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Biomedical subjects

W Jansen

Publications and source records attributed to W Jansen.

At least 109 records · Page 6Linked to original sources
PubMed1984

Comparative evaluation of netilmicin-ticarcillin and tobramycin-ticarcillin in the treatment of serious systemic infections in elderly patients.

The effectiveness and safety of two antibiotic regimens, netilmicin-ticarcillin (NT) and tobramycin-ticarcillin (TT), were compared in a prospective, randomized, blind-evaluator study involving 60 elderly patients with serious systemic infections. Fifty-three patients were evaluated for treatment effectiveness; 25 (93%) of 27 patients in the NT group and 24 (92%) of 26 patients in the TT group had complete clinical resolution or improvement of their infections. There were two clinical failures in each group. Bacteriological responses were comparable in both treatment groups, with 87% (58/67) of the pathogens eliminated from patients in the NT group and 83% (59/71) eliminated from the patients in the TT group. The elimination rate for Pseudomonas aeruginosa, the organism most frequently isolated, was 88% (14/16) in the NT group and 77% (10/13) in the TT group. The differences between response rates of the treatment groups were not statistically significant. Auditory toxicity, detected by pure tone audiometry, was observed in two of the 24 patients treated with TT and in none of the patients treated with NT. Dizziness or vertigo, possibly resulting from aminoglycoside administration, occurred in one of the 29 patients given NT and in four of the 31 patients given TT. Nephrotoxicity, detected by serial serum creatinine determinations, developed in none of the patients in the NT group and in five of the 31 patients in the TT group, the difference being statistically significant (P = 0.05). The results of this study indicate that NT and TT are comparable in efficacy and that NT is less likely than TT to cause nephrotoxicity or disturbances in eighth cranial nerve function.

Aged↗
PubMed1984

[Long-term therapy with nitrates. Relation between dosage and tolerance effect].

In 56 patients with angiographically-documented coronary artery disease, the longterm effects of isosorbide dinitrate (ISDN) and isosorbide 5-mononitrate (5-ISMN) on exercise hemodynamics and exercise capacity were assessed. The hemodynamic and antianginal acute and longterm effects of the respective agents were objectively analyzed on the basis of the tested parameters of mean pulmonary artery pressure and work capacity (watts X minutes). These parameters are unaffected by placebo and show reproducible changes at rest and during exercise after drug administration. After the standard 20 mg dose of ISDN or 5-ISMN, both at rest and during exercise, there was a marked decrease in pulmonary artery pressure as well as an increase in exercise capacity. The acute effects of 60 mg ISDN or 50 mg 5-ISMN were not substantially more marked than those of the 20 mg doses. During longterm treatment with 20 mg ISDN or 5-ISMN three times daily there was no attenuation of the hemodynamic effects, that is, no tolerance development; the increase in exercise capacity was maintained. In contrast, at the end of the four-week treatment period with 60 mg ISDN or 50 mg 5-ISMN three times daily there was a marked attenuation of the hemodynamic effects as well as the associated exercise capacity. The results of this study do not enable delineation of the mechanism responsible for the attenuated effect during high-dose treatment. Most probably, it is due to a complex process, in which, in addition to pharmacokinetics and pharmacodynamics, alterations in various reflex and adaptive mechanisms also play a role.

Adult↗
PubMed1984

The surgical treatment of postgastrectomy reflux gastritis.

Eighteen patients with postgastrectomy reflux gastritis were treated between 1970 and 1981 by Roux-en-Y diversion. All of the patients had a typical history of midepigastric burning pain and the majority had bilious vomiting as well. The diagnosis was confirmed by endoscopic results and histopathologic study of the gastric mucosa. Twelve surviving patients--one patient died postoperatively--experienced a dramatic relief of the symptoms. In five patients, gastrointestinal tract complaints reappeared but did not have the typical character of reflux gastritis. The macroscopically apparent gastritis subsided completely after revisional operations; while the histologic signs and symptoms of chronic gastritis remained. The Roux-en-Y diversion for patients with post-gastrectomy reflux gastritis proved to be a safe and relatively simple procedure with a high chance of relieving the complaints of the patient. The preoperative and postoperative gastric mucosal biopsies were not of much use in confirming the diagnosis or substantiation of the beneficial effect of the remedial operation.

Adult↗
PubMed1983

[Value of the dipyridamole test in the diagnosis of coronary heart disease. Comparison with the stress ECG and coronary angiogram].

In 500 patients suffering from angina pectoris (454 males, 46 females) in whom coronary angiography had been performed a dipyridamole test was carried out. The test was positive in 319 of 396 patients with stenosing coronary heart disease (sensitivity 80%); ECG changes typical of ischaemia were demonstrated in 51%. The exercise ECG test was positive in only 68% of 229 patients with coronary heart disease. Among 104 patients without stenosing coronary heart disease the dipyridamole test was false-positive in 47, giving a specificity of 55%, while in 17 (16%) there were false-positive ECG-changes. The exercise test was falsely positive in 20 of 38 patients without stenosing coronary heart disease (specificity of 47%). Coronary blood flow was measured with the argon technique in 19 of 47 with a false-positive dipyridamole test and three with a false-positive exercise ECG. Maximal pharmacologically induced coronary blood flow was significantly reduced in all so that the diagnosis of "atypical coronary heart disease" or "small vessel disease" was made. The dipyridamole test or the exercise ECG test were falsely positive in these patients only with regard to the coronary arteriogram, correctly positive, however, in relation to angiographically non-demonstrable coronary blood flow abnormalities. The dipyridamole test is complementary to the exercise ECG test and has comparable accuracy. The same precautions must be observed for both tests.

Angiography↗
PubMed1983

Randomised, controlled trial of the comparative efficacy, auditory toxicity, and nephrotoxicity of tobramycin and netilmicin.

254 patients with serious gram-negative bacillary infections were enrolled into a multicentre, randomised, blind clinical trial and treated with tobramycin-ticarcillin or netilmicin-ticarcillin. The two treatment groups were similar as to sex, age, and weight. The mean daily dose of netilmicin (237 mg) was higher than that of tobramycin (211 mg), p less than 0.01, but the mean duration of therapy was longer with tobramycin (9.4 days versus 8.7 days), p less than 0.01. The netilmicin cohort also had more serious underlying diseases, p less than 0.028. Clinical (tobramycin, 93% and netilmicin, 91%) and bacteriological responses (tobramycin, 87% and netilmicin, 89%) were similar. 84 tobramycin and 73 netilmicin patients had serial audiograms. Eighth nerve deficits developed in 10 (12%) tobramycin and two (3%) netilmicin patients, p = 0.037. Drug-related renal dysfunction developed in 5 (4%) of 114 tobramycin patients whose renal function was monitored and in 1 (1%) of 116 netilmicin patients, p = 0.12.

Anti-Bacterial Agents↗
PubMed1983

Noninvasive detection of intracardiac tumors by ultrasound and computed tomography.

Nine patients presenting with intracardiac masses were examined by ultrasound (US) and computed tomography (CT). Of these, 6 patients with atrial myxomas were diagnosed primarily by US, with the movement of the pedunculated tumors well visualized by this technique. The myxomas and the three solid tumors were demonstrated by CT as contrast defects following the intravenous administration of contrast medium. Two solid intraventricular tumors, however, were overlooked by US. In the detection of solid tumors CT is considered superior to US, owing to its better geometric resolution. Generally solid tumors require heart catheterization to obtain information about the blood supply. Visualization of atrial myxomas by CT and US, in contrast, should be followed by immediate operation without additional invasive procedures.

Adult↗
PubMed1983

Dose dependence of tolerance during treatment with mononitrates.

In order to test the clinically supposed development of tolerance during chronic high-dose nitrate therapy, we studied a total of 24 patients with angiographically proven coronary heart disease at rest and during ergometric exercise (supine position, 50 w for 3 min). Pulmonary arterial pressure (PAP, floating catheter), arterial blood pressure (cuff method), cardiac output (Fick principle), heart rate, and exercise capacity (w X min) were measured at rest and exercise before and during chronic (4 weeks) oral therapy with 5-isosorbide mononitrate (5-ISMN), 3 X 20 mg/day (n = 14) and 3 X 50 mg/day (n = 10). After acute administration, both doses of 5-ISMN decreased mean PAP at rest and during exercise (rest: by 25% with 20 mg and by 29% with 50 mg; exercise: by 30% with 20 mg and by 45% with 50 mg), whereas cardiac output and stroke volume were only reduced by 5-ISMN at rest. During chronic treatment with 60 mg and 150 mg 5-ISMN, and additional administration of 20 mg or 50 mg respectively lowered PAP at rest by 15% and 19%; during ergometric exercise PAP was 22% and 14% lower than during ergometry before any drug treatment. The exercise capacity slightly increased during treatment to 60 mg 5-ISMN, whereas it decreased by 25% on chronic treatment with 150 mg 5-ISMN per day. Our results show that acute administration of 5-ISMN in either dose (20 mg and 50 mg) exerts unloading effects on the heart and will increase the exercise tolerance. In contrast to the higher dose of 150 mg 5-ISMN per day, chronic treatment with the lower dose of 60 mg 5-ISMN daily will not result in drug tolerance.

Adult↗
PubMed1983

Long-term treatment of patients with coronary heart disease using isosorbide dinitrate, nifedipine and molsidomine.

1. After initial acute administration of 20 or 60 mg ISDN, 2 mg molsidomine and 20 mg nifedipine, a clear effect on the circulation and an increase in work tolerance is detectable. 2. Following 4 weeks' treatment with 3 X 20 mg ISDN, there is no essential loss of action in the venous branch or with respect to working capacity. 3. After 4 weeks' treatment with 3 X 60 mg ISDN, the improvement in working capacity is partially retained, but the action on the venous branch is significantly poorer. 4. During 4 weeks' treatment with 3 X 20 mg nifedipine, there is no essential loss of action in the arterial or venous branches, or with respect to working capacity. 5. Our results with continuous high doses of ISDN indicate that high doses should be used only in monitored exceptions.

Adult↗
PubMed1982

[5-isosorbide mononitrate at rest and on exercise in coronary heart disease: acute and long-term effect].

Haemodynamic effects of 5-isosorbide mononitrate (5-ISMN) were studied at rest and on exercise in 31 patients with angiographically confirmed coronary heart disease. A decrease in arterial blood pressure and mean pulmonary artery pressure without significant change in heart rate, cardiac output and stroke volume occurred both at rest and on exercise after 20 mg of 5-ISMN to 12 patients. Administration of 50 mg 5-ISMN to 19 patients achieved greater decrease in mean pulmonary artery pressure; cardiac output and stroke volume were highly significantly reduced at rest, while on exercise both cardiac output and stroke volume remained unchanged. Ten patients, in whom after a single dose of 50 mg 5-ISMN the mean pulmonary artery pressure at rest and on exercise had decreased 28% and 45%, respectively, with a definite rise in exercise tolerance, repeat acute administration of a single dose of 50 kmg 5-ISMN produced a fall in mean pulmonary artery pressure at rest by 20% after 50 mg three times daily for four weeks. On exercise the fall was only 14% below the control levels before treatment. In addition, exercise tolerance was reduced. These results indicate that acute administration of 5-ISMN at rest and on exercise decreases cardiac work load. But on chronic administration of high doses, tolerance to the drug may develop.

Adult↗