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Biomedical subjects

N H Mulder

Publications and source records attributed to N H Mulder.

At least 325 records · Page 18Linked to original sources
PubMed1982

Nephrotoxicity of cis-diamminedichloride platinum (CDDP) during remission-induction and maintenance chemotherapy of testicular carcinoma.

We studied renal function in nine patients with disseminated testicular carcinoma before and after remission-induction and maintenance therapy with a drug combination containing cis-platinum. The median glomerular filtration rate (GFR) decreased during remission-induction therapy from 146 to 118 ml/min. No effect of cumulative toxicity on the median GFR was found during maintenance therapy, nor did the median GFR improve. The median effective renal plasma flow (ERPF) decreased during the total period from 705 to 514 ml/min. No significant changes in median filtration fraction (FF) and serum creatinine were observed. It is suggested that intrarenal hemodynamic effects are important in the nephrotoxicity of cis-diamminedichloride platinum (CDDP).

Adult↗
PubMed1982

Vascular problems in paroxysmal nocturnal haemoglobinuria. A report of two cases.

Two patients with paroxysmal nocturnal haemoglobinuria (PNH) are described who had severe vascular complications. The first patient developed extensive thrombosis of the abdominal veins leading to intractable ascites symptomatically treated with a peritoneo-venous shunt. The second patient had aneurysm of the abdominal aorta treated with a prosthetic graft. Although in both patients prosthetic grafts were implanted no signs of an increased activation of the P.N.H. cells were found and no thrombosis or severe haemolytic anaemia occurred. It is suggested that surgical intervention for vascular complications in PNH should not be delayed because of fear of activating the PNH.

Adult↗
PubMed1982

Combination chemotherapy for acute lymphocytic leukaemia in 25 adults.

Twenty-five consecutive adult patients with acute lymphocytic leukaemia (ALL) all achieved complete remission, twenty-two with vincristine-prednisone, while thirteen patients also received daunorubicin (DNR). Three patients obtained remission only after treatment with cytosine arabinoside (Ara-C), 6 thioguanine (6-TG) and adriamycin (ADM). Despite central nervous system (CNS) prophylaxis by intraventricular infections via an Ommaya reservoir, 2/22 patients had a CNS relapse. The median remission duration of the whole group was 19 months. Four patients could stop therapy after 3 years. The median survival duration of all patients was 38 months. The quality of life of the patients during this chemotherapeutic regimen was good.

Adolescent↗
PubMed1982

The effect of amphotericin B lozenges on the presence and number of Candida cells in the oropharynx of neutropenic leukemia patients.

A retrospective evaluation was made on the value of amphotericin B lozenges in the selective elimination of yeasts from the oropharynx. Four different groups of severely granulocytopenic patients were studied. All 77 patients received amphotericin B orally as a suspension or as tablets. Four amphotericin B lozenges were also administered daily for topical antimycotic decontamination of the oropharynx. This was done in the presence of colonization-resistance decreasing factors such as a nasogastric tube (Group I, 19 patients) or mucosal damage (Group III, 25 patients) and in patients with four or more consecutive throat swab cultures with yeasts (Group IV, 11 patients). The 22 patients in Group II did not receive lozenges. The addition of lozenges resulted in a decrease in the mean "growth density" of Candida cells in the oropharynx. This reduction was significant in Group III (p less than 0.01) and Group IV (p less than 0.02) and became evident during the first week of treatment. In patients with a nasogastric tube, however, 51.8% of the throat swab cultures revealed yeasts. Increasing the dose of the lozenges might improve the results in these patients. Topical treatment of the oropharynx with amphotericin B lozenges is advocated for patients who are susceptible to Candida infections.

Amphotericin B↗
PubMed1982

Enteral nutrition by nasogastric tube in adult patients treated with intensive chemotherapy for acute leukemia.

In this study, nutritional status 3 wk after starting 20 induction course of chemotherapy with enteral nasogastric tube feeding was compared to the nutritional status after 35 courses with a normal oral hospital diet. Tube feeding consisted of 2000 to 3000 cal daily of a hospital made pasteurized formula or sterile Nutrison RTS. In the group fed by nasogastric tube the mean weight loss was significantly smaller (p less than 0.01) and there were fewer patients with a severe weight loss of more than 5% during the first 3 wk (p less than 0.01) than in the hospital diet group. Serum albumin reduction of more than 10% was present in 4/20 and 23/35 for each group respectively (p less than 0.01). Bacterial contamination occurred in the pasteurized hospital-made formula which led to Pseudomonas septicemia in one patient. During a short-term catabolic state (3 wk) sterile feeding by nasogastric tube can prevent weight loss and hypoalbuminemia in most patients. Bacteriological control of the food and supply system is mandatory in granulocytopenic patients.

Acute Disease↗
PubMed1982

A study of the cellular and humoral immune response in patients with myelofibrosis.

There was evidence of impaired cellular immunity in 10 patients with myelofibrosis. In-vitro lymphocyte transformation with phytohaemagglutin, concanavalin A, and dinitrochlorobenzene skin reaction were diminished. Signs of impaired humoral activity were also found, the primary response to alpha-Helix pomatia haemocyanin being impaired, particularly in the immunoglobulin-A class. Moreover three patients had a benign paraproteinaemia. Immunecomplexes (IC) could be demonstrated with various test systems. The indirect granulocyte phagocytosis test was positive in 50%, the C1q-binding in 70% and the polyethylene glycol precipitation test in 50%. In most patients complement levels were normal, although the patient with the most advanced disease had low C3A, C3 and C4 levels accompanied by high levels of IC. No correlation could be shown between impaired immune response or levels of IC when they were related to spleen diameter or degree of anaemia. Some relation however existed between disturbed immune response and IC when they were related to time elapsed since diagnosis. It is suggested that the impaired immune response is the result of primary bone marrow disease and that the presence of IC may reflect the extent of fibrosis.

Antibody Formation↗
PubMed1981

The value of prognostic indices in aplastic anaemia.

In 43 patients with aplastic anaemia we assessed the accuracy of different prognostic systems. Patients dying within 6 months after diagnosis were correctly predicted in 60% of cases with the Lynch-index with a sensitivity of 82%. With the Najean-index 40% of these patients are correctly predicted, this index has a sensitivity of 100%. More accurate are the prognostic criteria proposed by Camitta et al [5]. With these criteria, this rapidly fatal group is correctly predicted in 85% of the patients, indicating that 15% of the patients are incorrectly predicted to have a limited survival. The sensitivity, however, is 100%. The Lohrmann-index, based on reticulocyte count predicts 64% of this group with severe aplasia. None of these prognostic systems do accurately predict long survival. We suggest that the best differentiation between patients with a long-term prognosis (more than 5 years) and patients who die from aplastic anaemia within 5 years, is made by re-evaluating the leucocyte and platelet count 3 months after the initial diagnosis. Decrease in blood counts (over 10%) predicts death from aplastic anaemia within 5 years correctly in all patients; stable or increased blood counts predict long survival in 75% of the patients.

Anemia, Aplastic↗
PubMed1981

Bacteriological aspects of selective decontamination of the digestive tract as a method of infection prevention in granulocytopenic patients.

We describe the bacteriological results of a controlled clinical trial of selective decontamination of the digestive tract as a method of infection prevention in granulocytopenic patients. Selective elimination of Enterobacteriaceae and Pseudomonadaceae species was accomplished by the oral administration of nalidixic acid, co-trimoxazole, or polymyxin. Yeasts were eliminated selectively by amphotericin B or nystatin treatment. The drugs used in this study were chosen because of their capacities to selectively eliminate gram-negative rods and yeast without affecting the anaerobic part of the gut flora which is responsible for colonization resistance. Compared with the control group, the selectively decontaminated patients had significantly fewer (P less than 0.0005) gram-negative rods or yeasts or both in their throat swab cultures and in their feces. This reduction may explain the clinical effectiveness of selective decontamination.

Agranulocytosis↗
PubMed1981

Immunological dysfunction in paroxysmal nocturnal haemoglobinuria.

In five patients with paroxysmal nocturnal haemoglobinuria (PNH) immune capacity was tested. We found impaired in-vitro lymphocyte proliferation after stimulation with allogenic lymphocytes and concanavalin A (con A) in different concentrations. This suggests a disturbed T-cell immunity in these patients, although the number of T cells were normal. As the response to phytohaemagglutin (PHA) stimulation was adequate in most patients, it is presumed that a part of the T-cell population remains normal, as is also suggested by a normal in-vivo response to dinitrochlorobenzene (DNCB). Normal immunoglobulin (Ig) levels and normal anti Helix pomatia haemocyanin (HPH) antibody response were found in most patients. Some patients showed a very low response to pokeweed mitogen (PWM), suggesting some disturbance in the B cell capacity. The decreased number of B cells, found in all patients may also be attributed to this dysfunction. Exposure to inulin enhances the in-vitro effect in lymphocytes of patients with PNH. This indicates functional damage in a population of lymphocytes, possibly originating from an abnormal cell clone with the PNH characteristics. It is therefore suggested that the immunological disturbances could be caused by the primary bone marrow disease.

Adult↗
PubMed1980

Acquired pancytopenia in relatives of patients with aplastic anaemia.

We studied relatives of adult patients with acquired aplastic anaemia. Eight patients were found to have 11 family members with peripheral blood pancytopenia. Six of the 11 affected relatives had diminished and four normal cellularity and one had hypercellularity of the bone marrow. Thus, 19 persons in these eight families were affected. In two families, father and son were affected, in four families brother and/or sister, in one family a brother and an aunt and in one a nephew of the index patient. None of the patients or family members had congenital defects. All patients were diagnosed at an adult age and, furthermore, also the mode of inheritance in some of the families seems to exclude Fanconi's syndrome. It is concluded that relatives of patients with aplastic anaemia should be screened for manifestations of this syndrome of familial acquired blood pancytopenias.

Adult↗
PubMed1980

Defective stimulating capacity of leukocytes in mixed leukocyte culture in constitutional aplastic anemia caused by suppressor T cells. A case study.

A patient with constitutional Fanconi-like aplastic anemia who developed a preleukemic state was transplanted with bone marrow from his HLA-identical MLC-negative brother. Before transplantation his mononuclear leukocytes were found to have a defective stimulating and responder capacity in mixed leukocyte culture with cells of an unrelated individual. After removal of T cells the stimulating capacity was completely restored. MLC testing with separated cell fractions seems important to establish HLA-D identity with a possible donor, especially when MLC tests with unseparated cells are negative.

Adult↗