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S D van der Werf

Publications and source records attributed to S D van der Werf.

At least 19 recordsLinked to original sources
PubMed1997

[Echographic recognition of tuberculous peritonitis].

OBJECTIVE: To assess the role of ultrasonography (US) and US-guided puncture in the diagnostic procedure of tuberculous peritonitis. DESIGN: Retrospective study. SETTING: An inner-city hospital: Westeinde Ziekenhuis, The Hague, the Netherlands. METHODS: Of 12 patients with bacteriologically confirmed tuberculous peritonitis diagnosed between 1987 and 1995, the results of ultrasonography and the bacteriological and cytological results of US-guided puncture were studied. RESULTS: The ultrasonographic appearance of wet tuberculous peritonitis was recognized by the radiologist in all 11 cases. There was loculated ascites with fine septations as well as thickening of peritoneum, mesentery and omentum. Ultrasonography was of no merit in the one case of peritonitis sicca in this study. US-guided puncture of ascites and omentum yielded a bacteriological diagnosis in eight patients, six of whom had a positive Ziehl-Neelsen or auramine test. In two other patients cytological examination showed a granulomatous inflammation. On average, the ultrasonographic diagnosis of wet tuberculous peritonitis was suggested 3 days after admission and bacteriologically confirmed 10 days later. Eleven of the 12 patients were immigrants from countries where tuberculosis is endemic. The mean duration of residency in the Netherlands was 7 years. CONCLUSION: Ultrasonography is valuable in the diagnostic procedure of tuberculous peritonitis in that it considerably reduces diagnostic delay and unnecessary surgical procedures are avoided.

Adolescent↗
PubMed1996

Seroepidemiology of gastritis in Japanese and Dutch male employees with and without ulcer disease.

OBJECTIVE: To explore the state of the gastric mucosa in individuals with and without peptic ulcer disease from populations with contrasting peptic ulcer risks. DESIGN: Pepsinogen A, pepsinogen C, gastrin and Helicobacter pylori antibodies are serological markers of gastritis. A decreasing pepsinogen A-C ratio and pepsinogen A level are known to reflect an increasing severity of corpus atrophy, whereas gastrin levels decrease with an increasing severity of antral atrophy when corpus atrophy is present. Helicobacter pylori-positive men, with and without a peptic ulcer history, were the focus of the study. METHODS: In 190 Japanese and 425 Dutch male employees, of similar age (mean age 49 years) and level of occupation, fasting serum samples were analysed in the same laboratory for IgG antibodies to H. pylori, pepsinogen A, pepsinogen C and gastrin. Any history of ulcer disease was verified through case notes. RESULTS: The H. pylori seropositivity rate was higher in the Japanese men (72%) than in the Dutch (33%). There were 23 (12%) Japanese and 18 (4%) Dutch men with a verified duodenal ulcer history, and 14 (7%) Japanese and two (0.5%) Dutch men with a verified gastric ulcer history. H. pylori-positive men with a duodenal ulcer history differed from the H. pylori-positive men without an ulcer history in that they had a significantly higher mean pepsinogen A level (64 and 51 micrograms/l in Japanese men and 71 and 57 micrograms/l in Dutch men) and also a higher mean pepsinogen A-C ratio, whereas pepsinogen C and gastrin levels did not differ. In H. pylori-positive gastric ulcer patients the mean gastrin level was significantly lower than in H. pylori-positive men without ulcer disease (17 and 37 pmol/l in Japanese men), whereas pepsinogen levels were similar. CONCLUSION: This study suggests that in H. pylori-positive duodenal ulcer patients there is less mucosal atrophy of the corpus and in H. pylori-positive gastric ulcer patients more atrophy of the antrum than in H. pylori-positive individuals without peptic ulcer disease.

Adrenergic beta-Antagonists↗
PubMed1996

Risk factors of peptic ulcer disease: different impact of Helicobacter pylori in Dutch and Japanese populations?

Helicobacter pylori, non-steroidal anti-inflammatory drugs, family history, blood group O, hyperpepsinogenaemia A, alcohol and smoking have been reported to be risk factors for peptic ulcer disease. The strength of causal risk factors may differ in different populations. In 215 Japanese and 493 Dutch employees of similar age, gender and type of occupation, a structured history was obtained using a questionnaire and fasting serum samples were analysed for IgG antibodies to H. pylori and pepsinogen A all in the same laboratory. A past ulcer history was verified through case notes. We found that H. pylori seropositivity, a high serum pepsinogen A and a family history of ulcer disease were significant and independent risk factors for peptic ulcer disease. For H. pylori seropositivity there was a 20-fold increased risk among the Dutch and an eight-fold increased risk among the Japanese. The seroprevalence of H. pylori was 90% in 20 Dutch subjects with a verified ulcer history and 95% in 41 Japanese ulcer subjects; it was 29% in Dutch non-ulcer subjects and 70% in Japanese non-ulcer subjects. The cumulative difference in risk to develop peptic ulcer disease at the age of 48 years between H. pylori-infected and -uninfected subjects was 24.5-3.0 = 21.5% for the Japanese and 11.8-0.5 = 11.3% for the Dutch. Duodenal ulcer disease was associated with a high coffee consumption only among the Japanese population, where this habit was much less prevalent than among the Dutch. In conclusion, the characterization of peptic ulcer risk factors as weak or strong has no universal basis: the present study shows that from a diagnostic point of view H. pylori appears to be a weaker risk factor for peptic ulcer disease in a society with a higher seroprevalence. However, from an aetiological point of view, H. pylori has an even greater impact on ulcer morbidity in the Japanese than in the Dutch population.

Adult↗
PubMed1995

Nonulcer dyspepsia in a Dutch working population and Helicobacter pylori. Ulcer history as an explanation of an apparent association.

BACKGROUND: There is considerable debate about whether Helicobacter pylori infection is important in causing nonulcer dyspepsia. Many studies assessing this relationship have been performed in selected patient populations and included patients with a history of peptic ulcer. General population-based data with attention to ulcer history are needed to clarify this relationship. METHODS: A questionnaire on ulcer history and dyspeptic symptoms during the preceding 3-month period was obtained from apparently healthy employees who underwent a periodic medical examination in the Netherlands. In addition, serum samples were analyzed for anti-H pylori IgG antibodies. RESULTS: A total of 427 men and 73 women, aged 22 to 69 years, participated in the study. None of the women but 27 men (6%) had a previous diagnosis of peptic ulcer. Among 19 unoperated-on men with verified duodenal (17 subjects) and gastric (two subjects) ulcer, 89% were H pylori positive, while 74% had frequent dyspeptic symptoms in the 3 months before the study. Among the 400 men and 73 women without an ulcer history, the 3-month period prevalence of frequent dyspepsia was 13% and 21%, respectively. The rate of H pylori positivity was 25% in subjects with nonulcer dyspepsia and 29% in all others. The H pylori infection rate increased with age and with a lower occupational level but was independent of gender. In the male population, various differences in symptoms between H pylori-positive and H pylori-negative subjects could be detected when the 27 subjects with a history of ulcer were included, whereas these differences disappeared when these subjects were excluded. CONCLUSIONS: In the Dutch working population, nonulcer dyspepsia is not related to H pylori infection, whereas for duodenal ulcer the relationship is clear. The apparent association between dyspeptic symptoms and H pylori infection is entirely accounted for by subjects with an ulcer history.

Adult↗
PubMed1995

Severe thrombotic complications in a postpartum patient with active Crohn's disease resulting in ischemic spinal cord injury.

This report describes a 33-year-old female patient who presented with severe neurological symptoms and signs during postpartum relapse of Crohn's ileocolitis. The cause of the neurological deficit was extensive major vessel thrombosis resulting in spinal cord ischemia. Etiologic factors involved in this exceptional thrombotic state are discussed with emphasis on the relationship between low levels of folic acid, homocysteine metabolism, and coagulation.

Acute Disease↗
PubMed1995

Seroepidemiology of gastritis in Japanese and Dutch working populations: evidence for the development of atrophic gastritis that is not related to Helicobacter pylori.

Serological markers of gastritis, like pepsinogen A, pepsinogen C, gastrin, and Helicobacter pylori antibodies, can be used to explore the state of the gastric mucosa in populations with contrasting cancer risks. A decreasing pepsinogen A:C ratio and an increasing serum gastrin are known to reflect an increasing severity of atrophic corpus gastritis, which is a precursor of gastric cancer. In 723 subjects (without gastroduodenal surgery) from Japanese (n = 225) and Dutch (n = 498) working populations, which had a similar composition of age (mean 48 years), sex (male to female ratio 6:1), and type of occupation, fasting serum samples were analysed for IgG antibodies to H pylori, pepsinogen A, pepsinogen C, and gastrin in the same laboratory. H pylori infection was significantly more prevalent in the Japanese than in the Dutch (74.7% and 31.3%); as was a very low pepsinogen A, indicative of severe mucosal atrophy (4.4% and 1.6%). Among subjects with and without severe mucosal atrophy the H pylori seropositivity rate was similar. Between the Japanese and the Dutch there were significant differences in mean gastrin (31.8 and 13.4 pmol/l) and pepsinogen A:C ratio (1.7 and 2.9). These intercountry differences were as great for H pylori negative subjects (gastrin: 23.7 and 10.3 pmol/l, pepsinogen A:C ratio: 2.4 and 3.2) as for H pylori positive subjects (gastrin: 34.6 and 20.1 pmol/l, pepsinogen A:C ratio: 1.5 and 2.5). The intercountry difference in gastrin nearly disappeared after stratification into categories of pepsinogen A:C ratio. In conclusion, the intercountry differences in pepsinogen A:C ratio and gastrin reflect a higher prevalence of mild and severe mucosal atrophy of the corpus in the Japanese than in the Dutch, both among H pylori positive and negative subjects. Thus, these findings suggest that in the Japanese the development of atrophic gastritis is in part unrelated to H pylori.

Adult↗
PubMed1994

Unusual presentation of acquired toxoplasmosis in an immunocompetent adult.

We report an unusual clinical presentation of toxoplasmosis. Fever and headache were the only complaints of a 48-year-old immunocompetent man who was found to have a rash, hepatitis and a pericardial effusion. Lymphadenopathy was not present. Evolving atypical lymphocytosis was the clue to the diagnosis of toxoplasmosis. Undercooked meat was the probable source of infection.

Acute Disease↗
PubMed1993

Peptic ulcer, non-ulcer dyspepsia and irritable bowel syndrome in The Netherlands and Japan.

To study the prevalence of peptic ulcer, non-ulcer dyspepsia and irritable bowel syndrome (IBS) in the Dutch and Japanese working population, a structured history using a questionnaire on gastrointestinal symptoms during the preceding 3 months was obtained from persons undergoing a periodic medical examination. Principal components factor analysis of questionnaire responses was conducted to examine interrelationships of symptoms. In Holland, 427 men and 73 women participated (mean age 48.0 years), while in Japan 196 men and 35 women took part (mean age 48.8 years). In both the Japanese and the Dutch population, factor analysis yielded clusters of symptoms consistent with previously defined clinical syndromes: dyspepsia, diarrhoea-predominant IBS and constipation-predominant IBS. The prevalences of verified peptic ulcer history were 19% and 17% (95% confidence intervals (CI): 14-26% and 7-34%) in Japanese men and women in contrast to 5% and 0% (95% CI: 3-8% and 0-5%) in Dutch men and women respectively. The ratio of duodenal to gastric ulcer was 4.5: 1 in Holland and 1.5:1 in Japan. The 3-month period prevalence of non-ulcer dyspepsia was 13% in both the Japanese and the Dutch population and was twice as high in women as in men (p < 0.01). There was considerable overlap between dyspepsia subgroups. IBS was present in 25% of the Japanese and in 9% of the Dutch (p < 0.001) and occurred twice as often in women as in men (p < 0.01). In conclusion, factor analysis supported the existence of dyspepsia and IBS as distinct syndromes in both countries.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Serum bile acids and the bile acid tolerance test under oral contraception.

Oral contraceptives (OC) have lithogenic properties as shown by a rise in biliary cholesterol secretion and cholesterol saturation index. Since we noted not only a rise in saturation index, but also a reduction in chenodeoxycholate (CDC) pool size and an increase in cholate (C) pool size during oral contraception (30 micrograms ethinylestradiol + 150 micrograms desogestrel), we investigated the endogenous bile acid tolerance test as a potential predictor of this effect on bile acid pool sizes using a cholecystokinin infusion of 55 min duration (1.2 U.kg-1.hr-1) as stimulus of the enterohepatic bile acid circulation in 12 healthy females before and during oral contraception for 3-5 months. Serum C and CDC conjugates were measured at 5-10 min intervals over a period of 150 min and analysed by two specific RIA's. Although no significant correlations between the serum CDC and C measurements and CDC and C pool sizes were found, a significant reduction of nearly 40% for both serum peak levels and the integrated area under the serum curve of CDC conjugates during oral contraception, but not of C conjugates was found. The reduction in serum levels of CDC conjugates during OC using the present model is best explained by both a reduction in CDC pool size and more efficient hepatic uptake of CDC conjugates (consisting of considerably more taurine conjugates during OC use), as well as by an intestinal effect on bile acid absorption under OC.

Adult↗
PubMed1989

Incidence and sonographic diagnosis of bacterial ileocaecitis masquerading as appendicitis.

533 consecutive patients with suspected acute appendicitis or appendiceal mass were examined by ultrasonography to distinguish acute appendicitis from bacterial enteritis. In 61 (11.4%) ultrasonography revealed the characteristic picture associated with bacterial enteritis of the ileocaecal region--enlarged mesenteric lymph nodes and mural thickening of the terminal ileum and caecum--but no image of the appendix. In 41 of these a bacterial infection was confirmed: infection due to Yersinia enterocolitica in 21, Campylobacter jejuni in 15, Salmonella B in 3, Salmonella C in 1, and Yersinia pseudotuberculosis in 1. In the other 20 bacteriological tests were negative (10) or not done (10). Oral barium studies, done in 15 patients, showed thickening of the terminal ileum in all of them. Only 22 of the 61 patients had diarrhoea. Yersinia enteritis clinically simulated an appendiceal mass in 17 of 22 patients, 6 of the 61 patients underwent surgery, and in all of them the appendix removed was normal. The other 55 patients recovered with conservative treatment. In 26 a planned appendicectomy was cancelled because of the sonographic findings. Bacterial enteritis limited to the ileocaecal region (bacterial ileocaecitis) seems to be responsible for an appreciable number of unnecessary appendicetomies. It has characteristic sonographic features that distinguish it from appendicitis.

Adolescent↗
PubMed1989

Gall-stone dissolution treatment using cholelitholytic bile acids: experience with 24 patients.

Twenty-four patients with radiolucent gall stones were treated with cholelitholytic bile acids. Complete gall-stone dissolution was achieved in 8 patients (33%) and partial dissolution in 3 patients (13%). Therapy was never successful for large gall stones (greater than 15 mm). Even in the group of patients with very small stones (less than or equal to 5 mm) complete dissolution was obtained in only 47% of cases. Patients with atypical abdominal complaints or without symptoms never developed biliary pain or colic nor did their symptoms improve during therapy. On the contrary, 3 of 6 patients with previous biliary pain or colic had to be operated because of recurrence during therapy.

Adult↗
PubMed1988

Influence of age, intestinal transit time, and dietary composition on fecal bile acid profiles in healthy subjects.

Bacterial transformation of bile acids is possibly involved in colorectal carcinogenesis. In several epidemiological studies, the secondary bile acid concentration in feces is related to the incidence of colonic cancer. However, data on fecal bile acids in case-control studies are conflicting. We investigated the influence of age, intestinal transit time, and dietary composition on fecal bile acid profiles in healthy subjects of three different age groups (mean ages 22, 48, and 67 years). Fecal bile acids were analyzed by gas-liquid chromatography. The concentration of the major secondary fecal bile acids increased with advancing age and was significantly higher in elderly subjects, compared to young adults. The concentration in middle-aged persons was intermediate. Analysis of dietary constituents showed that the fat intake in the three groups was comparable. The dietary fiber intake in elderly subjects was significantly lower than in the other two groups. The former group did excrete less dry fecal material compared to both other groups. Dietary fiber intake was negatively correlated with the total bile acid concentration. Probably, a decrease in dietary fiber intake results in higher fecal bile acid concentrations with advancing age. From the findings of this study, it is obvious that matching for age is important when case-control studies concerning the role of fecal bile acids in colorectal carcinogenesis are conducted.

Adult↗
PubMed1988

Campylobacter ileocolitis mimicking acute appendicitis: differentiation with graded-compression US.

In nine patients with clinical symptoms of acute appendicitis, graded-compression ultrasound (US) did not depict the appendix but instead demonstrated mural thickening of the terminal ileum and part of the colon, as well as moderately enlarged mesenteric lymph nodes. In one patient a normal appendix was removed; eight patients recovered without treatment. Infection with Campylobacter jejuni was proved in all nine patients. In four patients, an unnecessary appendectomy was avoided because of the US findings. Graded-compression US enables differentiation between acute appendicitis and Campylobacter ileocolitis, a vital differentiation, since surgery is almost certainly not indicated for the latter.

Acute Disease↗