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Biomedical subjects

T J Kuijpers

Publications and source records attributed to T J Kuijpers.

11 recordsLinked to original sources
PubMed2000

Tuberculous aortitis with an aortoduodenal fistula presenting as recurrent gastrointestinal bleeding.

Tuberculous aortitis with a tuberculous mycotic aneurysm and an aortoduodenal fistula was diagnosed in a 38-year-old man with tuberculous cervical lymphadentitis and a 3-month history of recurrent gastrointestinal bleeding, in whom extensive investigation of the digestive tract had not revealed a bleeding lesion. Either by septic embolism or by direct extension from a neighboring focus, tuberculous infection can cause a mycotic aortic aneurysm with subsequent fistulation to the duodenum.

Adult↗
PubMed1995

Safety and efficacy of dotarem (Gd-DOTA) versus magnevist (Gd-DTPA) in magnetic resonance imaging of the central nervous system.

RATIONALE AND OBJECTIVES: Gd-DTPA is a well-characterized, safe contrast agent frequently used in magnetic resonance imaging (MRI) of the central nervous system. The purpose of this double-blind, comparative MRI study of brain, spine, trunk, and limbs was to evaluate the safety and efficacy of Gd-DOTA versus Gd-DTPA in a large number of patients (n = 1038). METHODS: T1-weighted MRI was performed before contrast and after the administration of Gd-DOTA or Gd-DTPA (0.1 mmol/kg). The MR images were scored for image quality, and the diagnostic efficacy also was assessed. Patients were questioned 1 hour after injection, and adverse reactions were recorded. RESULTS: Image quality of the T1-weighted MR images without contrast was good or excellent in 89.7% and 91.7% of the Gd-DOTA and Gd-DTPA groups, respectively (P > 0.2). After contrast, 85.8% (Gd-DOTA) and 88.2% (Gd-DTPA) of the T1-weighted MR images were of good to excellent image quality (P > 0.2), significantly less than before contrast (P < 0.001, both groups). In 82.3% of the Gd-DOTA group and 83.5% of the Gd-DTPA group (P > 0.2), the information obtained was more accurate with the administration of contrast agents. In 82.4% (Gd-DTPA) and 81.9% (Gd-DOTA) of patients, confirmation was obtained of diagnosis without contrast, whereas in 17.0% and 17.3% of patients, therapy was modified as a result of the use of contrast (P > 0.2, both groups). The MRI investigation was reported as abnormal in 58.3% (Gd-DOTA) and 59.6% of patients (Gd-DTPA), indicating a similar prevalence of disease in each group. Patients responded that 97.8% (Gd-DOTA) and 98.5% (Gd-DTPA) of the investigations went well and adverse reactions, none of them serious, were encountered in 0.97% of Gd-DOTA and 0.77% of Gd-DTPA groups (P > 0.2, both groups). CONCLUSION: This double-blind, randomized, clinical trial comparing Gd-DTPA and Gd-DOTA revealed no serious adverse reactions, whereas minor adverse reactions were encountered in fewer than 1% of patients. Gd-DOTA is as safe a contrast agent as Gd-DTPA and has similar diagnostic efficacy.

Adult↗
PubMed1994

Solid breast neoplasms: differential diagnosis with pulsed Doppler ultrasound.

In this prospective study, duplex Doppler ultrasound was used in 95 consecutive patients with solid breast masses to evaluate the presence of neovascular flow. A positive Doppler signal, i.e., a Doppler shift frequency of more than 1 kHz using a 5 MHz insonating frequency, was found in 34 of 57 patients with a carcinoma, and also in three patients with a benign condition. These results indicate that negative findings with pulsed Doppler ultrasound cannot be used to exclude malignancy. However, a frequency shift of more than 1 kHz indicates a high probability for malignancy. In our study a high frequency shift was not related to tumor size. We also evaluated the correlation between a high frequency shift and axillary nodal metastasis. According to our results there is a very low chance of axillary metastasis when no high frequency shifts are found.

Adult↗
PubMed1989

Disseminated histoplasmosis. Typical presentation with involvement of the adrenal glands.

A 67-yr-old Indonesian patient with disseminated histoplasmosis is described. He had general malaise and fever for 6 months; an oral ulcer, bilateral adrenal gland enlargement and partial adrenal insufficiency were found. An adrenal aspirate contained Histoplasma capsulatum. The literature on adrenal involvement in disseminated histoplasmosis is reviewed and it is concluded that bilateral enlargement, demonstrated by sonography or computed tomography, in a patient with general malaise is an important clue to the diagnosis.

Adrenal Glands↗
PubMed1986

Hepatic artery bolus infusion chemotherapy with mitomycin C. Angiographic results and complications.

Superselective catheterization of the hepatic artery and subsequent infusion of chemotherapeutic agents is an accepted treatment of inoperable hepatic neoplasms. In this article the results of 85 hepatic arterial infusions in 37 patients with biopsy-proven malignancies of the liver, treated in a period of 4 years, are described. Treatment consisted of a bolus injection of mitomycin C for a 10-min period. In 9 catheterizations (10.6%) a dissection of the hepatic artery occurred, followed by occlusion in 5 cases (5.8%). Gastric ulcers were seen in 2 patients, without evidence of displacement of the catheter. In 1 patient the catheter did displace leading to toxic gastritis, and subsequent pulmonary complications led to the patient's death. The response rate appeared to be 42% for colorectal cancer and 70% for breast cancer. The median duration of the response in colorectal cancer and breast cancer was 4 and 10 months, respectively.

Angiography↗
PubMed1985

Giant duodenal ulcer. A report of 12 cases with radiologic and endoscopic correlation.

Giant duodenal ulcers are difficult to recognize and prone to perforation and massive hemorrhage. The radiologist plays an important role in making the correct diagnosis. Early recognition and vigorous medical therapy decrease the mortality rate in a significant way. We present twelve giant duodenal ulcers in which the radiological findings are discussed. Medical therapy with H2 blockers is stressed. There was no mortality in our series of patients.

Adrenergic beta-Antagonists↗
PubMed1983

Pulmonary involvement in angio-immunoblastic lymphadenopathy (A.I.L.D.). Case report and review of literature.

A.I.L.D. is a hyperimmune disorder of the B-cell system of unknown etiology. Although it is distinguished morphologically from Hodgkin's disease, the clinical manifestations may be similar. Pulmonary localisation of A.I.L.D. is infrequently seen. We report the radiologic and pathologic findings of a pulmonary localisation of A.I.L.D. The infiltrates were first localised in the interstitium, developing into complete consolidation of the lung bases. It is important to remember that although superimposed infection is a frequent complication, specific interstitial infiltration may occur and is often fatal.

Aged↗
PubMedDate not supplied

MR lesion detection in a breast cancer population.

Implementation of MR imaging of the breast as an extension of the existing imaging modalities in the diagnosis of breast cancer was evaluated in a university cancer center, MR imaging of the breast was performed in 54 patients, in whom the MR results were compared with the triple test (the combination of clinical examination, mammographic evaluation, and cytology) and the final histological diagnosis. MR imaging of the breast depicted 30 of the 33 malignancies (sensitivity, 91%). In two of the malignancies, the carcinoma was clinically and mammographically occult. For the three patients with a false-negative MRI diagnosis, the conventional mammography showed suspicions clustered microcalcifications as a sign of in situ carcinoma. For seven patients, MR imaging of the breast incorrectly suggested the presence of a malignant lesion (specificity, 67%). To improve MR specificity, we perform MR-guided ultrasonographic fine-needle aspiration biopsy (FNAB). Although MR imaging of the breast is a highly sensitive examination, conventional x-ray mammography remains the most efficient imaging modality in the diagnosis of breast cancer. In our patient population, MR imaging of the breast had additional value for women with mammographically dense breast tissue and especially for patients with clinical evidence of breast carcinoma that could not be detected with conventional diagnostic methods.

Adenocarcinoma↗
PubMedDate not supplied

Self-expanding metal stents for palliative treatment of superior vena caval syndrome.

PURPOSE: Two stent types (a new Wallstent and a Z-stent) were investigated in 30 patients with recurrent malignant superior vena caval syndrome (SVCS). METHODS: Eligibility requirements were that the patient had recurrent symptoms after appropriate radiation therapy, chemotherapy, or both; >/= 75% of the vessel was occluded; and there was collateral flow. Because of the limited availability of stents, it was not possible to perform a prospectively randomized study. RESULTS: In the Z-stent group (17 patients), occlusion of the stent due to acute thrombosis occurred within 12 hr in 4 patients (24%), but in the other 13 patients (76%) symptoms disappeared completely. After 2 weeks the cavogram in these patients showed no signs of thrombosis, and 12 (61%) of the patients remained symptom-free. There was partial occlusion in 5 patients (29%), without relevant clinical symptoms. Of the 13 patients who received Wallstents, only 1 had an acute immediate thrombosis (8%). Symptoms disappeared completely in the other 12 patients and no signs of thrombosis were seen. However, after 2 weeks complete stent occlusion with SVCS was found in 3 patients (23%) and partial occlusion with minor clinical symptoms in 6 (46%). Only 3 patients (23%) had complete relief of the SVCS. The difference between the rates of occlusion of the two stents after 2 weeks was highly significant (p = 0.008). CONCLUSIONS: The overall clinical success rate for long-term patency was 100% for the Z-stents and 69% for the new Wallstent. These results suggest that when used for this purpose, the new Wallstent is more thrombogenic at 2 weeks than the Z-stent.

Combined Modality Therapy↗