization followed by chromosome segregation may underlie the development of AI at multiple sites. No correlation was found between mean FAI and clinico-pathological variables such as lymph-node involvement, stage, age, estrogen-receptor content and development of distant metastases, although there was a noticeable trend towards impaired survival for those patients with a higher-than-median FAI value.

Alleles↗

PubMed1992

A randomized clinical trial comparing two methods of fascia closure following midline laparotomy.

Three hundred forty women undergoing midline laparotomy were randomized into an interrupted suture (polyglactin 910, size 1) or a continuous suture (polyglyconate, size 0) closure group. The two groups were well balanced with respect to various risk factors for postoperative wound complications. Early evaluation revealed no differences between the continuous and interrupted suture groups with respect to wound infection (3% vs 1%), superficial wound dehiscence (2% vs 4%), and deep wound dehiscence (0.6% vs 0%). Late evaluation showed no differences between the two groups either. Continuous polyglyconate and interrupted polyglactin 910 sutures had a similar incidence of suture fistula (0% vs 2%), wound pain (1% vs 2%), and incisional hernia (3% vs 4%). Continuous closure was done faster and resulted in less foreign-body suture material. Despite its smaller diameter, the polyglyconate suture also retains a higher tensile strength after surgery than does the quicker-degrading polyglactin 910 suture. Results of this study lead to the conclusion that a running polyglyconate suture is the better choice for closure of the abdominal-wall fascia following midline laparotomy.

Abdominal Muscles↗

PubMed1992

Homologous genes for the C4 isoform of phosphoenolpyruvate carboxylase in a C3 and a C4 Flaveria species.

The C4 isoform of phosphoenolpyruvate carboxylase (PEPCase) in Flaveria trinervia is encoded by the ppcA subgroup of the PEPCase gene family and is abundantly expressed in the mesophyll cells of leaves. The homologous ppcA genes in the C3 plant F pringlei are only weakly expressed and their transcripts do not show the strictly leaf-specific accumulation pattern observed for the F. trinervia genes. Two representative members of the ppcA subfamilies of F. trinervia (C4) and F. pringeli (C3)-named ppcA1-were characterized by Southern blotting, nucleotide sequencing and primer extension analysis. Comparison of the deduced amino acid sequences reveals a close similarity between C4 and C3 isoforms. Only few C4-specific positions can be detected when all known plant PEPCases are included in the comparison. A regulatory domain involved in light-dependent phosphorylation/dephosphorylation of the C4 and crassulacean acid metabolism (CAM) isoforms is present in the ppcA1 gene products of both the C3 and C4 Flaveria. The 5' flanking regions are essentially homologous. The putative promoter regions share several identical sequence motifs (CCAAT, AT-1 and GT-1 box III/III* elements). Additionally, alterations in elements that could contribute to differences in expression rates and light regulation are found. The significance of these findings is discussed with respect to the molecular evolution of C4 photosynthesis in Flaveria.

Amino Acid Sequence↗

PubMed1992

Defecography and anorectal manometry.

In a prospective study anorectal manometry was performed in 160 consecutive patients who were referred for defecography. Leakage of contrast material of standardized viscosity, the anorectal angle (ARA), anal resting pressure (Pr) and squeeze pressure (Ps) were measured and analyzed. This was done to investigate the role of ARA on rectal continence during defecography and to investigate whether relevant findings of manometry can be predicted from findings at defecography as part of the diagnostic work-up in selected patients in order to avoid manometry in these patients. The ARA was of significance in maintaining rectal continence for the contrast medium (P = 0.008). With increasing leakage, Pr and Ps decreased significantly (P less than 0.001). In all fully incontinent patients (n = 36) Ps was distinctly below normal values. Manometry can be avoided in these patients if the level of Pr is not important for therapeutic strategy.

Adult↗

PubMed1992

Significance of local recurrence after mastectomy for breast cancer.

In a retrospective study 678 patients who underwent (modified) radical mastectomy between 1970 and 1986 were analysed. By comparing the groups of patients who experienced local recurrence, regional recurrence or distant metastasis during follow-up with patients who remained free of disease, we have tried to gain some insight into the significance of local recurrence. By looking at the prognostic factors and the disease-free period there is hardly any difference between the patients with either a local, regional or distant recurrence. Actuarial survival of patients with local recurrence is slightly better than the survival of patients with distant metastasis (P = 0.009). From our results and from the literature we conclude that an isolated local recurrence after mastectomy for breast cancer is, in most cases, a first manifestation of metastatic disease. Probably only a minority of the local recurrences is caused by tumour cells left behind in the operation field.

Adult↗