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Biomedical subjects

P H Wessels

Publications and source records attributed to P H Wessels.

At least 19 recordsLinked to original sources
PubMed2006

[Cerebral infarction due to polycythaemia as the initial manifestation of renal cell carcinoma].

A 65-year-old man with known diabetes mellitus and hypertension (cardiovascular risk factors) presented to the Emergency Clinic with a transient language disorder and motor- and cognitive-function disorders that had been present for the past half a year. Brain imaging revealed multiple white-matter lesions and a recent infarction. Routine blood tests revealed polycythaemia. Further tests revealed an elevated erythropoietin level and bilateral renal tumours. The cognitive functions improved after repeated phlebotomies and surgical resection of the renal-cell carcinomas. Before surgery, transcranial ultrasound had shown very low cerebral flow velocities, which became normal after correction of the haematocrit. This case emphasises the importance of routine blood tests in patients with suspected cerebral infarction. To our knowledge, this is the first case of cerebral infarction as the first manifestation ofa renal-cell carcinoma.

Aged↗
PubMed2004

Uterine artery embolization for symptomatic fibroids.

OBJECTIVES: The aim of this study was to introduce uterine artery embolization (UAE) as an effective and safe treatment option in patients with symptomatic fibroids. METHODS: Sixty-one patients underwent UAE with a 3- and 12-month follow-up. RESULTS: The procedure was well tolerated in all patients with the following symptoms improving: heavy bleeding [90% (95% CI 80.21%; 95.4%)]; dysmenorrhea [median -4 (95% CI -5; -4)]; feeling of a mass [74% (95% CI 57.9%; 85.8%)]; abdomino-pelvic discomfort [88% (95% CI 75.5%; 94.9%)]; and deep dyspareunia [90% (95% CI 71.1%; 97.3%)]. Uterine volume decreased by a median difference of 188 cm(3) (95% CI 146.5; 236), which related to a median % reduction of 37.7% (95% CI 32.4%; 45%) at 12-month follow-up. Most (91%) patients were satisfied with the procedure and only minor complications occurred. CONCLUSIONS: Uterine artery embolization can be performed effectively and safely at centers with the necessary expertise and can be used with success in Africa.

Adult↗
PubMed2004

Uterine artery embolisation for symptomatic fibroids: the effect of the large uterus on outcome.

OBJECTIVE: The aim of this study was to evaluate the efficacy of uterine artery embolisation (UAE) in myomatous uteri larger than 24 week's gestation (780 cm3). DESIGN: Prospective case control study. SETTING: Universitas Hospital, University of the Free State, Bloemfontein, South Africa. POPULATION: Sixty-one women, who underwent UAE, were included in the study. The study group comprised of 12 women with uteri > or =780 cm3 and the control group 49 women with uteri <780 cm3. METHODS: UAE was performed and the difference in outcome for the two groups was determined at 12 months. MAIN OUTCOME MEASURE: Symptomatic improvement with embolisation of the large uterus. RESULTS: Reduction of dysmenorrhoea, menorrhagia and pressure effects was similar for both groups. The median reduction in uterine volume (pre- to post-embolisation) was 188 cm3 (range 28-2038 cm3) with a 95% CI for the median difference for paired data of 146.5 and 236. Only 66% of the study group had, however, a reduction in volume to <780 cm3. The complication rates were similar for the two groups with regards to post-embolisation syndrome, fibroid slough, haematoma formation, infection, hysterectomy and failure to embolise. Satisfaction was similar between the two groups, with 91% of women satisfied with the procedure. CONCLUSION: The large uterus does not decrease UAE's efficacy. Although 33.3% of the study group still had a uterus of > or =780 cm3, symptom reduction was still similar for both groups. Women may thus still be left with a large uterine volume but without symptoms. This must be taken into consideration when counselling women with an extremely large uterus for UAE.

Adult↗
PubMed2003

[Postsurgical pain and weakness in the shoulder-arm region: iatrogenic or not?].

Four patients, one man aged 66 years and three women aged 69, 33 and 55 years, respectively, had postsurgical pain and weakness in the shoulder-arm region. Initially, a peripheral nerve lesion on a mechanical basis was suspected in all patients. However, because of the sharp pain starting after a postsurgical pain-free interval ranging from a few hours to two days, followed after some time by local muscular weakness, the diagnosis 'neuralgic amyotrophy' was made later. The electromyographic findings were in agreement with this diagnosis. The chronological sequence of the symptoms only became clear after targeted questioning. After 6-24 months, the strength was more or less restored. Usually, the prognosis of neuralgic amyotrophy is favourable, although full functional recovery may take two to three years and in a minority of cases recovery remains incomplete. Early diagnosis is important because of the prognostic aspects and to prevent unnecessary investigations or even surgical explorations, as well as legal claims. Therefore, not only neurologists but particularly surgeons and anaesthesiologists should be aware of this postsurgical condition.

Adult↗
PubMed2003

Proliferation and aneusomy predict survival of young patients with astrocytoma grade II.

The clinical course of astrocytoma grade II (AII) is highly variable and not reflected by histological characteristics. As one of the best prognostic factors, higher age identifies rapid progressive A II. For patients over 35 years of age, an aggressive treatment is normally propagated. For patients under 35 years, there is no clear guidance for treatment choices, and therefore also the necessity of histopathological diagnosis is often questioned. We studied the additional prognostic value of the proliferation index and the detection of genetic aberrations for patients with A II. The tumour samples were obtained by stereotactic biopsy or tumour resection and divided into two age groups, that is 18-34 years (n=19) and > or =35 years (n=28). Factors tested included the proliferation (Ki-67) index, and numerical aberrations for chromosomes 1, 7, and 10, as detected by in situ hybridisation (ISH). The results show that age is a prognostic indicator when studied in the total patient group, with patients above 35 years showing a relatively poor prognosis. Increased proliferation index in the presence of aneusomy appears to identify a subgroup of patients with poor prognosis more accurately than predicted by proliferation index alone. We conclude that histologically classified cases of A II comprise a heterogeneous group of tumours with different biological and genetic constitution, which exhibit a highly variable clinical course. Immunostaining for Ki-67 in combination with the detection of aneusomy by ISH allows the identification of a subgroup of patients with rapidly progressive A II. This is an extra argument not to defer stereotactic biopsy in young patients with radiological suspicion of A II.

Adolescent↗
PubMed2001

Differentiation between reactive gliosis and diffuse astrocytoma by in situ hybridization.

The authors examined the use of chromosomal analysis by in situ hybridization to differentiate between nonneoplastic reactive gliosis and astrocytomas in cases in which routine histology was inconclusive. Numerical chromosomal aberrations were found in 80% of low-grade astrocytoma specimens and in none of the reactive gliosis specimens. Aneusomic tumor cells were detected in four of 13 stereotactic samples with an initially inconclusive tissue diagnosis, three of which were later diagnosed as astrocytoma. The in situ hybridization procedure may have additional value in the differential diagnosis of reactive gliosis versus low-grade astrocytoma.

Adult↗
PubMed2001

Treatment of cerebellar hematoma in The Netherlands. A questionnaire survey.

A questionnaire was sent to Dutch neurosurgeons and neurologists in order to assess current management strategies for cerebellar hematoma. Seven patients were presented, using as determinants: size of hematoma, coma score, interval to clinical deterioration, hydrocephalus, comorbidity, anticoagulant treatment and age. Neurological management options were: no treatment, monitoring or referral for neurosurgery. Neurosurgical options were: no treatment, monitoring, hematoma evacuation, and/or external ventricular drainage. Ninety-seven of 161 (60%) neurologists, and 58 of 85 neurosurgeons (68%) responded. Only 20 respondents (13%) made use of a local guideline. Overall agreement was perfect in 1 case and moderate to high in the others, but chance-adjusted agreement (kappa) between pairs of neurologists and neurosurgeons who were matched for referral center was not statistically significant except in 1 case, a deeply comatose patient with a 4-cm hematoma. In an alert, slightly ataxic patient with a large (4.5-cm) hematoma, 84 neurologists (88%) decided not to refer the patient. The estimated time for transfer between centers was of no influence on this decision. We conclude that the management of cerebrellar hematoma can be improved upon by encouraging the use of local guidelines, and by promoting early referral to a center with neurosurgical facilities.

Aged↗
PubMed1992

Cost-effectiveness of gamete intrafallopian transfer in comparison with induction of ovulation with gonadotropins in the treatment of female infertility: a clinical trial.

OBJECTIVE: To compare the cost-effectiveness of gamete intrafallopian transfer (GIFT) with that of conventional infertility treatment in couples with female infertility, excluding tubal factors. DESIGN: Patients were randomly divided in two groups: receiving GIFT or conventional infertility treatment. For a period of 2 years, GIFT was compared with conventional infertility treatment in couples with endometriosis, anovulation, idiopathic infertility, cervical mucus factor, female immunologic factor, or multifactorial causes of infertility in a randomized clinical trial. SETTING: The study was performed in the Unit for Human Reproduction, Department of Obstetrics and Gynaecology, Faculty of Medicine, University of the Orange Free State, Bloemfontein, Republic of South Africa. PATIENTS: One hundred seventy-four successive couples with female infertility were selected for the study. All couples were from the higher socioeconomic bracket. INTERVENTIONS: One group received GIFT and the other received conventional infertility treatment consisting of induction of ovulation with gonadotropins followed by intrauterine artificial insemination or normal intercourse. MAIN OUTCOME MEASURES: The results were stratified according to the specific cause of infertility. Outcome was measured by the success rate per treatment cycle, as well as the cost per pregnancy. RESULTS: Overall, GIFT proved to be successful in 26.7% of treatment cycles compared with 9.7% with conventional therapy. CONCLUSIONS: After careful analysis, the authors came to the conclusion that GIFT is more cost-effective than conventional infertility treatment in patients with endometriosis and anovulation. In patients with idiopathic infertility, immunologic infertility, a cervical mucus factor, and multifactorial infertility, induction of ovulation followed by intrauterine artificial insemination or normal intercourse proved to be more cost-effective.

Coitus↗
PubMed1991

The prevalence, risks, and management of Chlamydia trachomatis infections in fertile and infertile patients from the high socioeconomic bracket of the South African population.

OBJECTIVE: The main objective of the study was to evaluate the prevalence of Chlamydia trachomatis endocervicitis in an infertile population. DESIGN: Forty consecutive patients were enrolled in the study group and 41 in the control group. SETTING: The study was undertaken in the Department of Obstetrics and Gynaecology of the University of the Orange Free State, Bloemfontein, Republic of South Africa. PATIENTS: Infertile white females, visiting an infertility clinic in an academic hospital and fertile white female patients visiting an antenatal clinic. INTERVENTIONS: Endocervical swabs were taken, and monoclonal direct immunofluorescence for C. Trachomatis were done on each. MAIN OUTCOME MEASURES: A difference was expected between the prevalence of C. trachomatis infection in the fertile and infertile population. RESULTS: In the study group, 14(35.9%) positive, 25(64.1%) negative, and 1 fallout were obtained. In the control group, 3 patients (7.32%) tested positive. CONCLUSION: Although no correlation was found between C. trachomatis infection of the female genital tract and the clinical history, it showed a significant correlation with infertility. This justifies routine screening tests and antibiotic treatment of positive infertile couples. Analysis of cost-effectiveness showed that empirical treatment of new infertile couples is justified in some populations.

Chlamydia Infections↗
PubMed1991

Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum infections in women. Prevalence, risks and management at a South African infertility clinic.

Chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum infections not only jeopardize fertility but also pose a risk for infertility treatment and resulting pregnancies. Routine screening tests or empirical antibiotic treatment of infertile couples may be justified by the prevalence of these organisms. We studied the wives in 40 consecutive infertile couples. Monoclonal direct immunofluorescence (DIF) for C trachomatis was performed on fixed smears from endocervical swabs. M hominis and U urealyticum were isolated by inoculation of Hayflick (HF) medium, HF broth and Ureaplasma A7 agar with endocervical swabs. Using DIF, 11 (27.5%) specimens were positive, 25 (62.5%) were negative, and 4 (10.0%) were equivocal. DIF was repeated on smears from three of the last four patients; all three were positive for C trachomatis. One patient was lost to follow-up and excluded from the study. For the total 39 specimens the final results were 14 (35.9%) positive and 25 (64.1%) negative. M hominis was isolated from 3 (7.5%) endocervical swabs. None of the endocervical swabs yielded a culture positive for U urealyticum. Statistical analysis showed no correlation between the clinical history and presence of infection with any of the three organisms. The prevalence of 35.9% for C trachomatis was surprisingly high for an infertile population and, if supported by culture confirmation, justifies routine screening. The potential adverse effects of these organisms on the success rate of highly specialized infertility treatments are essentially unresolved. Since our analysis of cost effectiveness as applicable to our unit, all new infertile couples are treated empirically with lymecycline.

Adult↗
PubMed1990

Tuberculosis of the female genital tract in patients attending an infertility clinic.

Mycobacterium tuberculosis plays a major role in infertility, which is the commonest symptom of genital tuberculosis in women. From August 1987 to July 1988, 109 women presenting with infertility were investigated for tuberculosis. None had any other symptoms or signs of the disease. In all cases it was diagnosed by culture of M. tuberculosis in one or more of the 5 specimens (3 menstrual fluid specimens, endometrial tissue and peritoneal fluid) obtained from each woman. In addition Ziehl-Neelsen staining and histological examination were performed on all the specimens. Twenty-three patients (21%) had positive cultures for M. tuberculosis. Of the 26 positive specimens, 16 (69.6%) were menstrual fluid, 4 (17%) endometrial tissue and 6 (26%) peritoneal fluid (3 patients had more than one positive culture). Chest radiographs were normal in all cases. M. tuberculosis cultured in human tissue must be recognized as a pathogen and necessitates treatment. Selective screening procedures should be done to exclude genital tuberculosis as a cause of infertility.

Female↗
PubMed1990

[The prevalence of Chlamydia trachomatis infections in new patients at the Infertility Clinic, UOFS, Bloemfontein].

Chlamydia trachomatis is a common sexually transmitted agent causing infertility. Routine screening tests or empirical antibiotic treatment of infertile couples may be justified by the prevalence of this organism. In this study the female partner of 40 consecutive infertile couples was investigated. As a screening test direct immunofluorescence (DIF) was performed on fixed smears from endocervical swabs. Of a total of 40 specimens, 11 (27.5%) were positive, 25 (62.5%) were negative and 4 (10.0%) were equivocal. DIF was repeated on smears from 3 of the last 4 patients and all 3 specimens were positive for C. trachomatis. One patient was lost to follow-up and excluded from the study. Of a total of 39 specimens the final results yielded 14 (35.9%) positive and 25 (64.1%) negative. Statistical analysis showed no correlation between the clinical history and the presence of C. trachomatis infection.

Adult↗
PubMed1990

[Sex selection as done by the Infertility Clinic, Universitas Hospital, Bloemfontein].

The possibility of selecting a child of a specific sex even before conception has taken place, is regarded as far-fetched. Due to the increasing demand for sex selection, a programme with this aim was established in Bloemfontein. Couples with two or more children of the same sex who wanted a child of the opposite sex were used as a study group. Due to a lack of interest in children of the female sex, selection was aimed mainly at boys. By meticulous control of ovulation and the time of insemination, selection of sex before fertilisation was attempted. A success rate of 100% was achieved in 8 consecutive cases.

Adult↗
PubMed1987

Gamete intrafallopian transfer: a treatment for long-standing infertility.

Gamete intrafallopian transfer (GIFT) has been described by Asch et al. (1,2) as an alternative technique in the treatment of infertile couples. At the University of the Orange Free State, the GIFT technique was introduced in July 1985, and during phase I, 31 patients were treated by means of GIFT. All patients had had at least six cycles of ovulation induction with human menopausal gonadotropin (hMG) and human chorionic gonadotropin (hCG). Their diagnoses were anovulation (3 patients), mild endometriosis (17 patients), and unexplained infertility (11 patients). All husbands' semen analyses were normal. Of the 31 patients, 3 failed, due to spontaneous ovulation before laparoscopy (1 patient) and unsuccessful follicle aspiration at laparoscopy with no oocytes found (2 patients). Four ongoing pregnancies resulted from the remaining 28 patients. This represents a pregnancy rate of 14.29% per laparoscopy (including the failures). The patients who became pregnant had had infertility treatment for 5, 6, 8, and 8 years, respectively. GIFT therefore appears to be a promising method of treatment for long-standing infertility.

Adult↗