Biomedical subjects
Publications and source records attributed to W Dekker.
Heterotopic gastric mucosa in the duodenal bulb is sometimes seen as elevated lesions. Radiological and endoscopic findings in 22 patients are reported, and the characteristic appearance on each study is described. Glucagon-induced hypotonia of the duodenal bulb facilitates the diagnosis.
To test the efficacy and toxicity of colloidal bismuth subcitrate (CBS) in a double-blind trial, forty-six consecutive outpatients with active duodenal ulceration were randomly allocated either to treatment with CBS or to a placebo for a period of four weeks. Symptomatic assessment was based on frequency and severity of pain. The ulcer size was measured endoscopically before and at the end of the trial. During the trial blood and urinary bismuth concentrations were measured. The symptomatic assessment of the patients receiving CBS or placebo showed that the reduction in pain was highly significant in both groups, but there was statistically significant difference in the degree of reduction of duodenal ulcer size in favour of the colloidal bismuth subcitrate-treated group (p less than 0.025). Although a marked increase in urinary bismuth concentration was noted, the blood bismuth levels remained within the acceptable levels.
The efficacy of cimetidine (1.6 g per day) was evaluated using a double blind placebo-controlled trial in 24 patients with moderate or severe peptic reflux esophagitis. The results show that cimetidine is superior to placebo when using endoscopic and histological criteria. Improved patient symptomatology and lower antacid comsumption failed to reach statistical significance. No change in the abnormally low lower esophageal sphincter pressure was observed at the end of the trial. No clinical side effects or significant biochemical changes were noted during the trial.
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Gastric cancer is a common cause of death in the Netherlands. The prognosis is generally poor at the time of diagnosis. The designation early gastric cancer (EGC) refers to a gastric carcinoma which does not infiltrate beyond the submucosa. This definition is not influenced by absence or presence of metastases or by the diameter of the tumour. The 5-year survival of EGC is 90% or more. In the Netherlands too, the diagnosis can regularly be made if--in the case of persistent vague upper abdominal complaints--an optimal radiological examination of the stomach is done. At even the slightest radiological suspicion, or if complaints persist in spite of negative radiological findings, gastroscopic examination and multiple aimed biopsies should follow. Personal observations in ten cases are presented.
The accuracy of fiberendoscopy with directed biopsy in the detection of upper intestinal malignancies has been evaluated by studying the operative or postmortem findings or the clinical follow-up data after at least 1 year and, for relevant lesions, after 2 or 3 years. Of 1005 patients examined, a satisfactory follow-up was obtained in 990. There turned out to be no false-positive diagnoses of malignancy in the 167 patients diagnosed fiberendoscopically to harbor an upper intestinal malignancy, and only two false-negative diagnoses in the fiberendoscopically benign group. Seven of the 135 adenocarcinomas of the stomach turned out to be early gastric cancers. The two missed malignancies were interpreted initially as benign gastric ulcers. The over-all endoscopic-bioptic accuracy rate calculated for all patients amounts to 99.8%. Such a high accuracy rate can only be reached provided high numbers of biopsies are taken, and particularly at least 10 of gastric ulcers and of suspicious lesions. Endoscopy by itself is not sufficiently reliable in determining the nature of the lesion. Indeed an incorrect endoscopic interpretation was made in 7.3% of the ulcerous lesions, and in 8.2% of them no firm conclusion could be reached.
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A patient is reported with eosinophilic enteritis of the jejunum with fatal evolution. Surgical resection was considered impossible and medical treatment with corticosteroids, elemental diet, parenteral nutrition, and antimicrobials to combat the intestinal bacterial overgrowth failed to control the disease. The destructive and fatal nature of the reported eosinophilic enteritis raises the problem of classification of such disease entity, refractory to corticosteroid therapy.
Varioliform gastric erosion is a common lesion which can be reliably diagnosed radiologically. The diagnosis was established in 27 (1.7%) of 1,600 detailed radiological examinations made in 1975. There was a good correlation with gastroscopic findings.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.