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Biomedical subjects

J Hermans

Publications and source records attributed to J Hermans.

At least 379 records · Page 21Linked to original sources
PubMed1991

External radiotherapy and extrahepatic bile duct cancer.

The hospital records of patients with extrahepatic bile duct cancer who where treated surgically between 1968 and 1983 were reviewed. Of 55 patients, 16 (29%) received radiotherapy after surgery. The total dose given ranged from 40 to 60 Gy. Median follow-up time for analysis was 4.0 months and lasted until January 1988. The overall median survival was 4 months (range 0-36), that of the irradiated patients was 16 months (range 2-36), and that of the 39 patients who were not irradiated was 3 months (range 0-32). When the 13 post operative deaths were excluded the median survival was 4 months. Radiotherapy did not cause any severe complications. No firm conclusion about the role of radiotherapy can be drawn from these data because the patients were not randomly chosen to receive radiotherapy and selection was therefore biased. We conclude that most patients with extrahepatic bile duct cancer still die of locoregional disease. Effective adjuvant treatments are needed and should be evaluated in prospective randomized trials.

Adenocarcinoma↗
PubMed1991

A randomized clinical trial to compare two different approaches in women with chronic pelvic pain.

One hundred six patients with chronic pelvic pain were randomly allocated to one of two treatment groups. In the standard-approach group, organic causes of pelvic pain were excluded first and diagnostic laparoscopy was routinely performed. If no somatic cause could be found, attention was given to other causes such as psychological disturbances. In the second group an integrated approach was chosen. From the beginning equal attention was devoted to somatic, psychological, dietary, environmental, and physiotherapeutic factors. In this group, laparoscopy was not routinely performed. Both groups were similar with respect to clinical characteristics of the patients and the severity of their pain as assessed by various pain parameters. Postcoital pain was reported by 27% of the patients. Twenty percent of the patients had had negative sexual experiences such as childhood sexual abuse or rape. Evaluation of the pain 1 year after the institution of treatment revealed that the integrated approach improved pelvic pain significantly more often than the standard approach for three out of four pain parameters (P less than .01). Laparoscopy played no important role in the treatment of pelvic pain. It is concluded that equal attention to both organic and other causative factors from the beginning of therapy is more likely to result in a reduction of pelvic pain than is a standard approach.

Adolescent↗
PubMed1991

Systemic effects of collagen-impregnated aortoiliac Dacron vascular prostheses on platelet activation and fibrin formation.

To minimize intraoperative blood loss a watertight knitted Dacron aortoiliac prosthesis has been developed by impregnation with bovine collagen. A potential disadvantage is that collagen may be associated with an increase in thrombus formation. We conducted a prospective randomized trial to study the systemic effects of collagen-impregnated prostheses and of aortoiliac operation as such on the coagulation mechanism during the first 10 days after operation. Forty-one patients randomly received either a collagen-impregnated (n = 20) or a nonimpregnated prosthesis (n = 21). Twelve patients who underwent cholecystectomies served as controls. Three markers of the coagulation mechanism were monitored: beta-thromboglobulin, fibrinopeptide A, and fibrin/fibrinogen degradation products. We found no significant differences in median beta-thromboglobulin, fibrinopeptide A, and fibrin/fibrinogen degradation product levels between patients in the collagen-impregnated prosthesis group and patients in the nonimpregnated prosthesis group. This indicates that collagen does not stimulate the coagulation cascade any more than conventional Dacron protheses do. In a comparison of patients who underwent aortoiliac reconstruction and patients who underwent cholecystectomies, the results indicated a significant increased platelet activation and fibrin metabolism in aortoiliac reconstruction group compared with the control group. Finally, we observed a significantly higher preoperative fibrin metabolism in patients with vascular disease than in control subjects. This difference is attributable to the high preoperative fibrin/fibrinogen degradation product values in patients with aortic aneurysms.

Adult↗
PubMed1991

Comparison of maximal airway narrowing to methacholine between children and adults.

Bronchial hyperresponsiveness in adults is characterized by an increased sensitivity as well as an elevated maximal response to inhaled bronchoconstrictors. In children, however, it is unknown whether the maximal response increases with increasing sensitivity. We investigated the maximal degree of airway narrowing to methacholine in nonasthmatic and asthmatic children (7-12 yrs), and compared it to that in adults. Nineteen children (9 normals, 10 asthmatics) and 19 adults (8 normals, 11 asthmatics) were selected in order to cover a wide distribution of bronchial responsiveness. All subjects underwent 2 methacholine challenge tests on separate days, by inhaling doubling doses using a standardized dosimeter technique (up to a noncumulative dose of 59 mumol). The response was measured by forced expiratory volume in one second (FEV1) and expressed as a percentage fall from baseline value. The complete dose-response curves were characterized by their position (PD20, the provocative dose causing a 20% fall in FEV1) and maximal response (MFEV1, the mean response on the plateau, defined as greater than or equal to 2 points within a 5% response range). Plateaus were observed in 13 children and 9 adults, the coefficient of repeatability of MFEV1 being 10.8 and 10.4% fall, respectively. There was an inverse relationship between log PD20 and MFEV1, which did not differ between children and adults (p greater than 0.15). In most of the asthmatic children and adults the plateau could not be measured (exceeding 50% fall in FEV1) if PD20 was less than 1 mumol. We conclude that, for a given bronchial sensitivity, the maximal response to inhaled methacholine is similar between children and adults.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Flow cytometric and histomorphometric analysis of limitations of clinical breast cytomorphometry.

The clinical value and limitations of a previously described cytomorphometric method, based on nuclear size and anisonucleosis, for evaluation of routine fine-needle aspiration of the breast were assessed in a series of 313 histologically investigated primary breast lesions. Limitations were analyzed by histomorphometry and DNA flow cytometry in 116 consecutive cases of histologically confirmed breast carcinoma. Eighty per cent of histologically proven malignant tumours were classified cytomorphometrically as malignant and no false-positive results were encountered. For benign lesions a benign cytomorphometric classification was reached in 66% of the cases. Histomorphometry showed that on the whole the assignment of histologically malignant tumours to a non-malignant cytomorphometric classification was determined by smaller nuclei and not by sampling error. Tumours assigned to a malignant cytomorphometric classification had on average significantly higher DNA indices than did tumours not assigned to a malignant cytomorphometric classification (P less than 0.001). The mean-nuclear areas in cytomorphometry and histomorphometry were strongly correlated with DNA indices indicated by DNA flow cytometry (P less than 0.001 for both). The present findings show that this cytomorphometric method is appropriate for routine quality control of a cytological diagnosis of malignancy in FNA of the breast. However, an inconclusive result in 15-25% of the tumours is inevitable.

Aneuploidy↗
PubMed1991

Hepatic metastases: comparative study of diagnostic ultrasound, CT, nuclear scintigraphy and laboratory tests.

Computed tomography, ultrasound, nuclear scintigraphy, and laboratory tests (lactic dehydrogenase, alkaline phosphatase, and 5-nucleotidase) were compared in 135 patients with gastro-intestinal carcinoma to define the most useful test to detect hepatic metastases. Thirty-six patients (26.7 per cent) had hepatic metastases at laparotomy. Sensitivities were low: 46.2 per cent for nuclear scintigraphy, 57.6 per cent for ultrasound, 67.7 per cent for computed tomography and 62.9 per cent for lactic dehydrogenase. Accuracies ranged from 62.9 (lactic dehydrogenase) to 77.6 per cent (nuclear scintigraphy). No significant differences were found. Accurate and efficient detection of hepatic metastases is hampered by relatively low sensitivity, specificity and accuracy of the conventional imaging tests and laboratory tests.

Diagnostic Tests, Routine↗
PubMed1991

Cytomorphometry as quality control for fine needle aspiration. A study in 321 breast lesions.

Material collected by fine needle aspiration (FNA) in 321 histologically examined primary breast lesions of previously untreated patients was analyzed by morphometry. The mean nuclear area (MNA) and its standard deviation (SD) were calculated for 50 cells in each case. Four subclasses were defined on the basis of the MNA and SD: benign (less than 10% probability of malignancy), doubtful benign (10% to 49%), doubtful malignant (50% to 90%) and malignant (greater than 90% probability of malignancy). FNA samples showing signs of acute inflammation or only apocrine metaplastic cells were not suitable for analysis by this morphometric method and were excluded. In 274 (85.4%) of the cases, the measurements allowed a definite morphometric conclusion, with predictive values of 99.5% and 100% for the histologically malignant and benign aspirates, respectively. The probability of malignancy in the doubtful malignant group was almost 86%. The morphometric method described is quick, easy to perform and well suited for use in routine daily practice; furthermore, it does not require expensive equipment. The ease of the technique and its high predictive value make this method appropriate for use as a quality control procedure in FNA cytology.

Biopsy, Needle↗
PubMed1990

[The significance of body temperature, sedimentation, C-reactive protein, leukocyte count and differential for the diagnosis of infections in an internal medicine emergency department].

The value of body temperature, erythrocyte sedimentation rate (ESR), C-reactive protein, white blood cell count and differentiation for the diagnosis of infections in patients in the first aid department of internal medicine, was investigated. Forty-six infections were observed in 260 patients (prevalence 18%). Patients with fever had a fourfold increased chance to have an infection. In a patient with fever and an increased ESR the chance to have an infection was 91%, with fever and a normal ESR 33%. In the absence of fever the chance to have an infection was 14% if the ESR was increased and 7% if normal. White blood cell count and differentiation, like C-reactive protein in addition to body temperature were of no use for the diagnosis of infections.

Adult↗
PubMed1990

[Fumaric acid therapy in psoriasis; a double-blind, placebo-controlled study].

Thirty-nine patients with psoriasis (12 females, 27 males) entered a randomised, double-blind, placebo-controlled study on the efficacy of fumaric acid therapy in an outpatient setting. During 16 weeks the patients were treated with tablets containing a combination of dimethylfumarate and different salts of monoethylfumarate, with octylhydrogen fumarate or with placebo tablets. All patients were treated with identical indifferent topical therapy and followed an elimination diet (avoidance of spices, wine and nuts). Thirty-four patients completed the study. Five patients dropped out because of side effects or aggravation of the skin lesions. The patients treated with the combination of monoethyl- and dimethylfumarate showed a significantly better therapeutic response compared with those who were treated with placebo or octylhydrogen fumarate. Side effects of the fumarate containing tablets were flushing, diarrhoea, a reversible elevation of transaminases, lymphocytopenia and eosinophilia. One patient developed a disturbance of the kidney function which normalised after discontinuation of the therapy.

Adult↗
PubMed1990

[Aspiration cytology of palpable breast lesions: testing of the results using the PALGA data (Pathological Anatomical National Automated Archives)].

For the testing of the results of 1233 breast punctures performed on 1132 women in the period 1985-1988, the question was studied whether a less time-consuming procedure than status examination might be used. The national computerized record office where all data on cytological and histological diagnostics per patient are centralized (PALGA) offered the possibility of determining whether and, if so, with what results histological examination of the breast had been carried out. Histological follow-up examination proved to be available of 476 punctates. In case of abnormal cytological findings without subsequent histological examination, the final diagnosis was made on the basis of the clinical findings (53 punctates; 4.6% of the women examined). In case of non-abnormal cytological findings without subsequent cytological or histological follow-up examination, the lesion was regarded as benign. It proved technically feasible with use of these final diagnoses to arrive at a numerical evaluation of aspiration cytology for the laboratory. These characteristics are valuable in making the decision whether, given a particular result of puncture biopsy, women with a palpable breast tumour should or should not be operated, provided the characteristics are always used only in combination with clinical and mammographic diagnostics. The method is also appropriate for evaluation of other forms of cytodiagnostic examination.

Adolescent↗
PubMed1990

Inhibition of thrombin by synthetic hirudin peptides.

To investigate the role of different regions of hirudin in the interaction with the proteinase thrombin, segments of hirudin containing 15-51 residues were synthesized. The C-terminal segment 40-65 inhibited the fibrinogen clotting activity of thrombin but not amidolysis of tosyl-Gly-Pro-Arg-p-nitroanilide. Central peptide 15-42 was insoluble at pH 7, but peptide 15-65 inhibited fibrinogen clotting and amidolysis to an equal extent. The N-terminal loop peptide 1-15 had no inhibitory activity and did not affect the potency of peptide 15-65. These data suggest that the central region inhibits catalysis.

Amino Acid Sequence↗
PubMed1990

Differential biogenesis of photosystem-II in mesophyll and bundle-sheath cells of 'malic' enzyme NADP(+)-type C4 plants. A comparative protein and RNA analysis.

We have investigated the photosystem-II organization in differentiating-bundle-sheath cells of the three malate dehydrogenase (oxaloacetate decarboxylating) (NADP+)-type C4 species maize, Sorghum and Pennisetum. Using a set of nine different antisera raised against individual subunits of photosystem-II, we demonstrate that photosystem-II components constitute a substantial part of the thylakoid membranes of young bundle-sheath chloroplasts. The abundance of subunits of the photosystem-II core, i.e. the 47-and 43-kDa chlorophyll-a-binding proteins, polypeptides D1 and D2, cytochrome b559, and the 34-kDa polypeptide, varies with the developmental state of the plant. However, the levels of the 23-kDa, 16-kDa and 10-kDa extrinsic polypeptides of the water-oxidation complex are drastically reduced in bundle-sheath chloroplasts of all three species analyzed, regardless of their state of differentiation. The reduction in protein abundance is also reflected at the transcript level: only traces of the nuclear-encoded mRNAs are found in differentiating bundle-sheath cells of Sorghum, suggesting that the transcription of these genes has been switched off. Our data are compatible with the idea that the water-oxidation complex is a prime site for initiating or maintaining the process leading to photosystem-II depletion during differentiation of bundle-sheath cells.

Chlorophyll↗
PubMed1990

The CMF-regimen. Modulation of cyclophosphamide uptake and clearance by methotrexate and fluorouracil.

Influence of the 2 antimetabolites used in the CMF-regimen, methotrexate (MTX, M) and fluorouracil (FUra, F) on in vivo pharmacokinetics of orally administered cyclophosphamide (CY, C), were studied in WAG/Rij rats. Blood plasma concentrations of CY following oral administration were monitored in single-agent CY, in CY + MTX (CM), in CY + FUra (CF) and in CY + MTX + FUra (CMF) treatments. Each treatment group consisted of at least 10 rats. CY was determined in 50 microliters of plasma by capillary gas chromatography on the first day of chemotherapy. Statistical analysis of blood plasma concentration data revealed a significant influence of both MTX and FUra on CY input/output function (p:0.01). MTX and FUra significantly increased the area under the plasma concentration time-curve, whereas tmax was significantly prolonged in CF and CMF treatment groups (p:0.01). It is suggested that MTX and FUra interact at the site of CY pre-systemic metabolism, including first-pass metabolism, subsequently resulting in prolonged absorption.

Animals↗
PubMed1990

[Renal artery reconstruction for renovascular hypertension].

Between 1959 and 1983, 172 patients were treated for hypertension by reconstruction of a renal artery. Reconstruction was preferably performed with autologous material. In a selected group of 29 patients with lesions in the distal renal artery or the hilar branches, an extracorporeal reconstruction with autotransplantation was performed. After a mean follow-up of 8.4 years the hypertension was cured or improved in 82% of the patients. In patients with an arteriosclerotic renal artery stenosis this result was favourably influenced by a short duration of hypertension before the operation. Their life expectancy after the operation was clearly favourably influenced by a beneficial blood pressure response even if arteriosclerotic lesions of coronary arteries, extracranial vessels and/or peripheral vessels were present before the renovascular operation. In selected patients, renal artery reconstruction for treatment of hypertension yields excellent short-term and long-term results, not only with regard to the blood pressure response but also with respect to the patients' life expectancy.

Adult↗
PubMed1990

Prognostic significance of DNA-ploidy in a series of 690 primary breast cancer patients.

Flow cytometric DNA-ploidy measurements were performed on paraffin-embedded and fresh tumor specimens from 690 patients with Stage I-III breast cancer. The conventional classification of DNA-ploidy (diploid versus aneuploid) was compared with a division of tumor ploidy into 5 classes based on DNA index (DI) range. The DI-classification showed a better correlation with tumor size and TNM stage than the conventional classification. Aneuploidy was associated with an impaired survival and distant relapse-free survival (p = 0.02) but the DI-classification improved the discrimination between different prognostic groups of patients. In general, this indicated a more aggressive phenotype for tumors evolved via polyploidization. Hyper-tetraploidy (DI greater than 2.10) indicated a very poor prognosis in pre-menopausal patients. No prognostic effect of aneuploidy and DI-class was found in node-negative and TI patients. Cox multivariate regression analysis showed that aneuploidy was an additional prognostic factor to nodal status (I less than or equal to N less than or equal to 3, N greater than 3 vs. N = 0) and tumor size (T2-4 vs. TI) for overall and distant relapse-free survival. Subdivision according to DI-class did not improve the prognostic power of DNA-ploidy due to stronger correlations with established prognostic factors.

Aged↗