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D Mulder

Publications and source records attributed to D Mulder.

At least 37 records · Page 2Linked to original sources
PubMed1995

Decreasing HIV-1 seroprevalence in young adults in a rural Ugandan cohort.

OBJECTIVE: To assess the trend in HIV-1 seroprevalence in an adult population in Uganda. DESIGN: An observational cohort study with four year follow up. SETTING: A cluster of 15 villages in rural Uganda. SUBJECTS: All residents of the 15 villages--about 10,000 people. MAIN OUTCOME MEASURE: Prevalence of HIV-1 infection as assessed by enzyme immunoassay. RESULTS: During the five year period the overall standardised seroprevalence of HIV-1 showed little change; 8.2% in 1990, 7.6% in 1994. Among males aged 13-24 years the prevalence decreased from 3.4% to 1.0% (P for trend < 0.001); among females of the same age the corresponding values were 9.9% and 7.3%. The decrease was greatest in males aged 20-24 years and females aged 13-19 years. CONCLUSION: This is the first report of a decline in HIV-1 prevalence among young adults in a general population in sub-Saharan Africa with high overall HIV-1 prevalence. It is too early to conclude that the epidemic in this population is in decline, but the results of this study should be reason for some cautious optimism and encourage the vigorous pursuit of AIDS control measures.

Adolescent↗
PubMed1995

Preventable death evaluation of the appropriateness of the on-site trauma care provided by Urgences-Santé physicians.

The study is based on 44 preventable deaths occurring in a cohort of 360 patients with major trauma. These cases were reviewed by a committee of nine experts. The mean Injury Severity Score (ISS) was 28, and most cases had injuries to the head/neck (68%) and chest (64%). The mean (+/- SD) observed prehospital times, and those considered the maximum allowable by the committee, were 40.6 +/- 12.0 minutes for head/neck injuries and 23.9 +/- 12.2 minutes for chest injuries (p < 0.05). Intravenous (i.v.) lines were started in 38 (86%) of the patients. The committee classified this procedure as harmful for 16 (42%) and neutral for 19 (50%). Among the 18 (46%) that were intubated, this intervention was considered harmful for 17% and neutral for 39%. In two of the three patients for whom a pneumatic antishock garment was applied, this procedure was considered harmful. Of the 34 patients that required direct transport at a level I trauma center, 50% were transferred to such a hospital. These results show significant prehospital delays and high rates of inappropriate IV line initiation and intubation in trauma patients receiving on-site care by physicians. We conclude that prehospital care protocols for trauma patients should emphasize prompt transport and specific on-site care algorithms.

Adult↗
PubMed1993

The extended family and support for people with AIDS in a rural population in south west Uganda: a safety net with holes?

It is commonly assumed that the extended family in Africa provides a safety net for individuals in times of need. This paper examines this assumption using data on the care of people with AIDS in a rural population in South West Uganda. Over a six month period data were collected by counsellors on the care given to 30 (17 women, 13 men) AIDS patients by their families. In 27 of the 30 cases there was evidence of limited care. Various reasons were given for this by the carers, including lack of food and money for medications and the carer's other family responsibilities. For 17 clients who died during the study period, records of seven cases show that other relatives were asked to help with care but refused on the grounds of poverty or other commitments. However, in all but one of these cases extended families did provide assistance for the funeral. The findings suggest that there is a need to question the assumption that the extended family, in the culture under study, is able to provide adequate support for AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Sjögren's syndrome in patients with interstitial cystitis.

OBJECTIVE: Patients with interstitial cystitis, a chronic nonbacterial inflammation of the bladder, were investigated for the presence of systemic autoimmune diseases, in particular for Sjögren's syndrome (SS). METHODS: Ten patients were included in the study on the basis of a diagnosis of interstitial cystitis according to usual criteria. They underwent clinical and laboratory investigations including those for keratoconjunctivitis (KCS) and focal lymphocytic sialoadenitis (FLS). RESULTS: In 2 patients both KCS and FLS were present allowing the diagnosis of primary SS according to classification criteria. Additionally, in 6 patients one of the 2 hallmarks of primary SS was present, KCS in 3 and FLS in 3. CONCLUSION: Interstitial cystitis is a new example of a disease that occurs in association with SS, supporting the concept that interstitial cystitis is an autoimmune cystitis. The clinical relevance of the finding is that a high index of suspicion for SS is indicated in patients with interstitial cystitis.

Adult↗
PubMed1993

Is lung retransplantation indicated? Report on four patients.

As more lung transplantations are performed, many patients will suffer graft failure and will be considered for retransplantation. This article reviews the case management reports of four patients who received lung or heart/lung retransplantation, with overall disappointing results. The pros and cons of lung retransplantation are discussed.

Adult↗
PubMed1992

Neoadjuvant chemotherapy with cytosine arabinoside by continuous infusion and cisplatin for resectable squamous cell carcinoma of the esophagus.

The combination of cisplatin and cytosine arabinoside has been shown in experimental models to be synergistic. We conducted a pilot study of cytosine arabinoside and cisplatin in unresectable or metastatic cancer of the esophagus in five patients and found significant activity, also on visceral metastasis. Therefore, we decided to examine this combination in the neoadjuvant setting. Since January 1989, eight patients with squamous cell carcinoma esophageal cancer were treated with two cycles of cytosine arabinoside (50 mg/m2) by continuous infusion for 4 days and by cisplatin (100 mg/m2) on the 5th day. Their ages ranged from 54-79 years. One patient had Stage I, three had Stage II, and four had Stage III disease. Responses assessed by endoscopy and computed tomographic (CT) scan prior to surgery were three with partial response, three with minor response, and two with no response. Only six patients were surgically resectable after chemotherapy. Toxicity consisted of grade 3 (one patient) and grade 4 (two patients) neutropenia, grade 3 (three patients) anemia, and grade 3 (two patients) and grade 4 (three patients) thrombocytopenia. All patients had subjective improvement of dysphagia 4 weeks after chemotherapy. Median survival of the whole group was 7.5 months. We concluded that there was no evidence of synergy of these drugs given in this manner in esophageal carcinoma since the response rate was no different from that achieved with cisplatin alone.

Aged↗
PubMed1991

The development of a community-based HIV/AIDS counselling service in a rural area in Uganda.

This paper describes the evolution of a counselling service in the context of an HIV/AIDS research programme in rural Uganda. The background to AIDS counselling both in Europe/America and in Africa is outlined first, and the cultural context of the programme explained. The evolution of the counselling procedure is then described and village case studies are used to illustrate the development and the difficulties that have been faced in finding an appropriate counselling model. It is noted that the Euro-American model of person-to-person counselling needs to be adapted to the rural African setting, by placing the emphasis on support for the family. It is emphasized that the approach to counselling needs to remain flexible and sensitive to the sociocultural context in which it is developed.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Successful treatment of steroid-resistant double-lung allograft rejection with Orthoclone OKT3.

An 18-yr-old woman with cystic fibrosis who received a double-lung transplant developed a severe episode of acute lung rejection. Bronchoalveolar lavage and transbronchial biopsy were used to establish the diagnosis. The rejection was refractory to administration of high-dose pulse steroids. OKT3 therapy was successfully used to reverse this episode. This is the first case report of a steroid-resistant double-lung allograft rejection successfully treated with OKT3.

Adolescent↗
PubMed1987

Mediastinal imaging in myasthenia gravis: correlation of chest radiography, CT, MR, and surgical findings.

Chest radiographs and CT and MR images of the mediastinum were studied in 16 patients with myasthenia gravis who underwent thymectomy (two with a final diagnosis of thymoma, seven with hyperplasia, and seven with a normal thymus). The anterior mediastinum was analyzed on imaging studies for thymic morphology and the presence of mass lesions, and the findings were then correlated with the results of surgical resection and pathologic examination. The chest radiographs detected an anterior mediastinal mass in two patients consistent with thymoma on subsequent CT and MR examinations. Chest radiographs in the other 14 patients were normal. In seven patients with a final diagnosis of thymic hyperplasia, both CT and MR demonstrated normal thymic morphology in five, an enlarged thymus in one, and a small thymus in one that was easily identified on CT but was difficult to define on MR. In the other seven patients with a normal thymus on pathologic examination, both CT and MR showed an involuted thymus in four, a normal thymus in two, and an enlarged thymus in one. While both CT and MR were superior to chest radiography for studying the thymus, CT provided better spatial resolution and thymic definition in a much shorter scanning time than MR did. This study suggests that CT should remain the procedure of choice when further imaging of the thymus is needed after the initial chest radiographs in patients with myasthenia gravis.

Adult↗
PubMed1980

Detection of thymoma in myasthenia gravis.

Twenty patients with myasthenia gravis had chest radiography, conventional tomography, and computed tomography (CT) of the thorax within 1 month of thymectomy. Four of the six macroscopic tumors were detected on routine chest radiography; conventional tomography provided no additional information. CT detected all six macroscopic tumors and provided additional information that was not available by other procedures. However, 18 patients (90%) had anterior mediastinum densities on CT, which could not be distinguished preoperatively from thymic tumors. All six patients with macroscopic tumors had serum antistriational muscle antibody titers; this test was negative in 10 of 11 patients (91%) without thymoma. Chest radiography, CT of the thorax, and antistriational antibodies are the tests recommended for detection of a thymoma in patients with myasthenia gravis.

Acetylcholine↗