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Biomedical subjects

E van Leer

Publications and source records attributed to E van Leer.

13 recordsLinked to original sources
PubMed1996

Intracutaneous versus intramuscular hepatitis B vaccination in primary non-responding haemodialysis patients.

OBJECTIVE: To determine whether hepatitis B vaccination given intracutaneously (i.c.) is more effective than intramuscularly (i.m.) in primary non-responding haemodialysis patients. DESIGN: A prospective, randomized study of antibody responses to hepatitis B vaccine given i.c. or i.m., in 25 haemodialysis patients. Outcome measures were rates of seroconversion, mean and geometric mean levels of antibody achieved, and antibody levels 1 year after vaccination. RESULTS: With a dosing schedule of 10 micrograms vaccine once a week i.c. in the skin overlying the deltoideus muscle of the non-dominant arm during 12 consecutive weeks, antibody levels to hepatitis B surface antigen (anti-HBsAg) of 10 IU/1 or more were achieved in nine of 10 evaluable patients, with a geometric mean of 70 IU/1. Nine months after the end of the vaccination anti-HBsAg levels had dropped to 9 +/- 4 IU/1 (M +/- SE), with a geometric mean of 5 IU/1, in the nine remaining evaluable patients. With a dosing schedule of 40 micrograms vaccine i.m. in the deltoideus muscle of the non-dominant arm at 0, 1, and 3 months, anti-HBsAg levels of at least 10 IU/1 were achieved in eight of 14 evaluable patients, with a geometric mean of 94 IU/1. Nine months after the end of the vaccination anti-HBsAG levels had dropped to 16 +/- 7 IU/1, with a geometric mean of 9 IU/1, in the nine remaining evaluable patients. Anti-HBsAg levels at 8 and 12 weeks were higher in the i.c. than in the group receiving vaccine i.m. (at 8 weeks 134 +/- 76 vs 39 +/- 20 IU/1, P < 0.05, and at 12 weeks 188 +/- 98 vs 47 +/- 18 IU/1 P < 0.01). The half-time of anti-HBsAg is about 13 weeks, both when the averaged absolute and when the geometric mean levels are used for the estimate. CONCLUSION: intracutaneous route is a less practical but effective method of vaccination against hepatitis B in primary non-responding haemodialysis patients. The weekly 10 micrograms vaccine i.c. scheme resulted in the fastest development of protective antibody levels, within 8 weeks, which may be useful in previously non-immune persons who may be infected with hepatitis B virus (e.g. needle-stick accidents).

Drug Administration Routes↗
PubMed1990

Phenprocoumon-induced hepatitis mimicking non-A, non-B hepatitis.

A 58-year-old man presented with jaundice 6 months after aortic valve replacement. Although non-A, non-B hepatitis was initially suspected, the final diagnosis of phenprocoumon (Marcoumar)-induced hepatitis progressing to cirrhosis was based on recurrence of jaundice after re-exposure to the drug, improvement after withdrawal and centrilobular necrosis with eosinophilic infiltration in the liver biopsy. Antibodies to hepatitis C virus were absent. The aortic valve was replaced by a bioprosthesis to eliminate the need for life-long anticoagulation.

Antibodies, Viral↗
PubMed1982

Mechanism of elevated serum pancreatic polypeptide concentrations in chronic renal failure.

Basal serum concentrations of pancreatic polypeptide (PP) in five patients with chronic renal failure (CRF; 165-2100 pmol/liter) were significantly (P less than 0.01) higher than those in six age-matched normal control subjects (18-54 pmol/liter). Ingestion of a mixed meal resulted in significantly (P less than 0.01) larger increases in serum PP in patients with CRF (245-1740 pmol/liter) than in the normal subjects (72-196 pmol/liter). The iv administration of somatostatin (125 micrograms as a bolus injection, followed by infusion of 125 micrograms/h) to two patients with CRF and two normal subjects completely abolished postprandial PP release. By administering the same dose of somatostatin 60 min after ingestion of the meal, the disappearance rate of endogenously released PP could be estimated. The half-life of disappearance for PP in patients with CRF (t1/2 = 13.2 +/- 1.8 min) was significantly (P less than 0.01) increased compared to that in the normal subjects (t1/2 = 5.6 +/- 0.8 min). Sephadex G-50 column chromatography of basal sera from three patients with CRF revealed three major peaks of PP: one eluting in the void volume, one coeluting with the 4200 molecular weight human PP standard, and one in between. The PP peak coeluting with standard PP comprised 64 +/- 3% of total PP immunoreactivity. Ingestion of food, followed by subsequent infusion of somatostatin, resulted in marked changes in the PP peak coeluting with standard PP, while the two larger molecular forms remained relatively unchanged. At least three findings may be related to the mechanism of elevated serum PP concentrations in patients with CRF: 1) the presence of large molecular forms of PP, 2) a slower disappearance rate for postprandially released PP, and 3) increased postprandial secretion of PP indicating hyperresponsiveness of PP cells to physiological stimuli.

Aged↗