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Biomedical subjects

W Doesburg

Publications and source records attributed to W Doesburg.

14 recordsLinked to original sources
PubMed1997

[Reading children's temperatures with the tympanic infrared thermometer and the rectal mercury thermometer: equally good results in the emergency room].

OBJECTIVE: To compare the results of reading body temperatures with a tympanic infrared thermometer and a rectal mercury thermometer in children in an emergency department. DESIGN: Prospective comparative study. SETTING: St. Elisabeth Hospital, Tilburg, the Netherlands. METHOD: In children up to 11 years of age seen in the emergency room between 1 January 1994 and 1 April 1994, the body temperature was measured with a rectal mercury thermometer as well as with a tympanic infrared thermometer. Data were collected on temperature read, clinical picture on arrival (not ill, ill, seriously ill) and appearance of the tympanic membrane (signs of acute otitis media, presence of cerumen). For the statistical comparison, the differences between the findings of the two methods were plotted against the means. The sensitivity and specificity of the results of tympanic measurement in relation to the values read rectally were determined. RESULTS: Data were collected on 213 children, of whom 19 were younger than 3 months, 46 between 3 and 12 months, and 148 between 1 and 11 years. The mean temperatures measured with the rectal and tympanic thermometers were 38.01 and 38.03 degrees C, respectively. The mean difference between the rectal and tympanic temperatures was -0.013 degree C. The correlation between the rectal and tympanic temperatures was high (r = 0.86; P = 0.0001). The results were the same in groups differing in age, severity of disease and appearance of the tympanic membrane. The sensitivity of the tympanic measurement for fever (rectal temperature > 38.0 degrees C) was 80.6% with a specificity of 92.5%. The sensitivity was 83.8% when a rectal temperature > 38.5 degrees C was taken as the criterion, with a specificity of 95.9%. CONCLUSION: The tympanic infrared measurement in children in an emergency department gave the same results as rectal measurement using a mercury thermometer.

Adult↗
PubMed1997

The value of antibiotic prophylaxis during extracorporeal shock wave lithotripsy in the prevention of urinary tract infections in patients with urine proven sterile prior to treatment.

INTRODUCTION: There are controversies in the literature regarding the need for and duration of antibiotic prophylaxis in patients treated with extracorporeal shock wave lithotripsy (ESWL) who have a negative urine culture before treatment. In order to determine the efficacy of antibiotic prophylaxis in ESWL treatment of patients with proven sterile urine, a randomized trial was performed. METHODS: Patients were randomized for placebo and 1 or 7 days antibiotic prophylaxis (cefuroxime or ciprofloxacin), starting 30 min before ESWL. Post-ESWL studies (immediately and 2 and 6 weeks after ESWL) included patient history, urine culture and Gram stain. RESULTS: After 2 weeks 20% of the patients and after 6 weeks 23% of the patients had bacteriuria, but there was no statistical significance between patients treated with placebo or those receiving prophylactic treatment. Only 2-3% of the patients (in the prophylaxis and placebo group) had clinical and bacteriological signs of a urinary tract infection, either 2 or 6 weeks after ESWL, possibly caused by re-infection, however, since bacteria were found in none of the urine samples collected directly after ESWL. There was no beneficial effect of antibiotic prophylaxis, in the prevention of urinary tract infections in patients with a nephrostomy catheter or dilatation at the site of treatment. CONCLUSION: We conclude that in patients with urine proven sterile prior to ESWL there is no need for antibiotic prophylaxis.

Administration, Oral↗
PubMed1995

Neonatal neurological outcome after low-risk pregnancies.

OBJECTIVES: To study neonatal neurological outcome and obstetrical interventions in a low-risk population. STUDY DESIGN: A prospective non-randomised study. SETTING: Six midwife practices, nine general practices in and around the city of Nijmegen, The Netherlands, and the obstetrical service at the Nijmegen University Hospital. SUBJECTS: 766 midwife/general practitioner deliveries and 268 deliveries guided by obstetricians using electronic fetal monitoring, all after low risk pregnancy (one out of three selected), 49.2% of the women delivered at home. METHODS: Neurological examination of the fullterm newborn infant according to Prechtl (1977). RESULTS: The deliveries directed by the obstetricians showed higher complication and intervention rates for primiparae and multiparae. Primiparous deliveries involved longer labor and firstborns showed lower neurological outcome. There were no differences in neonatal neurological outcome between groups attended by midwives, general practitioners or obstetricians despite the lower social profile of the hospital group. CONCLUSION: For the outcome of low-risk pregnancy, the place of birth in the Nijmegen area is irrelevant. Further investigations on the physiology of the first pregnancy and on the causes of the higher complication and intervention rates in hospital deliveries are recommended.

Family Practice↗
PubMed1993

A randomised prospective study comparing intravesical instillations of mitomycin-C, BCG-Tice, and BCG-RIVM in pTa-pT1 tumours and primary carcinoma in situ of the urinary bladder. Dutch South-East Cooperative Urological Group.

We compared intravesical instillations with mitomycin-C (MMC), Bacillus Calmette-Guerin (BCG) Tice, and BCG-RIVM in patients with pTa-pT1 papillary carcinoma and primary carcinoma in situ (CIS) of the bladder. Nine instillations with MMC were given or 6 weekly instillations with BCG. Early recurrences were treated with additional instillations. For toxicity and efficacy 437 patients were evaluated with a median follow-up of 32 months (range 12-56). Drug-induced and bacterial cystitis were the most frequent side-effects. The number and severity of side-effects (chi 2 test) were comparable in both BCG groups, but were significantly less in the MMC group for drug-induced cystitis (P = 0.009), other local side-effects (P = 0.004) and systemic side-effects (P < 0.001). The disease-free percentage (log-rank test) showed no significant difference for the three arms for papillary tumours (P = 0.08), nor the CIS (P = 0.20), although for CIS numbers are small. Additional instillations did not influence toxicity or efficacy.

Administration, Intravesical↗
PubMed1993

Influence of fibrin clot inhibitors on the efficacy of intravesical Bacillus Calmette-Guérin in the treatment of superficial bladder cancer. The Dutch Southeast Cooperative Urological Group.

After transurethral resection (TUR) of superficial bladder tumors, intravesical instillations with BCG are successfully used to lower the recurrence rate. The mechanism of the antitumor activity of BCG is not completely understood. After TUR, a fibrin clot is formed on the damaged urothelium. Fibronectin (FN) is part of the clot. It has been demonstrated that binding of BCG to the bladder wall is mediated by FN, and therefore FN seems necessary for the antitumor activity of BCG. This binding can be inhibited by fibrin clot inhibitors, like aspirin and coumarin. A reduced efficacy of BCG in patients with superficial bladder cancer using these drugs has been described. We studied 183 patients with superficial bladder cancer, treated with one or two 6-week courses of intravesical BCG instillations. Of the 42 patients that used fibrin clot inhibitors, 13 (31%) experienced a recurrent tumor, as compared to 56 (40%) of 141 patients who did not use these drugs (p = 0.28). The mean time to recurrence was the same in both groups. These results did not depend on the BCG strain used (Tice or RIVM, p = 0.92) and were not influenced by the use of antibiotics against urinary tract infections. We conclude that in our study fibrin clot inhibitors have no adverse effect on the efficacy of BCG therapy for superficial bladder cancer.

Administration, Intravesical↗
PubMed1988

Etiologic factors of jaundice in severely ill patients. A retrospective study in patients admitted to an intensive care unit with severe trauma or with septic intra-abdominal complications following surgery and without evidence of bile duct obstruction.

In order to understand the pathophysiology of jaundice in severely ill patients, we have examined several possible promoting factors in a retrospective study of 86 patients with multiple organ failure admitted to an intensive care unit (ICU). Patients with bile duct obstruction were excluded from this study. Cholestatic jaundice had developed in 19 of 54 patients after trauma and in 20 of 32 patients after septic intra-abdominal complications. No differences were found between the icteric and non-icteric groups of patients with regard to median age, sex distribution, duration of stay in the ICU, number of operations, utilization of gaseous and/or intravenously administered anaesthetics and lipid, and administration of potential hepatotoxic drugs. Twenty-six of 39 icteric patients had a normal renal function. However, a significantly higher number of blood transfusions was found in the icteric as compared to the non-icteric patients. The higher number of blood transfusions and the incidence of initial shock in the icteric trauma patients were probably related to the higher injury severity score. Furthermore, sepsis was found significantly more frequently in the icteric trauma patients, while the number of organ failures when the presence of jaundice was not accounted for was the same in both groups. Nevertheless, the severity of jaundice correlated well with the increasing number of failing organs and the increasing mortality. From these findings we can therefore conclude that jaundice occurring in patients with multiple organ failure is usually not due to the administration of potential hepatotoxic drugs. However, the number of blood transfusions may be an important associated factor.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

The short-term effect of an immunosuppressive treatment on CSF myelin basic protein in chronic progressive multiple sclerosis.

CSF levels of myelin basic protein (MBP) and intrathecally produced CSF IgG (de novo IgG) were measured in 11 chronic progressive multiple sclerosis patients with a deteriorating course of the disease for at least 6 months preceding observation and a reference group of 17 neurological patients suffering from disc herniation. In the multiple sclerosis patients, CSF levels were determined just before and once in the period 3 to 10 weeks after the start of an immunosuppressive treatment with cyclophosphamide and prednisone. For multiple sclerosis patients the CSF MBP levels before treatment were significantly higher than for controls. The CSF MBP levels after the treatment were nearly all within the control range. The abnormal high concentration of intrathecally produced CSF IgG (de novo IgG) in multiple sclerosis patients was reduced after treatment. A correlation between CSF MBP and CSF de novo IgG in multiple sclerosis patients could not be demonstrated. If CSF MBP is an indicator of the (activity of) myelin breakdown in the brain, it can be concluded that an intensive immunosuppressive treatment in combination with prednisone has, at least, a short-term, beneficial effect on the amount of demyelinisation and possibly on the disease activity.

Adult↗
PubMed1987

Oral versus im administration of high-dose medroxyprogesterone acetate in pretreated patients with advanced breast cancer.

In a multicenter trial, 123 patients with advanced breast cancer who had been treated with tamoxifen and/or chemotherapy were randomized to receive medroxyprogesterone acetate (MPA) orally 300 mg X 3 daily or im 500 mg daily for 4 weeks and 500 mg X 2 weekly thereafter. All case histories were reviewed extramurally by the criteria of the International Union Against Cancer. Five and 11 patients were not eligible and evaluable for response, respectively. Pretreatment characteristics were well balanced in both treated groups. Twenty-five of all 107 (23%) evaluable patients achieved an objective remission, whereas in a further 15% the disease became stable after previous progression. Results in both treatment arms did not differ significantly. The median duration of objective remission was 12 and 14 months for orally and im treated patients, respectively (P greater than 0.10). No statistically significant differences in the survival times of orally and im treated patients were found. Pretreatment characteristics positively correlated with an objective remission during MPA therapy in both groups were age greater than 50 years (P less than 0.02) and no previous chemotherapy (P less than 0.01). Toxicity included an increase in body weight, cushingoid effects, muscle cramps, and tremors in both groups. In four patients on im therapy, local infections developed. Mean serum MPA levels reached values above 100 ng/ml in nine orally and eight im treated patients (P greater than 0.10), and neither differed significantly in the patients responding to or failing therapy. In both MPA arms, plasma cortisol levels were suppressed. The drop in plasma cortisol levels was more pronounced in patients with objective remissions than in patients who failed (P = 0.04). In conclusion, oral and im MPA in the given doses had similar activity. Im administration of MPA should be reserved for patients not able to take oral medication.

Administration, Oral↗
PubMed1984

Friedreich's ataxia: intravenous pyruvate load to demonstrate a defect in pyruvate metabolism.

Nine patients with typical Friedreich's ataxia had normal levels of pyruvate and lactate in blood, urine, and CSF. Glucose, pyruvate, and lactate levels were also within the reference ranges after oral glucose loading. After intravenous pyruvate loading, the relative increase in blood pyruvate and lactate levels was significantly higher in Friedreich's ataxia patients than in controls. Significant differences between the two groups were also observed in lactate-pyruvate ratios at various times after infusion. The pyruvate loading test can be useful in demonstrating a defect in pyruvate metabolism in Friedreich's ataxia patients.

Adolescent↗
PubMed1981

Oxytocin enhances onset of lactation among mothers delivering prematurely.

In a double-blind group sequential trial the efficiency of an oxytocin nasal spray in enhancing lactation was studied during the first five days after delivery in women who had given birth prematurely. The cumulative volume of breast milk obtained between the second and fifth days after delivery was 3.5 times greater in primiparas given oxytocin than in primiparas given placebo. There was no significant difference in the composition of the milk between the untreated women and those given oxytocin. The results of this study show that oxytocin nasal spray is an effective and safe means of enhancing lactation in women using a breast pump.

Clinical Trials as Topic↗
PubMedDate not supplied

Primary angle-closure glaucoma among Alaskan Eskimos.

An epidemiological study of the occurrence of angle-closure glaucoma was made under the Eskimos population of the Norton Sound and Bering Straits region of Alaska. Among 1673 Alaskan Natives examined 14 cases (0.8%) of angle-closure glaucoma were found, in 0.5% of the men and 1.2% of the women; for persons above the age of 40 years these figures were 2.1% and 5.5% respectively. Angle-closure glaucoma was found in 11.8% of women above the age of 60 years. A shallow anterior chamber was seen twice as frequently in women as in men. Above the age of 30 years the chamber angle was considered to be occludable in 2% of men and 7.5% of women on gonioscopic examination. The average intra-ocular pressure of the right eyes of men was 11.7 mm Hg (s.d. 3.3) and of women 12.0 mm Hg (s.d. 3.4). Primary open-angle glaucoma was not seen in the population being studied.

Adolescent↗
PubMedDate not supplied

Effects on acne of two oral contraceptives containing desogestrel and cyproterone acetate.

OBJECTIVE: To compare the effects of a low-dose oral contraceptive containing desogestrel (Marvelon) and an anti-androgenic preparation containing cyproterone acetate (Diane) in Oriental women suffering from acne. METHODS: In an open-label, bi-center, randomized study, 32 women using Marvelon and 34 using Diane were followed for 6 treatment cycles. The measured variables were objective and subjective severity of acne, and related biochemical variables such as sex hormone-binding globulin and free and total testosterone. RESULTS: In Center A, with both preparations a decrease in mean objective acne score was observed, reaching statistical significance with Diane (P < .05). In addition, there was a significant between group difference at cycle 6 (P < .05). In Center B, a consistent and significant decrease in mean acne score was observed with Marvelon after three and six treatment cycles (P < .05 and P < .01) and with Diane after six treatment cycles (P < .001). There were no significant between-group differences. The decrease in percentage of severe/moderate acne was statistically significant with Marvelon in Center B (P = 0.002) and with Diane in Centers A (P = 0.014) and B (P = 0.004). Both preparations increased plasma levels of sex hormone binding globulin and seemed to decrease those of total and free testosterone, but no statistically significant relationships between acne severity and biochemical variables could be detected. CONCLUSION: Both Marvelon and Diane are effective in the treatment of acne in Oriental women who also need reliable contraception, without marked differences between the preparations.

Acne Vulgaris↗