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Biomedical subjects

J Stam

Publications and source records attributed to J Stam.

At least 55 records · Page 3Linked to original sources
PubMed1993

Long term survival of small cell lung cancer patients after chemotherapy.

Eighty-one patients with small cell lung cancer (SCLC) with a survival of more than 2 years after start of chemotherapy were studied. Twenty-six of the 28 patients who died of relapsed SCLC had in fact relapsed before two years and of the 55 who had not then only two (4%) relapsed subsequently. It is stressed that with such observations treatment related factors should be taken in account. Second tumours were observed in ten patients, nine proven malignant. Of the eight patients with non-small cell lung cancer three had residual disease after initial chemotherapy. In our patient group after a 2 year disease-free interval the risk of developing non-small cell lung cancer seems higher than a subsequent relapse of SCLC.

Adult↗
PubMed1993

Peripolesis in alveolar sarcoidosis.

We observed that in bronchoalveolar lavages (BAL) of patients with active sarcoidosis (SARC) a mononuclear cell infiltrate is present that often contains clusters consisting of lymphocytes adhering to a macrophage. In order to investigate what kind of cellular interactions are involved in such a process, cell suspensions obtained from BAL of patients with SARC or extrinsic allergic alveolitis (EAA) were cultured for 1 to 2 days, during which time lapse cinematography was applied. We were able to show that such clusters consist of lymphocytes gathered around a macrophage. This is known as peripolesis. Peripolesis, as observed in our BAL, could last for some minutes or for some hours during which time a number of lymphocytes were moving around a single alveolar macrophage, without losing contact with the macrophage. Short interactions were mostly observed in EAA, whereas SARC was characterized by long periods of lymphocyte-macrophage cooperation. We also found a correlation between the time-dependent peripolesis t > 30 min/t < 30 min and the CD4/CD8 ratio. Although the precise mechanisms of peripolesis are not well understood, some interactions between lymphocytes and macrophages have now become more comprehensive.

Alveolitis, Extrinsic Allergic↗
PubMed1993

The onset of action of formoterol, a new beta 2 adrenoceptor agonist.

Formoterol, a new long-acting beta 2-agonist, seems to be a step forward in the treatment of recurrent obstructive airway disease. Obstruction during the night and morning dip are less frequent and patient compliance is expected to be better than with the bronchodilators now in use. We studied the characteristics of the onset of action of formoterol by measuring sGAW (sGAW = specific airway conductance) to see if formoterol could be used as a rescue drug in cases of sudden attacks of obstruction. Our results show that one minute after inhalation of 12 micrograms formoterol MDI 14 patients out of 20 have a clinically relevant increase in sGAW after formoterol (+ 40% of the initial values) in comparison with 2 patients receiving placebo.

Adrenergic beta-Agonists↗
PubMed1992

[Routine screening for syphilis in neurology is not useful].

In a retrospective study the results of the screening for syphilis in one of the neurological wards of the Academic Medical Centre in Amsterdam were analysed. The Venereal Disease Research Laboratory test (VDRL) and the Treponema Pallidum Haemagglutination Assay (TPHA) in serum were used for screening. The data for analysis were obtained via the hospital computer data base and via the medical files of the department of neurology. During the 5-year study period (1986-1990) 2378 adult patients were admitted and 1247 (52.4%) of them were screened. In seven (0.56%) patients both tests were positive. Three of them had been treated for syphilis in the past and showed no symptoms of active syphilis. Four (0.32%) patients suffered from active neurosyphilis. In three of these four patients syphilis was suspected on admission and confirmed by the tests. In one patient the diagnosis of syphilis was not considered. The positive test results became available shortly before she died of pneumonia and were without consequences. None of the 32 (2.6%) patients with a positive TPHA and a negative VDRL was diagnosed as having (neuro-)syphilis. Two (0.16%) patients had a false-positive VDRL. We conclude that routine serological examination for syphilis of every patient admitted to a neurological ward is not useful. We advise a limited screening of patients who belong to a group with high risk for syphilis and patients with symptoms and signs that can be caused by syphilis, such as dementia or ischaemic strokes at a relatively young age.

Adult↗
PubMed1992

Itraconazole compared with amphotericin B plus flucytosine in AIDS patients with cryptococcal meningitis.

OBJECTIVE: We conducted a comparison of itraconazole versus amphotericin B plus flucytosine in the initial treatment of cryptococcal meningitis in patients with AIDS and established the efficacy of itraconazole as maintenance treatment. DESIGN: The trial was a prospective, randomized, and non-blinded study. SETTING: The study was performed at an academic centre for AIDS, Amsterdam, The Netherlands. PATIENTS, PARTICIPANTS: Twenty-eight HIV-1-seropositive men with a presumptive diagnosis of cryptococcal meningitis, randomized between 5 February 1987 and 1 January 1990, were included for analysis. INTERVENTIONS: Oral itraconazole (200 mg twice daily), versus amphotericin B (0.3 mg/kg daily) intravenously plus oral flucytosine (150 mg/kg daily) was administered for 6 weeks followed by maintenance therapy with oral itraconazole (200 mg daily) to all patients. MAIN OUTCOME MEASURES: Outcome measures were a complete or partial response, recrudescence and relapse. RESULTS: A complete response was observed in five out of the 12 patients who completed 6 weeks of initial treatment with itraconazole versus all 10 patients who completed treatment with amphotericin B plus flucytosine (P = 0.009). A partial response was observed in seven out of the 14 patients assigned to itraconazole. During maintenance therapy, recrudescence (n = 6) or relapse (n = 1) occurred in seven out of the 12 patients initially assigned to itraconazole, whereas two relapses occurred among nine patients initially treated with amphotericin B plus flucytosine (P = 0.22); recurrence of clinical symptoms was significantly related to a positive cerebrospinal fluid culture at 6 weeks (P = 0.003). CONCLUSION: Itraconazole is less effective compared with amphotericin B plus flucytosine in achieving a complete response in initial therapy in AIDS patients with cryptococcal meningitis.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Nd-YAG laser under local anaesthesia in obstructive endobronchial tumours.

Thirty-eight neodymium yttrium aluminium garnet (Nd-YAG) laser sessions have been performed in 26 patients under local anaesthesia. The majority of patients had recurrences of inoperable non-small-cell lung cancer after radiotherapy. At evaluation, a subjective improvement of dyspnoea was noticed in 70% (18/26) of the patients, and in 54% (14/26) of the cases, a greater than 50% improvement of the airway lumen diameter was assessed at bronchoscopy. Haemoptysis subsided in 4 out of the 5 patients. On 2 occasions, the rigid scope was introduced to provide optimal control of minor bleeding during the laser performance. Neither respiratory failure, nor any treatment-related death has occurred. In our hands, Nd-YAG treatment under local anaesthesia was a feasible, effective and safe procedure.

Airway Obstruction↗
PubMed1991

Macrophage-T suppressor cell interference in the lungs of steroid-treated sarcoidosis patients.

In the bronchoalveolar lavage of sarcoidosis patients the mononuclear cell infiltrate was enumerated on T helper and suppressor lymphocytes as well as macrophages by means of a triple-staining assay on cytospin slides. As was seen on the slides, lymphocytes were often adhered very closely to macrophages. This phenomenon, many times described but not understood, was studied in a group of 13 sarcoidosis patients, of whom 7 received prednisolone treatment. It could be shown that treatment with the corticosteroid was followed by an increase in the percentage of suppressor lymphocytes adhered to macrophages. Second, the number of such alveolar T suppressor lymphocyte-macrophage aggregates was dramatically increased in the prednisolone-treated patients.

Adult↗
PubMed1991

Spontaneous haemopneumothorax: a rare clinical entity.

A 39 yr old man presented with a spontaneous pneumothorax. On initial pleural drainage 120 ml of haemorrhagic fluid were collected. Twenty four hours, after re-expansion of the lung, shock developed and 1,200 ml of haemorrhagic fluid were spontaneously collected. The diagnosis haemopneumothorax was considered and at operation a bleeding vessel, which originated from the parietal pleura, was located and coagulated. The occurrence of an air fluid line at radiological examination, the development of a haemorrhagic pleural effusion and shock should alert the physician of this entity. This case stresses the importance of early recognition and surgical intervention because of the possible lethal evolution.

Adult↗
PubMed1991

Scoliosis as cause of pulmonary atelectasis.

We present a patients with persistent position-dependent productive cough and intermittent fever. He was first examined at 38 yrs of age. Chest X-ray showed a severe thoracic lordoscoliosis and an atelectasis of the right lower lobe. Bronchography revealed a total stenosis of the right lower lobe bronchus. Five years later had increased symptoms. Spirometry showed total lung capacity (TLC) 3.8 l (predicted value 6.7 l), forced vital capacity (FVC) 2.6 l (4.8 l) and forced expiratory volume in one second (FEV1) 1.7 l (3.9 l). Bronchoscopy demonstrated a smooth stenosis of the right lower lobe bronchus but the stenosis could be passed through with a brush. Computed tomographic scanning demonstrated compression of the right lower lobe bronchus and the atelectasis. After surgical removal of the right lower lobe, all symptoms disappeared. Histological examination of the right lower lobe revealed fibrosis and chronic inflammation.

Adult↗
PubMed1990

K-ras oncogene activation as a prognostic marker in adenocarcinoma of the lung.

BACKGROUND: The capability of activated oncogenes to induce malignant transformation of immortalized cells in vitro has suggested that they have a similar role in the pathogenesis of human tumors. We previously found that activation of the K-ras oncogene by a point mutation in codon 12 occurs in about one third of human lung adenocarcinomas. METHODS: We studied the clinical importance of this oncogene-activation in 69 patients with lung adenocarcinoma in whom complete resection of the tumor was possible. The polymerase chain reaction was used to amplify ras-specific sequences of DNA isolated from frozen or paraffin-embedded tumor samples. Ras point mutations were subsequently detected and classified with the use of mutation-specific oligonucleotide probes. RESULTS: Nineteen of the tumors harbored a point mutation in codon 12 of the K-ras oncogene. There was no association between the K-ras point mutation and the age at diagnosis, sex, or presence of previous or concurrent neoplasms. Tumors positive for K-ras point mutations tended to be smaller and less differentiated than those without mutations. The K-ras codon-12 point mutation was a strong (and unfavorable) prognostic factor: 12 of the 19 patients with K-ras point-mutation-positive tumors died during the follow-up period, as compared with 16 of the 50 patients with no mutation in the K-ras oncogene (P = 0.002). This difference in prognosis was also reflected in the duration of disease-free survival (P = 0.038) and in the number of deaths due to cancer (P less than 0.001). CONCLUSIONS: The presence of K-ras point mutations defines a subgroup of patients with lung adenocarcinoma in whom the prognosis is very poor and disease-free survival is not usually long despite radical resection and a small tumor load.

Adenocarcinoma↗
PubMed1990

[Can nearly finished medical students interpret their professional literature?].

The ability of senior medical students to interpret clinical research articles was examined by means of a written examination based upon two papers from general medical journals. The subjects of the articles were a diagnostic test and a therapeutic trial respectively. Knowledge of basic methodological and statistical concepts mentioned in the articles was in 86% of the students examined (n = 90) below the minimal level required for correct interpretation. 60% of the participants could not correctly apply the results mentioned in the diagnostic paper to a written clinical problem, and 11% could not apply the result of the therapeutic trial. From the reasons the participants gave for their decisions it appeared that 77% and 35% respectively had not been able to interpret the articles correctly. A comparison between self-rated knowledge and results of the test showed that the students tended to overestimate their knowledge. Knowledge of basic concepts of clinical epidemiology and statistics of these nearly graduated medical doctors is insufficient, and many of them cannot interpret clinical research articles correctly.

Clinical Competence↗
PubMed1990

Reliability of the clinical and electromyographic examination of tendon reflexes.

The reliability of clinical examination of the tendon reflexes was examined by studying inter-observer agreement. Twenty patients were examined by three neurologists. The briskness of the tendon reflexes in arms and legs was scored on a nine-point scale. In 28% of the 160 examined reflexes the observations disagreed 2 scale units or more. Disagreement on the presence of asymmetry occurred in 45% of the 80 reflex pairs. In 15% one observer judged a reflex pair to be symmetrical while another observer found asymmetry of at least 2 scale units. In a second experiment clinical observation of apparently asymmetrical quadriceps reflexes was compared with measurement by surface electromyography. A significant, semi-logarithmic relationship was found between clinical scores and measured reflex amplitudes. Measured reflex asymmetry always agreed with clinical asymmetry, and the magnitudes of right-left amplitude differences were correlated with the magnitude of clinically observed asymmetry. The bedside examination of tendon reflexes is subject to considerable inter-observer disagreement.

Adult↗
PubMed1990

Vitamins and lung cancer.

Several factors are known to promote the development of a lung cancer. Smoking, occupation, environment, chronic bronchitis, and scars in the lung are all risk factors. Many studies have stressed the importance of nutrition, in particular vitamins. Vitamin A is necessary for cell differentiation. Retrospective and prospective studies have proven the inverse relation between provitamin A, beta-carotene, and lung cancer of the squamous and oat cell types. Studies in which beta-carotene or natural vitamin A are supplied to smokers, controls, and patients after resection for lung cancer are in progress. The study of other vitamins such as vitamin C and vitamin E has not led to definitive conclusions. The trace element selenium may also exert a beneficial effect.

Carotenoids↗
PubMed1990

Mental changes in patients with AIDS.

Mental changes are common in patients with acquired immunodeficiency syndrome (AIDS). Neuropsychological data of 32 patients with AIDS and cognitive symptoms were reviewed. All patients were neurologically examined and ancillary investigations were performed. According to the neuropsychological data three groups could be distinguished: I) 4 patients with dementia and cortical deficits; II) 16 patients with subcortical dementia; III) 12 patients with subcortical cognitive deficits without global intellectual deterioration. AIDS Dementia Complex (ADC) was diagnosed in 12 patients and occurred in all three groups. The most frequent form of dementia in patients with AIDS is of a subcortical type. Impaired memory or reduced psychomotor speed, or both, are common in patients without global intellectual deterioration. ADC seems an unlikely diagnosis in patients with cortical dementia. Neuropsychological examination is important for diagnosing ADC but the diagnosis cannot be made without regarding the neurological findings and ancillary investigations.

AIDS Dementia Complex↗
PubMed1990

T lymphocytosis in a bronchoalveolar lavage of a pulmonary adenocarcinoma: case report.

We report the results of a bronchoalveolar lavage (BAL) in a patient suspected of interstitial lung disease and/or malignancy. The recovered cells from the lavage were characteristic of a high intensity alveolitis as seen in sarcoidosis. However, some adenocarcinoma cells were also found. The significance of these findings could be (a) that some immune response against this pulmonary malignancy may exist, and (b) that BAL can be used as a valuable tool to characterize the alveolitis of sarcoidosis, but carefully cytologic examination of BAL cells should be performed to exclude other causes of interstitial lung disease with an associated lymphocytic alveolitis.

Adenocarcinoma↗