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Biomedical subjects

J van der Zee

Publications and source records attributed to J van der Zee.

At least 73 records · Page 4Linked to original sources

The pro- and antioxidant properties of protoporphyrin IX.

The effect of protoporphyrin on lipid peroxidation in rat liver microsomes was investigated in the presence and absence of light. Protoporphyrin and light stimulated Fe(3+)-ADP/ascorbate-induced lipid peroxidation, whereas Fe(3+)-ADP/NADPH-mediated lipid peroxidation was inhibited. In the dark, on the other hand, protoporphyrin inhibited lipid peroxidation in both systems in a concentration-dependent manner. Protoporphyrin did not affect the reduction of the Fe(3+)-ADP complex by ascorbate, nor did it affect the activity of the NADPH-cytochrome P-450 reductase under these conditions. Uroporphyrin, a hydrophilic porphyrin and not localized in the membrane, did not inhibit lipid peroxidation in the dark in these systems, whereas bilirubin, a well-known radical scavenger and degradation product of protoporphyrin, inhibited lipid peroxidation in both systems. When peroxyl radicals were generated in solution by the azocompound 2,2'-azobis (2-amidino-propane)dihydrochloride lipid peroxidation was inhibited by both porphyrins and bilirubin. Reaction of bilirubin or protoporphyrin, in the presence of microsomes or human serum albumin, with these peroxyl radicals resulted in degradation of both compounds, which could be determined by a decrease in their absorbance at 460 or 407 nm, respectively. These results indicate that the inhibition of lipid peroxidation is most likely caused by scavenging of peroxyl radicals by protoporphyrin. Massive accumulation of protoporphyrin occurs in livers of erythropoietic protoporphyria patients. The fact that protoporphyrin was able to inhibit lipid peroxidation completely at micromolar concentrations also indicates that the deleterious effects of protoporphyrin, observed in these patients, are most likely not mediated by oxidation of lipids.

Adenosine Diphosphate↗

Community nursing in Belgium, Germany and The Netherlands.

This paper contains a comparative study on community nursing in the Netherlands, Belgium and Germany, carried out in the region around Maastricht, where the borders of the three countries meet. The well-known problem of comparative studies (the incomparability of concepts and data) has been solved by using the same measuring instruments in the three countries. The comparison between the countries was on three aspects: the level of care dependency of the patients, the type and number of services provided and the nurses' job interpretation and job satisfaction. During 1 week in June or September 1991, 89 community nurses made records of all their home visits and nursing activities. In total the community nurses paid 5165 home visits to provide care to 1796 patients. The results indicate that both the level of care dependency of the patients as well as the type of care provided differs between the three countries. Belgian community nurses have the highest number of patients with a high level of care dependency. Curative services like technical nursing care and domestic care are most frequently provided by the German and Belgian community nurses. Informing, educating and supporting care is most frequently provided by the Dutch community nurses. The German community nurses spend less time on administration activities. With respect to job interpretation and job satisfaction the following results were found. The Dutch community nurses mentioned in their job interpretation many more preventive tasks, whereas the German community nurses more often mentioned domestic tasks. Concerning the hygienic and technical tasks, no significant differences were found between the three countries. Finally, job satisfaction is lowest in the Netherlands. Dutch community nurses are less satisfied with the work organization and the possibilities of autonomy and professionalization than the German and Belgian community nurses.

Belgium↗

Correlates of exercise compliance in physical therapy.

BACKGROUND AND PURPOSE: This correlational study describes factors that are related to patient compliance with exercise regimens during physical therapy. We investigated whether patient compliance was related to characteristics of the patient or the patient's illness, to the patient's attitude, or to the physical therapist's behavior. SUBJECTS AND METHODS: Of a random sample of 300 physical therapists in private practice in the Netherlands, 222 therapists responded to a questionnaire survey. Eighty-four respondents also made audio recordings. Materials of the study were 1,931 registration forms, 1,837 audio-recorded sessions of physical therapy sessions, and 1,681 patient questionnaires. RESULTS: The results show that the three main factors related to noncompliance were (1) the barriers patients perceive and encounter, (2) the lack of positive feedback, and (3) the degree of helplessness. The first factor, the barriers patients perceive and encounter, shows the strongest relation with noncompliance. The results also show that noncompliance is more strongly related to the characteristics of the illness than to the illness, a bad prognosis is negatively related to compliance, and much hindrance of the complaint is positively related to compliance. There was no difference between men and women with regard to patient compliance, but less educated patients were slightly more compliant than more highly educated patients. CONCLUSION AND DISCUSSION: These correlational findings can be used to formulate hypotheses of cause and effect in future clinical research. Future research should take into account the type and efficacy of therapeutic exercise for different diseases. For physical therapy practice, it seems important that physical therapists carefully explore which problems patients encounter in their efforts to comply and that they seek solutions to those problems in mutual cooperation with their patients.

Adult↗

Regional variation in hospital admission rates in The Netherlands, Belgium, northern France, Nordrhein-Westfalen.

For the analysis of regional variations in hospital admission rates a model was set up, including both supply and demand indicators. Data were gathered for regions in four health care systems (the Dutch, Belgian, French and German), for 1982, 1979, 1974 (France 1982 only). Hospital bed supply proved to be the key factor in the explanation of the variation. The French health care system and, to a lesser extent, the German, turned out to be the strongest supply-dominated health care systems of the four. However, supply dominance in the German health care system seems to decrease over time. We concluded that the empirical generalisation, contained in Roemer's law, a bed built is a bed filled, is conditioned by time and place. Hypotheses on the conditional character of Roemer's law require further testing.

Belgium↗

[Income of family physicians in Western Europe].

Although doctors tend to belong to the best paid categories of professionals, considerable differences between countries in average remuneration can be found. This study is focused on incomes (1985) of general practitioners (GP) in II Western European countries (Austria, Belgium, Denmark, Finland, France, West Germany, Italy, United Kingdom, the Netherlands, Norway and Sweden). Beside a description of the incomes (before taxation) as such, an attempt is made to correlate the income figures with some characteristics of the general practitioner's position in each country. The average GP income per country (before taxes) was ECU 43,600. The German (ECU 67,000), Austrian (ECU 56,000) and Danish (ECU 55,000) form the top, the Italian (ECU 14,000), Belgian (ECU 31,000) and Swedish (ECU 34,500) doctors the bottom-three. Correcting for OECD purchasing power parities does not change the rank order of the GP income in the different countries essentially. The more doctors per inhabitant, the lower the income, and the more different tasks the GP has to perform, the higher the income. Direct access of specialist care has no relationship with GP incomes.

Europe↗

Measurement of tumor pH during microwave induced experimental and clinical hyperthermia with a fiber optic pH measurement system.

The influence of hyperthermia on tissue pH was investigated using a modified version of the fiber optic monitoring system. This newly developed system was tested for use in tissues and found to be suitable for pH measurement during microwave induced hyperthermia. The fiber optic pH probe (0.7 mm diameter) could be easily used in the electromagnetic fields produced by the microwave applicators, whereas only the display unit required some shielding. Tissue pH of experimental and clinical tumors was measured concurrently with local microwave hyperthermia treatment. The mean initial intratumor pH of a rat rhabdomyosarcoma was 7.03 (SD 0.13, n = 19) and the pH of human subcutis was 7.45 (SD 0.02, n = 8). In rat tumor a primary pH decrease was observed during heating which was fully reversed during cooling. The coefficient of temperature dependence was -0.016 pH unit/degree C (SD 0.004, n = 12). After approximately 1 hr of heating at 43 degrees C a further pH decrease of 0.1-0.3 unit occurred which was not reversed directly after treatment. Measurements during clinical local microwave hyperthermia treatments after radiotherapy revealed similar changes in pH values, primary as well as secondary. The estimated coefficient of temperature dependence for the reversible pH change, which occurred in subcutis as well as in tumor tissue, was -0.016 pH unit/degree C (SD 0.004, n = 12). The fiber optic pH measurement system is expected to be a valuable tool in the thorough investigation of temperature and time related pH changes in tumor during experimental as well as clinical hyperthermia treatment.

Acid-Base Equilibrium↗

Intractible cutaneous non-Hodgkin's lymphoma of the lower limb. Complete remission after sequential regional isolated hyperthermic perfusion and perfusion with 1-phenylalanine-mustard (melphalan, L-Pam).

A 61-year-old man with an intractible and progressively disabling cutaneous non-Hodgkin's lymphoma (NHL) in the lower limb was treated with sequential regional isolated perfusion at 10-day intervals. The first perfusion was hyperthermic (40.2-43.1 degrees C tumor-temperature); the second was at controlled normothermia with high-dose 1-phenylalanine mustard (melphalan, L-Pam; 11 mg/l perfused tissue). This treatment resulted in a complete remission in the perfused area of significant duration and has prevented amputation.

Chemotherapy, Cancer, Regional Perfusion↗

The relationship between the unmodified initial tissue pH of human tumours and the response to combined radiotherapy and local hyperthermia treatment.

The relationship between unmodified tumour pH before treatment and tumour response was investigated in patients receiving combined radiotherapy and local hyperthermia treatment. Tumour pH showed a statistically significant positive correlation with the response rate (Spearman correlation coefficient 0.31, n = 50, 2P less than 0.05). The mean pH of tumours showing a complete response (CR) was significantly higher than that of tumours showing a partial response (PR) as well as those showing no change (NC). As the means of the PR and NC groups were not significantly different from each other, these groups were combined for further analysis. The pH of the CR group was also significantly different from that of the NC + PR group (CR: 7.36 +/- 0.05, median 7.36, n = 18, NC + PR: 7.16 +/- 0.06, median 7.21, n = 32); Mann-Whitney test: 2P less than 0.05). Stratification of the data with respect to radiotherapy dose, hyperthermia dose or tumour volume showed that these factors were not associated with tumour pH to such a degree that they might have seriously biased the results. The results suggest that enhancement of the cytotoxic effects of hyperthermia by low pH known from experiments with cell cultures is not observed in tumours which are treated with radiotherapy and hyperthermia, and that even the converse may occur. The reasons for this are discussed at length and it is suggested that sudden modification of the tumour pH directly prior to or during treatment is imperative to obtain any sensitizing effect.

Combined Modality Therapy↗

Temperature distribution and pH changes during hyperthermic regional isolation perfusion.

Hyperthermic perfusion was given as a palliative treatment in three patients with a bulky tumour in the leg. During the treatment, temperature and pH data were collected in both tumour and normal tissues. The hyperthermia dose administered was 2 h at 41.9-42.7 degrees C. It was found that the temperature distribution was far from homogeneous. In one case tumour pH could be monitored throughout the whole treatment procedure. The tumour pH showed a steep decrease during the initial phase of the perfusion, from a mean value of 7.11 to 5.94 at the start of the hyperthermic phase. Subcutis pH decreased only 0.29 units during the whole procedure. In all three patients considerable tumour regression was observed, without severe toxicity. Hyperthermic perfusion appeared to be an effective debulking treatment. The pH decrease in tumour tissue, immediately before hyperthermia, may be responsible for the remarkable effectiveness of the hyperthermic treatment.

Aged↗

The comparison of health care systems through regional analysis: the case of hospital admissions in Belgium and The Netherlands.

One of the problems in the international comparison of health care systems is the small number of units of analysis. Usually only a small number of systems is compared which makes cross-sectional statistical analysis impossible. The two obvious solutions to this problem--neither of which is generally feasible--are either to enlarge the number of systems being compared or to use time series on a small number of health care systems. Quite another solution is to study regional variations within and between a small number of systems. The number of regions has to be sufficiently large to make statistical analysis possible. This is the solution chosen in this article. The phenomenon which is central to our analysis is the number of hospital admissions per 1000 of the population. To explain variations in the hospital admission rate, it is hypothesized that there are a number of variables that have the same kind of influence on hospital admission rates in all western industrialized countries (such as the supply of hospital beds and the health status of the population). On the other hand there are determinants of regional variation in the number of admissions which either exert an influence dependent on the nature of the system, or are unique to a particular health care system. Concerning the first group of hypotheses (the general model), our analysis based on data for 1974 showed that the only variables to have a clear and equal influence on the regional variation in hospital admission rates in the Netherlands as well as in Belgium are the number of hospital beds per 1000 inhabitants and standardized mortality (an operationalization of the concept of health status). The influence of system-specific variables (the second group of hypotheses) has been analysed, taking the difference between the actual number of admissions and the number of admissions expected on the basis of the number of beds and mortality as the dependent variable. In the Netherlands, none of the variables appears to have a clear influence on the level of this ratio, whereas in Belgium there is a greater number of admissions than expected in regions with a higher birth-rate and a higher number of both general practitioners and specialists in the common disciplines (internal medicine, pediatrics, gynaecology) in relation to the total number of specialists.

Belgium↗

Low dose reirradiation in combination with hyperthermia: a palliative treatment for patients with breast cancer recurring in previously irradiated areas.

Ninety-seven patients with breast cancer recurring in a previously irradiated area (mean dose 44 Gy) were reirradiated in combination with hyperthermia and had evaluable tumor responses. In the reirradiation series, radiotherapy was given twice weekly in most patients, with a fraction size varying from 200 to 400 cGy, the total dose varying from 8 to 32 Gy. Hyperthermia was given following the radiotherapy fractions. The combined treatment resulted in 35% complete and 55% partial responses. Duration of response was median 4 months for partial response and 26 months for complete response, respectively. The median survival time for all patients was 12 months. Acute skin reaction was mild, with more than moderate erythema in only 14/97 patients. Thermal burns occurred in 44/97 patients, generally at sites where pain sensation was decreased, and therefore they did not cause much inconvenience. In the 19 patients who survived more than 2 years, no late radiation damage was observed. When patients who received a "high dose" (greater than 29 Gy and hyperthermia) were compared with those who received a "low dose" (less than 29 Gy and hyperthermia), a higher complete response rate was observed in the high dose group (58% vs. 24%), whereas no difference in acute toxicity was found. We conclude that reirradiation with 8 x 4 Gy in combination with hyperthermia twice weekly is a safe, effective and well tolerated method for palliative treatment of patients with breast cancer recurring in previously irradiated areas.

Adult↗

Antigenic relatedness of a strongly immunogenic 65 kDA mycobacterial protein antigen with a similarly sized ubiquitous bacterial common antigen.

In gene libraries of Mycobacterium bovis BCG, Mycobacterium tuberculosis and Mycobacterium leprae recombinants were frequently found expressing an immunodominant 65 kDa protein antigen. In this study polyclonal and monoclonal antibodies against the 65 kDa antigen were found to react with a variety of different bacteria. Furthermore it is shown that the 65 kDa mycobacterial protein belongs to the family of antigens previously designated 'common antigen' due to their presence in a large variety of bacterial species. The molecular weight of this common antigen in 17 bacterial species was determined and it varied from 59 to 65 kDa. These bacteria included Gram-negative, Gram-positive and archae-bacteria, indicating that this antigen consists of members of an evolutionary well-conserved protein family. The 65 kDa protein was located in the cytoplasmic fraction of both Escherichia coli K12 and M. bovis BCG. Its function for the bacterial cell is presently unknown. The immunological relatedness of this common antigen to the MbaA protein might indicate a role in the etiology of rheumatoid arthritis, as was recently suggested for the mycobacterial 65 kDa antigen.

Antigens, Bacterial↗

General and specific factors in the explanation of regional variation of hospital admission rates: policy consequences for Belgium and the Netherlands.

The analysis of regional variations in hospital admission rates for Belgium and the Netherlands shows that the available number of hospital beds together with the health status of the population (roughly indicated by age-adjusted mortality rates) are common factors to influence these admissions in spite of the fundamental differences between the health care systems of both countries. Further analysis shows that in Belgium the relative number of providers of ambulatory care (general practitioners, internists, paediatricians and gynaecologists) influences the residual admission coefficients negatively. Policy consequences of these findings are discussed. The recent adaptation of the Belgian Hospital Act that enables closure of existing hospitals for planning reasons is hailed with satisfaction. The importance of Roemer's Law--'a bed build is a bed filled'--is illustrated once again by this analysis.

Belgium↗

Site-specific and bulk-phase generation of hydroxyl radicals in the presence of cupric ions and thiol compounds.

Addition of a thiol compound to a solution containing Cu2+ and H2O2 resulted in the generation of hydroxyl radicals (OH.). These radicals were able to oxidize salicylic acid and tryptamine in a reaction that was strongly inhibited by the OH.-scavenger mannitol. Covalent coupling of the thiol compound to tryptamine did not significantly influence the degradation of the indole moiety subsequent to addition of H2O2 and Cu2+. The inhibiting effect of mannitol, however, was strongly reduced, indicating that the scavenger could not interfere with site-specific reactions of OH..

Copper↗