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Biomedical subjects

J Zwartendijk

Publications and source records attributed to J Zwartendijk.

At least 19 recordsLinked to original sources
PubMed1997

The value of pretreatment clinical and biochemical parameters in patients with newly diagnosed untreated prostate carcinoma and no indications for bone metastases on the bone scintigram.

Between 10% and 25% of patients with newly diagnosed prostate cancer without bone metastases at the time of diagnosis will develop metastases during follow-up. To determine the value of clinical and biochemical parameters for assessment of prognosis at the time of diagnosis, a retrospective study was performed in 124 consecutive patients with newly diagnosed prostate cancer without bone metastases. The mean follow-up was 41 months, during which time 36 patients died and 15 patients developed metastases. Bone scans were classified from 0 (=normal) through 2 (=abnormal, but not typical for metastases) and were correlated with age, alkaline phosphatase (AP), prostate-specific antigen (PSA), tumour grade, T-stage and N-stage. In patients with a class 2 scan, additional roentgenograms and follow-up were used to exclude metastases at initial stage. All parameters, including therapy, were finally correlated with the development of metastases and survival. For survival 38 patients with proven metastases were used as controls. For all parameters tested, no statistically significant differences were found between the three bone scan classifications. The interval between diagnosis and the development of metastases ranged from 12 to 72 months. For the risk of development of metastases only PSA was found to be a significant correlate (P=0.0075). However, when tumour stages were clustered in limited disease (T0-2) and extensive disease (T3-4), the incidence of metastases was significantly higher in patients with extensive disease than in those with limited disease (P=0.0021). Finally, age, PSA and Anderson classification were found to be significant correlates of survival, but in stepwise analysis PSA was selected as the most prognostic variable (P<0.0001). In contrast with a typical pattern of metastases on bone scintigraphy, an abnormal scan (class 1 and 2) at the time of diagnosis is not a poor prognostic parameter of the risk of death. In conclusion, in patients with prostate cancer without bone metastases at the time of diagnosis, pretreatment PSA and tumour stage can be used for the assessment of risk of development of metastases during follow-up and survival. For this purpose, tumour stage should be clustered in limited and extensive disease.

Aged↗
PubMed1997

Trazodone, a double blind trial for treatment of erectile dysfunction.

OBJECTIVE: to assess the effectiveness of oral trazodone 150 mg/d for treatment of erectile dysfunction. PATIENTS AND METHODS: A double-blind, placebo controlled, multicentre trial. A run-in period of two weeks was followed by four weeks of medication. Evaluation was done by patients diary, a questionnaire and Rigiscan nightly penile tumescence and rigidity (NPTR) measurements in the second and sixth week of the trial. RESULTS: 69 patients were randomised, two patients never returned for follow-up, nine patients stopped the medication due to side-effects, so 58 patients are evaluable for effect assessment. Half of the patients suffered psychogenic impotence. There was no significant difference in the subjective results of trazodone compared to placebo. Side effects occurred more often with the use of trazodone, but this was not statistically significant. CONCLUSION: In a group of patients, that was not selected on the basis of the etiology of the erectile dysfunction, nor selected on the duration of the complaint, the efficacy of trazodone 150 mg/d, could not be shown.

Adrenergic alpha-Antagonists↗
PubMed1996

Prostaglandin E1 with phentolamine for the treatment of erectile dysfunction.

AIM OF THE STUDY: to evaluate the feasibility of a self-injection programme for impotence with a combination of 10 micrograms prostaglandine E1 (PGE1) and 0.5 mg phentolamine. METHOD: follow-up at outpatients department with history taking, physical examination and questionnaires of 58 patients using this combination. Many patients could compare this drug combination with previously used drugs for intracavernous use. RESULTS: 42 patients started regular use. After a follow-up of 14 months, 26 are still on the programme. Drug related problems encountered: 10 patients reported insufficient erectile response, five patients have had priapism, four patients experienced severe pain, one patient developed fibrosis. CONCLUSION: the combination of PGE1 and phentolamine is very effective. The complication rate is comparable with those reported from PGE1 alone and from papaverine with phentolamine.

Adrenergic alpha-Antagonists↗
PubMed1995

Analysis of continuous nocturnal penile rigidity measurements with the use of the RigiScan summary analysis software program.

The evaluation of the RigiScan nocturnal recordings of 324 patients, 18 to 72 years old (mean age 49 years), according to guidelines based on normal data, were compared with analysis of these recordings by using the RigiScan Summary Analysis Software Program. This enabled us to provide normal values for this program. We conclude that it should be possible to extend this RigiScan software program in such a way that a probability of normality is given to its user. In patients with corporal veno-occlusive dysfunction a significant lower total event duration was found when compared with the results of patients with normal and abnormal findings.

Adolescent↗
PubMed1994

Comparison of a mixture of papaverine, phentolamine and prostaglandin E1 with other intracavernous injections.

OBJECTIVE: evaluation of a self-injection program with a mixture of papaverine, phentolamine and prostaglandin E1 (PGE1). METHOD: a self-injection program for erectile dysfunction was started by 48 patients, using a 1-ml mixture of 4.5 mg papaverine, 0.2 mg phentolamine and 1.5 micrograms PGE1. Patients completed a questionnaire at 6 weeks and at 3 months and were followed at the Outpatients Department for an average of 1 year. RESULT: of these patients 25 had previous experience with 20 micrograms PGE1 for intracavernous use and 22 patients had previously used 30 mg papaverine with 1 mg phentolamine. None of these 3 self-injection drugs is obviously superior in its ability to induce erections. Priapism occurred twice on a total of 1,290 injections. After 1-year follow-up, 4 patients had developed problems with fibrosis of the corpora, 2 of whom had encountered this problem also in a previous self-injection program. CONCLUSION: this triple mixture has the disadvantage of causing fibrosis and priapism in susceptible patients.

Alprostadil↗
PubMed1993

Urinary symptoms due to leukemic infiltration of the prostate. A case report.

A patient with chronic lymphocytic leukemia is presented who suffered from urinary obstructive symptoms due to leukemic infiltration of the prostate gland. He was treated with local radiotherapy, which resulted in complete relief of symptoms. Our report indicates that leukemic infiltration of the prostate should be considered in the differential diagnosis in patients with CLL presenting with obstructive symptoms of the urinary tract.

Aged↗
PubMed1993

Urogenital malacoplakia treated with fluoroquinolones.

We report 2 cases of urogenital malacoplakia and discuss the problems associated with diagnosing and treating this rare disease. In 1 case extensive pelvic disease was successfully controlled with ciprofloxacin. In the other case the malacoplakia was localized in the distal ureter and was initially mistaken for urothelial carcinoma. Nephrectomy was performed due to persistent ureteral obstruction and renal dysfunction. In the management of urogenital malacoplakia it seems essential that urinary tract infections be effectively treated. The new fluoroquinolones appear to be potentially successful in managing this disorder due to their high uptake of macrophages.

Ciprofloxacin↗
PubMed1993

The negative pressure device for erectile disorders: when does it fail?

Of 74 men with erectile dysfunction who used a vacuum device at home only 20 were satisfied with the erections achieved. The device was offered only to men who had not been helped by sexual counseling, self-injection therapy or venous surgery, and to 8 patients who had had problems with a penile implant. Fibrosis reduces the chances of success with the vacuum device, and only 2 of 14 such patients used it successfully. In all 9 patients with psychogenic impotence the device failed. Although 9 men did achieve erections with the device, they disliked it so much that they did not begin regular use. Our disappointing overall result was probably due to negative patient selection.

Adult↗
PubMed1993

Prognosis after resection of residual masses following chemotherapy for metastatic nonseminomatous testicular cancer: a multivariate analysis.

Following chemotherapy for metastatic nonseminomatous testicular cancer, 86 patients with normal serum markers AFP and HCG underwent resection of residual tumour masses (63 laparotomy, 11 thoracotomy, 12 both). Prognostic factors for relapse and survival were analysed with Kaplan-Meier curves and Cox regression analysis. Putative prognostic factors included age, the primary histology, prechemotherapy level of the tumour markers AFP and HCG, the extent of disease (lymph nodes, lung and hepatic metastases) before and after chemotherapy, the histology of the resected material and the completeness of the surgical procedure. Eleven patients relapsed during follow-up (median 47 months), accounting for a 5 year relapse free percentage of 87.4%. Adverse prognostic factors were (1) prechemotherapy level of HCG (> or = 10,000 IU l-1; (2) incomplete resection; and (3) the extent of disease, especially of lung metastases (prechemotherapy number < or = 3,4-19, > or = 20; or size after chemotherapy > 1 cm; or presence of any residual lung metastasis after chemotherapy without residual abdominal metastases). The histology found at resection was not associated with the risk of relapse, which might be explained by the effectiveness of postresection chemotherapy, which in the majority of these patients was a salvage regimen rather than two further cycles of the initial cytostatics. A good and a poor risk group were formed, based on HCG level and completeness of resection. The effect of salvage chemotherapy after resection of viable cancer cells needs further investigation.

Adult↗
PubMed1992

Ciprofloxacin for treatment of malakoplakia.

The tumour-like lesions of the rare disease malakoplakia, which consist of macrophages containing undigested coliform bacteria, are often misdiagnosed as a carcinoma. Although an infectious aetiology is likely, no antimicrobial therapy has been successful in the long-term. Since ciprofloxacin penetrates well into macrophages, this drug was given to two patients with advanced malakoplakia (500 mg twice daily). After long-term treatment all granulomatous lesions disappeared. Thus, malakoplakia can be cured by antibiotic treatment.

Adult↗
PubMed1992

Long-term results of surgical treatment of renal carcinoma in solitary kidneys by extracorporeal resection and autotransplantation.

We describe the technique and present the long-term results of extracorporeal partial nephrectomy and autotransplantation in 6 patients with renal carcinoma. During a follow-up period exceeding 5 years, dialysis was not required and the patients' blood pressure improved or remained within normal limits. One patient died post-operatively from gastrointestinal bleeding. The mean duration of follow-up was 54 months (range 14-97). The alternatives to extracorporeal resection and autotransplantation (such as complete nephrectomy and in situ resection of the tumour) are discussed.

Adolescent↗
PubMed1991

Experiences with the Surgitek Art-1000 penile tumescence and rigidity monitor, and comparison with the RigiScan.

We compared real-time and nocturnal penile tumescence and rigidity monitoring with 2 different ambulatory rigidity and tumescence monitors: the Surgitek Art-1000 and the RigiScan devices. Real-time studies were performed in 5 patients with both devices used simultaneously. The results of the measurements with both monitors were rather identical, indicating that both devices are applicable in a satisfactory manner for real-time investigation. Within a short period 5 patients performed nocturnal monitoring at home with the Surgitek Art-1000 and RigiScan devices during 2 consecutive nights. The Surgitek Art-1000 device provided less reliable and less informative results when compared with the RigiScan monitor during these nocturnal measurements. It appears that problems with sizing and fixing of the passive sensing loops of the Surgitek Art-1000 device by the patient are the main cause of these disappointing results. We believe that when the loops are sized and fixed by the investigator, for example during nocturnal measurements in the hospital, the applicability will be more satisfying. This monitor seems not to be suitable for nocturnal measurements by the patient at home.

Equipment Design↗
PubMed1991

Cognitive function after spinal or general anesthesia for transurethral prostatectomy in elderly men.

Cognitive functions in 53 elderly men who underwent a transurethral prostatectomy were assessed pre-operatively and 4 days and 3 months post-operatively. Thirteen patients had a preference for one particular type of anesthesia, and the remaining 40 were randomly allocated to receive either spinal or general anesthesia. Cognitive function was not different between the groups receiving different types of anesthesia at either time point and did not decrease post-operatively. No pre- or perioperative variable could distinguish the subgroup of patients who had a post-operative decrease of 2 points or more on the Mini-Mental State Examination. No difference in post-operative performance was found in the patient groups with pre-operative Mini-Mental State Examination scores above or under their age-specific norm. It is concluded that neither hospitalization nor the two forms of anesthesia investigated cause a decrease in cognitive function in elderly men.

Aged↗