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Biomedical subjects

E F Schippers

Publications and source records attributed to E F Schippers.

18 recordsLinked to original sources
PubMed2006

Oral valganciclovir as pre-emptive therapy has similar efficacy on cytomegalovirus DNA load reduction as intravenous ganciclovir in allogeneic stem cell transplantation recipients.

The efficacy and safety of oral valganciclovir was compared to ganciclovir i.v. in pre-emptive treatment of cytomegalovirus (CMV) in T-cell-depleted allogeneic stem cell transplant (allo-SCT) recipients. A therapeutic guideline was developed to allow the safe application of valganciclovir in allo-SCT recipients requiring CMV therapy. In total, 107 consecutive transplant recipients were evaluated. Cytomegalovirus DNA load in plasma was monitored longitudinally; details on antiviral therapy and treatment responses were analyzed retrospectively. Fifty-seven CMV treatment episodes were recorded in 34 patients: 20 with valganciclovir (900 mg twice-daily) and 37 with ganciclovir (5 mg/kg twice-daily). Median CMV DNA load reduction was 0.079 and 0.069 log10 copies/ml/day in the ganciclovir and valganciclovir group, respectively. Good response on CMV DNA load (reduction below 3.0 log10 copies/ml) was observed in 75.7% of ganciclovir and 80.0% of valganciclovir treatment episodes. Severe adverse effects were not observed and CMV-related disease did not occur. However, the percentage of patients receiving erythrocyte transfusion was higher in the group of patients receiving ganciclovir as compared to valganciclovir (41 versus 20%, P=0.116). In conclusion, pre-emptive treatment with valganciclovir and ganciclovir, led to similar reduction of CMV DNA load. Oral valganciclovir is an attractive and safe alternative for pre-emptive CMV treatment in T-cell-depleted allo-SCT recipients.

Administration, Oral↗
PubMed2005

Contrast echocardiography as a useful additional diagnostic tool in evaluating a primary cardiac tumor.

The current report describes a case of a primary cardiac lymphoma. For early and appropriate treatment of a cardiac mass it is not only important to determine its localization and extension but also to differentiate between malignant and benign lesions. This report demonstrates that not only transthoracic echocardiography but also the other different forms of echocardiography such as transesophageal echocardiography, as well as contrast and intracardiac echocardiography, are useful tools in the diagnostic workup of cardiac masses.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2004

[Linezolid, an agent from a new class of antibiotics].

Linezolid is the first of a new class of antibacterial agents, the oxazolidinones, to become available. Linezolid has a unique mechanism of action in its inhibition of bacterial protein synthesis in Gram-positive and a number of anaerobic bacteria. Because of this unique mechanism of action, linezolid exhibits no cross-resistance with other antibiotics and is effective against methicillin-resistant staphylococci, penicillin-resistant pneumococci and vancomycin-resistant enterococci. The excellent bioavailability after oral administration (almost 100%) makes it suitable for outpatient treatment and treatment by general practitioners. In the Netherlands, however, the indications for linezolid are limited by its high cost, the availability of other effective antibiotics for the treatment of sensitive micro-organisms, and the toxicity associated with a prolonged treatment period. Resistance to the new agent was reported rather quickly after the introduction of linezolid.

Acetamides↗
PubMed2004

[Sharp increase in the number of syphilis cases in The Netherlands: early recognition and treatment is of great importance].

Syphilis was diagnosed in three men having sex with men, aged 36, 38 and 58 years, who had a variety of skin lesions and other symptoms. In a woman aged 38 years and her 39-year-old husband, syphilis was found during routine pregnancy screening. All patients were successfully treated with intramuscular (benzathin) benzylpenicillin. Early recognition and treatment as well as advice on avoiding high-risk sexual behaviour are important in preventing further spread of the disease. Although generally the risk of HIV transmission during unprotected oral sexual contact is believed to be low, the transmission of Treponema pallidum during this type of contact is possible and is probably the most important transmission route amongst men having sex with men.

Adult↗
PubMed2003

[A case of diphtheria in the Netherlands due to an infection with Corynebacterium ulcerans].

A 58-year-old woman was admitted due to a pseudomembranous pharyngitis. The patient had not been vaccinated against diphtheria. Corynebacterium ulcerans was cultured from a throat swab. The production of diphtheria toxin by these bacteria was demonstrated with PCR and an immunoprecipitation test. The patient was cared for in respiratory isolation and was treated with benzylpenicillin. She quickly recovered and was discharged four days after admission. A contact investigation did not reveal any dissemination of the toxin-producing C. ulcerans and a source was not found. In spite of the large-scale vaccination against diphtheria which has taken place in the Netherlands since 1953, a physician has to consider diphtheria in the differential diagnosis of patients who present with a clinical syndrome compatible with this disease. Either Corynebacterium diphtheriae or C. ulcerans could be the pathogen responsible.

Corynebacterium↗
PubMed2002

[How to treat a patient with indications for an infectious viral hemorrhagic fever].

Lassa, Ebola, Marburg and Crimean-Congo haemorrhagic fever viruses are the most important causes of viral haemorrhagic fever which is transmitted from person to person through contact with blood or excreta. A non-specific fever may be the initial symptom of viral haemorrhagic fever. By means of carefully noting where the patient has travelled, possible exposure to ill persons, vectors or an animal reservoir, and the incubation period (< or = 21 days versus longer), it is possible to estimate the risk of infection with one of these viruses. Using this approach it is possible to diagnose high-risk patients in good time and to take appropriate measures.

Adult↗
PubMed2002

[A man with fatal Lassa fever following a stay in Sierra Leone].

A 48-year-old-man returned to the Netherlands from Sierra Leone and was admitted with nausea, crampy abdominal pain, myalgia, arthralgia, headache and watery diarrhoea. This was the first case of Lassa fever diagnosed in the Netherlands since 1980. Despite treatment with ribavirin, the patient died on the 16th day of illness. Prompt diagnosis of Lassa fever is critical for the timely administration of ribavirin which improves diagnosis considerably, and for the timely implementation of isolation measures. Recently, a reverse transcriptase polymerase chain reaction (RT-PCR) has become available for the rapid diagnosis of acute Lassa fever, which was implemented to diagnose this patient.

Antiviral Agents↗
PubMed1998

[Clinical thinking and decision making in practice. A patient with pain in the upper abdomen].

A 74-year-old woman was admitted because of abdominal pain. A few weeks before this admission she had had a cerebral infarction in the right hemisphere, reflected by a left sided paralysis, dysarthria, depression and a slight cognitive disorder. The night before admission she woke up from a sharp, continuous pain in the right upper abdomen. Physical examination disclosed pain in the right upper abdomen on palpation. Laboratory tests showed a slight elevation of all 'liver' enzymes. A differential diagnosis of cholecystitis or pyelonephritis was made. Additional tests did not confirm either of these diagnoses. Because of immobilisation pulmonary embolism was then suspected. This diagnosis was confirmed by scintigraphy. The patient was treated and made a full recovery. Diagnostic errors can be made by faulty triggering and omitting verification. The diagnostic strategy for pulmonary embolism is a ventilation perfusion scan, which is followed in case of a non high-probability result by pulmonary angiography. It is emphasized that the presentation of pulmonary embolism can be aspecific.

Abdominal Pain↗
PubMed1998

[Clinical thinking and decision making in practice. A patient with icterus].

A 55-year-old man was admitted because of cholestatic jaundice. Extrahepatic obstruction and viral causes were excluded. A diagnosis of liver damage due to the combination preparation amoxicillin and clavulanic acid (Augmentin) was made. The patient had an uneventful recovery. It is pointed out that in case of cholestatic jaundice drug-induced cholestasis should be suspected early in the course. History taking is an important tool. If a suspected drug is found other causes of the disease can be excluded with simple tests.

Amoxicillin-Potassium Clavulanate Combination↗
PubMed1998

[Clinical thinking and decision making in the practice. A patient with fever of unknown origin].

A 75-year-old woman was admitted because of fever of unknown origin (FUO). In the year before the current admission she developed myalgias and was treated for polymyalgia rheumatica with low-dose prednisone. Her complaints persisted and prednisone was discontinued. Five months before the present admission she developed fever (37.7-38.9 degrees C), malaise, fatigue and occipital headache. Laboratory tests showed an elevated erythrocyte sedimentation rate (98 mm in the first hour) and a severe hypochromic, slightly microcytic, anaemia. Although a recent temporal artery biopsy was negative, a second biopsy was taken which showed giant cell arteritis. The patient was treated with high-dose prednisone (60 mg daily) and made a full recovery. It is emphasized that temporal arteritis is a common cause of FUO in the elderly.

Aged↗
PubMed1998

[Clinical decision making in family practice. A patient with abdominal pain and chills].

An 82-year-old man was admitted because of abdominal pain and a shaking chill. His medical history revealed ileocecal resection because of ileitis associated with a Yersinia infection 3 years before admission. One year later he was readmitted because of bowel obstruction due to recurrent ileitis. He was treated with trimethoprim-sulfamethoxazole for two weeks because of positive serological tests for Yersinia and made a full recovery except for chronic diarrhoea. On the current admission, stool cultures yielded Campylobacter upsaliensis. Further analysis showed severe non-specific ulcerative ileitis without colitis. A diagnosis of Crohn's disease was made. The patient was treated with prednisone and mesalazine and made a full recovery. The chronic diarrhoea disappeared. The course was complicated by a cerebro-vascular thrombosis and severe thrombocytosis due to polycythaemia vera. Treatment with hydroxyurea was effective in lowering the thrombocyte count.

Abdominal Pain↗
PubMed1992

Pertussis toxin partially inhibits phagocytosis of immunoglobulin G-opsonized Staphylococcus aureus by human granulocytes but does not affect intracellular killing.

The aim of the present study was to determine whether pertussis toxin (PT)-sensitive GTP-binding proteins (G proteins) are involved in the signal transduction pathway(s) used for phagocytosis and intracellular killing of bacteria by human granulocytes. Treatment of granulocytes with PT resulted in decreased phagocytosis of immunoglobulin G (IgG)-opsonized Staphylococcus aureus but did not affect subsequent intracellular killing of these bacteria. PT also caused a decrease in the extracellular release of superoxide anion (O2-) and hydrogen peroxide (H2O2) by granulocytes in response to S. aureus opsonized by IgG. However, neither the phagocytosis nor the intracellular killing of S. aureus opsonized by fresh serum was affected by PT, and the release of O2- was partially inhibited. The release of O2- in response to serum-treated zymosan, opsonized mainly by complement components, was also only partially inhibited by PT. It is therefore possible that PT inhibits responses mediated through complement receptors to a lesser extent than those mediated via Fc gamma receptors. The results of this study indicate that PT-sensitive G proteins are involved in the signal transduction pathways that mediate the phagocytosis of IgG-opsonized bacteria and the accompanying respiratory burst.

Cytotoxicity, Immunologic↗