Biomedical subjects
A Dees
Publications and source records attributed to A Dees.
Calcium antagonists, a useful additional therapy in treatment resistant hypertension: comparison of felodipine ER and nifedipine Retard by 24-h ambulatory blood pressure monitoring.
OBJECTIVE: To compare the efficacy and tolerability of felodipine extended release (ER) 2.5 mg (F2.5) and 5 mg (F5) once daily with nifedipine Retard 10 mg (N20) and 20 mg (N40) twice daily as additional therapy in patients who remained hypertensive despite treatment with an ACE-inhibitor, beta-blocker or diuretic. DESIGN AND METHODS: In a multicentre, double-blind parallel study, 61 men and 54 women, aged 35-75, with a supine diastolic blood pressure between 95 and 115 mmHg were randomised to treatment with F2.5, F5, N20 or N40 for 8 weeks, with optional doubling of the dose after 4 weeks. Blood pressure was measured at the office after 0, 4 and 8 weeks and by 24-h ambulatory monitoring (ABPM) after 0 and 4 weeks. Spontaneously reported adverse events and a subjective symptom assessment questionnaire were used for side-effect profiling. RESULTS: Mean office systolic/diastolic blood pressure was clinically relevantly reduced in all treatment groups after 4 weeks by 8/7, 12/9, 11/9 and 18/11 mmHg for F2.5, F5, N20 and N40, respectively, and after 8 weeks (F2.5-5: 17/11 mmHg: F5-10: 18/14 mmHg; N20-40: 19/14 mmHg; N40-80: 25/14 mmHg) with no statistically significant differences between these groups. The lowest dose of felodipine (F2.5) was the least effective. After 4 weeks the ABPM showed consistent 24-h reductions in blood pressure (4/2; 8/5; 7/5; 10/6 mmHg, respectively) over 24 h for the felodipine ER 5 mg group only and for both nifedipine groups. No statistically significant difference between these groups was found. An office responder does not appear to be identical to an ambulatory one and vice versa. The adverse events, mostly oedema, flushing and headache, were dose-related. CONCLUSIONS: Both felodipine ER and nifedipine Retard are effective "add-on' drugs in patients with monotherapy-resistant hypertension. The blood-pressure-lowering effect is dose-dependent and tolerability is inversely related to efficacy. The results emphasize the benefits of combining two agents with low doses.
Colitis and lower abdominal mass by Actinomyces israelii in a patient with an IUD.
Abdominal actinomycosis is a rare disorder. The diagnosis is frequently missed preoperatively. We describe a patient who had had an intrauterine contraceptive device in situ for 5 years. She presented with a painful pelvicoabdominal mass, located between the uterus and rectum, and a colitis-like disease of the distal colon. Culture of the removed IUD demonstrated Actinomyces. She was intensively treated with intravenously penicillin for six weeks. Following this conservative treatment the abdominal tumor and the colitis-like symptoms totally disappeared. During two years follow-up she is free of symptoms and no signs of recurrence of the disease have been noticed. The case described here strongly underlines that Actinomyces infection should be born in mind in the differential diagnosis of a young female with an IUD, presenting with colitis, fever and an abdominal mass. Prolonged intravenously administered penicillin is warranted before surgery should be considered.
Granulomatous hepatitis caused by Bacillus Calmette-Guerin (BCG) infection after BCG bladder instillation.
BACKGROUND: Bladder instillations with Bacillus Calmette-Guerin (BCG) are commonly used as immunotherapy for bladder carcinoma. Sometimes patients experience serious systemic side effects, such as sepsis or pneumonitis. Granulomatous hepatitis is a rare serious side effect, which has been considered a hypersensitivity reaction to BCG. PATIENT: The first case of granulomatous hepatitis after BCG bladder instillation in which mycobacteria were identified by staining techniques and mycobacterial DNA was detected in liver tissue using the polymerase chain reaction is reported. CONCLUSION: The granulomatous hepatitis was caused by BCG infection of the liver after haematogenous dissemination of BCG, rather than hypersensitivity.
'Hypertension resistant to two-drug treatment' is a useful criterion to select patients for angiography: the 'Dutch Renal Artery Stenosis Intervention Cooperative' (DRASTIC) study.
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Unexplained recurrent pneumonia: a post-childhood case of chronic granulomatous disease.
A 31-year-old patient was recurrently admitted because of pneumonia. Specialised leukocyte function tests revealed the diagnosis of an X-linked type of chronic granulomatous disease. Treatment with interferon-gamma successfully prevented new infections.
Reversibility of myocardial dyskinaesia due to severe hypertension.
Two cases of acute left ventricular failure associated with severe essential hypertension are presented. On admission echocardiography indicated severe dyskinaesia of all wall segments of the heart. Anti-hypertensive treatment resulted in significant improvement in clinical and echocardiographic findings.
[Dyspepsia... or something more?].
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Weekly low-dose mitoxantrone plus doxorubicin as second-line chemotherapy for advanced breast cancer.
Weekly low dose mitoxantrone (3 mg/m2) plus doxorubicin (8 mg/m2) was administered as second-line chemotherapy to 33 patients with advanced breast cancer. Four out of 28 evaluable patients (14%) obtained a partial response with a median duration of 34 weeks (range 18-67+ weeks), while 8 patients (29%) showed stable disease with a median duration of 28 weeks (range 11+-60 weeks). Gastrointestinal toxicity and alopecia were mild. Grade II and III leukopenia occurred in 63% of the courses without serious infectious disease. Four patients experienced an asymptomatic drop of 16-20% in the left ventricular ejection fraction (LVEF) after relatively low cumulative doses of each drug, and one patient with a history of pericarditis carcinomatosa and mediastinal irradiation developed a heart failure. In conclusion, this second-line combination treatment had moderate activity in breast cancer and caused only few subjective side effects, especially with respect to gastrointestinal symptoms.
Carotid sinus syndrome after carotid artery surgery.
A 63 year old woman had been intensively treated for recurrent carcinoma of the neck. Following acute vascular surgery of the carotid artery, she developed the vasodilatory type of the carotid sinus syndrome. The presentation of this type of the syndrome was remarkable, since it is usually associated with primary or metastatic carcinoma in the neck region. Previous cancer treatment may have modified the course of disease in this patient, which ultimately had a lethal outcome.
[The use of the T-Scan system in occlusal diagnosis].
The present study examines the T-Scan reproduction system used in occlusal diagnosis. The system represents a major technical innovation in functional diagnostics. Nevertheless, various aspects of it still require improvement. Amplifying or confirming the results of previous studies, the following observations are intended to indicate how the system might be improved, and how it can be reliably used at present: The reproduction afforded by the sensor as situated in the mouth is insufficient. Exact reproduction of the topography of the occlusal contacts is not possible. Reproducibility of the temporal sequence of the contacts is slight. The registering of dental functional movements can give rise to errors of interpretation. Threshold values for the registration of contact points in the system's pressure mode are uneven. The relative reproduction of different impressions is unreliable. Since in the system's pressure-mode early contacts cannot be distinguished from strong physiological contacts, in clinical practice the former must first be identified using the time-mode.
[Pulmonary hypertension and cor pulmonale caused by chronic obstructive lung disease; pathogenesis and treatment].
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[When latex disintegrates, or a mechanical pyloric ulcer].
Complications of Celestin oesophageal tube disintegration are discussed with reference to the case of a patient with a tube inserted because of extrinsic stenosis presenting with upper abdominal complaints.
Cerebral emboli in chronic intravascular coagulation detected by single photon emission computer tomography (SPECT)
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Strongyloides stercoralis associated with a bleeding gastric ulcer.
Infection with the helminthic parasite, Strongyloides stercoralis, is usually acquired by skin invasion (or occasionally via ingestion of larvae). After transformation to the adult form, the parasite preferentially localises in the small intestine, especially in the duodenal and jejunal part. A remarkable feature of Strongyloides is its property of endogenous reinfection. In the case of an immunocompromised host a massive infection, called hyperinfections Strongyloides, may occur. Numerous gastrointestinal complications of strongyloides infections, sometimes with a lethal outcome, have been reported. The intestinal manifestations are usually limited to the small bowel, and rarely involve the stomach. We report a patient with complicated strongyloides infection of the stomach.
Mechanical ventilation in cancer patients. Analysis of clinical data and outcome.
Between 1984 and 1988, 49 medically treated cancer patients were ventilated in the intensive care unit (ICU) of our hospitals. The charts of these patients were analyzed retrospectively. Sixty-seven percent of patients died during ventilation; 24% were able to leave hospital. The remaining 9% were transferred from the ICU to the ward, but died shortly thereafter in hospital. Assessment of the severity of acute disease prior to intubation by means of the organ failure score or the APACHE-II score was strongly associated with outcome after ventilation.
Pseudo-renal failure associated with internal leakage of urine.
Three patients with internal leakage of urine are described. As a result of urine resorption into the blood a condition developed resembling acute renal failure. Internal loss of urine is divided into intraperitoneal and extraperitoneal leakage and usually gives rise to oliguria and microscopic haematuria. In the intraperitoneal type increasing abdominal complaints and ascites will develop whereas in the extraperitoneal type regional oedema will become present without, in the case of sterile urine, abdominal complaints of importance. Important clues as to the diagnosis are the concentrations in serum and urine of urea, creatinine and sodium, and the demonstration of the leak by means of imaging techniques. Treatment of choice is a drainage procedure, for instance by a bladder catheter. In acute renal failure this pseudo form should be distinguished from the real thing.
[Lowering of blood pressure, an easy job?].
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