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Biomedical subjects

E J van der Wouden

Publications and source records attributed to E J van der Wouden.

15 recordsLinked to original sources

Directional flow induced by synchronized longitudinal and zeta-potential controlling AC-electrical fields.

Electroosmotic flow (EOF) in a microchannel can be controlled by electronic control of the surface charge using an electrode embedded in the wall of the channel. By setting a voltage to the electrode, the zeta-potential at the wall can be changed locally. Thus, the electrode acts as a "gate" for liquid flow, in analogy with a gate in a field-effect transistor. In this paper we will show three aspects of a Field Effect Flow Control (FEFC) structure. We demonstrate the induction of directional flow by the synchronized switching of the gate potential with the channel axial potential. The advantage of this procedure is that potential gas formation by electrolysis at the electrodes that provide the axial electric field is suppressed at sufficiently large switching frequencies, while the direction and magnitude of the EOF can be maintained. Furthermore we will give an analysis of the time constants involved in the charging of the insulator, and thus the switching of the zeta potential, in order to predict the maximum operating frequency. For this purpose an equivalent electrical circuit is presented and analyzed. It is shown that in order to accurately describe the charging dynamics and pH dependency the traditionally used three capacitor model should be expanded with an element describing the buffer capacitance of the silica wall surface.

Buffers↗

[A schizophrenic patient with loss of teeth].

A 53-year-old woman, known with a schizophrenic disorder and a history of drug addiction, was referred because of progressive hematomas of the lower extremities and fatigue. Her medical history included hyperplastic gums, tooth hypermobility and anaemia. Scurvy was diagnosed as a result of an insufficient diet due to drug addiction and a paranoid psychosis. After suppletion of vitamin C and starting highly nutritious food a rapid amelioration of the scurvy related complaints was observed. While dreaded and often fatal in earlier eras, in the 21st century scurvy is easily treatable if this diagnosis is recognised.

Anemia↗

[Bruises, loose teeth and fatigue in a patient with schizophrenia].

A 53-year-old woman was referred because of progressive haematomas of the lower extremities and fatigue. Her medical history included hyperplastic gums and tooth loss. Scurvy was diagnosed; this was the result of an insufficient diet due to a paranoid psychosis. There was a dramatic improvement within a few days after addition of vitamin C and starting highly nutritious food. Scurvy is easily treated, but is not a disease of the past.

Ascorbic Acid↗

[Devastating community-acquired Staphylococcus aureus bacteremia].

Three patients, two men aged 52 and 62 years and a woman aged 83 years, experienced non-specific flu-like symptoms for a few days but subsequently developed a complicated disease with multiple metastatic infections and endocarditis due to bacteraemia. Only the man aged 62 years had a port of entry, a finger wound. Two patients died. Community-acquired S. aureus bacteraemia is a much more serious disease than nosocomial bacteraemia. The community-acquired bacteraemia is characterised by the absence of a primary focus and non-specific flu-like symptoms in the beginning. This results in a long-duration bacteraemia with a high incidence of metastatic infections, endocarditis and a high mortality rate. A multidisciplinary treatment approach with a careful search for and treatment of endocarditic and metastatic infections in combination with long-duration, high-dose antibiotics is warranted.

Aged↗

Implications of the simultaneous presence of metronidazole-susceptible and -resistant Helicobacter pylori colonies within a single biopsy specimen.

This study examined whether the simultaneous presence of metronidazole-susceptible and -resistant Helicobacter pylori colonies in a single biopsy specimen is caused by a multiple strain infection with a susceptible and a resistant strain or by two subpopulations within a single strain. Single colonies obtained from seven biopsy specimens known to harbour both susceptible and resistant Helicobacter pylori were fingerprinted by restricted fragment length polymorphism typing of the ureC gene and by the random amplified polymorphic DNA procedure. Metronidazole susceptibility was determined by the E test. The results indicated that the occurrence of metronidazole-resistant and metronidazole-susceptible bacteria within a single biopsy does not imply the presence of a multiple strain infection with one resistant and one sensitive strain.

Anti-Bacterial Agents↗

Mechanism and clinical significance of metronidazole resistance in Helicobacter pylori.

Metronidazole was introduced in 1959 for the treatment of Trichomonas vaginalis, but was subsequently shown to be active against anaerobic and some micro-aerophilic bacteria as well. In anaerobic microorganisms with their low redox potential, metronidazole is reduced to its active metabolite by a one-electron transfer step. Metronidazole is often used in treatment regimens for Helicobacter pylori, a microaerophilic bacterium, but resistance to this drug is frequently encountered. The metabolism of metronidazole in H. pylori must differ from that in anaerobic bacteria as metabolites formed by a one-electron transfer are readily re-oxidized in the micro-aerophilic environment of H. pylori. This process is called 'futile cycling' and is accompanied by the formation of toxic oxygen radicals that are neutralized by an active scavenger system. Recently, it has been shown that in H. pylori, in contrast to the situation in anaerobes, an oxygen-insensitive nitroreductase. encoded by the rdxA gene, is responsible for the activation of metronidazole. Activation by this enzyme is by a two-electron transfer step, preventing futile cycling' and thereby enabling the activation of metronidazole in a micro-aerophilic environment. Metronidazole resistance has been shown to be associated with null mutations in the rdxA gene in most clinical isolates. However, there may be some 'background metronidazole susceptibility' in metronidazole-resistant strains caused by other (oxygen-sensitive) nitroreductases. Recently, three meta-analyses of the impact of metronidazole resistance on treatment efficacy have all shown a significant reduction in efficacy of metronidazole containing regimens in patients infected with a resistant strain. The impact of resistance proved to be dependent on the other components of the regimen and on treatment duration.

Anti-Bacterial Agents↗

Six-year follow-up after successful triple therapy for Helicobacter pylori infection in patients with peptic ulcer disease.

OBJECTIVE & DESIGN: We question whether Helicobacter pylori eradication in peptic ulcer disease patients leads to a decrease in symptoms and reduced use of anti-dyspeptic drugs. Therefore, the recurrence rate of H. pylori, upper abdominal symptoms and the use of acid-suppressive drugs were determined 6 years after successful triple therapy. METHODS: Peptic ulcer disease patients successfully treated in 1990-1993 with 'classic' triple therapy were eligible. Patients were asked about symptoms and invited for a 13C-urea breath test or endoscopy in 1997-1998. Data on the use of anti-dyspeptic drugs were obtained from the pharmacy or general practitioner. RESULTS: Of the 113 eligible patients, 90 could be included in the study. The mean follow-up time was 6 years (range 4.6-7.6 years). H. pylori infection recurred in one patient (recurrence rate: 0.19% per patient-year; 95% confidence interval: 0.01-1.1%). Moderate or severe symptoms were experienced before therapy by 79% of the patients and after therapy by 18% of the patients (P< 10(-7)). Before triple therapy, 98% of the patients used H2-receptor antagonists and 54% were on maintenance treatment. After treatment, 30% used anti-dyspeptic medication and only 13% were on maintenance treatment (P < 10(-7)). CONCLUSIONS: Six years after successful triple therapy in peptic ulcer disease patients, the recurrence rate of H. pylori infection is low and both symptoms and the use of anti-dyspeptic drugs have decreased significantly.

Aged↗

Reliability of biopsy-based diagnostic tests for Helicobacter pylori after treatment aimed at its eradication.

OBJECTIVE: Recurrence of Heliobacter pylori after apparently successful treatment mostly represents resurgence of the infection, rather than a new one. Therefore, the reliability of biopsy-based tests after treatment was investigated. METHODS: Four weeks or more after treatment, antral biopsy samples were taken for culture, histology, urease test and polymerase chain reaction (PCR), and a corpus specimen for culture. Treatment failure was defined as > or = 2 tests positive. If one test was positive, a 13C-urea breath test was performed and considered conclusive. RESULTS: One hundred and ninety-seven patients were evaluated. Endoscopy was performed 53 days (27-92 days) after treatment. Twenty-one patients with missing test results and 19 patients on acid-suppressive drugs were excluded. In 140 of 156 patients (89.7%), H. pylori was eradicated. Sensitivity and specificity of culture of antrum were, respectively, 100% and 100%; culture of corpus, 100% and 100%; rapid urease test, 87% and 99%; haematoxylin/eosin stain, 94% and 95%; Giemsa stain, 81% and 99%; and PCR, 88% and 100%. CONCLUSION: Although all biopsy-based tests are reliable after treatment, culture is the biopsy-based test of first choice as it is the most accurate and gives additional information on antibiotic resistance.

Adult↗

The influence of in vitro nitroimidazole resistance on the efficacy of nitroimidazole-containing anti-Helicobacter pylori regimens: a meta-analysis.

OBJECTIVE: The aim of this study was to determine the influence of nitroimidazole resistance (NIR) on the efficacy of treatment for Helicobacter pylori (H. pylori) infections by meta-analysis of the world literature. METHODS: A MEDLINE search, a manual search of all major gastroenterological journals from 1993 to 1997, and abstracts of gastroenterological and H. pylori meetings from 1993 to 1997 were performed. All treatment studies using a nitroimidazole and providing data about the medication used, dose frequency, total daily dose, duration of treatment, and eradication results in relation to NIR were included. Eradication had to be assessed by two biopsy-based tests or a urea breath test > or = 4 wk after treatment. Individual studies were pooled into groups according to the medication used and the duration of treatment. The pooled estimate of the odds ratio (OR) of NIR for treatment failure and its 95% confidence interval (95% CI) were calculated for each group using the logit method. To detect any possible bias, funnel plots (plots of effect estimates against sample size) were constructed. RESULTS: A total of 91 treatment arms, including a total of 4823 patients, were evaluated. The pooled ORs of NIR for treatment failure (95% CI) of proton pump inhibitors, bismuth, and quadruple regimens were 5.2 (3.8-7.1), 5.9 (4.1-8.3), and 7.0 (3.1-16.0), respectively. Eradication rates were 90% in susceptible strains but <75% in resistant strains. In susceptible strains, neither treatment duration nor the choice of the second antibiotic influenced efficacy. In resistant strains, tetracycline was more effective than amoxicillin (bismuth regimens), and the longer the duration of regimens (bismuth-amoxicillin regimens) the more effective they were. Only quadruple regimens given for > or = 1 wk were effective in resistant strains. CONCLUSIONS: NIR decreases treatment efficacy. Treatment duration and choice of other drugs influence the impact of NIR on treatment efficacy. If NIR is present, a nitroimidazole-containing regimen should be avoided or a quadruple regimen should be given for > 1 wk.

Drug Resistance, Microbial↗

Subpopulations of Helicobacter pylori are responsible for discrepancies in the outcome of nitroimidazole susceptibility testing.

Metronidazole susceptibility testing by E test was compared to that by disk diffusion for 263 Helicobacter pylori isolates and to that by breakpoint agar dilution for 90 H. pylori isolates. In 5% and 6% of the cases, respectively, results were discrepant. For each of 52 clinical isolates an E test was performed on 10 separate colonies. Subpopulations of resistant and susceptible bacteria were found in five cases. From three isolates, each colony was subcultured and tested up to 10 times. All but 1 of 292 tests showed the same result. We conclude that the E test is reliable and that subpopulations are responsible for discordant results.

Anti-Bacterial Agents↗

One-week triple therapy with ranitidine bismuth citrate, clarithromycin and metronidazole versus two-week dual therapy with ranitidine bismuth citrate and clarithromycin for Helicobacter pylori infection: a randomized, clinical trial.

OBJECTIVE: The aim of this study was to compare the efficacy and side effects of 1-wk triple therapy with ranitidine bismuth citrate (RBC) 400 mg b.i.d., clarithromycin 500 mg b.i.d., and metronidazole 500 mg b.i.d., to 2-wk dual therapy with RBC 400 mg b.i.d. and clarithromycin 500 mg b.i.d. for H. pylori infection in a randomized, clinical trial. METHODS: Patients (18-80 yr) with a culture proven H. pylori infection were randomized to one of these regimens. Side effects were scored on a semiquantitative scale. Endoscopy was performed > or = 4 wk after treatment. Antral biopsy samples were taken for hematoxylin-eosin stain (HE), rapid urease test, and culture and corpus samples for culture and HE. Two weeks after the endoscopy, a 13C-urea breath test was performed. Eradication failure was defined as detection of H. pylori by culture or by at least two other tests. RESULTS: A total of 104 patients, 54 men, age 54+/-14 yr, (36 duodenal ulcer, 16 gastric ulcer, and 52 functional dyspepsia) were included. Gender, age, and diagnosis were comparable in both groups. Fourteen of 52 patients in both triple and dual therapy, respectively, had significant side effects, but all patients completed the course. Eradication results were 49 of 52 (94%; 95% CI: 84-99%) and 50 of 52 (96%; 95% CI: 87-100%) on intention to treat analysis and 44 of 46 (96%; 95% CI: 85-99%) and 48 of 49 (98%; 95% CI: 89-100%) on per protocol analysis for triple and dual therapy respectively. CONCLUSION: Both regimens are very effective and well tolerated in the treatment of H. pylori infection. The triple regimen has the advantage of being shorter.

Adolescent↗

Low cure rate of Helicobacter pylori infection with omeprazole and furazolidone dual therapy for one week.

BACKGROUND: Furazolidone is an inexpensive antibiotic that has considerable anti-Helicobacter pylori activity in vitro. METHODS: Twenty-three patients with culture-proven H. pylori infection were treated for one week with a dual therapy containing omeprazole and furazolidone. RESULTS: Eradication succeeded in 10 of the first 20 evaluable patients (50%; 95% CI: 27.2-72.8%). This percentage was regarded as too low, and the study was terminated. Side-effects were mild. CONCLUSION: With the possible increase in resistance to metronidazole and clarithromycin world-wide, furazolidone may be useful alternative in the treatment of H. pylori infection. Dual therapy for one week, however, is not sufficient.

Anti-Bacterial Agents↗

Rapid increase in the prevalence of metronidazole-resistant Helicobacter pylori in the Netherlands.

The prevalence of primary metronidazole resistance of Helicobacter pylori was studied in one Dutch hospital from 1993 to 1996 and in two additional Dutch hospitals in 1993 and 1996. All cultures of antral biopsy specimens yielding H. pylori in the study period were evaluated, except those from patients who had received anti-H. pylori treatment; 1,037 H. pylori strains, all from different patients were included. Metronidazole resistance was determined by disk diffusion in 1993 and by Epilipsometer-test in 1994 to 1996. Metronidazole resistance increased from 7% (18/245) in 1993 to 32% (161/509) in 1996. More patients with nonulcer dyspepsia and more non-Western European patients were seen in 1996 than in 1993, but age and sex differences were not observed. A comparable increase in metronidazole resistance was observed in both nonulcer dyspepsia patients and peptic ulcer patients, and the prevalence of metronidazole resistance in Western Europeans increased from 5% in 1993 to 28% in 1996.

Anti-Bacterial Agents↗