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Biomedical subjects

J M Van Den Bosch

Publications and source records attributed to J M Van Den Bosch.

6 recordsLinked to original sources

An Epstein-Barr virus-associated pulmonary lymphoproliferative disorder as complication of immunosuppression.

Inherited or acquired immunodeficiencies as well as autoimmune diseases treated with cytotoxic drugs are associated with an increased incidence of lymphoma. Non-Hodgkin's lymphomas that occur in the context of drug-induced immunosuppression, acquired or congenital immunodeficiency, are frequently associated with Epstein-Barr virus infection. This report describes the occurrence of an Epstein-Barr virus associated pulmonary B cell lymphoma in a patient with longstanding rheumatoid arthritis treated with methotrexate.

Arthritis, Rheumatoid↗

Age-related interference with Chlamydia pneumoniae microimmunofluorescence serology due to circulating rheumatoid factor.

Microimmunofluorescence (MIF) serology is commonly used in the diagnosis of chlamydial infections. In the MIF assay, Chlamydia pneumoniae elementary bodies were used to detect C. pneumoniae immunoglobulin G (IgG) and IgM antibodies in paired serum samples from 286 patients with respiratory illnesses. In 69 patients, MIF serology was compared with C. pneumoniae cultures. All C. pneumoniae cultures remained negative. However, 205 (71%) of 286 patients were C. pneumoniae antibody positive and 64 (22%) had MIF test results indicating recent infection; 11 showed a fourfold increase in IgG titer, 18 had IgG titers of greater than or equal to 1:512, and 41 had IgM titers of greater than or equal to 1:16. In 35 (55%) of 64 patients, a recent-infection diagnosis was based on C. pneumoniae IgM antibodies only. However, 78% of C. pneumoniae IgM-positive patients had circulating rheumatoid factor (RF) by rheumatoid arthritis latex assay. RF positivity increased with age. After absorption with anti-human IgG, all C. pneumoniae IgM-positive sera became C. pneumoniae IgM negative in the MIF assay. Twenty-five patients with active rheumatoid arthritis but without respiratory illness were also tested; 14 were C. pneumoniae IgG positive and C. pneumoniae IgM positive as well. Absorption of IgG from these RF-containing sera invariably resulted in disappearance of reactivity in the MIF IgM assay. We conclude that with age the serologic diagnosis of recent C. pneumoniae infection becomes increasingly prone to false-positive results unless sera are routinely absorbed prior to MIF IgM testing.

Adult↗

Exploratory thoracotomy in bronchial carcinoma.

Of 2,540 patients with bronchial carcinoma, 1,223 (48.1%) were judged primarily to have inoperable disease. Of the 1,317 (51.9%) patients who seemed operable, 150 (11.4%) proved to have inoperable lesions at thoracotomy. The resectability rate was 45.9%. The difference between the clinical and surgical staging, i.e., the ultimate reason for inoperability, had various causes: inadequate assessment of the available radiologic data, inadequate performance of mediastinoscopy, and pleural or thoracic wall involvement without clinical suspicion preoperatively. Exploratory thoracotomy cannot always be avoided. However, it seems important that physicians check their results with exploratory thoracotomy to improve the quality of the diagnostic procedures in the preoperative work-up.

Adult↗

Lobectomy with sleeve resection in the treatment of tumors of the bronchus.

We evaluated the results of right upper lobectomy with a sleeve resection of the right main bronchus in 50 patients with a bronchial neoplasm. Four patients (8 percent) died during surgery or postoperatively. Eight of the 22 patients who underwent surgery for carcinoma between the years 1960 and 1974 had tumor-positive hilar lymph nodes. They died as a result of subsequent extension of the resected carcinoma. Fourteen of the 22 patients had no lymph node metastasis and nine of them (64 percent) were alive after five years without detectable recurrence. The finding of positive hilar lymph nodes contraindicates sleeve resection. In these cases, when pneumonectomy is impossible from a functional point of view, sleeve resection is to be regarded as a palliative procedure.

Adult↗

Postpneumonectomy oesophagopleural fistula.

Patients with oesophagopleural fistula after a pneumonectomy present a difficult therapeutic problem. There are two types of presentation, early and late. We report three cases in addition to the 49 previously published. All three patients developed their fistulae after right-sided pneumonectomy (one month, four years, and 21 years respectively) and presented with the features of an empyema. The existence of an oesophagopleural fistula can be demonstrated by the discovery of food particles in the pleural aspirate, by direct visualisation during oesophagoscopy after instilling methylene blue into the pleural cavity, by barium swallow, or by identification of helium in the pleural space after swallowing a mouthful of helium. After the initial treatment of empyema we believe that surgical repair of the oesophagopleural fistula is the treatment of choice.

Adult↗