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Biomedical subjects

N H Schut

Publications and source records attributed to N H Schut.

At least 19 recordsLinked to original sources
PubMed2001

Severe atherosclerotic changes, including aortic occlusion, associated with hyperhomocysteinaemia and antiphospholipid antibodies.

Three patients are described with severe systemic atherosclerosis, including aortic occlusion, in the presence of a spectrum of risk factors, including hypercholesterolaemia, hypertension, a positive family history of cardiovascular problems, and hyperhomocysteinaemia. In all three patients high levels of anticardiolipin antibodies were found. The possible pathogenic role of antiphospholipid antibodies in atherosclerosis in the context of hyperhomocysteinaemia in these patients is discussed.

Adult↗
PubMed2001

Morbidity and mortality during renal replacement therapy: dialysis versus transplantation.

AIM: Many patients with end-stage renal disease are eligible for renal transplantation. To enable a patient to choose between transplantation or to remain on dialysis comparable data on morbidity and mortality should be available. METHODS: Data were collected retrospectively from the medical records of all patients on the waiting list for renal transplantation and of transplanted patients during the period January 1, 1990, to January 1, 1997. All patients were dialyzed in the Kennemer Gasthuis and renal transplantation was performed in the Leiden University Medical Center (LUMC). Morbidity and mortality in both groups were compared. Morbidity was assessed by studying number, length and cause of hospital admissions. RESULTS: During the study period 102 patients had been on the waiting list and 54 patients had been transplanted in the LUMC. Mean length of stay on the waiting list before transplantation was 37 months. During the follow-up period 11 patients (10.8%) died on the waiting list and 6 patients (11.1%) died after renal transplantation. The mean length of stay on the waiting list of these two groups was much longer, being 55 months and 62 months, respectively. Length of hospitalization was significantly different between both patient groups during the first 6 months of treatment (13.24 days for those on the waiting list versus 40.75 days transplanted patients) and after 6 months (32.4 days for those on the waiting list versus 13.1 days transplanted patients). The number of hospital admissions did not differ significantly. Dialysis-related admissions constituted 47% of the total of admissions in the waiting list group and transplantation-related admissions were 43% in the transplanted group. CONCLUSION: In the present study we revealed no difference in overall mortality. However, mortality was influenced by length of stay on the waiting list. Morbidity was increased during the first 6 months after transplantation. Therapy modality greatly influenced the specific cause of morbidity.

Female↗
PubMed2000

Acute pancreatitis in peritoneal dialysis and haemodialysis: risk, clinical course, outcome, and possible aetiology.

BACKGROUND: It has been suggested that the incidence of acute pancreatitis in patients with end stage renal failure is increased. AIMS: To assess the risk of acute pancreatitis in patients on long term peritoneal dialysis and long term haemodialysis compared with the general population, to evaluate its clinical course and outcome, and to identify possible aetiological factors. PATIENTS: All patients who were maintained on long term peritoneal dialysis and/or haemodialysis (total dialysis time more than six weeks) from January 1989 to March 1998 in a large general hospital in The Netherlands. METHODS: Retrospective cohort study. Standardised ratios (as an approximate relative risk) between the incidence of acute pancreatitis in haemodialysis or peritoneal dialysis and the general population were calculated. Possible risk factors were identified. Patients with and without acute pancreatitis were compared. RESULTS: In 269 patients on haemodialysis (total of 614 person years), one patient developed an attack of acute pancreatitis. Patients on haemodialysis did not show an increased risk for acute pancreatitis compared with the general population (standardised ratio 11; 95% confidence interval (CI) 0.275 to 60.5). In 128 patients on peritoneal dialysis (total of 241 person years), seven patients had nine attacks of acute pancreatitis. Patients on peritoneal dialysis had a significantly and highly increased risk for acute pancreatitis (standardised ratio 249; 95% CI 114 to 473). Mortality in this series of nine attacks was 11%. No single aetiological risk factor could be identified. CONCLUSIONS: The risk of acute pancreatitis in patients on long term peritoneal dialysis is significantly and highly increased compared with the general population. The underlying causal mechanisms remain to be elucidated.

Acute Disease↗
PubMed1998

Acute renal failure due to self-medication.

A patient with rhabdomyolysis and transient renal failure due to auto injection of the procaine containing drug "Gerovital" is described. This case illustrates the hazards of self-regulated alternative treatment.

Acute Kidney Injury↗
PubMed1998

Colonic pseudo-obstruction due to beta2-microglobulin amyloidosis after long-term haemodialysis.

Beta2-microglobulin (A beta2M) amyloidosis is a relatively new secondary amyloidosis associated with renal failure and haemo- and peritoneal dialysis. Although beta2-microglobulin depositions are systemic, clinical manifestations are limited to articular and para-articular disease in most cases. A very limited number of patients have been reported with extra-articular manifestations including those of the gastrointestinal tract. We report on a patient who was treated with haemodialysis for 23 years and developed colonic pseudo-obstruction due to A beta2M amyloidosis.

Aged↗
PubMed1993

No decreased erythrocyte deformability in type 1 (insulin-dependent) diabetes, either by filtration or by ektacytometry.

A lower erythrocyte deformability, which causes impairment of the microcirculation, is postulated to contribute to diabetic organ complications. Erythrocyte deformability was measured in four groups of type 1 (insulin-dependent) diabetic subjects and 30 controls by filtration and ektacytometry. Twenty-five patients without organ complications, 21 with microalbuminuria, 13 with overt nephropathy and 12 with leg ulceration were studied. No decreased erythrocyte deformability was found in any of the diabetic groups with either technique, and neither did the total group of 71 diabetic subjects have a lower erythrocyte deformability when compared with the controls. In order to imitate local conditions in the kidney, erythrocyte deformability was also measured in hyperosmolar solutions. Again no differences were found between the diabetic groups separately or as a whole and the controls. Furthermore no correlation was found between erythrocyte deformability and the plasma glucose or glycosylated haemoglobin level.

Adult↗
PubMed1993

Erythrocyte deformability, endothelin levels, and renal function in cyclosporin-treated renal transplant recipients: effects of intervention with fish oil and corn oil.

Twenty nine stable renal transplant recipients, 10 receiving cyclosporin, 10 cyclosporin-prednisolone and nine azathioprine-prednisolone were supplemented in a double blind randomization cross-over study with fish oil and corn oil for a period of 4 months each. Erythrocyte deformability was reduced in the cyclosporin-treated patients and returned to normal values after supplementation of either oil. The oil supplementation resulted in an increased polyunsaturated fatty acid content in the plasma phospholipids. An increased erythrocyte membrane polyunsaturated fatty acid content might correct the lower erythrocyte deformability in cyclosporin treated patients. Therefore, it is probable that these changes are membrane-related. The oil supplementation had no effect on glomerular filtration rate, effective renal plasma flow, filtration fraction or blood pressure, which does not exclude effects of the cyclosporin-induced rigidified erythrocytes in the acute phase of renal transplantation. Decreased erythrocyte deformability could play a role in the cyclosporin-induced deterioration of renal haemodynamics. This may enhance the effects of endothelin, as these patients also had elevated endothelin levels.

Adult↗
PubMed1993

Methimazole-induced agranulocytosis preceded by transient granulocytopenia. A case report.

A 36-year-old patient, euthyroid under methimazole treatment, was admitted because of an active Graves' ophthalmopathy and found to have a transient granulocytopenia. Forty-five days after this episode she developed classical agranulocytosis because of which the methimazole was stopped. The agranulocytosis occurred more than 20 months after the initiation of antithyroid drug therapy. Other causes for the initial phase of granulocytopenia were not found.

Adult↗
PubMed1992

Decrease of erythrocyte deformability in cyclosporine-treated renal transplant patients: correction with fish oil as well as corn oil.

Twenty-nine renal transplant recipients with good, stable transplant function were included in a double-blind cross-over study to investigate the effects of different immunosuppressive treatment modalities and also the effects of fish oil and corn oil supplementation on erythrocyte deformability. Ten patients were treated with cyclosporine (CyA) only, 10 patients with CyA and prednisolone, and 9 patients with azathioprine and prednisolone. Erythrocyte deformability, as measured by an ektacytometric technique, was significantly decreased in both CyA-treated groups compared with the azathioprine-prednisolone-treated group, and this decrease was corrected with fish oil and with corn oil. The cause and the clinical significance of less deformable erythrocytes due to CyA are not yet clear. However, less deformable erythrocytes could play a role in the genesis of the complications of CyA.

Adult↗
PubMed1992

Blood and plasma viscosity in diabetes: possible contribution to late organ complications?

It has been postulated that an increased whole blood and plasma viscosity contribute to diabetic organ complications. Blood viscosity was measured in 30 controls and four groups of insulin-dependent diabetic patients at three shear rates: 70 sec-1, 0.5 sec-1 and 0.05 sec-1. Results were compared before and after correction for a haematocrit of 0.45. Twenty-five patients without organ complications, 21 with microalbuminuria, 13 with overt nephropathy and 12 patients with leg ulcerations were studied. Blood and plasma viscosity were normal in the patients without organ complications and with microalbuminuria. Plasma viscosity was significantly elevated in the diabetic patient with nephropathy and leg ulceration. After correction for haematocrit blood viscosity was also higher in these two groups, although this was only significant in the group with leg ulceration. In conclusion blood and plasma viscosity were only elevated in the patients with major organ complications and not in the patients without or with early complications. Therefore it is unlikely that an elevation of blood or plasma viscosity contributes early in the pathogenesis of diabetic organ damage.

Adult↗