Biomedical subjects

W C Hop

Publications and source records attributed to W C Hop.

At least 253 records · Page 14Linked to original sources

PubMed1992

Achalasia complicated by oesophageal squamous cell carcinoma: a prospective study in 195 patients.

To determine the incidence of oesophageal carcinoma in patients with achalasia and to establish the efficacy of endoscopic surveillance, 195 consecutive patients with achalasia (90 men and 105 women, mean age 52 years), who were treated by pneumatic dilatation in our institution between 1973 and 1988 were prospectively studied. None of the patients had undergone cardiomyotomy. Follow up totalled 874 person years after pneumatic dilatation. In this period three patients developed an oesophageal squamous cell carcinoma. The mean age at diagnosis of the oesophageal carcinoma was 68 years (37, 77, and 89 years). The mean period between the onset of dysphagia and the diagnosis of the tumour was 17 years (19, 28, and 5 years); the mean interval between the diagnosis of achalasia and carcinoma was 5.7 years (5, 8, and 4 years). The incidence of oesophageal squamous cell carcinoma in this series (3.4/1000 patients per year) is significantly higher than the statistically expected incidence (0.104/1000 patients per year) using age and sex specific incidence data from the population of the Netherlands (Poisson statistics: p less than 0.001). The risk of developing oesophageal squamous cell carcinoma in patients with achalasia is therefore increased 33 fold. Periodic endoscopy showed the potential for detecting early stage oesophageal carcinoma in two cases but a larger study with a longer follow up is required to determine the efficacy of endoscopic screening in improving the prognosis for patients with achalasia who develop oesophageal squamous cell carcinoma.

Adult↗

PubMed1992

How to discriminate between normal and polycystic ovaries: transvaginal US study.

Transvaginal sonography was used in 29 women with regular menstrual cycles and 52 patients with the polycystic ovary syndrome to determine cutoff levels in the size and number of ovarian follicles and ovarian echogenicity and volume for diagnosis of polycystic ovaries. Median values of the mean size and number of follicles and ovarian volume were, respectively, 5.1 mm, 5.0, and 5.9 mL in control subjects and 3.8 mm, 9.8, and 9.8 mL in patients. Ovarian stroma echogenicity was normal in 26 control subjects (90%) and moderately increased in three control subjects (10%), whereas it was markedly increased in 28 patients (54%), moderately increased in 21 patients (40%), and normal in 13 patients (6%). The sensitivity and specificity of moderately or markedly increased echogenicity of ovarian stroma in the diagnosis of polycystic ovaries was 94% and 90%, respectively. The greatest power of discrimination between normal and polycystic ovaries was obtained with combined measurement of follicular size and ovarian volume (sensitivity, 92% [48 of 52 patients]; specificity, 97% [28 of 29 control subjects]).

Adult↗

PubMed1992

Pelvic phleboliths: is there an association with diverticulitis?

Pelvic phleboliths are familiar structures to radiologists although their pathogenesis is not fully understood. The literature suggests a relationship between the prevalence of phleboliths and diverticular disease, and with a low-fibre diet. Phleboliths are said to be seen more frequently in women and on the left side in the pelvis. Their number seems to increase with advancing age. We have attempted to establish relations of phleboliths with diverticulitis, diverticulosis, sex, age and pelvic location. In this study the only statistically significant relation was an increase of the number of phleboliths with advancing age.

Adult↗

PubMed1992

Diffusion capacity in heart transplant recipients.

Preoperative diffusion capacity per liter alveolar volume (Kco) in cardiac transplant recipients with an intrinsic normal lung is within the normal range. In the first postoperative year, Kco showed a significant mean decrease of 12 percent (p less than 0.004). Lung function (TLC, VC, FEV1) tended to normalize after heart transplantation. Ventilation distribution remained stable before and after heart transplantation. Preoperatively, weak correlations were found between Kco and diastolic pulmonary arterial pressure (dPAP) and mean pulmonary capillary wedge pressure (PCWP). Postoperatively, correlation between Kco and PCWP was weak, and between Kco and dPAP it was not significant at all. These pressures determine the capillary blood volume before and after transplantation. Probably these weak correlations indicate that intrapulmonary factors, not cardiac factors, are of primary importance in the regulation of blood distribution. The percentage of decrease in Kco in the first postoperative year correlated with the change in dPAP and PCWP, but also with the cyclosporine level in the first posttransplant year. No correlation was found between cyclosporine level and pulmonary vascular resistance. It is suggested that higher levels of cyclosporine influence the alveolar capillary membrane, so that Kco decreases. The percentage of decrease in Kco was significantly more outspoken in patients who had rales on auscultation preoperatively. Using multiple regression analysis, we found that the factors most strongly related to the percentage of change in Kco in the first posttransplant year were the preoperative Kco, the cyclosporine level in the first postoperative year, and the change in dPAP in that year.

Adult↗

PubMed1992

Protein restriction affects fat intake and serum lipids in children with chronic renal failure.

Cardiovascular complications in patients with chronic renal failure have been associated with the hyperlipidemia present in many of these patients. Since a protein-restricted diet is often prescribed in an attempt to preserve renal function, we performed a randomized controlled study in children with chronic renal failure on the effect of a protein-restricted diet on fat intake and serum lipid profiles. Although total fat intake did not change, we found a lower cholesterol intake and a higher polyunsaturated/saturated fat ratio in the patients with the protein-restricted diet. This is probably caused by the restriction of animal protein which results in the replacement of animal fat by vegetable fat in the protein-restricted group. Moreover, we observed an increase of plasma cholesterol and low-density lipoprotein cholesterol in patients with a normal protein intake which was absent in the protein-restricted group. This suggests a favourable effect of the institution of a protein-restricted diet on lipid intake and plasma profile.

Adolescent↗

PubMed1991

[Survival chances of patients diagnosed with cancer in 1975-1985 in southeast Noord-Brabant and north Limburg].

In order to determine the population-based survival of patients with cancer and changes over time, a follow-up study with the Eindhoven Cancer Registry was carried out in 11 hospitals in southeastern Noord Brabant and northern Limburg. Data were collected from medical records and supplemented with information on date of death as of 31 December, 1987, and the relative survival, the ratio of observed and expected survival and trends in age-specific cancer mortality were calculated. Of 22,833 patients diagnosed in the period 1975-85 22,744 could be evaluated; 22% were over 75 years of age and 13% did not receive primary treatment of the tumour. The 5 and 10-year cumulative relative survival rates were 33% and 27% for men and 51% and 44% for women, respectively. The 10-year relative survival rate was more than 50% for Hodgkin's disease, melanoma and cancer of the testis, breast, larynx, thyroid, uterine cervix and corpus; it was less than 20% for multiple myeloma, cancer of the oesophagus, stomach, gallbladder, pancreas, lung and brain. Comparison with 5-year relative survival rates for the various tumours reported in Finland, the Canton of Vaud (Switzerland) and the United States revealed only small differences. The 5-year relative survival rate remained unaltered for men and increased from 50% in the period 1975-79 to 52% in 1980-85 for women; it improved mainly in patients below 45 years, while cancer mortality also declined below this age. In conclusion, there was a slight increase of survival of cancer patients, mainly the young and women.

Adolescent↗

PubMed1991

Recurrent inguinal hernia treated by classical hernioplasty.

The treatment of recurrent inguinal hernia by classical hernioplasty, ie, via the anterior approach and using endogenous tissue for repair, was evaluated in 163 patients operated on between 1980 and 1987. One hundred fifteen patients had a first recurrence and 48 had a multiple recurrence; 58% were of the direct type; 30% were of the indirect type; 7% were of the combined type; and 5% were not defined. In 1989 a questionnaire was sent to all patients; those indicating symptoms of recurrence underwent further examination. There was a mean follow-up of 52 months and a total follow-up period of 706 years. Thirty-seven patients had a repeated recurrence with a cumulative recurrence rate of 16%, 21%, and 23%, after 1, 2, and 5 years, respectively. Increase of age and time passed since the last repair reduced the recurrence rate. Increased abdominal pressure, type of anesthesia or surgical technique, and wound hematoma had no effect. It is concluded that the technique of classical hernioplasty as such may be unsuitable for repair of recurrent inguinal hernias.

Actuarial Analysis↗

PubMed1991

Comparison of FEV1 and transcutaneous oxygen tension in the measurement of airway responsiveness to methacholine.

The measurement of airway responsiveness in preschool children is hampered by the fact that most tests of airway caliber are difficult to carry out at a young age. Patient cooperation is only needed to a limited extent when transcutaneous oxygen tension (PtcO2) is used as an indicator of airway obstruction following bronchial provocation. In 51 children, aged 6-14 years with asthma we have measured PtcO2 and forced expiratory volume in 1 second (FEV1) concurrently after bronchial provocation, using increasing doses of methacholine administered with a De Villbiss 646 nebulizer and a French-Rosenthal dosimeter. The shapes of the dose-response curves to PtcO2 and FEV1 show a close similarity. After methacholine challenge, the decrease in PtcO2 correlates highly with the decrease in FEV1. We conclude that in children a 20% decrease in PtcO2 can be used as a sensitive indicator of airway narrowing after methacholine challenge.

Asthma↗

PubMed1991

Plain film diagnosis in meconium plug syndrome, meconium ileus and neonatal Hirschsprung's disease. A scoring system.

Abdominal plain films of 133 neonates, with 82 cases of meconium plug syndrome (MPS), 27 cases of meconium ileus (MI) and 24 cases of neonatal Hirschsprung's disease (HD), were reviewed to assess the value of such radiographs for diagnosis. The radiographs were examined according to a list of 11 parameters. By using multivariate discriminant analysis, it appeared that 4 parameters i.e. dilatation of bowel loops, varying loop calibre, fluid levels and colonic gas were most important in discriminating among the three disorders. For each parameter the weight (in points) was derived. To classify patients, three group-scores had to be calculated: the group-score with the largest value indicated the most likely disorder. So in 99%, 88% and 63% of MPS, HD and MI, respectively, an accurate diagnosis could be predicted. The overall diagnostic accuracy was 89%. Such a diagnosis can be a sound basis for further investigation.

Dilatation, Pathologic↗

PubMed1991

Improved prognosis of ovarian cancer in The Netherlands during the period 1975-1985: a registry-based study.

Survival of 568 patients with ovarian cancer, diagnosed in 1975-1985, was studied by means of a population-based registry in the Southeast Netherlands. Patients diagnosed in the period 1981-1985 had a significantly better prognosis than patients diagnosed in 1975-1980. This improvement of survival declined with advancing age of the patients. In women younger than 60 years, mortality from ovarian cancer decreased, while incidence remained stable. Apart from the effect of new treatment methods, consisting of more extensive tumor reduction and cisplatin-based combination chemotherapy, advances in supportive care as well as a trend toward earlier diagnosis, possibly in combination with an increasing proportion of less malignant tumors, may explain the improvement in prognosis. Survival was strongly related to stage at diagnosis and to age, the prognosis of younger patients being more favorable. Patients with tumors of either germ cell or stromal origin generally survived longer than patients with epithelial tumors, but this difference disappeared after adjustment for stage and age. Patients still alive after 6 years did not have a survival significantly different from that of the general female population.

Adolescent↗

PubMed1991

Doppler flow velocity waveforms in the fetal cardiac outflow tract: reproducibility of waveform recording and analysis.

Reproducibility of flow velocity waveform recording and analysis was studied at fetal cardiac level (ductus arteriosus, pulmonary artery and ascending aorta) in 42 normal pregnancies. The flow velocity parameters studied were the peak systolic velocity (PSV), acceleration time (ACT), acceleration velocity (ACV), average velocity (AV) and flow velocity integral (FVI). In each patient, two consecutive measurements were performed (time delay 15 min) and of each measurement two hardcopies were analysed. A high reproducibility was achieved for the PSV, AV and FVI in all vessels studied; the coefficients of variation between readings of hardcopies were less than or equal to 3%, and the coefficients of variation between tests within patients were less than or equal to 7%. A moderate reproducibility was achieved for the ACT in the ascending aorta and pulmonary artery; the variation between tests was large for the ductus arteriosus. The reproducibility of the ACV was poor.

Aorta↗

PubMed1991

Transvaginal sonography and abnormal ovarian appearance in menstrual cycle disturbances.

Transvaginal ultrasound examinations were performed in 37 oligo- or a-menorrheic women to describe ovarian changes and potential correlations with clinical and some biochemical features of polycystic ovarian syndrome (PCOS). Findings were compared between the right and left ovary and between each of three subsequent examinations of the same ovary. In any one ovary, no significant difference was found between mean ovarian volume, stroma echogenicity, mean follicle number and size. Correlation between ovarian volume and follicle number was strong in all examinations. Follicle number in both ovaries correlated significantly with ovarian stroma echogenicity and some biochemical markers of PCOS. These observations validate the usefulness of transvaginal sonography in demonstrating numerous correlations in menstrual cycle disturbances. The strong necessity to reevaluate sonographic criteria of PCOS is highlighted.

Adult↗

PubMed1991

Relationship between fetal cardiac and extra-cardiac Doppler flow velocity waveforms and neonatal outcome in intrauterine growth retardation.

In a total of 42 consecutive pregnancies with intrauterine growth retardation (IUGR), Doppler velocimetry was related to neonatal outcome as determined by Apgar score at 1 min, umbilical artery acid-base status and PO2, number of nucleated red blood cells (NRBC), duration of ventilatory support, and sonographic appearance of cerebral leukomalacia. Doppler flow velocity waveforms were obtained from the ascending aorta (AO), pulmonary artery (PA), internal carotid artery (ICA) and umbilical artery (UA) at 2-3 day intervals until delivery. At cardiac level the peak systolic velocity (PSV) and time-averaged velocity (AV), and at peripheral level the pulsatility index (PI) was determined. As all Doppler parameters were significantly related to gestational age at birth, gestational age was taken into account in the analysis. There was no relationship between Apgar score, acid-base status and Doppler parameters. Low AVAO was related to a low umbilical artery PO2. Significant correlations were established between PSVPA, AVPA and PIUA, and the duration of neonatal ventilatory support. Infants who died within 22 days after admission to the neonatal intensive care unit (n = 7) displayed a significantly higher PIUA than those who remained alive. The PIUA was also related to the absolute and relative number of NRBCs. No relationship existed between the Doppler parameters and degree of leukomalacia. The present study demonstrates that from all Doppler parameters, the PIUA is most clearly related to neonatal outcome in IUGR.

Acid-Base Equilibrium↗

PubMed1991

Ovarian morphology in long-term androgen-treated female to male transsexuals. A human model for the study of polycystic ovarian syndrome?

Descriptions of the effect of androgens on ovarian human tissues are exceptional. This opportunity was provided for us by 17 women with transsexualism--female to male transsexuals (TSX)--who had been given androgens for a mean period of 21 months before hystero-salpingo-oophorectomy took place. Twenty-nine ovaries from TSX and 14 control ovaries from 13 regularly cycling women were examined. As compared with controls, TSX ovaries were enlarged and displayed a two-fold increase in cystic follicles and a 3.5-fold increase in atretic follicles; the ovarian cortex was collagenized and three-times thicker. Theca interna hyperplasia and luteinization were uniformly observed in TSX cystic follicles. Stromal hyperplasia was a constant finding in TSX ovaries, accompanied by clusters of luteinized stromal cells in 12 cases. Eventually, these findings met the histological criteria for the diagnosis of polycystic ovaries. These observations demonstrate that androgens alone may induce polycystic changes. The assumption that the role of androgens is pivotal at the follicular level--inducing follicle growth arrest and accelerating cystic changes--in the genesis of polycystic ovaries is reinforced.

Adolescent↗

PubMed1991

Failure to demonstrate unconscious perception during balanced anaesthesia by postoperative motor response.

Eighty patients undergoing a standardized balanced anaesthesia were randomly assigned to either a suggestion group (N = 38) or a control group (N = 42), in a double-blind design. Anaesthesia was maintained with nitrous oxide, enflurane and fentanyl. Patients in the suggestion group were played seaside sounds, interrupted by statements of the importance of touching the ear during a postoperative visit, by means of a prerecorded audiotape and headphones. Tapes containing these suggestions were played from 30 min after the first incision, for a duration of 15 min. Patients in the control group were only played seaside sounds. There were no significant differences between the groups in either the number of patients touching their ears postoperatively or the number and duration of ear touches.

Adult↗

PubMed1991

Effect of cold exposure on the hypothalamic release of thyrotropin-releasing hormone and catecholamines.

The effects of cold exposure on the release of thyrotropin-releasing hormone (TRH) and catecholamines as estimated by push-pull perfusion of the mediobasal hypothalamus were studied. Before cold exposure, the male rats had been kept at room temperature or at 30 degrees C for 3 weeks. Transfer to 4 degrees C increased plasma levels of thyroid-stimulating hormone (TSH), but this cold-induced TSH response was more pronounced in animals which had been acclimatized to 30 degrees C. Exposure to 4 degrees C also increased plasma thyroid hormone levels, but had no effect on plasma prolactin. The hypothalamic content of TRH and dopamine remained similar after transfer to 4 degrees C, but after 6 h of cold, the content of noradrenaline and adrenaline had increased 1.6-fold and 3-fold, respectively. In vivo hypothalamic release of TRH, adrenaline and dopamine remained similar during a 2-hour period in control rats kept at room temperature or 30 degrees C. The hypothalamic release of TRH, dopamine and adrenaline did not change in rats transferred from room temperature to 4 degrees C. The amount of dopamine and adrenaline in push-pull perfusate also remained similar in rats acclimatized to 30 degrees C after transfer to low temperatures. However, in these rats kept at 30 degrees C for 3 weeks, exposure to 4 degrees C increased TRH release in perfusate from the mediobasal hypothalamus in the first 15 min of cold exposure (2-fold increase). Thus, exposure to cold stimulates the hypothalamo-pituitary-thyroid axis and increases the hypothalamic release of TRH in rats which had been acclimatized to 30 degrees C.

Animals↗

PubMed1991

Serum bioactive and immunoreactive luteinizing hormone and follicle-stimulating hormone levels in women with cycle abnormalities, with or without polycystic ovarian disease.

Serum steroid, gonadotropin, and alpha-subunit levels were assessed in 35 women with cycle abnormalities [11 with and 24 without polycystic ovarian disease (PCOD) according to strict clinical and biochemical criteria] and 8 regularly cycling women in the early (cycle day 3 or 4) and mid (cycle day 7 or 8) follicular phase. LH and FSH levels were estimated using two immunological techniques [RIA and immunoradiometric assay (IRMA)] and in vitro bioassays (BIO), using mouse Leydig cells and rat granulosa cells, respectively. In PCOD patients mean alpha-subunit, free androgen index [FAI; testosterone x 100/sex hormone-binding globulin (SHBG)], androstenedione, estrone, and estradiol (E2) were significantly elevated compared to levels in the early follicular phase of control cycles and non-PCOD patients. In addition, in PCOD patients mean IRMA-LH and RIA-LH levels were distinctly increased (2.8- to 3.6 fold, respectively; both comparisons, P less than 0.001) compared to control values, but in the same order of magnitude (1.3- to 1.4-fold increments) as that in non-PCOD patients. However, the median BIO-LH level in PCOD patients was 5.9-fold higher than that in non-PCOD patients and 4.0-fold higher than the BIO-LH in the early follicular phase of control women. Consequently, the median BIO/IRMA-LH ratio was 4.8-fold higher in PCOD patients compared to non-PCOD patients. In women with cycle abnormalities, individual BIO/IRMA-LH ratios correlated with BIO-LH (rs = 0.48), FAI (rs = 0.39), free estrogens (E2/SHBG ratios; rs = 0 0.47), and dehydroepiandrosterone sulfate (rs = 0.60) concentrations. Mean IRMA-, RIA-, and BIO-FSH levels and BIO/IRMA-FSH ratios were not significantly different when various groups were compared. Although RIA- and IRMA-LH levels showed good correlation (rs = 0.88), RIA-LH levels were consistently higher, resulting in distinctly higher RIA-LH/FSH ratios (mean, 4.5) compared to IRMA-LH/FSH ratios (median, 1.8) in PCOD patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1991

Controlled trial of hypnotherapy in the treatment of refractory fibromyalgia.

In a controlled study, 40 patients with refractory fibromyalgia were randomly allocated to treatment with either hypnotherapy or physical therapy for 12 weeks with followup at 24 weeks. Compared with the patients in the physical therapy group, the patients in the hypnotherapy group showed a significantly better outcome with respect to their pain experience, fatigue on awakening, sleep pattern and global assessment at 12 and 24 weeks, but this was not reflected in an improvement of the total myalgic score measured by a dolorimeter. At baseline most patients in both groups had strong feelings of somatic and psychic discomfort as measured by the Hopkins Symptom Checklist. These feelings showed a significant decrease in patients treated by hypnotherapy compared with physical therapy, but they remained abnormally strong in many cases. We conclude hypnotherapy may be useful in relieving symptoms in patients with refractory fibromyalgia.

Adult↗