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Biomedical subjects

J Hermans

Publications and source records attributed to J Hermans.

At least 397 records · Page 22Linked to original sources
PubMed1990

Coeliac artery compression syndrome: the effect of decompression.

The effects of operation to decompress the coeliac artery were evaluated in 11 consecutive patients with coeliac artery compression syndrome. Immediately after the operation all patients were free of symptoms. Three months later three of the 11 had recurrent abdominal pain. Long-term follow-up between 15 and 23 years, obtained by questionnaire, was available for eight patients. All eight had return of symptoms similar to those before surgery. These unsatisfactory results suggest that operation should not be undertaken in patients with vague upper abdominal complaints and compression of the coeliac artery by the median arcuate ligament, who do not otherwise have pathological conditions which might explain their symptoms.

Adolescent↗
PubMed1990

Is long-term follow-up justified after excision of a thin melanoma (less than or equal to 1.5 mm)? A retrospective analysis of 206 patients.

From 1964 to 1988, 231 patients underwent local excision as the single treatment of melanoma with a thickness of less than or equal to 1.5 mm. We investigated the prognostic value of several factors on cancer-specific survival and cancer-specific disease-free survival, from time of excision on, by performing life-table analysis on 206 evaluable patients. Recurrence developed in 11 patients; local recurrence occurred in four patients, hematogenic spread in three patients and lymph node metastases in another four patients. Six patients died as a result of the disease. Tumors with a thickness of less than or equal to 1.5 mm have an excellent prognosis regardless of the localization of the melanoma. At 15 years cancer-specific survival was 92.3% and cancer-specific disease-free survival was 86.9%. Recurrence was successfully treated with hope for cure in 4 patients. This figures does not justify aggressive follow-up for all patients.

Adolescent↗
PubMed1990

Bone marrow relapse occurring as first relapse in children with acute lymphoblastic leukemia.

In a retrospective review which covered the whole Dutch childhood population of approximately 3 million children we studied the prognosis in 164 children with acute lymphoblastic leukemia (ALL) who were initially treated between 1973 and 1983, and who had an isolated bone marrow relapse occurring as first relapse. Until their first relapse, the patients were initially treated according to standard protocols, while treatment for relapse was heterogeneous, and not intensive. Second complete remission (CR) was attained by 78% of the patients. The median duration of second CR was 9 months, the median survival 13 months. Multivariate analysis showed that the duration of the first CR was the most significant variable with regard to prognosis. None of the patients who developed their bone marrow relapse during initial treatment, i.e., within 24 months from diagnosis, survived. Among the 73 patients who relapsed after cessation of the initial treatment there were 19 long-term disease-free survivors, 14 of whom had not developed subsequent relapses after 48(+)-125 + months. From this study we conclude that treatment in children with first bone marrow relapse has to be intensified.

Adolescent↗
PubMed1990

Reconstruction of large skeletal defects by vascularized fibula transfer. Factors that influenced the outcome of union in 62 cases.

We have studied the results of reconstruction of a large skeletal defect using a vascularized fibula graft in 62 consecutive cases. We were particularly interested in factors that may significantly influence the outcome of union. In at least 90% of cases, eventual union can be expected in the reconstruction of large skeletal defects resulting from tumour resection, traumatic bone loss, or nonunion. The results of reconstruction for osteomyelitis were less favorable. Statistical analysis of the influences of bone graft polarity, internal fixation, additional bone graft polarity, internal fixation, additional bone graft material, and the length of the graft on the outcome of union revealed that the use of stable fixation and additional bone graft material significantly enhanced bone union, whereas the length or polarity of the graft had no influence.

Adolescent↗
PubMed1990

Analysis of expression and evolutionary relationships of phosphoenolpyruvate carboxylase genes in Flaveria trinervia (C4) and F. pringlei (C3).

Phosphoenolpyruvate carboxylase (PEPCase) was shown to be encoded by a multigene family in various Flaveria species analysed. Several clones were isolated from genomic libraries of F. pringlei (C3 species) and F. trinervia (C4 species) and classified into four distinct groups according to their hybridization behaviour to a full-length cDNA clone encoding the PEPCase C4 isozyme of F. trinervia. A detailed cross-hybridization analysis demonstrated that the closest relative of most of the PEPCase genes isolated from F. trinervia and F. pringlei was not found in the same but in the other species. Northern analysis, using stringent conditions, allowed discrimination of class-specific PEPCase transcripts and revealed characteristic organ-specific expression patterns.

Biological Evolution↗
PubMed1990

Prevention of infection and graft-versus-host disease by suppression of intestinal microflora in children treated with allogeneic bone marrow transplantation.

The effect of suppression with antimicrobial agents of the intestinal microflora of paediatric bone marrow graft recipients on severe bacterial and fungal infections and on moderate to severe acute graft-versus-host disease was studied retrospectively. Data on 65 cases of bone marrow transplantation for either severe bone marrow failure or leukaemia, performed in a strict protective environment with either complete or selective gastrointestinal decontamination, were evaluated. All bone marrow grafts were from HLA-identical siblings and were not depleted of T-lymphocytes. Twenty percent of the recipients had one or more episodes of septicaemia during the granulocytopenic period after transplantation, mostly due to gram-positive bacteria. Only five children died due to infection, in each case caused by a microorganism originating from the endogenous flora. Complete gastrointestinal decontamination was superior to selective gastrointestinal decontamination in preventing infectious complications (p less than 0.001). The same was the case for the prevention of acute graft-versus-host disease of grade II or higher, which was observed in 7 of 40 (17.5%) completely decontaminated children versus 9 of 18 (50%) selectively decontaminated children evaluable for graft-versus-host disease (p less than 0.01). It is concluded that complete gastrointestinal decontamination in a strict protective environment is a feasible and very effective method for preventing severe infections and acute graft-versus-host disease after allogeneic bone marrow transplantation in children and adolescents; it resulted in a low transplantation-related mortality of 26% and a good quality of survival in 69% of the graft recipients.

Adolescent↗
PubMed1990

Reasons for incomplete surgical staging in early ovarian carcinoma.

The completeness and associated morbidity of surgical staging in 86 patients with early ovarian carcinoma were analyzed. According to strict criteria for completeness of the procedure established before the onset of the study, surgical staging after one or two laparotomies was complete in only 53% of cases. Initial staging in a peripheral hospital was complete in only 15% of patients. Intraoperative complications occurred in between 8 and 15% of patients and included injury of the vena cava (5), small bowel injury (2), myocardial infarction (1), transection of the ureter (1), and splenic rupture (1). The most frequently omitted staging steps were biopsy of the paracolic gutter, biopsy of the pelvic peritoneum, and sampling of retroperitoneal lymph nodes. Reasons for incomplete surgical staging were divided into factors associated with increased risk of difficulty of the procedure and lack of knowledge of the sites at risk for ovarian cancer metastases. It was found that both phenomena should be held responsible to the same extent for the large number of incomplete surgical staging procedures. The conclusion was made that either gynecologists should be better educated in the staging of ovarian cancer or a more efficient patient referral policy should be considered.

Adult↗
PubMed1990

DNA ploidy level as prognostic factor in low stage carcinoma of the uterine cervix.

Flow cytometry was used to measure DNA content of tumor cells in paraffin-embedded archival material from 89 patients with squamous cell carcinoma of the cervix uteri stages IB and IIA. Patients were all treated with radical hysterectomy and transperitoneal lymphadenectomy. Twenty-four percent received radiotherapy postoperatively because of tumor spread into parametria or positive lymph nodes. Ploidy grade was compared to other prognostic factors. DNA-aneuploidy was seen in 44 (49%), DNA-diploidy in 16 (18%) and 29 (33%) of the tumors were DNA-periploid. Sixty-nine (78%) patients were in FIGO stage IB, 20 (22%) in IIA. In 19 (21%) lymph node metastases were found, vasoinvasion in 25 (28%). Overall disease-specific 5-year survival was 80%. There was a significant effect of positive lymph nodes (90% vs 47%) and vasoinvasion (87% vs 64%) on the 5-year survival (resp. P less than 0.01 and P = 0.02). No correlation was found between stage (81% for IB vs 80% for IIA) or DNA-ploidy grade (81% for aneuploidy, 82% for periploidy, 79% for diploidy) and survival (resp. P = 0.9 and P = 0.8). Ploidy grade was equally divided over other prognostic factors. In stepwise Cox regression analysis DNA-ploidy grade showed no independent effect on survival. We conclude that DNA flow cytometry in this material was of no additional prognostic value.

DNA, Neoplasm↗
PubMed1990

Time trends and survival in patients presented for surgery with non-small-cell lung cancer 1969-1985.

All evaluable patients (n = 920) with primary non-small-cell lung cancer (NSCLC) who were presented for surgery in our hospital between 1969 and 1985 were reviewed as to histological findings, postoperative stage, age group and surgical procedure. Time trend analyses showed a significant increase over time in the proportion of adenocarcinomas (p = 0.025) and in the proportion of the elderly (greater than or equal to 70 years; p = 0.014). The 5-year survival rates by year of operation showed no improvement at all over time; on the contrary they showed a decline, which however only reached significance for patients who underwent pneumonectomy (p = 0.034). It is noted that the overall survival curves up to 5 years showed no significant differences between patients with adenocarcinoma and patients with squamous cell carcinoma, or between patients aged 70 years or more and patients aged 60-69 years. Despite expanded preoperative diagnostic techniques and developments in surgical treatment, no improvement in the survival after surgery for NSCLC over the period 1969-1985 could be established.

Adenocarcinoma↗
PubMed1990

Surgical treatment of intestinal artery aneurysms.

Intestinal artery aneurysms are usually asymptomatic. However, occasionally they occur as a vascular emergency and when rupture occurs, mortality rates of up to 75% have been reported. Therefore, elective surgery of asymptomatic intestinal artery aneurysms seems indicated provided that the procedure is safe with a low morbidity and mortality. We have reviewed the results of surgical treatment of eight patients with intestinal artery aneurysm who were operated on electively and seven who had emergency procedures over a 20 year period. Mortality was high when rupture had occurred, despite acute surgical intervention. After elective procedures however mortality and morbidity were substantially lower. Elective surgical intervention should therefore be performed as soon as an intestinal artery aneurysm is diagnosed.

Aneurysm↗
PubMed1990

Acute bronchitis: general practitioners' views regarding diagnosis and treatment.

A survey was conducted among 800 Dutch general practitioners to establish their views on the diagnosis and treatment of bronchitis and related disorders with reference to 12 theoretical patients. The answers of the 467 respondents (response rate 60%) showed no clear relationship between signs and symptoms of the patients and the diagnosis made. In the authors' opinion the diagnosis of pneumonia was made too often. The decision whether or not to prescribe an antibiotic for a coughing patient was based in part on the diagnosis made, but in part it was also made on the basis of the signs and symptoms, irrespective of the diagnosis. The authors have the impression that general practitioners tend to prescribe antibiotics too quickly to coughing patients. There is a need for guidelines for diagnosis and treatment of patients with acute bronchitis and related conditions.

Acute Disease↗
PubMed1990

Correlations between consumption of antibiotics and methicillin resistance in coagulase negative staphylococci.

The correlation between antibiotic consumption, expressed in defined daily doses (DDD), and antibiotic resistance rates was studied, using 976 isolates of coagulase negative staphylococci (CNS) from human pathological material. Data from four hospitals, including 14 participating departments, were analysed for this purpose. Susceptibility tests were performed according to Dutch national standards, except for methicillin, which for the majority of isolates was tested according to adapted NCCLS standards. Resistance to methicillin was most frequent in Staphylococcus epidermidis (29%) and S. haemolyticus (16%). Among the departments, thoracic surgery (29-47%), surgical intensive care (68%) and neonatology (32%) scored highest. Significant correlations were found between percentages of methicillin resistance in CNS and consumption (DDD/month/bed) of (flu)cloxacillin (P0.008), of cephalosporins (P0.01) and of gentamicin (P0.005). (Flu)cloxacillin was used mainly prophylactically, cephalosporins and gentamicin therapeutically. Results were similar for S. epidermidis (n = 639) alone. There was no significant correlation between consumption and resistance to trimethoprim, erythromycin (P0.08) or gentamicin (P0.09). Analysis of data from individual patients showed significant differences in proportions of methicillin resistance rates in CNS, between use and non-use of penicillinase resistant beta-lactams or gentamicin. It is concluded that clinical use of both (flu)cloxacillin and cephalosporins selects for methicillin resistant CNS.

Anti-Bacterial Agents↗
PubMed1990

The use of cultured autologous epidermis in the treatment of extensive burn wounds.

Seventeen patients with deep second- and third-degree burn wounds have been grafted with cultured autologous epidermis. These epidermal cell sheets were cultivated according to the feeder layer technique as described by Rheinwald and Green. After dispase treatment and detachment from the culture vessel, the cell sheets, mounted on a polyamide mesh, were ready for grafting. Patients with wounds excised at an early stage, prepared with human cadaver allografts or synthetic dressings, showed a significantly better graft take than nonexcised, chronic granulating wounds which were grafted at a later stage (47% versus 15%; p less than 0.002). Sandwich treatment of expanded mesh autografts and cultured autograft overlay did not improve the graft take, although in some cases wound healing was accelerated. The graft take was inversely correlated with the age of the patient (p = 0.01), and showed a weak inverse correlation with the day of first (and subsequent) culture grafting (p = 0.07). Wound infection was the main cause of graft failure. Up to 4 years after grafting, the grafted areas showed continued stability and the regenerated skin became supple, smooth, and pliable. Hypertrophic scar formation was less than observed in comparable areas treated with meshed grafts. Wound contraction occurred approximately to the same extent as in split-thickness skin grafts. We emphasize that by a better control of wound infection the graft take, also in secondary-stage procedures, can significantly improve.

Adolescent↗
PubMed1990

Allogeneic bone marrow transplantation for secondary leukaemia and myelodysplastic syndrome: a survey by the Leukaemia Working Party of the European Bone Marrow Transplantation Group (EBMTG)

This retrospective survey of the EBMT Leukaemia Working Party describes 78 patients with myelodysplasia (MDS) or secondary acute myelogenous leukaemia (sAML) who received an allogeneic bone marrow transplant (BMT). The status of underlying disease at the time of transplantation was prognostic for the 2-year disease-free survival. Thirty-four patients received intensive chemotherapy prior to the conditioning for BMT. The 2-year disease-free survival was 60% for the 16 patients transplanted in complete remission. The results were significantly less favourable for those with more advanced disease who only partially responded to prior intensive chemotherapy (2-year disease-free survival: 18%) while none of those who either relapsed or were resistant to chemotherapy survived BMT for 2 years. Forty-four patients had not received any prior intensive chemotherapy. The disease-free survival at 2 years after BMT was 58 +/- 19% when a patient was transplanted for refractory anaemia (RA(S], 74 +/- 14% for refractory anaemia with excess of blasts (RAEB), 50 +/- 16% for RAEB in transformation (RAEBt), and 18 +/- 11% for secondary AML. Allogeneic BMT can therefore be considered as curative treatment for patients with MDS. Patients with sAML who have a histocompatible donor should be given chemotherapy intensive enough to induce complete remission. If this is achieved these individuals have a prognosis comparable to those with de novo AML in first remission after BMT.

Adolescent↗
PubMed1990

Evaluation of microcytosis using serum ferritin and red blood cell distribution width.

Out of 104 patients with microcytosis (MCV less than 80 fl), 69% had an iron deficiency, 21% a chronic disease and 10% hemoglobinopathy or thalassemia trait. The absence of bone marrow iron stores or the response to iron supplementation were used to establish the diagnosis iron deficiency. On the basis of sensitivity (90%) and specificity (100%), the serum ferritin concentration is more suitable for assessment of iron deficiency than the serum iron concentration, the total iron-binding capacity or the percentual saturation of transferrin. The red cell distribution width (RDW) is the parameter with the highest sensitivity for iron deficiency (94%). An RDW value within the reference interval can be used to exclude iron deficiency in those cases in which the serum ferritin concentration does not accurately reflect the iron stores owing to severe tissue damage, as in inflammation or malignancy.

Adult↗
PubMed1990

The long-term effects of nedocromil sodium and beclomethasone dipropionate on bronchial responsiveness to methacholine in nonatopic asthmatic subjects.

We investigated the effects of long-term treatment with two anti-inflammatory drugs, nedocromil sodium and beclomethasone dipropionate, on airway hyperresponsiveness to methacholine (PC20), on baseline FEV1 and on the bronchodilating effect of a deep breath in 25 nonsteroid-dependent nonatopic asthmatic adults. In all subjects the prestudy PC20 was less than 8 mg/ml, the postbronchodilator FEV1 was greater than 75% predicted, and skin prick tests and RAST to 13 common allergens were negative. After 2 months run-in, the subjects were randomly allocated into 3 parallel treatment groups to inhale double-blind either 4 mg nedocromil (n = 9) or 100 micrograms beclomethasone (n = 8) or placebo (n = 8) 4 times daily for 4 months. PC20 was measured using the 2-min tidal breathing method. The effect of a deep breath was measured during methacholine-induced bronchoconstriction by standardized maximal and partial expiratory flow-volume curves and was expressed as a flow ratio (M/P ratio). Pretreatment values of FEV1, PC20, and M/P ratio were not different between the 3 groups. PC20 did not change in the placebo group, but increased significantly by a factor of 3 after 8 wk of treatment with beclomethasone or nedocromil (p less than 0.001). FEV1 did not change after treatment with placebo or nedocromil (p greater than 0.2), but increased (mean change 0.2 L, SD 0.2) after 4 wk of treatment with beclomethasone (p less than 0.05). Geometric mean M/P ratio increased from 1.98 to 2.66 after 4 wk of beclomethasone (p less than 0.01), but not after nedocromil or placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

The value of MR imaging in monitoring the effect of chemotherapy on bone sarcomas.

We studied the value of MR imaging in monitoring the response of Ewing sarcoma and osteosarcoma to chemotherapy. Relative signal-intensity changes on MR images in the course of chemotherapy were compared with changes in tumor volume and histopathologic findings. MR scans (T1- and T2-weighted spin-echo images) were obtained in 20 patients with bone sarcoma. The first MR scan was obtained before the administration of chemotherapy in all patients. The follow-up scan was obtained in the course of treatment, before surgery. Tumor-volume and signal-intensity measurements of the intra- and extraosseous components of the tumor were analyzed. In 17 patients, histopathologic findings of the resected tumor were available for comparison with the MR images. In 12 of 17 patients there was complete agreement between changes in tumor volume, changes in the signal intensity of the extraosseous tumor component on T2-weighted images, and histopathology. In another four cases, changes in signal intensity correlated either with histopathology or with changes in tumor volume. In one patient with a pathologic fracture, no such correlation existed. A significant correlation was found between changes in signal intensities and pathologic response (r = .57, p = .02), as well as between changes in tumor volume and pathologic response (r = .53, p = .03). No correlation could be found between changes in signal intensity of the intraosseous tumor component and changes in tumor volume or histopathology. We conclude that the signal intensity of the extraosseous component of bone sarcomas on T2-weighted MR images in addition to changes in tumor volume may be useful in evaluating response to chemotherapy.

Adolescent↗