PubMed Health⌕ Search

Biomedical subjects

A Vermey

Publications and source records attributed to A Vermey.

At least 19 recordsLinked to original sources
PubMed2002

Is sentinel node biopsy beneficial in melanoma patients? A report on 200 patients with cutaneous melanoma.

AIM: The aim of this study was to evaluate the reliability and clinical impact of sentinel node biopsy, including preoperative lymphoscintigraphy and intraoperative lymphatic mapping in patients with cutaneous melanoma of the head, neck, trunk or extremities. METHODS: Two hundred patients (103 women, 97 men), median age 57 (range 21-86) years with cutaneous melanoma > or =1.0mm Breslow thickness and clinically negative lymph nodes participated in a single institutional prospective study from May 1995 to January 2000. Primary melanoma sites included: 22 head and neck (11%), 67 trunk (34%), 29 upper extremity (14%) and 82 lower extremity (41%). The median Breslow thickness was 2.5 (range 1.0-20.0)mm. Preoperative dynamic and static lymphoscintigraphy, intraoperative blue dye and a gamma detection probe were used. If histological examination with HE or IHC showed metastases, therapeutic lymph node dissection (TLND) was performed. RESULTS: Sentinel node(s) could be identified in 197 patients (99%); 393 sentinel nodes (mean: 2.0 per patient, range 1-7) were removed from 241 basins. Three procedures failed in the head and neck region. In 167 patients, the sentinel nodes were both blue and radioactive (85%); in 26 patients, they were only radioactive (13%) and in four patients only blue (2%). In total, 150 patients had tumour-negative sentinel nodes (76%). During a median follow-up of 47 (range 24-79) months, nodal recurrence in a negative mapped basin was documented in six patients of which isolated recurrence was in two patients and recurrence together with locoregional recurrence in four patients (false negative rate 6/54=11%). Estimated three-year recurrence-free survival in the node-negative patients and node-positive patients was 83 and 66% respectively (P<0.05). The overall survival at three years was 92 and 73% respectively (P<0.05). CONCLUSION: Sentinel node biopsy provides accurate staging and important prognostic information. The final place of sentinel node biopsy is still undefined, and therefore sentinel node biopsy is still considered as an experimental surgical staging procedure.

Adult↗
PubMed2002

Long-term functional outcome of mandibular reconstruction with stainless steel AO reconstruction plates.

Mandibular continuity defects are usually reconstructed with bone grafts. However, factors associated with the tumour and the patient can still be reasons to choose reconstruction plates. The aim of this study was to find out the results of mandibular reconstructions with stainless steel AO reconstruction plates after a long follow-up period. The records of 36 patients were reviewed for personal data and the history of disease, treatment and complications. Patients with failed reconstructions were compared with those in whom the procedure had been successful. Patients and surgeons gave their opinion on the functional and cosmetic results. The mean follow-up was 39 months (range 4-99); 4 patients were withdrawn because they developed early recurrent disease and in 17 patients the reconstruction failed. We found no significant differences between the successful and the failed group. Fourteen patients could be evaluated for functional outcome, 10 of whom were totally or satisfactorily rehabilitated. Therefore, stainless steel reconstruction plates can be used in patients when other options are inappropriate.

Adult↗
PubMed2002

Surgical margins for resection of squamous cell carcinoma of the lower lip.

A prospective study was undertaken to evaluate the efficacy of 3 mm margins of resection with surgical excision of squamous cell carcinoma of the lower lip (SCCLL) in its early stages whereby the margins were checked with the systematic use of frozen-section examination. During the period of 1991-1998, 72 consecutive patients with a primary stage I/II SCCLL underwent surgical excision as the initial treatment. There were 58 males (81%) and 14 females (19%) with a median age of 66.8 years (range 37-91 years). The majority of cases (94.4%) were stage I tumours. Treatment consisted of a full-thickness excision including a 3 mm margin of clinically uninvolved tissue. Intraoperative frozen-section analysis of the margins of the excised specimen was used to confirm tumour-free margins. Clinically determined margins were tumour-free in 89.9% on initial excision. The false-positive rate associated with frozen-section analysis was 1.4%. The minimum follow-up period for all patients was 2 years (median 5.1 years, range 2-9 years). Local recurrence was found in two patients (2.8%). A 3 mm margin with excision of early SCCLL seems to be appropriate, if the margins are controlled by systematic use of frozen-section analysis.

Adult↗
PubMed2001

Surgical treatment of recurrent pleomorphic adenoma of the parotid gland: a clinical analysis of 52 patients.

BACKGROUND: Surgical management of recurrent pleomorphic adenoma of the parotid gland has a considerable risk of facial nerve injury and a high re-recurrence rate. To obtain more insight into this issue we evaluated our experiences. METHODS: Medical records and histologic material of all these patients (31 women and 21 men), who had been treated from 1976-1995 were reviewed. Median interval between initial treatment and commencement of recurrences was 3 (0.8-18) years. Last surgery consisted of parotidectomy in 48 patients (92%), including 19 (40%) total procedures and wide local excision with involved skin in four patients. RESULTS: At a median follow-up of 9 years, eight patients (8/52; 15%) had re-recurrences develop, including 4 of 21 patients (19%) after a previous parotidectomy (group I) and 4 of 31 patients (13%) without prior parotidectomy (group II). The chance of re-recurrence in a group of patients with a minimal follow-up of 10 years after salvage surgery was 17% (4 of 24). The risk of a new relapse was, respectively, 4% and 8% at 1 and 5 years after treatment of recurrent disease. Acceptable N.VII function was preserved in 45 of the 49 (92%) nerves at risk. The risk of N.VII injuy was higher and more serious in group I (29% vs 10% in group II). The function of four of the five (80%) reconstructed zygomaticotemporal branches of the N.VII was adequate. CONCLUSION: Surgical treatment of recurrent pleomorphic adenoma of the parotid gland, usually consisting of a parotidectomy with wide extent and eventually facial nerve reconstruction, demonstrates favorable results with acceptable morbidity. The risk of new relapse and N.VII injury was higher after previous parotidectomy.

Adenoma, Pleomorphic↗
PubMed2001

Outcome of surgical treatment for carotid body paraganglioma.

BACKGROUND: The present study reviewed a 30-year experience of managing carotid body paraganglioma (CBP) and analysed clinical findings associated with perioperative morbidity. METHODS: Clinical records, radiological findings and pathological reports of all patients who presented with CBP between 1966 and 1997 were reviewed. There were 39 consecutive patients with 45 tumours and median follow-up was 10 years. The Shamblin classification was used to define complication rates and long-term surgical results. RESULTS: Preoperative information derived from magnetic resonance angiography (MRA) and colour Doppler imaging (CDI) was comparable to that from standard four-vessel arteriography. Forty-one CBPs were resected in 35 patients. Six patients had bilateral tumours and seven had multicentric tumours. The median duration of operation and blood loss were substantially higher for Shamblin type III tumours. All major vascular complications (four of 39 patients) and permanent neurological complications (three of 39) were observed in type III tumours. CONCLUSION: Surgical planning and prediction of perioperative complications can be obtained by staging derived from MRA and CDI. Severe complications occur predominantly in type III CBPs.

Adolescent↗
PubMed2001

Regional guideline for diagnosis and treatment of squamous cell carcinoma of the lip: what is the level of compliance?

OBJECTIVE: To investigate to what extent physicians comply with a regional guideline for the diagnosis, staging, treatment and follow-up of patients with squamous cell carcinoma of the lower lip. DESIGN: Retrospective analysis of data from the medical records of 248 patients diagnosed with squamous cell carcinoma of the lower lip during the period 1989-1997. SETTING: Comprehensive Cancer Centre of the Northern region of the Netherlands. STUDY PARTICIPANTS: The data were collected by this Centre for the regional population-based cancer registry. RESULTS: Overall compliance with the separate guidelines varied between 4 and 80%. For diagnosis and staging, the guideline was followed for 4-70% of patients. The type of treatment in relation to age conformed to the guideline in 34% of cases. Of the 208 surgically-treated patients, treatment was performed in accordance with the guidelines in 92 (44%) patients, compared with seven out of 18 (39%) patients who received radiotherapy. Follow-up in accordance with the guideline was 11% in the first year, 9% in the second year and 21% in the third year. CONCLUSION: Only a minority of patients with squamous cell carcinoma of the lower lip, a rare rumour, were managed according to the available regional guideline. Regular review of both the guideline and its implementation is necessary in order to optimize its use.

Carcinoma, Squamous Cell↗
PubMed2000

[Embolization of skeletal metastases in patients with differentiated thyroid carcinoma].

Treatment options in patients with bone metastases of differentiated thyroid carcinoma are limited and mostly aimed at palliation. Conventional treatment modalities are: radioiodine therapy, surgery or external irradiation. A lesser known option is selective embolization of tumour metastases. During selective catheterization of the arteries that feed the metastases embolization material (e.g. polyvinyl alcohol particles) is injected into the local vasculature under radiographic control. The embolization is immediately evaluated angiographically. This therapy was used in three patients with differentiated thyroid carcinoma, a 60-year-old man suffering from back ache, paresis and afterwards paralysis of the lower body parts with incontinence, and in two women aged 59 years (suffering from diplopia and a pelvic metastasis) and aged 27 years (suffering from neurological symptoms or pain of the right leg due to a pelvic metastasis). In all three the symptoms disappeared after the embolization and ensuing treatment with radioactive iodine. Due to recurrent increase in serum thyroglobulin concentration repeated re-embolization was necessary, but during a follow-up period of 3-5 years the palliation remained adequate. Selective embolization appears to be a safe and efficacious treatment, with good tolerability for the patient. Embolization alone or preferably preceded by radioiodine therapy may lead to decreased tumour progression and often gives rise to immediate relief of symptoms.

Adenocarcinoma, Follicular↗
PubMed2000

Sentinel node biopsy for melanoma in the head and neck region.

BACKGROUND: Lymphatic drainage in the head and neck region is known to be particularly complex. This study explores the value of sentinel node biopsy for melanoma in the head and neck region. METHODS: Thirty consecutive patients with clinically localized cutaneous melanoma in the head and neck region were included. Sentinel node biopsy was performed with blue dye and a gamma probe after preoperative lymphoscintigraphy. Average follow-up was 23 months (range, 1-48). RESULTS: In 27 of 30 patients, a sentinel node was identified (90%). Only 53% of sentinel nodes were both blue and radioactive. A sentinel node was tumor-positive in 8 patients. The sentinel node was false-negative in two cases. Sensitivity of the procedure was 80% (8 of 10). CONCLUSIONS: Sentinel node biopsy in the head and neck region is a technically demanding procedure. Although it may help determine whether a neck dissection is necessary in certain patients, further investigation is required before this technique can be recommended for the standard management of cutaneous head and neck melanoma.

Adult↗
PubMed2000

Embolization in combination with radioiodine therapy for bone metastases from differentiated thyroid carcinoma.

BACKGROUND: The outcome for patients with bone metastases from differentiated thyroid carcinoma is worse compared to the overall prognosis of patients with differentiated thyroid carcinoma. The aim of this study is to evaluate the effect of embolization with concomitant radioiodine treatment on the serum thyroglobulin (Tg) level, pain and neurological symptoms in patients with large bone metastases from differentiated thyroid carcinoma. PATIENTS AND METHODS: Five symptomatic patients, who presented with a large unresectable bone metastasis of differentiated thyroid carcinoma were treated with radioiodine and embolization. The effect of this combined treatment was compared to the effect of radioiodine without embolization in a previously treated control group of 6 patients. Serum Tg levels, pain and neurological symptoms were scored. Both groups were treated similarly with total thyroidectomy followed by ablation with 5.55 GBq 131I and a second dose of 5.55 GBq 131I three months later, except for embolization in the embolization group, which took place between the 2 radioiodine treatments. RESULTS: In the embolization group, serum Tg at the second 131I therapy had decreased by 88.7% (median, range: 77.1-99.3%), which was significantly more compared to the decrease of serum Tg in the control group (18.6%, range: -4.7-95%, P < 0.05). CT-scanning showed a median volume reduction of the metastasis after radioiodine treatment combined with embolization of 52.5% (range: 39-80%). Both strategies resulted in a rapid relief of pain and neurological symptoms. Embolization was not accompanied with severe complications. CONCLUSIONS: This preliminary study suggests that embolization of bone metastases of differentiated thyroid carcinoma in combination with radioiodine treatment results in a significant initial reduction of serum Tg level compared to radioiodine treatment alone. This suggests a beneficial reduction in tumour burden. In this patient category, embolization appears to be a safe and well tolerated procedure.

Adult↗
PubMed1999

Carbon dioxide laser evaporation of leukoplakia of the lower lip: a retrospective evaluation.

The purpose of this study was the retrospective evaluation of the treatment results of CO2 laser evaporation for 27 cases of leukoplakia of the lip. The data were derived from 23 patients who presented with leukoplakia of the lower lip during the period 1978-96. Four patients developed a second primary leukoplakia of the lip resulting in 27 cases of leukoplakia. All lesions were treated with a CO2 laser equipped with an operation microscope and micromanipulator. Short-term evaluation showed complete epithelialisation 4 weeks after CO2 laser evaporation; there was minimal scar formation and no subsequent interference with normal lip function. During long-term evaluation, four recurrences (14.8%) were diagnosed which developed between 5 and 31 months after treatment, these were retreated with CO2 laser evaporation. There was no development of squamous cell carcinoma in the CO2 laser-treated area. Selective removal of affected epithelium with minimal damage to surrounding structures is possible using CO2 laser evaporation, followed by excellent wound healing and good functional result. Treatment can be performed under local anaesthesia on an outpatient basis. The recurrence rate is low compared with the recurrence rate after surgical excision. Therefore, CO2 laser evaporation is considered a reliable and effective treatment modality for leukoplakia of the lip.

Aged↗
PubMed1998

Detection of unknown occult primary tumors using positron emission tomography.

BACKGROUND: The potential of positron emission tomography (PET) with 18F-fluoro-2-deoxy-D-glucose (FDG) to detect primary tumors after unsuccessful conventional diagnostic workup was assessed in patients with metastatic disease from an unknown primary tumor. METHODS: Twenty-nine patients with various histologic types of metastases from an unknown primary site were studied after unsuccessful conventional diagnostic workup. The patients received 370 megabecquerels (MBq) (10 millicuries) FDG intravenously and whole body scans were made after 30 minutes after injection onward. RESULTS: All but one known metastatic tumor sites were visualized. Additional metastases were discovered in five patients. With FDG-PET the primary tumor was identified in 7 patients (24%): in 2 patients with carcinoma of the nasopharynx, in 1 patient with plasmacytoma of the base of the tongue, in 1 patient with carcinoma of the lung, in 1 patient with carcinoma of the colon, and in 2 patients with breast carcinoma. FDG-PET did not identify a primary tumor in the remaining 22 patients (76%). Despite a negative PET study, the primary lesion was identified in a later phase in 3 of these patients (14%). Survival was not altered by discovery of the primary tumor. CONCLUSIONS: A previously unknown primary tumor was able to be identified with FDG-PET in 7 of 29 patients after an unsuccessful conventional diagnostic workup. However, the clinical relevance of PET information in this setting is limited.

Adult↗
PubMed1998

Radiotherapy for cancer of the lip. A long-term evaluation of 85 treated cases.

The results of radiation therapy, both as a single treatment modality and after radical surgery for squamous cell carcinoma of the vermilion surface/border of the lip, are retrospectively analyzed in 85 patients. All recurrences (7%) occurred in T2 and T3 tumors treated with external beam radiotherapy only. The long-term esthetic result and functional morbidity are evaluated. Referral patterns are discussed, and the need for a multidisciplinary treatment protocol is emphasized.

Adult↗
PubMed1998

Oncological implications of RET gene mutations in Hirschsprung's disease.

BACKGROUND: Germline mutations of the RET proto-oncogene identical to those found in the tumour predisposition syndrome multiple endocrine neoplasia type 2A (MEN2A), were detected in 2.5-5% of sporadic and familial cases of Hirschsprung's disease. Some patients with Hirschsprung's disease may therefore be exposed to a highly increased risk of tumours. AIMS: To define clinical use of RET gene testing in Hirschsprung's disease and related patient management from an oncological point of view. METHODS: Sixty patients with Hirschsprung's disease were screened for RET mutations. In three, MEN2A type RET mutations were detected. Case reports for these three patients are presented. RESULTS AND CONCLUSIONS: Only 22 families or sporadic patients with Hirschsprung's disease and MEN2A type RET mutations have been reported. Therefore, it is difficult to predict tumour risk for patients with familial or sporadic Hirschsprung's disease, and their relatives, who carry these mutations. For these mutation carriers, periodic screening for tumours as in MEN2A is advised, but prophylactic thyroidectomy is offered hesitantly. RET gene testing in familial or sporadic Hirschsprung's disease is not recommended at present outside a complete clinical research setting. In combined MEN2A/Hirschsprung's disease families RET gene testing, tumour screening, and prophylactic thyroidectomy are indicated as in MEN2A.

Adult↗
PubMed1998

Detection of oral dysplasia in animals with fluorine-18-FDG and carbon-11-tyrosine.

UNLABELLED: The uptake of 18F-fluorodeoxyglucose (FDG) and L-[1-(11)C]tyrosine (TYR) was investigated in male Wistar albino rats with chemically induced dysplasia and oral squamous cell carcinoma (SCC) to correlate the uptake values with the grade of dysplasia. METHODS: The palates of 54 rats was painted three times per week with 4-nitroquinoline 1-oxide to create different stages of dysplasia and SCC. After 2, 4, 6, 8, 12, 16, 20, 26 and 30 wk, these rats were investigated with PET. Immediately thereafter, the rats were killed and histologically prepared. Standardized uptake values (SUVs) of the palate of the rats were calculated and correlated with the Epithelial Atypia Index (EAI) and the thickness of the epithelial layer. RESULTS: The TYR SUV correlated with the EAI and the epithelial thickness, 0.5 and 0.74, respectively. No correlation could be found for FDG SUV, compared to EAI and the epithelial thickness. CONCLUSION: For dysplasia and SCC, TYR showed higher uptake values than did FDG. It appeared that, for the detection of oral dysplasia, the tissue hyperplasia was more important than malignant features of dysplastic mucosa.

4-Nitroquinoline-1-oxide↗
PubMed1997

Detection of unknown primary head and neck tumors by positron emission tomography.

The purpose of this study was to investigate the potential of using positron emission tomography (PET) with 18F-labeled fluoro-2-deoxy-D-glucose (FDG) to detect unknown primary tumors of cervical metastases. Thirteen patients with various histologic types of cervical metastases of unknown primary origin were studied. Patients received 185-370 MBq FDG intravenously and were scanned from 30 min after injection onward. Whole-body scans were made with a Siemens ECAT 951/31 PET camera. PET identified the primary tumor in four patients: plasmocytoma, squamous cell carcinoma of the oropharynx, squamous cell carcinoma of the larynx, and bronchial carcinoma, respectively. All known metastatic tumor sites were visualized. PET did not identify a primary tumor in one patient in whom a squamous cell carcinoma at the base of the tongue was found in a later phase. In the remaining eight patients, a primary lesion was never found. The follow up ranged from 18 to 30 months. A previously unknown primary tumor can be identified with FDG-PET in approximately 30% of patients with cervical metastases. PET can reveal useful information that results in more appropriate treatment, and it can be of value in guiding endoscopic biopsies for histologic diagnosis.

Adult↗
PubMed1997

Osteosarcoma of the jaw bones. Long-term follow up of 48 cases.

To evaluate the incidence and treatment results of osteosarcoma of the jaw (OSJ) in the Netherlands, data from 48 patients with a histologically proven diagnosis of osteogenic sarcoma of the maxilla or mandible were retrospectively analysed. Patient files, covering the period from 1964 to 1992, were obtained from all university hospitals in the Netherlands and the Netherlands Cancer Institute. The incidence of OSJ in the Netherlands is estimated to be at least 0.14 per 1,000,000. The overall 10-year survival was 59%. Distant metastasis occurred in 21% and local recurrences in 31% of the cases. Survival was significantly better in case of radical surgery and small tumours. Long-term survival after treatment of OSJ was good if complete surgical excision was achieved. Radiotherapy should only be considered to prevent local recurrence if surgery is not complete. The possible benefit of current chemotherapy in preventing metastatic disease is still questionable. Since other malignant neoplasms associated with OSJ occurred in 17% of the cases, lifelong follow up is mandatory for the detection of these second primary malignancies.

Adolescent↗
PubMed1997

Photofrin-mediated photodynamic therapy of chemically-induced premalignant lesions and squamous cell carcinoma of the palatal mucosa in rats.

Photodynamic therapy (PDT), an experimental cancer therapy, was studied in an animal model of chemically-induced epithelial dysplasia and squamous cell carcinoma. PDT was performed 24 hours after i.v. injection of 2.5 mg/kg bw Photofrin, and using 100 J/cm2 incident light at two activation wavelengths (514.5 nm or 625 nm). Two days after PDT, the majority of rats macroscopically showed a marked erythema of the entire palatal region. Microscopically all the rats showed oedema, haemorrhage, and necrosis of the epithelium of the intermolar area. The long-term results were not so favourable. No evidence of disease was found in 6 out of 20 rats in the 514.5 nm group and in 2 out of 20 rats in the 625 nm treated group. Epithelial dysplasia was found in 14 out of 20 rats in the 514.5 nm group, and in 18 out of 20 rats of the 625 nm treated group. Squamous cell carcinomas were found in 4 out of 20 rats treated with 514.5 nm and in 7 out of 20 rats in the 625 nm treated groups. Comparing both treatment wavelengths, better results were obtained in the 514.5 nm groups as this wavelength gave less normal tissue damage. Based on the results of this study the application of PDT for the treatment of field cancerization and squamous cell carcinoma of the oral cavity, is discussed.

4-Nitroquinoline-1-oxide↗