Biomedical subjects
Publications and source records attributed to E L Schoofs.
A 44-year-old woman complaining of thoracic back pain was found to have a large mediastinal leiomyosarcoma. This was completely excised. No adjuvant treatment was given. Follow-up after 24 months showed no evidence of disease. For these rare tumours surgery offers the best treatment, although local recurrence and metastases do occur.
To determine more precisely the role of mediastinoscopy in the preoperative staging of bronchogenic carcinoma, we studied 85 patients in the period 1983 to 1985 and compared the results of mediastinoscopy and computed tomographic scanning with the findings at thoracotomy. Mediastinoscopy was performed in 48 patients when mediastinal nodes larger than 1 cm were found at computed tomographic scanning. Only 21 of them (44%) were found to have metastatic nodes. Of the remaining patients, 22 were operated on and two showed false negative results (9%). Mediastinoscopy had a sensitivity of 91% and a specificity of 100%. The positive predictive value of computed tomographic scanning was only 54%. Thirty-seven patients underwent thoracotomy after having negative computed tomographic scan results. Eleven of them (30%) were found to have metastatic mediastinal lymph nodes. The negative predictive value of computed tomographic scanning was 70%. When results from both series of patients were compared, the sensitivity and specificity of computed tomographic scanning proved to be 68% and 57%, respectively, with an accuracy of 61%. Because of the low accuracy rate of computed tomographic scanning, a more routine use of mediastinoscopy seems to be justified.
In an attempt to meet superior hemodynamic criteria without patch angioplasty and to prevent recurrent stenosis, Division-Endarterectomy-Reanastomosis (D.E.R.) was used as a routine technique in a prospective study on 26 consecutive interventions in 25 patients. One patient had a residual technical stenosis of less than 30%. Eight patients died during the one and a half year follow-up from nonstroke-related causes. After on an average 14 months flow parameters were evaluated with Color Duplex Sonography to detect recurrent stenosis. One (5.5%) mild asymptomatic recurrent stenosis of less than 50% was diagnosed. The residual stenosis remained unchanged and all other sites showed normal flow patterns. Division-Endarterectomy-Reanastomosis of the internal carotid artery, as described, meets all requirements for safe carotid restoration.
During a five-year period, seven out of 85 patients undergoing surgery for abdominal aortic aneurysm, were identified as having the inflammatory variant. The clinical data, management and follow-up are reported. Computed tomography is the preferred examination for the disclosure of the nature of the aneurysm. Aneurysmectomy with graft replacement is advocated as the treatment of choice and requires a specific technique. Inflammatory abdominal aortic aneurysms are a clinical distinct entity but are considered as being a variant of the atherosclerotic abdominal aneurysm. The etiology has as yet not been clarified, even though various theories have been proposed.