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Biomedical subjects

M C Verpalen

Publications and source records attributed to M C Verpalen.

8 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↗

Sonographically guided needle biopsy in peripheral thoracic masses: results in 50 patients.

50 patients with thoracic lesions were selected for percutaneous biopsy guided by real-time sonography. The indications were pulmonary, pleural and mediastinal lesions which made contact with the chest wall and sonographically accessible. Included were lesions near vital structures in the mediastinum (n = 3), in the apex of the lung (n = 8), small pulmonary nodules in contact with the chest wall (n = 24), lesions with intervening pleural fluid (n = 2), pleural nodules (n = 9) and masses arising from the chest wall itself (n = 4). A definitive diagnosis was established in 38 of the 45 (84.4%) malignant lesions and in 4 of the 5 (80%) benign lesions. Complications were restricted to one pneumothorax. Sonographically guided biopsy can be carried out as a bedside procedure. Real-time monitoring compensates for respiratory movements. Its role is curbed by intervening air such as in aerated lung, pneumothorax or primarily cavitatory lesions.

Biopsy, Needle↗

Chronic obstructive pulmonary disease and abdominal aortic aneurysms.

In a prospective study during the period January-May 1992, 362 consecutive out-patients above 65 years of age, attending the pulmonary department for chronic obstructive airways disease (COPD), were ultrasonographically screened for an aneurysm of the abdominal aorta (AAA). Data from pulmonary function tests together with history of cardiac disease, diabetes mellitus, hypertension, hypercholesterolaemia, peripheral arterial obstructive disease, smoking and corticosteroid medication were collected. 30/282 men and 6/80 women with COPD had an AAA > or = 30 mm in diameter, which equals a prevalence of 9.9% (95% confidence limits: 6.8-13.0%). COPD patients with severe emphysema, having a decreased forced expiratory volume/vital capacity ratio (FEV/VC) of < 55%, have a significantly higher prevalence of aortic dilatation or AAA compared to COPD patients with mild or moderate decreased FEV/VC (chi-squared test: p < 0.05, alpha = 0.05). In the group of patients with AAA, significantly more smokers were seen compared to the group with normal and dilated aortas (chi-squared test: p < 0.05).

Aged↗

[Spontaneous pneumothorax; to operate or not?].

Disagreement remains on the best mode of therapy for spontaneous pneumothorax (SP). Treatment options vary from observation alone to thoracotomy depending on the stage of the disease and the preference of the physician. Between 1983 and 1988, 122 patients with SP were treated at the Elisabeth Hospital Tilburg according to a fixed protocol. Of these patients 86 (68%) were primarily treated with observation alone or with intercostal tubes. Seven of these patients (8%) had to be treated surgically after failure of the primary treatment. After thoracoscopical selection and in case of recurrent disease 39 patients underwent surgery: apical pleurectomy and bullectomy, in most cases by the transaxillary approach. In this group morbidity was minimal and there were no recurrences. We conclude that for most patients with spontaneous pneumothorax non-surgical therapy is the therapy of first choice.

Adolescent↗

Conjunctival sarcoidosis.

A biopsy from the lower conjunctival fornix, whether or not taken from follicles, is a method which yields a positive result in +/- 25% of cases of suspected sarcoidosis. We saw a patient with chronic recurrent follicular conjunctivitis of the upper eyelid, without further ocular symptoms. He was known to suffer from allergy and chronic respiratory disease. As the conjunctivitis did not improve a biopsy was taken from the conjunctiva of the upper eyelid. The specimen showed non-necrotizing epithelioid-cell granulomata with multinucleate giant cells and asteroid bodies, and an increase in reticular fibres. The diagnosis of sarcoidosis was confirmed by finding parabronchial granulomata and a raised level of angiotensin-converting enzyme in the serum. Prolonged local corticoid therapy then gradually cleared up the conjunctival condition.

Adult↗