Piet Kager | Academic Medical Centre/ Universiteit van Amsterdam (original) (raw)
Papers by Piet Kager
Pulmonary damage after radiotherapy for breast cancer.-Radiation therapy for breast cancer can ca... more Pulmonary damage after radiotherapy for breast cancer.-Radiation therapy for breast cancer can cause pulmonary damage. This was diagnosed in two patients aged 75 and 57 years respectively. They had different types of radiation pneumonitis. The first patient presented with a socalled bronchiolitis obliterans organizing pneumonia (BOOP), four months after radiation therapy. Characteristic in BOOP are the bilateral and migrating lung infiltrates that are distributed predominantly in the middle and lower lung zones. The second patient developed a pneumonitis that classically was confined to the area of irradiation four months after radiation therapy. The two types of radiation pneumonitis can be treated successfully with corticosteroids. If symptomatic radiation pneumonitis is diagnosed early it can be treated well and than has a good prognosis.
Journal of Clinical Microbiology, 1988
To increase the potential for the wide-scale application of our direct agglutination test for vis... more To increase the potential for the wide-scale application of our direct agglutination test for visceral leishmaniasis, modifications in the components and procedures were introduced. Supplementation with 0.056 M citrate of the suspension medium stabilized the antigen for 9 weeks at 37 degrees C. To circumvent the need for cooling systems in the field, 0.2% (wt/vol) gelatin was added to the serum diluent instead of fetal bovine serum, with reliable results. Specificity and sensitivity were improved by the incorporation of 0.1 M 2-mercaptoethanol in samples with borderline titers. The test could be performed on samples of whole blood; thus the difficulties of preparation and storage of serum, plasma, or filter paper blood are avoided. For mass screening programs, a single serum dilution of 1:6,400 could be employed, contributing to a further reduction in test expenses. Sera from different geographical areas showed equal reactivities in this direct agglutination test despite the nonhomo...
The American Journal of Tropical Medicine and Hygiene, 1984
Of 16 patients with kala-azar treated with sodium stibogluconate (0.1 ml/kg body weight a day), o... more Of 16 patients with kala-azar treated with sodium stibogluconate (0.1 ml/kg body weight a day), one died on the 12th day of treatment and nine were cured by a 30-day course, although two subsequently relapsed. Extending the course cured a further five patients, and in one patient allopurinol was used in addition before a cure was achieved. Clinical and hematological recovery began within a few days of the start of treatment, but parasites continued to be seen in splenic aspirates for 3 weeks or more.
The American Journal of Tropical Medicine and Hygiene, 1982
Abstract We describe a patient with kala azar who presented with retinal hemorrhages. The hemorrh... more Abstract We describe a patient with kala azar who presented with retinal hemorrhages. The hemorrhages resolved during treatment with pentavalent antimony.
The American Journal of Tropical Medicine and Hygiene, 2000
The low bioavailability of albendazole affects the therapeutic response in patients with echinoco... more The low bioavailability of albendazole affects the therapeutic response in patients with echinococcosis. Cimetidine co-administration is reported to improve bioavailability. To analyze the assumed dose-dependent bioavailability of albendazole, we administered 5 to 30 mg/kg albendazole to 6 male volunteers in a randomized cross-over study. To assess the effect of cimetidine (10 mg/kg twice daily), the drug was given with albendazole (20 mg/kg). A dose-dependent bioavailability was not observed. This was due to inter-individual variability of the maximal concentration (C max 38%-72%) of albendazole sulphoxide (ABZSX), the active metabolite of albendazole. C max was 0.21 Ϯ 0.14 mg/L after 5 mg/kg and 0.39 Ϯ 0.19 mg/L after 30 mg/kg albendazole (P ϭ 0.217). Cimetidine tended to decrease C max by 52% (P ϭ 0.109) and significantly inhibited ABZSX breakdown as indicated by the prolongation of ABZSX elimination half-life from 7.4 Ϯ 3.3 hr to 19.0 Ϯ 11.7 hr (P ϭ 0.028). Remarkably, the inter-individual variability of C max was significantly lower during cimetidine co-administration: 14% versus 72%.
Clinical Immunology and Immunopathology, 1982
As part of the study of the pancytopenia of kala azar, levels of complement factors and of circul... more As part of the study of the pancytopenia of kala azar, levels of complement factors and of circulating immune complexes were measured in 12 patients. High levels of Clq, in contrast to normal or even decreased Cls levels, were found. C3, C4, and C9 were more or less normal. High levels of circulating immune complexes, as measured by the '%C lq binding test, were found in all. The concentrations of Clq and of circulating immune complexes fell over a period of months but clinical and parasitological cure with successful treatment preceded the fall. Thus it seems unlikely that the elevated levels of circulating immune complexes are directly responsible for the pancytopenia that is a characteristic of kala azar.
Nederlands tijdschrift voor geneeskunde, Jan 19, 2000
In Africa malaria parasites are increasingly developing resistance to the 3 affordable and tolera... more In Africa malaria parasites are increasingly developing resistance to the 3 affordable and tolerable drugs: chloroquine, amodiaquine and sulfadoxine-pyrimethamine. Alternative products are much more expensive and more toxic. A malaria disaster is looming. On the contrary, in Vietnam a disaster appears to have been averted. Data on malaria epidemiology, on the mosquito, the parasite and the host, man, give insight into the differences and the possibilities of control. Artemisinin derivatives can play an important role in malaria control, also in Africa. Without improvement of care which will require considerable investment and attention, the prospects are bleak.
Diagnose en therapie 2011, 2011
Nederlands tijdschrift voor geneeskunde, Jan 16, 1977
Nederlands tijdschrift voor geneeskunde, Jan 10, 2002
A 39-year-old man, who had made a cycling tour from Tibet to Nepal, visited the outpatients' ... more A 39-year-old man, who had made a cycling tour from Tibet to Nepal, visited the outpatients' clinic one month later because of prolonged diarrhoea, abdominal complaints and serious weight loss. Parasitological examination of the stool revealed oocysts of Cyclospora cayetanensis and the patient was treated with trimethoprim-sulfamethoxazole (co-trimoxazole) with good result. C. cayetanensis has only recently been discovered as a protozoal cause of diarrhoea. Infections are primarily reported from areas with a low hygienic standard e.g. Central and South America, the Indian subcontinent (Nepal), Indonesia and South-East Asia. Clinical symptoms of infection are diarrhoea (usually watery), abdominal cramps and discomfort. The infection can have a prolonged course. Diagnosis is made by parasitological examination of the stool (one should be cautious not to confuse with cryptosporidia) and treatment with trimethoprim-sulfamethoxazole is effective.
![Research paper thumbnail of [Malaise after a trip to Africa: amoebic liver abscess]](https://attachments.academia-assets.com/87505497/thumbnails/1.jpg)
](Nederlands tijdschrift voor geneeskunde, Jan 2, 2002
During a flight to Kenya, a 42-year-old man took a therapeutic dose of chloroquine because of fev... more During a flight to Kenya, a 42-year-old man took a therapeutic dose of chloroquine because of fever. He regularly travelled to Africa and always took chloroquine and proguanil for malaria prophylaxis. The fever disappeared but he did not fully recover. He complained of malaise and weight loss. Fourteen years previously he had suffered from amoebic dysentery. One month after the onset of the patient's complaints, an amoebic liver abscess was suspected on the basis of his medical history, an elevated ESR and a slight leukocytosis. The diagnosis was confirmed by ultrasonography and serology.
Nederlands tijdschrift voor geneeskunde, Jan 29, 2000
Nederlands tijdschrift voor geneeskunde, Jan 8, 2000
In a general practice in Amsterdam Southeast in 1998 a delayed first attack of Plasmodium ovale i... more In a general practice in Amsterdam Southeast in 1998 a delayed first attack of Plasmodium ovale infection was diagnosed in a 13-year-old girl from Ghana, malaria tropica with a low parasitaemia index in a 43-year-old Ghanaian man and a 8-year-old Ghanaian girl, and Plasmodium vivax infection in a 44-year-old Surinam woman. The Ghanaian patients had visited their native country, the Surinam woman had contracted the infection during a visit to India. All patients responded well to antimalaria medication. These patients were among a total of 6 patients of non-Dutch origin diagnosed with malaria in 1998 in this general practice. Four patients had not taken any prophylactic drug and two had not used the drugs properly. A relative increase of malaria in immigrants has been seen in the Netherlands and elsewhere in Europe in recent years. Underestimation of the risks and lack of knowledge of malaria and of the changing epidemiology make people of ethnic minorities travel without taking appr...
Nederlands tijdschrift voor geneeskunde, Jan 29, 1993
Nederlands tijdschrift voor geneeskunde, Jan 29, 1993
Nederlands tijdschrift voor geneeskunde, Jan 18, 1994
Tropical and geographical medicine, 1995
The relationship between splenomegaly and visceral leishmaniasis (VL) was investigated during a c... more The relationship between splenomegaly and visceral leishmaniasis (VL) was investigated during a cross-sectional study in 2,941 individuals in Baringo District, Kenya, where both malaria and VL are endemic. Spleen size was correlated with presence of malaria parasites in thick blood films and with evidence of present or past Leishmania donovani infection as determined by serology and history. Marked splenomegaly (Hackett grade 3 or greater) significantly correlated with present or previous leishmanial infection (chi 2 = 53.5; p < 0.001) whereas moderate splenomegaly (Hackett grade 1 or 2) significantly correlated with malaria parasitaemia (chi 2 = 73.03; p < 0.001). The presence of antimalarial antibodies did not contribute to the differentiation of the cause of splenomegaly. The diagnostic significance of splenomegaly in this population is discussed.
Nederlands tijdschrift voor geneeskunde, Jan 23, 1995
To determine how and where malaria was diagnosed in a forestry area in South-Vietnam and how it w... more To determine how and where malaria was diagnosed in a forestry area in South-Vietnam and how it was treated. Descriptive. Hieu Liem, Dong Nai province, Vietnam. In the government hospital and health posts malaria diagnosis and treatment were free of charge while treatment had to be paid for in four private clinics. A population survey was carried out in the forestry area and outside this area: the people were examined for splenic enlargement and a blood sample was analysed. Most patients went to private clinics and it was here that malaria was most frequently diagnosed. In 7.5% of the population in the forest area parasites were found while 1.8% of those living outside the forest appeared to have parasites in the blood. None of the persons with parasitaemia had splenomegaly. Splenomegaly was found in 2.9% of the population, 6.7% in and 0.9% outside the forest area. Recent changes in the health sector in Vietnam have liberalized malaria treatment, possibly control. The wide distribut...
Tropical and geographical medicine, 1982
Pulmonary damage after radiotherapy for breast cancer.-Radiation therapy for breast cancer can ca... more Pulmonary damage after radiotherapy for breast cancer.-Radiation therapy for breast cancer can cause pulmonary damage. This was diagnosed in two patients aged 75 and 57 years respectively. They had different types of radiation pneumonitis. The first patient presented with a socalled bronchiolitis obliterans organizing pneumonia (BOOP), four months after radiation therapy. Characteristic in BOOP are the bilateral and migrating lung infiltrates that are distributed predominantly in the middle and lower lung zones. The second patient developed a pneumonitis that classically was confined to the area of irradiation four months after radiation therapy. The two types of radiation pneumonitis can be treated successfully with corticosteroids. If symptomatic radiation pneumonitis is diagnosed early it can be treated well and than has a good prognosis.
Journal of Clinical Microbiology, 1988
To increase the potential for the wide-scale application of our direct agglutination test for vis... more To increase the potential for the wide-scale application of our direct agglutination test for visceral leishmaniasis, modifications in the components and procedures were introduced. Supplementation with 0.056 M citrate of the suspension medium stabilized the antigen for 9 weeks at 37 degrees C. To circumvent the need for cooling systems in the field, 0.2% (wt/vol) gelatin was added to the serum diluent instead of fetal bovine serum, with reliable results. Specificity and sensitivity were improved by the incorporation of 0.1 M 2-mercaptoethanol in samples with borderline titers. The test could be performed on samples of whole blood; thus the difficulties of preparation and storage of serum, plasma, or filter paper blood are avoided. For mass screening programs, a single serum dilution of 1:6,400 could be employed, contributing to a further reduction in test expenses. Sera from different geographical areas showed equal reactivities in this direct agglutination test despite the nonhomo...
The American Journal of Tropical Medicine and Hygiene, 1984
Of 16 patients with kala-azar treated with sodium stibogluconate (0.1 ml/kg body weight a day), o... more Of 16 patients with kala-azar treated with sodium stibogluconate (0.1 ml/kg body weight a day), one died on the 12th day of treatment and nine were cured by a 30-day course, although two subsequently relapsed. Extending the course cured a further five patients, and in one patient allopurinol was used in addition before a cure was achieved. Clinical and hematological recovery began within a few days of the start of treatment, but parasites continued to be seen in splenic aspirates for 3 weeks or more.
The American Journal of Tropical Medicine and Hygiene, 1982
Abstract We describe a patient with kala azar who presented with retinal hemorrhages. The hemorrh... more Abstract We describe a patient with kala azar who presented with retinal hemorrhages. The hemorrhages resolved during treatment with pentavalent antimony.
The American Journal of Tropical Medicine and Hygiene, 2000
The low bioavailability of albendazole affects the therapeutic response in patients with echinoco... more The low bioavailability of albendazole affects the therapeutic response in patients with echinococcosis. Cimetidine co-administration is reported to improve bioavailability. To analyze the assumed dose-dependent bioavailability of albendazole, we administered 5 to 30 mg/kg albendazole to 6 male volunteers in a randomized cross-over study. To assess the effect of cimetidine (10 mg/kg twice daily), the drug was given with albendazole (20 mg/kg). A dose-dependent bioavailability was not observed. This was due to inter-individual variability of the maximal concentration (C max 38%-72%) of albendazole sulphoxide (ABZSX), the active metabolite of albendazole. C max was 0.21 Ϯ 0.14 mg/L after 5 mg/kg and 0.39 Ϯ 0.19 mg/L after 30 mg/kg albendazole (P ϭ 0.217). Cimetidine tended to decrease C max by 52% (P ϭ 0.109) and significantly inhibited ABZSX breakdown as indicated by the prolongation of ABZSX elimination half-life from 7.4 Ϯ 3.3 hr to 19.0 Ϯ 11.7 hr (P ϭ 0.028). Remarkably, the inter-individual variability of C max was significantly lower during cimetidine co-administration: 14% versus 72%.
Clinical Immunology and Immunopathology, 1982
As part of the study of the pancytopenia of kala azar, levels of complement factors and of circul... more As part of the study of the pancytopenia of kala azar, levels of complement factors and of circulating immune complexes were measured in 12 patients. High levels of Clq, in contrast to normal or even decreased Cls levels, were found. C3, C4, and C9 were more or less normal. High levels of circulating immune complexes, as measured by the '%C lq binding test, were found in all. The concentrations of Clq and of circulating immune complexes fell over a period of months but clinical and parasitological cure with successful treatment preceded the fall. Thus it seems unlikely that the elevated levels of circulating immune complexes are directly responsible for the pancytopenia that is a characteristic of kala azar.
Nederlands tijdschrift voor geneeskunde, Jan 19, 2000
In Africa malaria parasites are increasingly developing resistance to the 3 affordable and tolera... more In Africa malaria parasites are increasingly developing resistance to the 3 affordable and tolerable drugs: chloroquine, amodiaquine and sulfadoxine-pyrimethamine. Alternative products are much more expensive and more toxic. A malaria disaster is looming. On the contrary, in Vietnam a disaster appears to have been averted. Data on malaria epidemiology, on the mosquito, the parasite and the host, man, give insight into the differences and the possibilities of control. Artemisinin derivatives can play an important role in malaria control, also in Africa. Without improvement of care which will require considerable investment and attention, the prospects are bleak.
Diagnose en therapie 2011, 2011
Nederlands tijdschrift voor geneeskunde, Jan 16, 1977
Nederlands tijdschrift voor geneeskunde, Jan 10, 2002
A 39-year-old man, who had made a cycling tour from Tibet to Nepal, visited the outpatients' ... more A 39-year-old man, who had made a cycling tour from Tibet to Nepal, visited the outpatients' clinic one month later because of prolonged diarrhoea, abdominal complaints and serious weight loss. Parasitological examination of the stool revealed oocysts of Cyclospora cayetanensis and the patient was treated with trimethoprim-sulfamethoxazole (co-trimoxazole) with good result. C. cayetanensis has only recently been discovered as a protozoal cause of diarrhoea. Infections are primarily reported from areas with a low hygienic standard e.g. Central and South America, the Indian subcontinent (Nepal), Indonesia and South-East Asia. Clinical symptoms of infection are diarrhoea (usually watery), abdominal cramps and discomfort. The infection can have a prolonged course. Diagnosis is made by parasitological examination of the stool (one should be cautious not to confuse with cryptosporidia) and treatment with trimethoprim-sulfamethoxazole is effective.
Nederlands tijdschrift voor geneeskunde, Jan 2, 2002
During a flight to Kenya, a 42-year-old man took a therapeutic dose of chloroquine because of fev... more During a flight to Kenya, a 42-year-old man took a therapeutic dose of chloroquine because of fever. He regularly travelled to Africa and always took chloroquine and proguanil for malaria prophylaxis. The fever disappeared but he did not fully recover. He complained of malaise and weight loss. Fourteen years previously he had suffered from amoebic dysentery. One month after the onset of the patient's complaints, an amoebic liver abscess was suspected on the basis of his medical history, an elevated ESR and a slight leukocytosis. The diagnosis was confirmed by ultrasonography and serology.
Nederlands tijdschrift voor geneeskunde, Jan 29, 2000
Nederlands tijdschrift voor geneeskunde, Jan 8, 2000
In a general practice in Amsterdam Southeast in 1998 a delayed first attack of Plasmodium ovale i... more In a general practice in Amsterdam Southeast in 1998 a delayed first attack of Plasmodium ovale infection was diagnosed in a 13-year-old girl from Ghana, malaria tropica with a low parasitaemia index in a 43-year-old Ghanaian man and a 8-year-old Ghanaian girl, and Plasmodium vivax infection in a 44-year-old Surinam woman. The Ghanaian patients had visited their native country, the Surinam woman had contracted the infection during a visit to India. All patients responded well to antimalaria medication. These patients were among a total of 6 patients of non-Dutch origin diagnosed with malaria in 1998 in this general practice. Four patients had not taken any prophylactic drug and two had not used the drugs properly. A relative increase of malaria in immigrants has been seen in the Netherlands and elsewhere in Europe in recent years. Underestimation of the risks and lack of knowledge of malaria and of the changing epidemiology make people of ethnic minorities travel without taking appr...
Nederlands tijdschrift voor geneeskunde, Jan 29, 1993
Nederlands tijdschrift voor geneeskunde, Jan 29, 1993
Nederlands tijdschrift voor geneeskunde, Jan 18, 1994
Tropical and geographical medicine, 1995
The relationship between splenomegaly and visceral leishmaniasis (VL) was investigated during a c... more The relationship between splenomegaly and visceral leishmaniasis (VL) was investigated during a cross-sectional study in 2,941 individuals in Baringo District, Kenya, where both malaria and VL are endemic. Spleen size was correlated with presence of malaria parasites in thick blood films and with evidence of present or past Leishmania donovani infection as determined by serology and history. Marked splenomegaly (Hackett grade 3 or greater) significantly correlated with present or previous leishmanial infection (chi 2 = 53.5; p < 0.001) whereas moderate splenomegaly (Hackett grade 1 or 2) significantly correlated with malaria parasitaemia (chi 2 = 73.03; p < 0.001). The presence of antimalarial antibodies did not contribute to the differentiation of the cause of splenomegaly. The diagnostic significance of splenomegaly in this population is discussed.
Nederlands tijdschrift voor geneeskunde, Jan 23, 1995
To determine how and where malaria was diagnosed in a forestry area in South-Vietnam and how it w... more To determine how and where malaria was diagnosed in a forestry area in South-Vietnam and how it was treated. Descriptive. Hieu Liem, Dong Nai province, Vietnam. In the government hospital and health posts malaria diagnosis and treatment were free of charge while treatment had to be paid for in four private clinics. A population survey was carried out in the forestry area and outside this area: the people were examined for splenic enlargement and a blood sample was analysed. Most patients went to private clinics and it was here that malaria was most frequently diagnosed. In 7.5% of the population in the forest area parasites were found while 1.8% of those living outside the forest appeared to have parasites in the blood. None of the persons with parasitaemia had splenomegaly. Splenomegaly was found in 2.9% of the population, 6.7% in and 0.9% outside the forest area. Recent changes in the health sector in Vietnam have liberalized malaria treatment, possibly control. The wide distribut...
Tropical and geographical medicine, 1982