European experience of bone marrow transplantation for leukemia.
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Aging↗
Biomedical subjects
J Hermans
Publications and source records attributed to J Hermans.
[Diagnostic value of thallium 201 scintigraphy in the determination of malignancy of cold thyroid nodules].
In this paper we discuss and quantify the respective values of Thallium 201 scintigraphy and cytologic punction in determining malignancy of the cold thyroid nodule. These two diagnostic tests are evaluated on the basis of their sensitivity and specificity while taking into consideration various therapeutic attitudes in the presence of a cold thyroid nodule.
Bayes Theorem↗
Factors influencing the incidence of infections in Felty's syndrome.
To identify clinical and laboratory risk factors for the susceptibility to infections in Felty's syndrome, 46 patients were studied prospectively during a total number of 431 periods of three months ("patient-quarters"). The incidence of infections increased significantly with polymorphonuclear leukocyte (PMN) counts below 0.1 X 10(3)/mm3 (less than 0.1 X 10(9)/L). At PMN levels over 0.1 X 10(3)/mm3 (greater than 0.1 X 10(9)/L), no association was found between PMN counts and the incidence of infections. Other factors found to be associated with an increased incidence of infections were severe disability, skin ulcers, glucocorticosteroid dose, monocyte counts, hypocomplementemia, and high levels of circulating immune complexes. The activity of the rheumatoid arthritis, erythrocyte sedimentation rate, hemoglobin concentrations, and lymphocyte counts were not associated with increased incidence of infections.
Arthritis, Rheumatoid↗
Surgical treatment of renovascular hypertension caused by arteriosclerosis. I. Influence of preoperative factors on blood pressure control early and late after reconstructive surgery.
This study evaluates the long-term efficacy of reconstructive surgery for renovascular hypertension caused by arteriosclerosis, which was performed on 112 patients from 1959 to 1983. Despite medical therapy, all patients had persistent hypertension, with a mean preoperative blood pressure of 188/113 mm Hg. Their median age was 49 years, and the median duration of objectively documented hypertension was 21 months at the time of surgery. Manifestations of extrarenal arteriosclerosis (ERA) were present in 57 patients (51%). Results were evaluated both at a short-term (ST) interval (mean: 8.4 months) and at a long-term (LT) interval (mean: 8.9 years) postoperatively. Patients were classified by means of strict criteria as cured, improved, or unsuccessfully treated. If a patient was cured or if his condition improved, this was considered a beneficial blood pressure response. Beneficial responses were maintained during LT follow-up, since the respective percentages for cure and improvement were 24% and 50% at the ST interval and 18% and 61% at the LT interval. These results had not been influenced by either older age or the presence of ERA, since results were similar in patients older and younger than the median age and in those with and without ERA. The preoperative duration of hypertension was the only pertinent clinical feature that influenced the LT interval results, LT beneficial responses were observed in 95% of the patients with a shorter duration and in 78% of those with a longer duration of preoperative hypertension than the median (p = 0.01). We conclude that surgical therapy for renovascular hypertension caused by arteriosclerosis can effectively reduce blood pressure and that this result is maintained during LT follow-up. In terms of anticipated blood pressure response, older age, longer duration of hypertension, and the presence of ERA do not exclude surgical therapy.
Adult↗
Long-term results of in situ and extracorporeal surgery for renovascular hypertension caused by fibrodysplasia.
In this study the early and late results of surgical reconstruction for renovascular hypertension caused by fibrodysplasia are evaluated in 53 patients treated between 1962 and 1983. There were 40 female and 13 male patients. The mean blood pressure was 208/126 mm Hg before medical therapy and 171/109 mm Hg thereafter. Bilateral renal artery stenoses were present in 12 patients. In situ revascularization was used in 26 patients and extracorporeal surgery to repair branch artery lesions was performed in 27 patients. Surgical therapy reduced the blood pressure to normal levels with minimal antihypertensive medications. This effect was already apparent 6 to 12 months after operation (mean blood pressure level of 140/90 mm Hg) and it was maintained during a mean follow-up period of 8.4 years (range 1 to 20 years) (mean blood pressure level of 134/85 mm Hg). At 6 to 12 months after operation, 79% of the patients were classified as either cured or improved. At this time the results did not appear to have been influenced by the preoperative duration of hypertension, nor by manifestations of extrarenal arteriosclerosis (ERA) as found in 10 patients, or by the surgical technique applied. But at the end of the long-term follow-up period (mean 8.3 years) the beneficial response rate of 87% appeared to have been adversely influenced by the presence of preoperative ERA, since beneficial response rates were 93% for those without and 67% for those with ERA (p = 0.17). We conclude that renal revascularization is effective both early and late for the treatment of renovascular hypertension caused by fibrodysplasia and that complex renovascular obstruction can be treated effectively with extracorporeal repair.
Adolescent↗
Interactions of methotrexate and cyclophosphamide with the pharmacokinetics of 5-fluorouracil in an animal model.
The interaction of methotrexate and/or cyclophosphamide with the pharmacokinetics of 5-fluorouracil (5-FU) was studied in tumor-bearing WAG/Rij rats. Four groups were formed including treatment with single-agent 5-FU (eight rats); 5-FU plus methotrexate (11 rats); 5-FU plus cyclophosphamide (12 rats); and 5-FU, cyclophosphamide, and methotrexate (13 rats). The area-under-the-plasma-concentration/time curve, total-body clearance, elimination half-life, mean residence time, and steady-state volume of distribution were computed and compared. The mean residence time and elimination half-life of 5-FU increased when methotrexate was included in the combination. The increase was significant (P less than 0.05) for 5-FU, cyclophosphamide, and methotrexate versus 5-FU and cyclophosphamide.
Animals↗
Breast scintigraphy with 99mTc-diethylene triamine penta-acetic acid for the detection of malignant disease.
A single-blind prospective study of 99mTc-diethylene triamine penta-acetic acid (DTPA) breast scintigraphy was performed on 160 women who presented at the outpatient clinic with suspected breast tumour. The sensitivity of scintigraphy in establishing the diagnosis of breast cancer was 75 per cent. The specificity of scintigraphy in excluding the presence of breast cancer was 91 per cent. The diagnostic value of DTPA breast scintigraphy is at present too low in comparison with mammography to be clinically useful.
Adult↗
Prognoses and surgical treatment of patients with stage I melanomas of the skin: a retrospective analysis of 211 patients.
From 1960 to 1982, a total number of 216 patients with Stage I melanoma underwent local excision as the single treatment. Life-table analysis was performed on 211 evaluable patients to investigate the prognostic value of several factors on survival as well as disease-free survival. The influence of sex, age, localization of the tumor, and margin of the excision on prognosis was not statistically significant. The Clark level and Breslow thickness were important factors to predict the prognosis. Local recurrence occurred in only one patient; in most cases tumor growth close to the original site of excision indicates early manifestation of hematogenic spread. Lymph node metastases developed in 31 patients; ten of them remained free of disease after node dissection. Six patients died from hematogenic metastases without nodal involvement. Tumors with thickness less than 1.5 mm have excellent prognosis regardless of the location of the melanoma or the margin of the excision. With increasing thickness of the tumor, prognosis is proportionally worse. By performing wide excisions the final outcome can not be improved.
Adolescent↗
A double-blind study on the effect of discontinuation of gold therapy in patients with rheumatoid arthritis.
To assess the benefit of further gold treatment of rheumatoid arthritis (RA) patients who had already received more than 6 g of this metal, 24 such patients were included in a double-blind trial. Besides this "gold group" comprising 11 patients who received gold (Auromyose) in the same dosage schedule as before the study, the trial included a "placebo group" comprising 13 patients who received gold in a suspension diluted 1/100. In either group clinical, laboratory, and radiological data did not differ after 6 and 24 months in relation to the results at entry except for the serum gold concentrations, which were lower in the placebo group. We conclude that discontinuation of the treatment in RA patients who have received more than 6 g gold is not harmful to the patients for at least two years after withdrawal.
Aged↗
The calibration of rabbit tissue thromboplastins: experience of the Dutch Reference Laboratory for anticoagulant control.
A number of commercial rabbit tissue thromboplastins used in oral anticoagulant control have been calibrated against the first International Reference Preparation for thromboplastins. This was done in a three-stage procedure by one laboratory, each stage representing a different level of thromboplastin comparability. The calibration model recently recommended by ICTH and ICSH was tested. This model proved to be suitable, although a statistically significant aberration was observed for some of the thromboplastins. The bias introduced by using the model in these non-ideal cases was small compared to the overall variation of the International Normalized Ratio, being the universal scale for reporting the prothrombin time during oral anticoagulant control. Batch-to-batch calibration using lyophilized pooled plasmas could be reliably performed for several commercial thromboplastins.
Administration, Oral↗
Vindesine, cisplatin, and bleomycin combination chemotherapy in non-small cell lung cancer: survival and quality of life.
Although combination chemotherapy is applied on a large scale in advanced non-small cell lung cancer (NSCLC), we still lack evidence indicating in which subsets of patients survival or quality of life might be improved. We studied these issues among a sample of 28 NSCLC patients with a high performance status, who received a tri-weekly vindesine, cisplatin, and bleomycin combination. Treatment was extended for an additional two courses only if a response was observed after the initial three courses. An overall response rate of 13/27 evaluable patients (48%) was found (complete response 1/27 and partial response 12/27) with a median response duration of 24 weeks. Median survival was 33 weeks (47 for responders and 26 for non-responders). Toxicity was primarily related to cisplatin, including severe nausea and vomiting and nephrotoxicity in 68% and 21% of the patients, respectively. Performance status and body weight dropped significantly during chemotherapy both among responders and non-responders. Performance status after discontinuation of chemotherapy approached pre-treatment scores in responders only. While the antitumor effect of this drug combination was confirmed, we conclude that treatment-associated toxicity and deterioration of the patients' well-being offset any potential survival advantage for the majority of patients.
Adult↗
Quantitative analysis of morphological features in Huntington's disease.
In an electron microscopic study neuronal nuclear membrane indentations and astrocyte/neuron ratios in the nucleus accumbens, caudate nucleus and frontal cortex were counted in 30 Huntington's disease patients and 23 controls. Discriminant analysis was performed and resulted in a discriminant equation, which was able to recognize all controls correctly. Three Huntington patients were not correctly recognized, although in only one patient the probability of being a control was higher than being a Huntington patient. This discriminant equation was used in four choreatic patients with a negative family history. Two patients were indicated as controls, one patient as being a Huntington patient, and one as dubious. The diagnostic yield of discriminant analysis is discussed.
Adolescent↗
Significance of in vitro cultures in myelodysplastic syndromes.
Bone marrow samples from 20 controls, 41 patients suffering from various types of myelodysplasia and 19 suffering from ANLL were investigated by in vitro cultures. The cultures were stimulated by various concentrations of leucocyte conditioned medium (LCM) and PHA-stimulated conditioned medium (PCM) and were examined after 7 and 14 d. We found that, in clinically stable MDS, growth patterns and dose-response to CM's were mostly within the normal range. With progressive blastic transformation, these features became abnormal with an increase in cluster growth. Clusters responding to a high dose of LCM, persisting after 14 d and enhanced by PCM may represent 'early' clonogenic cells. These clusters were found in progressive MDS with increased numbers of blast cells. Clusters formed by 'late' clonogenic cells were found in normal bone marrow and stable MDS. In ANLL the disturbance of proliferation and maturation seems to be much more pronounced than in progressive MDS with blastic transformation. We conclude that the interpretation of in vitro bone marrow culture data in terms of a disorderly arrangement of clonogenic cells in MDS and ANLL is facilitated by comparing different conditioned medium stimulations and by scoring after different time intervals.
Acute Disease↗
Cyclosporin treatment for rheumatoid arthritis: a placebo controlled, double blind, multicentre study.
The efficacy and safety of cyclosporin for patients with rheumatoid arthritis (RA) were assessed in a six month double blind, placebo controlled, multicentre study. The initial dosage of the drug was 10 mg/kg daily for two months. There were many discontinuations in both the cyclosporin group (eight out of 17) and the placebo group (six out of 19). Of the patients who completed the six months of therapy, those who had received cyclosporin showed a significant improvement in the number of swollen joints, the Ritchie articular index, and pain at active movement and at rest, compared not only with their condition at the start of the study, but also with the end results of the placebo group. Major adverse reactions to the drug were gastrointestinal disturbances and nephrotoxicity, which were probably due to the relatively high dosages of cyclosporin given in combination with non-steroidal anti-inflammatory drugs.
Adult↗
Morphometry and breast cancer. II. Characterisation of breast cancer cells with high malignant potential in patients with spread to lymph nodes: preliminary results.
The prognostic value of clinical, quantitative, and qualitative microscopical features of both the primary tumour and also of the affected lymph nodes were investigated in 71 patients with breast cancer with spread to lymph nodes (T X N + M0). Age, tumour size, and localisation of the tumour comprised the clinical features; morphometry included assessment of the cellularity index, the mitotic activity index, and seven nuclear indices; the qualitative features investigated were histological type and grade, nuclear grade, oestrogen receptor content, number of lymph nodes affected, capsule infiltration of the nodes, presence of metastatic deposits in the efferent lymph vessels, percentage area of lymph node occupied by tumour. Immunohistochemistry was performed to show the presence of carcinoembryonic antigen and peanut agglutinin. All the patients had a minimum follow up of 24 months (maximum 48 months, mean 36 months). Analysis of the results showed that the combined results of morphometry (of the primary tumour and the axillary lymph node metastatic deposits) yielded more information than analysis of axillary lymph node state, or morphometry of the primary tumour, or the lymph node metastases alone. Patients with a nuclear axes ratio of greater than 1.41 in the primary tumour and greater than 1.36 in the lymph node metastatic deposits were less likely to develop distant metastases than patients with values below any of these thresholds (recurrence rates 5.2% and 46%, respectively). Thus the preliminary results of this prospective study indicate that morphometry provides important prognostic information in patients with breast cancer that has spread to lymph nodes.
Adult↗
Quantitative electron microscopy in the early diagnosis of cutaneous T-cell lymphomas. A long-term follow-up study of 77 patients.
Previous studies have demonstrated that quantitative analysis of nuclear convolution of lymphoid cells in electron micrographs is a valuable method of differentiation between well-established cutaneous T-cell lymphoma (CTCL) and chronic benign skin disease. The usefulness of these methods in the diagnosis of early and controversial cases of CTCL has, however, not been fully established. In the present study the authors compared the diagnostic accuracy of two different quantitative ultrastructural methods on a group of 77 patients suspected of having early CTCL. These methods included measurements of the nuclear contour index (NCI) as well as a simple counting of the number of sharply angled nuclear indentations of at least 75 lymphoid cells present on electron micrographs. The results were correlated with the final diagnosis after a follow-up period of 1 to more than 10 years. Measurement of the NCI proved to be a much more sensitive method than determination of the percentage of cells having no sharply angled nuclear indentations (sensitivity, 96% and 62%, respectively). None of these two methods produced false-positive diagnoses. It is concluded that quantitative ultrastructural methods, in particular, NCI measurements, are an important adjunct in the diagnosis of CTCL, even in early and controversial cases.
Cell Nucleus↗
A prospective randomised comparative study on the influence of cyclosporin and azathioprine on renal allograft survival and function.
To study the effectiveness and nephrotoxic side-effects of cyclosporin A (CsA) in renal transplant recipients, a prospective randomised trial was designed to compare CsA with azathioprine (Aza). Each treatment group consisted of 40 patients; in the CsA group, 18 were randomly selected for conversion to Aza after 3 months. The 1-year graft survival for CsA-treated patients was 87% compared with 66% for the Aza group (P = 0.033). Anti-rejection therapy was administrated to 78% of the patients in the Aza group and 47% of those in the CsA group (P less than 0.01). There was no difference in the incidence of primary non-functioning kidneys, cytomegalovirus infections, hypertension, or degree of proteinuria between the two treatment groups. At 3 months the mean creatinine clearance was 42 +/- 2 ml/min (mean +/- SEM) for the CsA group compared with 56 +/- 4 ml/min for the Aza group (P less than 0.01), whereas the mean creatinine clearances at 6 months for both the converted and the non-converted CsA-treated patients did not differ from that found in the Aza-treated group. At 1 year, the mean creatinine clearance for CsA-treated patients who were converted to Aza was higher than that found for Aza-treated patients (62 +/- 7 vs 50 +/- 6 ml/min; P less than 0.05). Furthermore, the increment in creatinine clearance observed after conversion from CsA to Aza at 3 months showed a linear relationship (r = 0.9061) with the CsA trough levels before discontinuation of the drug. This indicates that CsA treatment induces a dose-dependent, nephrotoxic side-effect which is probably reversible.
Azathioprine↗
Scintigraphy of the female breast with Tc-99m-DTPA: a prospective blind evaluation.
Following a report on the use of Tc-99m-diethylenetriamine pentaacetic acid (Tc-99m-DTPA) for detection of malignant breast tumors we compared this method with other diagnostic aids such as mammography and cytology. Among 160 women referred to our department for diagnosis, 166 examinations were performed (six patients had bilateral lesions); the final diagnosis of the breast lesion was established as malignant in 62 cases and benign in 104 cases. The scintigraphic image was reported malignant if an area of focal uptake observed on the scan 30 minutes after injection of the tracer persisted or became more intense on the 2-hour scintigram. All other uptake patterns were considered benign. For this examination we obtained a sensitivity of 75% and a specificity of 91%. For mammography, sensitivity was 90% and specificity was 82%. The lower false-positive results of scintigraphy may serve to confirm the benignancy of doubtful mammographic findings, for when both examinations suggest a benign lesion, the combined imaging procedure is a useful means of excluding cancer (sensitivity 96%, predictive value 98%). It is concluded that in all other cases Tc-99m-DTPA breast scintigraphy is of limited value.
Adult↗