Biomedical subjects

P E Scholten

Publications and source records attributed to P E Scholten.

8 recordsLinked to original sources

PubMed2000

A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology.

We describe a 2-portal endoscopic approach of the hindfoot with the patient in the prone position. By means of this approach, it is possible to visualize and treat a variety of posterior ankle problems. Not only can pathology of the posterior ankle joint and subtalar joint be visualized and treated, but also periarticular pathology, such as calcifications or scar tissue, can be diagnosed and treated. We describe a professional ballet dancer with chronic flexor hallucis longus tendinitis and a posterior ankle impingement syndrome caused by an os trigonum of both ankles. The patient was successfully treated by removing the os trigonum and releasing the flexor hallucis longus tendon. She resumed her professional activities within 2 months after endoscopic treatment.

Adult↗

PubMed1998

Increased production of tumor necrosis factor alpha, and not of interferon gamma, preceding disease activity in patients with multiple sclerosis.

OBJECTIVE: To study whether tumor necrosis factor (TNF) alpha or interferon (IFN) gamma production by stimulated white blood cells precedes or accompanies clinical and magnetic resonance imaging signs of disease activity in patients with multiple sclerosis. DESIGN: Prospective study with a follow-up of 9 months. SETTING: Patients visiting an outpatient university clinic. PATIENTS: The 30 Amsterdam-based patients (28 completing all evaluations) participating in a multicenter, randomized, placebo-controlled, double-blind trial of a chimeric anti-CD4 antibody in the treatment of active relapsing-remitting and secondary progressive multiple sclerosis. Patients in both treatment arms were included, because for these patients anti-CD4 treatment in this study did not affect TNF-alpha and IFN-gamma production and did not reduce signs of disease activity on magnetic resonance imaging. MAIN OUTCOME MEASURE: Distribution of classes of TNF-alpha and IFN-gamma production (expressed as z scores) in patients with or without clinical or magnetic resonance imaging signs of disease activity. RESULTS: One month preceding exacerbations of multiple sclerosis, there was a shift toward higher z scores of TNF-alpha production (P<.05), but not of IFN-gamma production. There was no statistically significant relationship between IFN-gamma and TNF-alpha production and magnetic resonance imaging markers of multiple sclerosis activity. CONCLUSION: The production of TNF-alpha, and not of IFN-gamma, is significantly higher in patients with multiple sclerosis before exacerbations than in patients with stable disease. Although present, this relationship is too weak to use TNF-alpha production as a surrogate marker of disease activity in multiple sclerosis.

Adult↗

PubMed1998

Differences in immune status between well-nourished and malnourished head and neck cancer patients.

Malnutrition is reported to occur in approximately 30% of head and neck cancer patients. Also, impaired immunocompetence is described as a common phenomenon in this patient group. The purpose of this study was to assess the possible relationship between malnutrition and some prognostically important immune parameters in head and neck cancer patients. Thirty-two malnourished (recent weight loss >/= 10%) and 34 well-nourished patients undergoing curative treatment for advanced head and neck cancer were studied prospectively, and six parameters of their immune status (leucocytes, lymphocytes, lymphocyte phenotyping, monocytes, HLA-DR expression on monocytes and serum interleukin-10) were determined on the day of panendoscopy. Reference values for monocytes, HLA-DR expression and interleukin-10 were obtained from 43 healthy controls. Although the number of monocytes was elevated in both patient groups, the HLA-DR expression on these monocytes was significantly lower in the malnourished than in the well-nourished and control groups. Tumor stage, tumor localization, recurrence after initial radiotherapy, age and gender were not correlated to HLA-DR expression. No relationships emerged between nutritional status and lymphocyte subsets. Malnourished head and neck cancer patients show a significantly lower HLA-DR expression on monocytes than well-nourished ones and healthy controls. According to the literature this would imply an increased risk for postoperative complications. Indeed, postoperative complications occur more frequently in malnourished than in well-nourished patients.

Adult↗

PubMed1997

Tendoscopy of the posterior tibial tendon.

An anatomic cadaver study was performed and subsequently, in a prospective study, diagnostic and therapeutic tendoscopy (tendon sheath endoscopy) was performed in 16 consecutive patients with a history of persistent posteromedial ankle pain for at least 6 months. All patients had pain on palpation over the posterior tibial tendon, a positive tibial tendon resistance test, and local swelling. The indications were diagnostic procedure after surgery in 5 patients, diagnostic procedure after fracture in 5, diagnostic after trauma in 1, chronic tenosynovitis in 2, screw removal in 1, and posterior ankle arthrotomy in 2 patients. Inspection and surgery of the complete tendon and its tendon sheath can be performed by a standard two-portal technique. A new finding is the vincula that was consistently present in all our autopsy specimens as well as all our patients. At 1-year follow-up, 3 of the 4 patients in whom resection of a pathological thickened vincula, and 2 patients in whom tenosynovectomy and tendon sheath release were performed, were free of symptoms. Other procedures such as removal of adhesions and screw removal could well be performed. In 2 patients with a posteromedially located loose body, successful removal took place by means of a posterior tibial tendoscopic approach. There were no complications.

Adolescent↗

PubMed1996

A pilot study investigating the effects of orally administered pentoxifylline on selected immune variables in patients with multiple sclerosis.

Multiple sclerosis is probably mainly mediated by T-helper 1 (TH1)-lymphocytes. TH1-function can be down-regulated in vitro and in animal experiments by pentoxifylline. Therefore, we included 20 multiple sclerosis patients in an open label pilot trial of pentoxifylline. Outcome parameter was the effect of treatment on levels of various cytokines and adhesion molecules in cerebrospinal fluid and serum, on production of TH1- and TH2-cytokines using cell stimulation assays, as well as on measures of T-cell activation and proliferation. Kurtzke's EDSS was a secondary efficacy parameter. A convincing and consistent effect of pentoxifylline could not be demonstrated.

Administration, Oral↗

PubMed1993

High cathepsin B activity in arthroplasty interface membranes. A histochemical study of 9 loose cemented total hip prostheses.

We studied biopsies of interface membranes of 9 aseptically loosened total hip prostheses. The morphologic resemblance of the cement-facing surface of the membranes to synovial tissue of arthritic joints, as noticed by others, was confirmed by histochemical techniques. High cathepsin B activity was found in the bone-facing surface of the membranes. Since this enzyme also plays an important role in tissue destruction of arthritic joints, further similarities in the mechanisms of tissue breakdown in arthritis and aseptic loosening of cemented hip prostheses may be conjectured.

Aged↗

PubMedDate not supplied

Survival of malnourished head and neck cancer patients can be predicted by human leukocyte antigen-DR expression and interleukin-6/tumor necrosis factor-alpha response of the monocyte.

BACKGROUND: Patients with advanced stages of head and neck cancer are often characterized by malnutrition and by an impaired immune system. Because some of the suppressed immune parameters were shown to be of prognostic importance in trauma and sepsis, we investigated whether these would also correlate with survival in head and neck cancer. METHODS: Severely malnourished head and neck cancer patients undergoing ablative and reconstructive surgery were followed prospectively and their perioperative immune parameters were related to long-term survival. RESULTS: Forty-nine patients with a preoperative weight loss of more than 10% were followed up for a period of at least 16 months after surgery. Analyses of variance revealed that preoperative human leukocyte antigen-DR (HLA-DR) expression on monocytes and endotoxin-induced production of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) were different between patients who survived and patients who died. Proportional hazards identified a weight loss of more than 12%, the presence of coexistent disease, and an HLA-DR expression on monocytes below the cutoff points (mean fluorescence index < 15, peak channel index < 9) to be of significant influence on survival. CONCLUSIONS: In addition to known prognostic parameters such as tumor stage, coexistent disease, and weight loss, the immune parameters HLA-DR expression on monocytes and endotoxin-induced cytokine production may carry prognostic value in cancer patients. Immunomodulating therapies leading to improvement of these parameters might in the future lead to increased options for treatment.

Adjuvants, Immunologic↗

PubMedDate not supplied

Endoscopic calcaneoplasty.

Endoscopic calcaneoplasty offers access to the retrocalcaneal space, thereby making it possible to remove inflamed retrocalcaneal bursa as well as the posterosuperior part of the calcaneus in applicable cases of painful hindfoot. In this study, endoscopic calcaneoplasty was performed in 21 procedures in 20 patients. All of the patients had typical complaints of inflammation of the retrocalcaneal bursa that were unresponsive to nonoperative treatment for more than 6 months. In all patients a superior calcaneal angle of more than 75 degrees and positive parallel pitch lines were present on the lateral calcaneal radiograph. The mean follow-up was 3.9 years (range, 2 to 6.5). There were no surgical complications and no postoperative infections. One patient had a fair result, 4 patients had good results, and the remaining 15 patients had excellent results. Whether this operation is performed by endoscopic or open technique, enough bone must be removed to prevent impingement of the bursa between the calcaneus and Achilles tendon. Endoscopic calcaneoplasty is a minimally invasive technique performed in an outpatient setting and combined with a functional rehabilitation program. The procedure has low morbidity. Patients have a short recovery time and quickly resume work and sports.

Adolescent↗