E. J. T. Krul

Leiden University Medical Centre, Leiden, South Holland, Netherlands

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Publications (9)23.36 Total impact

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    ABSTRACT: To determine the prevalence of cytologic abnormalities in cervical smears from women attending the first organized screening program in Suriname and to compare the prevalences in 4 Surinamese ethnicities with different cervical carcinoma incidences. Cervical scrapes were taken from women with 4 different ethnicities: Maroons, Amerindians, Javanese and Hindustani. Papanicolaou staining and cytologic screening were performed on 807 cervical smears. RESULTS Cervical cytologic abnormalities were seen in 13.4%, of which 8.1% (62 of 764) had atypical changes, 2.6% (20 of 764) had mild and 2.6% (20 of 764) had moderate and severe dysplasia/carcinoma in situ (CIS). The cytologic abnormalities varied between the ethnicities: 42.1% (83 of 197) in the Maroons and 2.3% (4 of 176), 5.0% (9 of 183) and 3.0% (6 of 208) in the Javanese, Amerindians, and Hindustani, respectively. The high prevalence of moderate and severe dysplasia/CIS in all ethnicities correlates with the high cervical carcinoma incidence in Suriname. A significantly higher prevalence of mild abnormalities in the Maroons was observed; it did not reflect the relatively low cervical cancer incidence in this ethnicity. However, this can be explained by the possibility that these women have a different sexual lifestyle, leading to a higher prevalence of
    Acta cytologica 11/2006; 50(6):621-6. DOI:10.1159/000326030 · 1.56 Impact Factor
  • E. J. T. Krul · P. Gagliardotto · H. W. M. Kayser · R. Dion · P. J. Bode ·
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    ABSTRACT: In patients with acute myocardial infarction, left ventricular free-wall rupture (LVFWR) is a well-recognized complication associated with high mortality. Accurate diagnosis of LVFWR allows successful surgical treatment and may improve survival rates. We report on two patients initially evaluated with a presumed diagnosis of thoracic aortic dissection. In both cases CT revealed the presence of LVFWR.
    Emergency Radiology 01/2001; 8(3):147-148. DOI:10.1007/PL00011892
  • C. E. Loo · E. J. T. Krul · P. J. Bode ·
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    ABSTRACT: Aneurysms of the subclavian arteries are rare. We report a case of a post-traumatic pseudoaneurysm of the subclavian artery which has been diagnosed by chest radiography, CT scan, and subsequently angiography.
    Emergency Radiology 11/1999; 6(6):358-360. DOI:10.1007/s101400050086
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    ABSTRACT: Cervical carcinoma is the second most common malignancy among women worldwide. The highest incidence rates are observed in developing countries. The increased susceptibility to cervical carcinoma in high incidence populations may result from several factors including human papillomavirus exposure and both inherited and acquired genetic traits. Using comparative molecular analysis of cervical carcinomas from Surinam, a high incidence area, and the Netherlands, a low incidence area, distinct molecular genetic profiles were studied in two populations with contrasting risk for the disease. In the two populations, the authors compared allelic loss as a marker for the involvement of putative tumor suppressor genes in 40 and 67 carcinoma specimens from Surinam and the Netherlands, respectively. Loss of heterozygosity (LOH) analysis was performed using polymorphic microsatellite markers at sites of known tumor suppressor genes (17p [p53], 13q [Rb, BRCA2], 16q [E-cadherin], and 17q [BRCA1]) and at chromosomes 3p, 6p, 6q, and 11q, which frequently are lost in cervical carcinoma. Remarkable differences in LOH were found between both populations. The most prominent observation was the extremely high frequency of LOH, up to 72%, in the region of the major histocompatibility complex on chromosome 6p in specimens from Surinam. In the group of specimens from the Netherlands, only 45% of LOH was observed at this locus. In addition, LOH was detected significantly more frequently at 6q and 13q in the cases from Surinam whereas LOH was found more frequently at 17p in cases from the Netherlands. The results of the current study show that heterogeneity exists in tumor-associated somatic genetic alterations between these two populations that may be indicative of the existence of multiple genetic pathways in cervical tumorigenesis.
    Cancer 10/1999; 86(6):997-1004. DOI:10.1002/(SICI)1097-0142(19990915)86:6<997::AID-CNCR15>3.3.CO;2-H · 4.89 Impact Factor
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    ABSTRACT: A phase I-II clinical trial was performed involving vaccination with HPV16 E7 peptides of patients suffering from HPV16 positive cervical carcinoma which was refractory to conventional treatment. Patients receiving the vaccine were HLA-A*0201 positive with HPV16 positive cervical carcinoma. The clinical trial was designed as a dose-escalation study, in which successive groups of patients received 100 micrograms, 300 micrograms or 1000 micrograms of each peptide, respectively. The vaccine consisted of two HPV16 E7 peptides and one helper peptide emulsified in Montanide ISA 51 adjuvant. 19 patients were included in the study, no adverse side-effects were observed. 2 patients showed stable disease for 1 year after vaccination; 15 patients showed progressive disease of whom 1 died during the vaccination treatment due to progressive disease; and 2 patients showed tumour-regression after chemotherapy following vaccination. A relative low count of lymphocytes before and after vaccination was present in 11/19 patients indicating that these patients were immunocompromised. This study shows that HPV16 E7 peptide vaccination is feasible, even in a group of patients with terminal disease. This paves the way for vaccinating patients with less advanced disease, whose immune system is less compromised by progressive disease.
    European Journal of Cancer 07/1999; 35(6):946-52. DOI:10.1016/S0959-8049(99)00048-9 · 5.42 Impact Factor
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    ABSTRACT: In various countries epidemiologic studies show an association between human papillomavirus (HPV) and cancer of the uterine cervix. We determined the presence of HPV and the distribution of the different HPV genotypes in cervical carcinomas from Surinam, a high-incidence country. The results were compared to the Netherlands where the incidence is five times lower. One hundred thirty cervical carcinomas from patients in Surinam were randomly selected and compared to an unselected group of 128 cervical carcinomas from caucasoid Dutch patients. Presence of HPV and distribution of HPV genotypes was determined in DNA extracted from paraffin-embedded specimens by polymerase chain reaction and sequence analysis. HPV DNA was detected in 82% of the Surinamese cervical cancer patients and in 87% of the Dutch patients. Thirteen different HPV genotypes were detected in the Surinamese group, and nine different HPV genotypes were detected in the Dutch group. Among the HPV-positive samples, HPV 16 was present in 68% in the Netherlands compared to only 49% in Surinam, where less common genotypes such as HPV 35, 45, and 58 were more prevalent. The results show a strong association between HPV and cervical cancer in both groups. However, the observed significant variation in distribution of the genotypes in the two populations with a large difference in cervical carcinoma incidence is important to the general understanding of the etiology of cervical cancer and to the development of HPV vaccination strategies.
    International Journal of Gynecological Cancer 06/1999; 9(3):206-211. DOI:10.1046/j.1525-1438.1999.99020.x · 1.95 Impact Factor
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    ABSTRACT: The association between cervical neoplasia and certain HLA phenotypes observed in different studies has not been consistent. By serological typing, the association between HLA antigens, cervical carcinoma and cervical intraepithelial neoplasia (CIN) was studied in a group of 172 and 116 patients, respectively. We demonstrated an increased frequency of B63 in patients with HPV types other than HPV 16 or 18, and B55 in patients that were negative for all HPV types. The association between cervical carcinoma and DQ3, described in various populations, was not observed in the present study. However, we confirmed other previously observed associations between cervical cancer and class II antigens, i.e., a positive correlation with DR15 irrespective of the HPV status, with DR3 in patients harboring HPV types other than HPV 16 or 18, and with DR11 among HPV 16 positive patients. In contrast, a negative correlation between DR13 and HPV positive cervical cancer was observed which suggests protection of this antigen against HPV-associated cervical cancer. A slight increase of DR15 and DQ4 antigens was observed in CIN patients, suggesting that these specific HLA antigens may be important in determining the risk of CIN.
    Human Immunology 05/1999; 60(4):337-42. DOI:10.1016/S0198-8859(98)00127-X · 2.14 Impact Factor
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    ABSTRACT: Epidemiologic data show a high incidence of cervical cancer throughout the world and a high mortality, particularly in developing countries. The aim of this study was to describe the incidence and stages of cervical carcinoma in Surinam. Results were compared with data from The Netherlands (used as representative of western European countries) because of a medical and patient exchange program. Data for Surinamese patients analyzed in this study were based on the files from the Department of Pathology at the University of Surinam from 1989 through 1994. Cumulative and incidence rates standardized to the World Standard Population were calculated and compared with rates in other South American countries and in The Netherlands. Age distribution and stage of disease (according to the International Federation of Gynecology and Obstetrics) among Surinamese and Dutch women were compared. Furthermore, differences in incidence rates among the multiple ethnicities of the Surinamese population were evaluated. Age standardized incidence rates for Surinam and The Netherlands were 26.7 and 6.2 per 100,000 women, respectively. The cumulative rate up to age 74 years was 2.9 in Surinam versus 0.6 in The Netherlands. Incidence in Surinam rose sharply with age. More than 40% of the Surinamese women presented with Stage IIB disease or higher compared with 12% in The Netherlands. In Surinam, low stage of disease was highest in the youngest group (48%), whereas only 18% of women 65 years or older presented with Stage I disease. Incidence rates in Surinam varied by ethnic group. Amerindians and Javanese were more likely to develop cervical cancer than were other ethnicities. Cervical carcinoma in Surinam was characterized by high incidence rates and relatively advanced stage of disease at presentation. Moreover, incidence was not equally distributed among the different ethnic groups. This may reflect a greater exposure to risk factors and differential access to diagnostic and treatment services.
    Cancer 05/1996; 77(7):1329-33. · 4.89 Impact Factor
  • C.G.J.M. Hilders · J.G.A. Houbiers · E.J.T. Krul · G J Fleuren ·
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    ABSTRACT: The major histocompatibility complex probably plays a crucial role in the efficacy of the cellular immune response against virally infected cervical diseases. Therefore, the allele-specific histocompatibility-related leukocyte antigens (HLA) class I and II expression on normal (n = 10), premalignant (n = 25), and malignant cervical tissue (n = 30) was investigated. No alterations in monomorphic or locus/allele-specific HLA class I or II expression were observed in normal and premalignant epithelial tissue. In cervical carcinomas, however, a reduced expression of HLA class I antigens was present in 70% of the cases, comprising a monomorphic class I loss in 20%, and an allele-specific loss in 50% of HLA-A2-, 66% of A3-, 56% of Bw4-, and 37% of Bw6-positive patients. De novo expression of class II antigens was observed in 80% of the cervical carcinomas, with the sublocus products being expressed in the order HLA-DR > HLA-DQ > HLA-DP. The authors' results show that alteration in HLA expression is a process confined to malignant cells, which may allow tumors to evade immune surveillance. In addition, these findings have to be considered as new strategies of immunotherapy using cytotoxic T lymphocytes are developed.
    American Journal of Clinical Pathology 01/1994; 101(1):5-12. · 2.51 Impact Factor

Publication Stats

344 Citations
23.36 Total Impact Points


  • 1996-2001
    • Leiden University Medical Centre
      • • Department of Radiology
      • • Department of Gynaecology
      • • Department of Pathology
      Leiden, South Holland, Netherlands
  • 1994
    • Leiden University
      Leyden, South Holland, Netherlands