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F B Lammes

Publications and source records attributed to F B Lammes.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Treatment of patients with trophoblastic tumors in the Academic Medical Center: 31 patients in 10 years, 1983-1992].

OBJECTIVE: Evaluation of the treatment of patients with gestational trophoblastic disease. SETTING: Academic Medical Centre, Amsterdam. DESIGN: Descriptive. METHOD: Clinical data from all patients treated between 1983 and 1992 were collected. RESULTS: Thirty-one patients were treated in this period. Eighteen patients had persistent trophoblast after a molar pregnancy, 7 had choriocarcinoma after a normal pregnancy and in 6 patients the obstetrical history was unclear. The initial treatment strategy was chosen on the basis of prognostic factors; low-risk patients received mono-chemotherapy (Methotrexate) and high-risk patients were treated with polychemotherapy (EMA/CO). In 15 cases adjuvant therapy was necessary. Complete remission was achieved in 29 patients, 2 patients died. The adverse effects of the chemotherapy were generally mild. CONCLUSION: Persistent trophoblastic disease has an unpredictable presentation and course. Therefore treatment should preferably be given in a reference centre.

Adult↗
PubMed1995

Multifocal vulvar intraepithelial neoplasia grade III and multicentric lower genital tract neoplasia is associated with transcriptionally active human papillomavirus.

BACKGROUND: The incidence of vulvar intraepithelial neoplasia Grade III (VIN III) is increasing and is diagnosed at a younger age than previously. VIN III is often multifocal and frequently coexists with multicentric dysplastic lesions in the cervix and vagina. Warty-type VIN III more often has been found to contain human papillomavirus (HPV) DNA than basaloid-type VIN III: The authors performed HPV DNA polymerase chain reaction (PCR) analysis in 48 VIN III biopsies and reverse transcriptase (RT)-PCR in 8 HPV-16 DNA-positive multifocal VIN III biopsies to detect E6/E7 transcripts. METHODS: Human papillomavirus DNA detection and histologic analysis were performed on alternating slides of paraffin embedded biopsies. Polymerase chain reaction was performed with consensus primers, and HPV typing was performed by direct sequencing. Total RNA was isolated from frozen biopsies by centrifuging a guanidinium thiocyanate (GTC) lysate through a cesium chloride (CsCl) cushion. The RT reaction was performed using a 3' primer, located just downstream of the E7 stop codon, and the PCR reaction was performed using the same 3' primer and a 5' primer located just downstream of the E6 start codon. RESULTS: The mean age of the 48 patients was 37.7 years. Eighty-one percent had multifocal VIN III: Sixty-six percent had multicentric neoplasia. Forty-six percent of the biopsies were warty-type, 17% basaloid-type, 35% mixed-type and 2% differentiated-type. Ninety-two percent were HPV-positive and 83% contained HPV-16 DNA. Human papillomavirus DNA was more often present in multifocal VIN III lesions than in unifocal VIN III lesions and also more often in VIN III lesions coexisting with other dysplastic multicentric lesions than in unicentric VIN III lesions. Warty-type VIN III more often contained koilocytes than basaloid-type VIN III: A correlation between different morphologic forms of VIN III and the presence of HPV DNA was not found. Both types of VIN III often coexist in one lesion. In all the RT-PCRs, a 593-base-pair fragment was detected, corresponding to the expected length of the major E6*-E7 mRNA. CONCLUSIONS: The observed high prevalence of transcriptionally active HPV DNA associated with multifocal and multicentric dysplasia suggests a role of HPV in the pathogenesis of these lesions. A positive correlation between different morphologic forms of VIN III and the presence of HPV DNA was not found.

Adult↗
PubMed1995

Extracapsular growth of lymph node metastases in squamous cell carcinoma of the vulva. The impact on recurrence and survival.

BACKGROUND: Patients with squamous cell carcinoma of the vulva who present with multiple positive groin lymph nodes have poor survival. Growth of cancer through the capsule of the groin lymph nodes recently has been identified as an important prognostic factor for survival in that patient group. The objective of this study was to determine the influence of several clinicopathologic parameters on the pattern of recurrence and survival. METHODS: A review of 71 patients with squamous cell carcinoma of the vulva and positive lymph nodes was performed to assess the independent prognostic value of a number of variables for survival. Variables analyzed included tumor size, stage, number of positive lymph nodes, extracapsular growth of lymph node metastasis, the greatest dimension of tumor in the lymph nodes, the percentage of replacement of the lymph nodes by tumor, clinical lymph node status, and laterality of positive lymph nodes. RESULTS: Using the Mantel-Cox test, extracapsular growth of lymph node metastases (P = 0.00), two or more positive lymph nodes (P = 0.02), and greater than 50% replacement of lymph nodes by tumor (P = 0.03) were predictors of poor survival. No difference was found between the groups with two positive lymph nodes and those with three or more. Extracapsular growth of lymph node metastases was the most significant independent predictor for survival. Distant metastases occurred in 7 of 15 patients (48%) who had a combination of extranodal spread, lymph node replacement greater than 50%, and three or more positive lymph nodes. CONCLUSION: Extracapsular growth of lymph node metastases in the groin is the most important predictor for poor survival in patients with squamous cell carcinoma of the vulva. Because of the predominant distant failure pattern in a subgroup of patients who have a combination of extranodal spread, multiple positive lymph nodes, and lymph nodes replaced by tumor greater than 50%, a future study of the effectiveness of systemic therapy for vulvar cancer must include these patients.

Adult↗
PubMed1995

[Providing patients with an audio recording of the outpatient oncological consultation; experiences of patients and physicians].

OBJECTIVE: Gaining insight into the experiences of physicians and patients who were provided with an audiotape of an oncological consultation. DESIGN: Questionnaire study. SETTING: Academic Medical Hospital, Amsterdam. METHOD: Consultations with 30 consecutive patients referred to the gynaecology or urology outpatient clinic for an initial consultation regarding the diagnosis and (or) treatment policy were taped. Afterwards, patients took the tapes home. The following week they were phoned and asked what they had done with the tape and how they appreciated the intervention. By means of a questionnaire the physicians (n = 6) were asked about their experiences. RESULTS: Two patient could not be reached. Twenty-three out of 28 patients had listened to the tape, mostly together with others (spouse, relatives). Twenty-six out of 28 patients were positive about implementation of this intervention. According to most patients the tape contained information they had forgotten. Most patients found the tape contained reassuring information. Physicians regarded the optimal transmission of information achieved by this intervention as an advantage. Three out of six saw possible misinterpretation of the imparted information as a disadvantage. For some physicians, the taping of consultations led to more careful phrasing. Most physicians saw no logistical difficulties. In general, participation in the study did not take any extra time. CONCLUSION: This first study shows that both cancer patients and physicians find it useful to provide patients with an audiotape of the initial consultation.

Adult↗
PubMed1995

A prospective comparison of transvaginal ultrasonography and diagnostic hysteroscopy in the evaluation of patients with abnormal uterine bleeding: clinical implications.

OBJECTIVE: We determined the diagnostic value of transvaginal ultrasonography for endometrial and intrauterine abnormalities in patients with abnormal uterine bleeding. STUDY DESIGN: Between June 1, 1992, and June 1, 1993, 279 consecutive patients underwent transvaginal ultrasonography. Findings were compared with the final diagnosis established by diagnostic hysteroscopy and histologic examination. RESULTS: Transvaginal ultrasonography demonstrated a sensitivity of 0.96 and a specificity of 0.89. With a pretest probability (prevalence) of 0.42, this resulted in posttest probabilities of 0.03 in the case of a normal sonogram and 0.87 for an abnormal sonogram. The corresponding likelihood ratios were 0.04 and 9.09, respectively. CONCLUSION: Transvaginal ultrasonography seems to be an effective procedure to exclude endometrial and intrauterine abnormalities. Its use could be implemented as a routine first-step procedure in patients with abnormal uterine bleeding, and it selects those in need of further diagnostic evaluation in the case of an abnormal or inconclusive sonogram.

Adolescent↗
PubMed1995

The prognosis of cervical cancer associated with pregnancy: a matched cohort study.

OBJECTIVE: To assess the effect of pregnancy on the prognosis of cervical cancer and the morbidity of standard treatment. METHODS: We analyzed 44 women with cervical carcinoma associated with pregnancy, who were matched with 44 controls. Matching criteria were age, stage of disease (according to the International Federation of Gynecology and Obstetrics classification), tumor type, treatment modality, and period of treatment. RESULTS: In 23 cases, cervical cancer was diagnosed during pregnancy and in the other 21 cases, within 6 months after delivery. Thirty-nine women had early-stage disease (eight IA, 25 IB, and six IIA), and five had advanced stages (four IIB and one IIIB). The overall 5-year survival rate was 80% among subjects and 82% among controls, whereas the relative risk (RR) of dying within 5 years was 1.12 (95% confidence interval [CI] 0.48-2.65). With regard to the 5-year survival rate (85% for both subjects and controls, the RR of dying was 1.00 [95% CI 0.35-2.83]); no differences were found between subjects and controls for early-stage cervical carcinoma. The size of the group with advanced-stage cervical carcinoma was too small to allow any statistical analysis. No statistically significant differences in survival were observed between cases diagnosed during pregnancy and cases diagnosed after delivery. In addition, the mode of delivery had no effect on survival. Early complications within 6 weeks after treatment were seen 33 times in 25 subjects and 29 times in 23 controls. No differences were observed in the prevalence and type of early complications in subjects versus controls. Late complications after 6 weeks of treatment were seen nine times in nine subjects and 11 times in ten controls. No significant differences were observed in the prevalence and type of late complications in subjects versus controls. CONCLUSION: The prognosis of early-stage cervical cancer is similar in pregnant and nonpregnant patients when standard treatment is given. Because of the limited number of patients, no conclusions can be drawn about advanced-stage cervical cancer. The goal should be standard oncologic treatment, which does not lead to increased morbidity in pregnant patients.

Adult↗
PubMed1995

Doctor-patient communication: a review of the literature.

Communication can be seen as the main ingredient in medical care. In reviewing doctor-patient communication, the following topics are addressed: (1) different purposes of medical communication; (2) analysis of doctor-patient communication; (3) specific communicative behaviors; (4) the influence of communicative behaviors on patient outcomes; and (5) concluding remarks. Three different purposes of communication are identified, namely: (a) creating a good inter-personal relationship; (b) exchanging information; and (c) making treatment-related decisions. Communication during medical encounters can be analyzed by using different interaction analysis systems (IAS). These systems differ with regard to their clinical relevance, observational strategy, reliability/validity and channels of communicative behavior. Several communicative behaviors that occur in consultations are discussed: instrumental (cure oriented) vs affective (care oriented) behavior, verbal vs non-verbal behavior, privacy behavior, high vs low controlling behavior, and medical vs everyday language vocabularies. Consequences of specific physician behaviors on certain patient outcomes, namely: satisfaction, compliance/adherence to treatment, recall and understanding of information, and health status/psychiatric morbidity are described. Finally, a framework relating background, process and outcome variables is presented.

Communication↗
PubMed1995

Clearance curves of serum human chorionic gonadotrophin for the diagnosis of persistent trophoblast.

A well recognized hazard of conservative surgical treatment of tubal pregnancy is incomplete removal of trophoblastic tissue. Persistent trophoblast can be detected by postoperative serum human chorionic gonadotrophin (HCG) monitoring. The impact of various surgical techniques on the post-operative clearance of serum HCG was investigated in a retrospective study. The medical records of 97 patients treated surgically for tubal pregnancy in the Academic Medical Center of the University of Amsterdam, The Netherlands, between 1 January 1992 and 1 August 1994 were reviewed; 28 patients were treated by salpingostomy by laparoscopy, 16 by salpingostomy by open surgery and 53 by salpingectomy by either method. There was no difference in the post-operative clearance of serum HCG after successful conservative surgery compared to radical surgery. However, persistent trophoblast occurred in eight patients (29%) after laparoscopic salpingostomy and in only one patient (6.3%) who had a salpingostomy by open surgery (relative risk 4.57). Serum HCG clearance curves allow early identification of patients with persistent trophoblast after conservative surgical treatment. Moreover, monitoring of post-operative serum HCG until it becomes undetectable is mandatory in order to reveal late-onset types of persistent trophoblast.

Chorionic Gonadotropin↗
PubMed1995

Focal vulvitis: a psychosexual problem for which surgery is not the answer.

In the last decade focal vulvitis has been identified as a distinct syndrome, characterized by unexplained burning vulvar pain and superficial dyspareunia. A 'Woodruff perineoplasty' has been recommended as a treatment method. A research project was conducted, investigating the long-term results of surgical treatment and the etiology of focal vulvitis. Results showed that the great majority of women continued to suffer from focal vulvitis after the operation, which leads to the conclusion that the procedure should be abandoned. Retrospective data revealed several immediate causes of mechanical and chemical irritation of the vulva. All women exhibited 'inadequate sexual behavior': having intercourse without a sufficient amount of lubrication and/or in the presence of hypertonia of the pelvic floor. Psychosexual processes were further characterized by deterioration of sexual and general well-being, resulting in lack of libido and depression, which contributed considerably to the problem. An integrated approach to treatment is recommended, which incorporates protection of the vulvar skin, relaxation of pelvic muscles and sexological treatment of the psychosexual and relational aspects.

Adult↗
PubMed1995

Suspected ectopic pregnancy. What to do when human chorionic gonadotropin levels are below the discriminatory zone.

OBJECTIVE: To assess the value of a noninvasive diagnostic strategy in cases of suspected ectopic pregnancy when transvaginal sonography (TVS) and serum human chorionic gonadotropin (hCG) measurement show inconclusive findings. STUDY DESIGN: Prospective study of 85 patients without pregnancy detectable on initial TVS together with low hCG levels (< 1,500 IU/L). The diagnostic strategy combined the results of TVS, hCG measurements and time, according to a strict algorithm. RESULTS: Overall test results of the strategy were excellent: sensitivity, 0.94; specificity, 1.00; likelihood ratio of a positive test result, infinity; likelihood ratio of a negative test result, 0.06. The strategy revealed a new diagnostic entity, trophoblast in regression (TIR). TIR represents patients with declining hCG levels and unknown locations of their pregnancies, presenting a benign clinical picture, and constituted 54% of the population studied. CONCLUSION: This noninvasive diagnostic strategy proved to be very reliable. Because the strategy integrated expectant management of patients with declining hCG levels, it prevented many unnecessary surgical procedures. This was of great benefit for both patients with early intrauterine pregnancies and those with TIR.

Algorithms↗
PubMed1995

Suspected ectopic pregnancy: expectant management in patients with negative sonographic findings and low serum hCG concentrations.

Between July 1989 and December 1994, we performed a prospective study in 265 patients with suspected ectopic pregnancy to assess the value of expectant management in patients with negative transvaginal sonographic findings and low serum human chorionic gonadotropin (hCG) concentrations. All patients had serum hCG concentrations < 1500 IU/l. Eventually, ectopic pregnancy was diagnosed in 68 patients (25.6%), intrauterine pregnancy in 81 patients (30.6%) and trophoblast in regression in 116 patients (43.8%). Test results of our diagnostic strategy, that integrated the results of serial transvaginal sonography, serum hCG monitoring and expectant management, were good: sensitivity 90%, specificity 98%, likelihood ratio of a positive test result 45 and likelihood ratio of a negative test result 0.1. Expectant management in patients with suspected ectopic pregnancy and low serum hCG concentrations proved to be safe, and it enabled us to avoid untimely invasive interventions in patients with an early intrauterine pregnancy or with trophoblast in regression.

Abdominal Pain↗
PubMed1994

['Finally dry'].

Explore the source record for details and available documents.

Female↗
PubMed1994

Symptom perception: psychological correlates of symptom reporting and illness behavior of women with medically unexplained gynecological symptoms.

Medically unexplained (gynecological) symptoms can be viewed as an indication of the somatization of negative emotions. Most studies regarding psychological correlates of medically unexplained gynecological symptoms have paid attention only to certain personality characteristics of women with these symptoms. In this study the reporting of physical symptoms and the resulting illness behavior is explained in terms of information processing or a perception process, i.e. the process by which people detect and interpret physical sensations as symptoms of illness (symptom perception). Symptom perception is in part determined by environmental characteristics and cognitive and emotional processes, such as variation in daily life, (coping with) emotional threat and the use of cognitive illness schemes. Differences in symptom perception and illness behavior of women with medically unexplained and explained gynecological symptoms, compared to women with medically explained gynecological symptoms and a control group, were established with the help of a questionnaire, containing a number of scales. As expected, women with medically unexplained gynecological symptoms had higher reports of common symptoms and sensations and showed also more other illness behavior than the other two groups. They reported less variation and more threat in daily life than the other two groups. These variables together with the use of illness schemes contributed most to symptom reporting of women with medically unexplained symptoms. It is concluded that defence against threat is probably an important determinant. Suggestions for further research and some practical implications are discussed.

Adolescent↗
PubMed1993

Laparoscopy: a dispensable tool in the diagnosis of ectopic pregnancy?

Laparoscopy is regarded as the final decisive diagnostic test in suspected ectopic pregnancy. The new non-invasive diagnostic methods of transvaginal sonography and serum human chorionic gonadotrophin (HCG) monitoring now challenge this pivotal role of laparoscopy. In this prospective study the diagnostic value of an algorithm, combining transvaginal sonography with an HCG cut-off level between 1000 and 1500 IU/l (IRP) was tested in 208 consecutive women at risk for ectopic pregnancy. Three diagnostic categories are designated by the algorithm: intra-uterine pregnancy (n = 73), ectopic pregnancy (n = 89), and trophoblast in regression (n = 46). The latter category represents patients in whom no pregnancy could be located by transvaginal sonography, with an initial HCG concentration < 1500 IU/l, declining during follow-up. The algorithm has a sensitivity of 0.97, a specificity of 0.95, a likelihood ratio for a positive test of 19.4, and a likelihood ratio for a negative test of 0.03. The described diagnostic strategy thus proved extremely reliable in the safe management of patients at risk for ectopic pregnancy, and renders laparoscopy obsolete.

Algorithms↗
PubMed1993

Transvaginal sonography and human chorionic gonadotrophin measurements in suspected ectopic pregnancy: a detailed analysis of a diagnostic approach.

In this prospective study among 208 high-risk patients with suspected ectopic pregnancy, the diagnostic value of transvaginal sonography and serum human chorionic gonadotrophin (HCG) measurements were analysed in detail. The absence of an intra-uterine gestational sac obviously was the most constant sonographic finding among patients with ectopic pregnancy (n = 89), with a very high sensitivity (0.99) but a low specificity (0.41). The application of different HCG cut-off levels improved specificity to 1.00 for values exceeding 4500 IU/l. Clinical utility obviously decreased, as many patients presented with HCG values well below this level. The additional effect of adnexal findings was analysed. Sonographic identification of an ectopic pregnancy was very specific (0.99) but had low sensitivity (0.56) because many ectopics were not detected. The additional effect of HCG values on these results was minor. The low HCG cut-off levels advocated in recent studies are questioned by the results of our analysis: whereas the combined use of sonography and HCG measurements is shown to be of great benefit, the limitations are also documented, underlining the need for re-evaluation at intervals of patients with low HCG values. The question of which cut-off level should be used in practice, however, hinges on a difficult choice between a certain specificity and clinical utility.

Adnexa Uteri↗
PubMed1993

The role of CA 125 and conventional examinations in diagnosing progressive carcinoma of the ovary.

The clinical significance of the serum marker CA 125 and conventional examinations in diagnosing progressive disease was evaluated in 98 patients. The examinations included CA 125, gynecologic and complete physical examination, abdominal computed tomography (CT), roentgenogram of the chest, second look operation and serum biochemistry profile. Progressive disease occurred in 49 patients and the time to progression was a median of 12 months (range of four to 52 months). At the time of progression, an elevated CA 125 was found in 73 percent of the patients, and in 63 percent of the patients, CA 125 increase preceded clinical progression for a median of four and one-half months (range of 0.5 to 29.5 months). A positive gynecologic examination at progression was found in 67 percent of the patients, physical examination and abdominal CT scan were positive in 30 percent, intervention operation in 14 percent and roentgenogram of the chest in 12 percent of the patients. With the combination of serum CA 125, gynecologic and general physical examination, progressive disease could be diagnosed in 92 percent of the patients. The false-positive rate in the 49 patients with no evidence of disease was 1.6 percent for CA 125, 2.0 percent for gynecologic examination, 4.0 percent for physical examination, 14.0 percent for CT scan and 2.0 percent for roentgenograms of the chest. Serum CA 125 is the most reliable examination to detect progressive disease early. With the combined use of serum CA 125 and the gynecologic and general physical examination, progression of the disease can be detected in about 90 percent of the patients.

Adenocarcinoma↗
PubMed1992

CA 125 in ovarian cancer.

The serum tumour marker CA 125 is useful in the management of ovarian cancer, although it has its limitations. Approximately 85% of the ovarian cancer patients have an increased serum CA 125 at the start of treatment. There is a good correlation between the course of CA 125 and the clinical response of the tumour. Patients with an increasing CA 125 are found to have progressive disease in 97%. In these patients further examinations to document progression should be performed. A decrease in serum CA 125 corresponds in 87% of the patients with tumour regression. A normal serum CA 125, however, does not exclude tumour. More than 40% of the patients with a normal CA 125 still have microscopic or macroscopic tumour at second look surgery. On the other hand, an increased serum CA 125 corresponds in 90% of the patients with the presence of tumour or tumour progression shortly after the second look. The same holds for secondary debulking surgery. Patients with an increasing serum CA 125 before secondary debulking surgery have progressive disease at or shortly after surgery, even if an adequate tumour debulking has been performed. In these patients surgery should be omitted as long as no effective second line therapy is available. The course of serum CA 125 during the first 3 months of treatment is of prognostic value for response rate as well as time to progression and overall survival. Patients with a serum half-life of more than 20 days, or a CA 125 which is still high 3 months after the start of treatment, have a significantly lower response rate and progression-free survival. Whether it is possible to improve the prognosis of these patients by dose-intensification will have to be investigated in randomized trials. Serum CA 125 is not specific for ovarian cancer. High levels can also be found in patients with non-ovarian gynaecological and non-gynaecological tumours as well as patients with benign diseases and even in apparently healthy persons. In view of this aspecificity, serum CA 125 cannot be proposed for mass screening. For the same reason, serum CA 125 and the immunohistochemical staining with OC 125 are of limited value in the differential diagnosis between a primary ovarian tumour and metastatic disease in an ovary, as well as for differential diagnosis of pelvic tumours.

Antigens, Tumor-Associated, Carbohydrate↗