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Biomedical subjects

A C Douwes

Publications and source records attributed to A C Douwes.

At least 19 recordsLinked to original sources
PubMed1996

Diagnostic dilemmas and results of treatment for chronic constipation.

Chronic functional constipation (CFC) may be difficult to recognise and information regarding its long term prognosis is scarce. The records of 244 children with CFC, aged 0-18 years, were analysed for symptoms at presentation and results of treatment, and long term outcome was evaluated by means of a telephone interview in 137 patients discharged for more than one year. The patients presented with a great variety of symptoms, only 22% having infrequent defecation of increased consistency, another 22% having an obviously normal defecation pattern. The mean duration of treatment was 13 months. At the time of discharge, 69% of the patients still used laxatives. At a median of four years after discharge, 66% of the children were free of symptoms and without medication, 39% having experienced a recurrence. It is concluded that CFC may be difficult to recognise and can be alleviated by an intensive laxative regimen. Recurrence of symptoms is common, but the long term prognosis is good in most patients.

Adolescent↗
PubMed1994

Hydrogen breath test as a simple noninvasive method for evaluation of carbohydrate malabsorption during exercise.

The aim of this study was to examine hydrogen (H2) production with the hydrogen breath test (HBT) after ingesting primarily digestible carbohydrate (CHO) during 3 h of 75% maximal oxygen consumption exercise. This was done to indicate CHO overflow in the colon which may occur when gastric emptying, intestinal transit and CHO absorption are not matched and CHO accumulates in the colon where it is subject to bacterial degradation. Further, this study was designed to assess breath H2 production as a function of the type of CHO ingested and the type of exercise. A group of 32 male triathletes performed three exercise trials at 1-week intervals with either a semisolid (S) intake, an equal energy fluid intake (F) or a fluid placebo (P). Each trial consisted of cycling (sessions 1 and 3) and running (sessions 2 and 4). The mixed-expired H2 concentrations in the resting and "recovery" periods (5 min after each session) did not change significantly in time and did not differ among intakes. There were also no significant differences in H2 concentrations between resting and "recovery" conditions. During exercise, H2 concentrations decreased three to six-fold in comparison to resting and recovery levels and differed among intakes (ANOVA; P < 0.05). The H2 concentrations were almost continuously lower with P than with F and S. The H2 concentrations were significantly higher during running than during cycling. During exercise, we found that CHO overflow could be compared among intakes and between exercise types by using the HBT, provided the influence of other factors on H2 excretion--ventilation and intestinal blood flow--was similar for each condition.

Adult↗
PubMed1993

[Idiopathic neonatal hepatitis].

Idiopathic neonatal hepatitis is one of the more important causes of neonatal cholestasis. It is regarded one of the clinical presentations of 'idiopathic obstructive cholangiopathy', just like extrahepatic biliary atresia. Is it not possible to discriminate between intrahepatic and extrahepatic causes of neonatal cholestasis, or between idiopathic neonatal hepatitis and metabolic, infectious, or toxic causes, by using clinical or laboratory parameters. Liver histology is slightly more helpful: giant cell formation, focal liver necrosis, and lymphocytic and neutrophilic infiltration may be found in idiopathic neonatal hepatitis. In infectious hepatitis liver pathology mostly is only a lesser part of the symptomatology. Sporadic idiopathic neonatal hepatitis has a better prognosis than familial; about 75% of children with sporadic hepatitis experience complete recovery as compared to less than 25% of children with familial hepatitis. Therapy is confined to the prevention and treatment of complications such as itching, portal hypertension and variceal bleeding, and (fat) malabsorption.

Cholestasis↗
PubMed1990

Plasma polyol levels in patients with cataract.

Galactitol and sorbitol concentrations in plasma were determined in patients (with or without cataract) in whom homo- or heterozygosity for galactokinase, galactose-1-phosphate uridyltransferase, systemic or peripheral UDP-galactose epimerase and sorbitol dehydrogenase deficiency was confirmed. For the above disorders it can be concluded that elevation of plasma polyols is not always related to the presence or absence of cataract. In all cases with cataract, however, the plasma galactitol or sorbitol levels were elevated. In another group of patients with unexplained congenital or infantile cataracts, but without apparent enzyme defects, mild to moderately elevated concentrations of plasma galactitol or sorbitol were found in about 45%. In 8% of this group the cataract and the elevated plasma galactitol concentration could possibly have been related to partial maternal enzyme deficiency. In all the other cases the elevated plasma polyol concentration remains unexplained but could indicate a further cause of cataract formation due to a hitherto unknown galactose or glucose metabolic aberration.

Carbohydrate Epimerases↗
PubMed1989

Apple juice, fructose, and chronic nonspecific diarrhoea.

Apple juice contains fructose and sorbitol, substances that have been shown to be incompletely absorbed by most people. As this might have clinical consequences, especially in young children, we investigated the absorption of the carbohydrate content of apple juice in apple juice consuming toddlers with chronic nonspecific diarrhoea as compared to controls, using the breath hydrogen (H2) test. Incomplete absorption of the carbohydrates from 250 ml of apple juice, as indicated by a maximum breath H2 increase of greater than or equal to 20 parts per million (ppm), was found in all nine patients (mean +/- SEM 57 +/- 8 ppm), and in five out of eight controls (22 +/- 7 ppm) (P less than 0.01). Six patients were retested with apple juice "enriched" with glucose, which is known to improve fructose absorption. The maximum breath H2 increase as well as the area under the breath H2 curve decreased significantly. It was thus estimated that fructose accounted for 80% of the incomplete absorption and sorbitol for 20%. Elimination of apple juice from the diets of the nine patients resulted in normalisation of both the frequency and the consistency of the stools. Incomplete absorption of the carbohydrates, particularly fructose, from apple juice seems to be quite common, and may contribute to chronic diarrhoea in young children.

Breath Tests↗
PubMed1985

A milder variant of Zellweger syndrome.

A 4.5-year-old male patient is described with chorioretinopathy, minor facial anomalies, delayed closure of the fontanel, mental retardation, moderate hypotonia, epilepsy and hepatic fibrosis. Postural control, intentional vocalising and manual dexterity were superior to the performance of patients with classical Zellweger syndrome (ZS). Morphologically distinct peroxisomes were absent in the liver. In blood elevated pipecolic acid levels and abnormal levels of bile acid intermediates were found. The plasmalogen content of erythrocytes was normal. In fibroblasts we found an accumulation of very long chain fatty acids, decreased activity of acyl CoA:dihydroxyacetone phosphate acyltransferase, and impaired de novo biosynthesis of plasmalogens. On the basis of these clinical, ultrastructural and biochemical characteristics we assume that this patient represents a milder variant of the classical cerebro-hepato-renal syndrome of Zellweger.

Abnormalities, Multiple↗
PubMed1985

Hydrogen breath test in schoolchildren.

The frequency of negative hydrogen breath tests due to colonic bacterial flora which are unable to produce hydrogen was determined after oral lactulose challenge in 98 healthy Dutch schoolchildren. There was a negative result in 9.2%. The probability of a false normal lactose breath test (1:77) was calculated from these results together with those from a separate group of children with lactose malabsorption (also determined by hydrogen breath test). A study of siblings and mothers of subjects with a negative breath test did not show familial clustering of this condition. Faecal incubation tests with various sugars showed an increase in breath hydrogen greater than 100 parts per million in those with a positive breath test while subjects with a negative breath test also had a negative faecal incubation test. The frequency of a false negative hydrogen breath test was higher than previously reported, but this does not affect the superiority of this method of testing over the conventional blood glucose determination.

Adolescent↗
PubMed1984

New principle for estimation of hydrogen in expired air.

A new device for estimation of hydrogen in expired air is described. The measuring principle consists of a semi-conductive detector with a high affinity for hydrogen. Experiments on reliability and reproducibility are satisfactory. A good correlation has been obtained with the results of gas chromatographic analysis of hydrogen in reference gases as well as in samples of expired air. Discrimination between lactose absorbers and lactose malabsorbers in 50 consecutive patients is the same when using both methods simultaneously. This so-called "Lactoscreen", supplied with separate collection systems for infants and for older children, provides a rapid estimation of breath hydrogen concentration. A built-in hydrogen generator produces hydrogen air mixtures of variable concentrations, thus obviating the need for external reference gases. The "Lactoscreen" appears to be reliable for routine screening for carbohydrate malabsorption in children and adults and is easy for medical assistants to handle.

Adult↗
PubMed1984

A family infected with hepatitis B and with concurrently circulating HBsAg and heterotypic anti-HBs.

A family is described, of whom all members were found to be infected with the adw2 subtype hepatitis B virus. The mother and both the children were positive for anti-HBs (anti-y). The usual explanation for the co-occurrence of HBsAg and anti-HBs ("two infections hypothesis") was clinically highly unlikely. HLA typing was performed to investigate the possibility that genetically determined host dependent factors are involved. However, no relationship between the simultaneous presence of HBsAg and anti-HBs and a particular haplotype was observed.

Adult↗