Therapeutic equivalence of a novel HFA134a-containing metered-dose inhaler and the conventional CFC inhaler (Berodual) for the delivery of a fixed combination of fenoterol/ipratropium bromide. A randomized double-blind placebo-controlled crossover study in patients with asthma.

The efficacy and safety of a novel fenoterol/ipratropium bromide metered-dose inhaler (MDI) formulated with a non-chlorinated propellant, HFA134a, has been compared with placebo and the conventional chlorofluorocarbon (CFC)-containing fenoterol/ipratropium bromide inhaler (Berodual) in asthmatic patients. Fifty-two patients were enrolled in two centres. The fenoterol/ ipratropium bromide treatment produced significantly (P < 0.

Coagulation factor XIII in pregnant smokers and non-smokers.

Human blood coagulation factor XIII is a transglutaminase zymogen. Two forms exist, an extracellular or plasma factor XIII and an intracellular form. Factor XIII occurs in platelets, blood, monocytes, megakaryocytes, the liver, the placenta, and the uterus.

Right heart failure: diagnosis via ultrasonography of the inferior vena cava and hepatic veins.

Purpose: To determine the efficiency of ultrasonographic measurements of the inferior vena cava (IVC) and hepatic vein (HV) in the detection of elevated systemic venous pressure due to right heart failure.

Material And Methods: Measurements of the Collapsibility Index (CI) of the Inferior vena cava (IVC) and hepatic vein (HV) was obtained from 95 persons without right failure. The CI values of 32 patients with clinically documented right heart failure and the data of a subgroup of 24 patients who received therapy, were statistically compared to those of the group without right heart failure.

Pulmonary sarcoid-like granulomata in a patient treated for extrapulmonary Hodgkin's disease.

We report a case of interstitial lung disease developing during treatment with chlorambucil, vinblastine, procarbazine and prednisone for extrapulmonary Hodgkin's disease. Transbronchial biopsies demonstrated noncaseating epithelioid cell granulomata, and bronchoalveolar lavage fluid showed an increased percentage of lymphocytes, with a raised T cell helper-suppressor ratio, suggesting a diagnosis of sarcoidosis. Treatment with corticosteroids brought about complete resolution of the radiographic lesions.

Haematuria: intravenous urography, ultrasound or both?

Purpose: To compare the diagnostic value of intravenous urography (IVU), ultrasound (US) and their combination in detecting upper urinary tract malignancies in patients with haematuria.

Materials And Methods: In a prospective study, 360 consecutive patients who consulted the urologist for haematuria without renal colic were scheduled for IVU and US on the same day. The two procedures were performed by two different radiologists and reported independently.

Late complications of percutaneous dilatational tracheotomy.

Study Objective: To assess the late complications of percutaneous dilatational tracheotomy, particularly the incidence of tracheal stenosis and voice changes.

Design: Prospective descriptive clinical study.

Setting: Teaching hospital, the Netherlands.

Percutaneous dilatational versus conventional open tracheotomy in a growing animal: a study in goats.

Percutaneous dilatational tracheotomy (PDT) is a new technique for the introduction of a tracheal cannula. It has been performed successfully in adults; however, in children, the open conventional technique is preferred because of the technical limitations of PDT, with fear of tracheal stenosis and adverse effects on tracheal growth. The authors studied the applicability of PDT in a growing animal.

Granulocytic sarcoma with expression of CD30.

A case of a young man with a spinal epidural tumour, initially diagnosed as large cell anaplastic malignant lymphoma, is reported. The tumour consisted of poorly differentiated cells showing immunoreactivity with antibodies directed against CD30 and CD45. Ten months later the patient developed acute myeloid leukaemia.

Haematological variables in prostatic carcinoma patients.

Routine laboratory tests of the red, white and platelet blood cell systems were performed in 49 patients with benign prostatic hyperplasia (BPH), in 24 hormonally treated patients with metastatic prostatic carcinoma, in 17 patients with untreated prostatic carcinoma without metastases and in 14 patients with untreated metastatic prostatic carcinoma. Significantly lower erythrocyte counts, haemoglobin levels and haematocrit values were found in the hormonally treated cancer group compared to all three other groups. The untreated metastatic cancer group had significantly lower haemoglobin levels and haematocrit values compared to the untreated non-metastatic cancer group.

Tick-borne encephalitis complicated by a polio-like syndrome following a holiday in central Europe.

We report a case of Central European tick-borne encephalitis (CETE) in a 54-year-old man, presenting with fever and neurological complications following a holiday in Austria. A disease resembling paralytic poliomyelitis may develop with upper and lower extremity paralysis, as is the case in our patient. Our patient was most likely infected by eating goat's cheese, made of unpasteurised goat's milk.

Salmeterol versus formoterol in patients with moderately severe asthma: onset and duration of action.

We evaluated the profile of the bronchodilatory effect of three inhaled beta2-agonists, 24 microg formoterol, 50 microg salmeterol and 200 microg salbutamol, in patients with stable, moderately severe asthma. Thirty asthmatics (mean+/-SD age 54+/-8 yrs; forced expiratory volume in one second (FEV1) 58+/-12% predicted; reversibility of FEV1 21+/-8% from baseline) participated in a single-centre, double-blind, randomized, single-dose, cross-over study. FEV1 was obtained in baseline condition and 10, 20, 30, 60 min, and every hour up to 12 h after inhalation of the trial drug.

Coagulation and fibrinolysis in smoking and nonsmoking pregnant women.

Objectives: To assess the effects of smoking during pregnancy on coagulation and fibrinolysis.

Design: A cross-sectional study.

Setting: A teaching hospital in Heerlen, The Netherlands.

Clinical experience with percutaneous dilatational tracheostomy: report of 150 cases.

Objective: To report our experience with percutaneous dilatational tracheostomy.

Design: Retrospective study.

Setting: Teaching hospital.

Cotinine concentrations in plasma of smoking pregnant women and their infants.

In the Netherlands 30% of all women of reproductive age are habitual smokers. One third of these women continue to smoke during pregnancy. Tobacco smoke consists of more than 3600 different compounds.

Pathologic changes of the trachea after percutaneous dilatational tracheotomy.

The tracheas of 12 patients who had undergone autopsies after percutaneous dilatational tracheotomy (PDT) were analyzed macroscopically and microscopically. The puncture site of the trachea varied from just below the cricoid cartilage (two patients) to below the third ring (three patients). A fracture of one or more tracheal rings was present in 11 patients, of whom 2 had a fractured cricoid.

Delayed radiation myelopathy: serial MR-imaging and pathology.

Clinical data, MR-scans, time-dose fractionation schemes and neuropathologic findings of two cases of delayed radiation myelopathy (DRM), are presented. Both patients, a 72-year-old diabetic woman with cervical lymphnode metastasis from a squamous cell carcinoma and a 46-year-old woman with tonsillar carcinoma, developed paraparesis followed by quadriplegia, at 7 and at 10 months following radiation. The spinal cord received 46 and 49 Gy.

Hematological variables in cord blood of neonates of smoking and nonsmoking mothers.

Smoking during pregnancy is associated with maternal and fetal complications. In the present study the effect of maternal smoking on neonatal cellular blood components was investigated. The values of whole blood cell count, leukocyte differential count, and thrombocyte and reticulocyte counts were determined and compared in cord blood of neonates of nonsmoking (n = 89) and smoking (n = 53) mothers.

Low dose cyclosporine in early rheumatoid arthritis: effective and safe after two years of therapy when compared with chloroquine.

Forty-four patients with early RA who had participated in a six months double-blind trial, comparing cyclosporine A (CsA) (n = 22) with chloroquine (Chl) (n = 22), were followed for a further 18 months irrespective of their treatment status. At two years follow up, the mean CsA dose was 2.7 +/- 1.

Flunarizine in stroke treatment (FIST): a double-blind, placebo-controlled trial in Scandinavia and the Netherlands.

Introduction: An international, multicenter trial was conducted in 331 patients to determine the effect of a large dose of flunarizine (a calcium entry blocker) in the treatment of acute ischemic stroke in the territory of the Middle cerebral artery.

Methods: The administration of the trial medication should start within 24 h after the initial symptoms of stroke. According to a random schedule, the patients were assigned to a 4-weeks double-blind treatment with either flunarizine (n = 166) or placebo (n = 165): one week intravenous administration (50 mg daily), followed by 3 weeks oral treatment (week 2, 21 mg daily; week 3-4, 7 mg daily).

Urethral metastasis from a rectal carcinoma.

A 67-year-old man presented with a tumour of the penis. Endoscopy revealed a bleeding tumour. Histological examination showed an adenocarcinoma; urethral metastasis of rectal carcinoma.

Onset of action of eformoterol by dry powder inhaler: objective and subjective measures.

This double-blind, randomised, placebo-controlled crossover trial in 18 adults with asthma evaluated the onset of efficacy of doses of 12 and 24 micrograms eformoterol delivered as a dry powder, and compared patients' subjective assessments of efficacy with objective measures. Bronchodilatory efficacy was measured in terms of specific conductance (sGaw) and forced expiratory volume in one minute (FEV1). With both doses of eformoterol, a bronchodilatory effect was observed one minute after inhalation.

The "dural tail sign" in MRI of spinal meningiomas.

Objective: Evaluation of "dural tail sign" in spinal meningiomas with gadolinium enhanced MRI in sagittal, axial, and especially coronal planes.

Materials And Methods: On a 0.5 T system, sagittal and axial T1 spin echo images (TR/TE 550/22) and sagittal T2 turbo spin echo images (TR/TE 2855/150) of the thoracolumbar spine were acquired.

Obstetric antecedents of surgically treated obstetric brachial plexus injuries.

Objective: To determine whether the anatomy of an obstetric brachial plexus lesion (OBPL) is causally related to the preceding obstetric history.

Design: Anatomical classification of the OBPL during reconstructive neurosurgical treatment in consecutive infants who had surgery for OBPL between 1986 and 1994 and relating these findings with the characteristics of the preceding birth.

Setting: De Wever Hospital, Heerlen, The Netherlands.

Tiotropium bromide, a new long-acting antimuscarinic bronchodilator: a pharmacodynamic study in patients with chronic obstructive pulmonary disease (COPD). Dutch Study Group.

The objective of the present study was to investigate the dose-dependent bronchodilator efficacy and duration of action of the newly developed antimuscarinic agent tiotropium bromide in patients with chronic obstructive pulmonary disease (COPD). In a randomized, double-blind, placebo-controlled, crossover design, patients inhaled single doses of 10-80 micrograms tiotropium bromide and placebo, formulated in lactose powder capsules. The washout period between test doses was 72 h.

Bivariate cytokeratin/DNA flow cytometric analysis of paraffin-embedded samples from colorectal carcinomas.

Admixture of normal and neoplastic cells is a serious problem in the evaluation of tumor cell kinetic parameters by flow cytometry, in particular for DNA diploid tumors. The admixture of non-neoplastic cells, such as stromal cells and inflammatory cells, can disturb the estimation of the proliferative tumor fraction. This problem has been addressed in fresh tumor samples by applying bivariate flow cytometric analyses for DNA and cytokeratin.