PubMed Health⌕ Search

Biomedical subjects

D Willems

Publications and source records attributed to D Willems.

At least 37 records · Page 2Linked to original sources
PubMed1996

Colonoscopy without premedication versus barium enema: a comparison of patient discomfort.

BACKGROUND: Colonoscopy is considered a painful procedure requiring routine intravenous sedation. We investigated whether unsedated colonoscopy causes more discomfort than barium enema. METHODS: Procedure-related discomfort was determined in 100 consecutive patients undergoing colonoscopy without premedication and in an equal number of patients referred for sigmoidoscopy and barium enema. All patients underwent such examinations for the first time and had no history of previous bowel surgery. During colonoscopy, sedation was offered if significant pain or discomfort occurred. RESULTS: In patients without stenosis and with satisfactory preparation, the completion rate of colonoscopy was 95%. Five percent of all patients undergoing endoscopy required sedation. On an analog scale ranging from 1 to 9, patients undergoing colonoscopy and barium enema reported similar ratings for procedure related discomfort (3.2 +/- 1.7 and 3.1 +/- 1.9) and for discomfort caused by bowel preparation (3.2 +/- 2.1 and 3.1 +/- 1.8). Eighty-seven percent of all patients undergoing colonoscopy stated that they would prefer no premedication in the event of repeated examinations. CONCLUSIONS: Colonoscopy with sedation on demand does not cause more discomfort than barium enema and will be accepted by the vast majority of patients undergoing this procedure.

Barium Sulfate↗
PubMed1996

The case manager in Holland behind the dikes: a hole filler or bridge builder?

The health and social care service system in the Netherlands is fragmented and poorly organized. Facing an increase in the number of elderly citizens, a more consumer-oriented and vocal citizenry, and rising competition at least in part in response to government concerns over runaway costs, Dutch government officials and social researchers have been experimenting with various forms of case management since the mid-1980s. For some types of clients, such as the mentally handicapped, case management seems to be well accepted. Many issues remain to be resolved, however, including (a) the level of clinical expertise needed by case managers for clients with complex medical problems; (b) whether case management tasks are more appropriately carried out by service providers or as a separate function; and (c) how much autonomy service providers will be expected to relinquish under the control of a case manager.

Case Management↗
PubMed1993

Measurement of urinary sugars by HPLC in the estimation of intestinal permeability: evaluation in pediatric clinical practice.

Determinations of the permeability of the intestine to various sugars have been used to assess intestinal mucosal abnormalities, but the widespread application of such tests has been prohibited by the complexity of most classically used techniques. In this study, we evaluated the sensitivity and practicability of using HPLC to estimate intestinal permeability, with mannitol and lactulose as mono- and disaccharides, respectively. The results of the permeability tests were compared with those of intestinal biopsy in 20 children. All patients with an abnormal intestinal biopsy showed a low mannitol recovery, and the patients with allergic symptoms showed a high lactulose recovery. Our preliminary data suggest that HPLC is reliable, gives results comparable with those of other methods, and is a practical way to determine intestinal permeability noninvasively.

Adolescent↗
PubMed1992

Single dilation of symptomatic Schatzki rings. A prospective evaluation of its effectiveness.

This study investigates the effect of a single dilation on the morphology of the lower esophageal ring and on the clinical course of symptomatic patients. Thirty-three patients were studied prospectively for a mean period of 24.3 +/- 19.2 months. Passage of a large bougie (46-58 F) resulted in a rupture of the ring in each instance and its mean diameter increased from 11.4 +/- 3.6 to 17.2 +/- 4.1 mm. No complications occurred, and all patients were symptom-free at the first follow-up examination four weeks after dilation. However, late symptomatic recurrences were frequent. After one year, the estimated proportion of patients remaining free of symptoms was 68% after two years 35%, and after five years 11%. Repeated treatments were performed with similar ease and effectiveness; again, no complications were encountered. Neither the initial ring size nor the presence or absence of esophagitis determined the likelihood of symptomatic recurrences. It is concluded that single dilations of symptomatic lower esophageal rings are safe, easily performed, and well tolerated. Long-term cure of episodic dysphagia is rare, but recurrences can be successfully treated by repeated dilations.

Adult↗
PubMed1992

Results of the multicenter evaluation of a homogeneous immunoassay for digitoxin based on the cloned enzyme donor immunoassay technology.

We evaluated a CEDIA assay for the determination of digitoxin in serum on random access analyzers. The multicenter evaluation included studies on the analytical range, calibration stability and reproducibility of the new assay. Moreover, recovery in controls, transferability of results obtained in different laboratories, comparability with routine methods, and the effect of various interfering factors have been analyzed. Summarized the analytical performance was comparable to that of routine methods. The CEDIA Digitoxin assay represents an attractive alternative to established digitoxin immunoassays because it can be performed on random access analyzers, thus permitting the simultaneous determination of digitoxin and other serum analytes without sample splitting.

Digitoxin↗
PubMed1991

Stimulation of calcitonin secretion by an oral calcium load test in normal subjects and in idiopathic renal stone formers.

Circulating concentrations of calcitonin (CT) have been found high in idiopathic renal calcium stone formers (RSF). It has been postulated that this could result from increased serum calcium concentrations following calcium-containing meals. To verify this hypothesis, 15 male idiopathic RSF and 15 male normal subjects underwent plasma CT measurements, following an extraction-concentration technique (exCT), in basal state and during an oral calcium load test. Most RSF exhibited increased excretion of calcium following oral calcium loading, suggesting overabsorption of calcium, but serum calcium did not increase more in RSF than in normal subjects. Basal plasma exCT concentrations were normal in RSF. ExCT plasma concentrations following calcium loading, and the area under the curve of exCT levels, tended to be higher in RSF than in normal subjects, but not significantly. Our results thus do not support the hypothesis that increased plasma CT levels in RSF result from increased serum calcium concentrations following calcium-containing meals.

Administration, Oral↗
PubMed1990

Effect of acute hypercalcemia on thyrotropin (TSH) and triiodothyronine responses to TSH-releasing hormone in man.

In chronic hypercalcemia, basal TSH has been found to be low, with normal serum circulating concentrations of T3 and T4. This observation suggested a potentiation by hypercalcemia of the thyroid secretory response to TSH. The present study was undertaken to assess the possible influence of hypercalcemia on the T3 secretory response to TSH. Since T3 secretion was studied after stimulation of endogenous TSH by TRH, it was first necessary to find a protocol enabling us to study the effect of calcium on T3 release without affecting TSH secretion. Eighteen subjects underwent two TRH tests, with and without simultaneous calcium infusion, at 2-week interval and in a randomized order. In group A (five subjects) calcium infusion started 1 min after TRH, in group B (five subjects) 10 min after TRH, and in group C (eight subjects) 20 min after TRH. In groups A and B, TSH secretion was markedly blunted by hypercalcemia. In contrast, when calcium infusion was started 20 min after TRH (group C), the TSH secretion profile was no longer different from that in the control study. However, in this situation the increments of T3 and free T3 120 and 180 min after TRH were significantly higher when the subjects were rendered hypercalcemic than in the control study. These findings suggest that calcium might act at two different levels, to enhance the thyroid secretory response to TSH and decrease TSH secretion by acting directly on the pituitary gland. Both effects would produce the association of low serum TSH and normal levels of T3 and T4 observed in chronic hypercalcemia.

Adult↗
PubMed1988

[Are filiform fibromas of the skin a marker for colonic neoplasia?].

750 consecutive out-patients undergoing diagnosis for possible disease of the colon but no history of colon neoplasia were examined for skin tags (achrocordons). They were found in 257 patients, in 30 as multiple (greater than five) lesions. Benign adenoma of the colon was found with similar frequency in patients with (27.6%) and without (22.1%) tags. However, colon carcinoma was twice as frequent in patients with skin tags (8.2%) than controls (4.1%). Patients with multiple tags had an even higher risk of colon carcinoma (odds ratio 7.8; 95% confidence limits 2.2-24.4; P less than 0.01) and a slightly increased risk of benign colon adenoma (odds ratio 2.4; 95% confidence limits 0.9-6.0; P less than 0.05). Whether this association is important in the diagnosis of colon tumours should be tested further by investigating healthy subjects with skin tags.

Aged↗
PubMed1988

[Postoperative pancreatitis, hyperamylasemia and amylase isoenzymes after parathyroidectomy for primary hyperparathyroidism].

Recent studies have cast doubt on the concept of causative association between parathyroidectomy for primary hyperparathyroidism and postoperative pancreatitis. The present study indicated that the relationship was real and that the development of acute pancreatitis after parathyroid surgery was not purely incidental. Acute pancreatitis was observed postoperatively in 3 p. 100 of cases after parathyroidectomy (6/196 cases), in 37 p. 100 after pancreatic surgery (19/51 cases), but never after thyroidectomy (100 cases) or other extra-abdominal operations (100 cases). During the first five postoperative days, the incidence of hyperamylasemia was 16 p. 100 after parathyroidectomy, 47 p. 100 after pancreatic surgery, 3 p. 100 after thyroidectomy, 2 p. 100 after other extra-abdominal operations. During the same period, the frequency of hyperlipasemia was similar: 20 p. 100 after parathyroidectomy, 54 p. 100 after pancreatic surgery, 1 p. 100 after thyroidectomy, 0 p. 100 after other extra-abdominal operations. In all cases with hyperamylasemia after parathyroidectomy, the pancreatic fractions of amylase isoenzymes were abnormally elevated.

Adolescent↗
PubMed1984

Eighty months persistence of poorly differentiated early gastric cancer.

A patient is presented who was diagnosed in 1976 as having a signet-ring cell carcinoma of the gastric antrum. The patient delayed surgery for 7 yr, after which time an early gastric cancer of the intramucosal type was found. It is suggested that in addition to its high cure rate, early gastric cancer may have an extraordinarily slow growth.

Adenocarcinoma, Mucinous↗
PubMed1984

[Acquired infundibular pulmonary stenosis. Possible late complication following radiotherapy of Hodgkin disease].

A case of infundibular pulmonary stenosis occurring years after a mediastinal radiation for Hodgkin's disease is reported. As far as the literature is known to us, a similar case has not yet been described. It is most likely that the development of the stenosis is due to the radiation therapy, since a murmur was not heard before radiation and a mild stenosis was proved several years after radiation. Now, a high gradient with the typical signs of an infundibular pulmonary stenosis was present. Unfortunately the patient refused the operation. Further possibilities for acquired pulmonary stenosis and cardial complications after mediastinal radiation for Hodgkin's disease will be discussed.

Adult↗