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Biomedical subjects

F J Hilgers

Publications and source records attributed to F J Hilgers.

At least 55 records · Page 3Linked to original sources
PubMed1996

The value of computed tomography scan versus an explorative surgical approach for removal of squamous cell carcinoma of the posterior pharyngeal wall.

BACKGROUND: The prevertebral fascia plays a key role in surgery of posterior pharyngeal wall tumors. Invasion of the prevertebral muscles determines the irresectability of the tumor and accurate diagnosis of invasion posteriorly is a prerequisite for major ablative surgery. METHODS: A retrospective study was performed to define the value of CT scanning versus open neck exploration with regard to the resectability of posterior pharyngeal wall carcinoma. The predictive value of preoperative CT scans was assessed and compared with the outcome of open neck exploration and resectability of the primary tumor, using the final histopathology report as a gold standard. RESULTS: Nineteen patients with 20 tumors were included in this study. Overall the CT scan was correct concerning prevertebral muscle status in 4 out of 20 (20%), whereas open neck exploration was correct in 18 tumors (90%). CONCLUSION: The predictive value of a suspicious CT scan in determining prevertebral muscle invasion is extremely low in this study. Open neck exploration seems to be superior for determining resectability of posterior wall carcinoma.

Adult↗
PubMed1996

A new heat and moisture exchanger with speech valve (Provox stomafilter).

In previous studies investigating the influence of a heat and moisture exchanger on the respiratory and psychosocial problems of laryngectomized patients, the value of regular use of such a device could clearly be established. However, the compliance with the use of these devices was not optimal, mainly due to problems related to the plaster and to the often troublesome combination of these HMEs with a voice prosthesis. Therefore, a prospective, clinical trial was undertaken to investigate whether the use of a newly developed heat and moisture exchanger (HME, Provox stomafilter) could improve the acceptibility of such a device. In total, 19 patients participated in this study, 13 men and six women. Vocal rehabilitation was achieved with a Provox voice prosthesis in all patients. Each of the patients was provided with a supply of HMEs for a 3-week trial period. The results showed that all patients were clearly positive about the valve used for digital occlusion of the stoma. Voicing was considerably facilitated and the intelligibility improved. Problems experienced in previous studies related to the adhesive tape, such as skin irritation, inadequate adherence and loosening of the plaster by coughing or forced expectoration, could be solved by the availability of the different adhesives included in this system.

Adhesives↗
PubMed1996

Survival of adult patients with head and neck soft tissue sarcomas.

A retrospective review and survival analysis is presented of 58 adult patients referred between 1963 and 1993 for treatment of a head and neck soft tissue sarcoma. The 5 year overall and disease-free survival was 60% and 52% respectively. Univariate analysis indicated that age, positive margins, bone invasion, distant metastases, single modality treatment, histological grading, sites below the deep fascia and size might be predictors of survival. On multivariate analysis, age, histological grade, distant metastases, site and referral for recurrent disease emerged as prognostic factors known before treatment. By including variables known after treatment, age remained the most important independent prognostic factor followed by the presence of free margins, histological grading and distant metastases at presentation.

Adolescent↗
PubMed1996

Disease-specific survival and locoregional control in tonsillar carcinoma.

In a nationwide survey on oropharyngeal carcinoma in the Netherlands (1986-1990), 380 patients with a tonsillar carcinoma were retrospectively studied. The records of 268 (71%) men and 112 (29%) women with a median age of 59 yr (range 31-91), who had squamous cell carcinoma (272 patients, 98%) or undifferentiated carcinoma (8 patients, 2%) were reviewed with respect to treatment, disease-specific survival and locoregional control. Distribution by stage according to the UICC'92 system was: 27 patients (7%) stage I, 59 (15%) stage II, 99 (26%) stage III, 182 (48%) stage IV and 13 patients (3%) unknown stage. Using a previously reported revised staging system the following distribution was obtained: 118 patients (31%) stage I, 120 (31%) stage II, 67 (18%) stage III, 54 (14%) stage IV and 21 patients (6%) with an unknown stage. Treatment consisted of radiotherapy alone in 231 patients (61%), surgery and radiotherapy in 101 (27%), surgery alone in 30 (8%), chemotherapy in 5 (2%) and 13 patients (3%) did not receive any treatment. At 5-yr the overall survival was 32%, the disease-specific survival 42% and the locoregional control 61%. In patients treated with radiotherapy alone the disease-specific survival was 39%, for surgery and radiotherapy 53% and for surgery alone 83%. The disease-specific survival according to UICC'92 stage was 71% in stage I, 59% in II, 50% in III and 32% in stage IV (P < 0.0001). In the revised staging the survival figures were 63% in stage I, 43% in II, 31% in III and 9% in IV (P < 0.0001). The two staging systems appeared to be comparable in prognostic discrimination; the clinical relevance of the revised stage might, however, be slightly superior to the UICC'92 version. The difference in results after radiotherapy alone and surgery + radiotherapy remained significant, also after adjusting for stage (P < 0.0001).

Carcinoma↗
PubMed1996

Management of cervical metastases in supraglottic cancer.

A retrospective review of patients from 1979 to 1988 was performed to assess the efficacy of neck dissection, prognostic factors, and the philosophy of treatment of the neck in supraglottic cancer. Of the 89 patients available for analysis, 26 were managed by horizontal partial laryngectomy (HPL), 44 by primary radiotherapy (RT), and 19 by total laryngectomy (TL). A total of 41 patients from the group had 63 neck dissections (NDs); 22 had bilateral and 19 unilateral dissections. A correlation of the pN with N staging revealed that when presenting with N2a nodes (> 3 cm), one third had contralateral metastases, and with N2b (multiple), 100% had contralateral metastases. In multivariate analysis of the disease-free interval, age and staging emerged as independent prognostic variables. Although we observed no increased morbidity by dissecting the opposite side, our results did not support routine bilateral neck dissection in NO patients. However, when the nodes are larger than 3 cm, or ipsilateral and multiple, bilateral neck dissection is recommended.

Carcinoma, Squamous Cell↗
PubMed1995

The importance of correct stage grouping in oncology. Results of a nationwide study of oropharyngeal carcinoma in The Netherlands.

BACKGROUND: In the frame of a nationwide study of oropharyngeal carcinoma in the Netherlands (1986-1990), the current International Union Against Cancer 1992/American Joint Committee on Cancer 1988 staging system was evaluated with respect to patient distribution and prognostic value. METHODS: Data related to epidemiology, treatment and survival from 640 patients referred for primary treatment were analyzed. Staging was first evaluated in a proportional-hazard regression analysis controlled for these data. Next, all possible combinations of T, N, and M were tested in a stepwise backward elimination model until all remaining indicator variables had a P value of less than 0.05. New stages were defined, based on the coefficients of the remaining indicator variables. RESULTS: The revised stages revealed two advantages compared with the UICC 1992/AJCC 1988 version: a more balanced distribution of patients (31% in Stage I, 31% in Stage II, 18% in Stage III, 14% in Stage IV, and 5% unknown in the revised staging system versus 7% in Stage I, 17% in Stage II, 24% in Stage III, 50% in Stage IV, and 2% unknown in the UICC 1992/AJCC 1988 staging system), and an improved prognostic discrimination for the disease specific survival (5-year results in the revised staging were 67% in Stage I, 42% in Stage II, 28% in Stage III, and 11% in Stage IV, versus 68% in Stage I, 64% in Stage II, 44% in Stage III and 27% in Stage IV in UICC 1992/AJCC 1988). CONCLUSION: Improvements in the current staging system in patient distribution in the stages in prognostic discrimination is feasible by regrouping the T, N, and M but without redefining the categories themselves.

Adult↗
PubMed1995

A nationwide study of the epidemiology, treatment and survival of oropharyngeal carcinoma in The Netherlands.

Seven head and neck oncology cooperative groups in the Netherlands have reviewed the epidemiology, staging, treatment and survival of oropharyngeal carcinoma patients treated between 1986 and 1990. In all, 640 patients with squamous cell carcinoma (628, 98%) or undifferentiated carcinoma (12, 2%) referred for primary treatment were analyzed. The total group included 441 males (69%) and 199 females (31%), with a median age of 59 years (range, 30-92). Tumor distribution by subsite was the tonsillar region (372 patients, 58%), base of the tongue/vallecula (179, 28%), soft palate/uvula (62, 10%) and posterior oropharyngeal wall (27, 4%). Forty-four patients (7%) had stage I disease, 106 (17%) had stage II disease, 157 (24%) stage III, and 319 (50%) stage IV. Staging was unknown in 14 patients (2%). Radiotherapy was given to the primary tumor in 408 patients (64%), surgery and radiotherapy to 147 (23%), surgery alone to 42 (7%), other treatments to 14 (2%) and no treatment to 29 patients (4%). The 5-year overall survival was 28% and the 5-year disease-specific survival was 41%. This latter survival was 35% in males and 51% in females (P = 0.003). Five-year survival by subsite was 54% in the soft palate/uvula, 42% in the tonsillar region, 33% in the base of the tongue and 32% in the posterior oropharyngeal wall (P = 0.003). When analyzing survival by stage, 5-year survival in patients with stage I disease was 68% and decreased significantly to 27% in stage IV disease (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Report of a symposium on diagnosis and treatment of adult soft tissue sarcomas in the head and neck.

A series of presentations and discussions was held during a symposium on the diagnosis and treatment of adult soft tissue sarcomas in the head and neck (HNSTS). The purpose of this meeting was to define guidelines on diagnosis and treatment of HNSTS. The results of this symposium are summarized and condensed in this report. Recommendations are made for diagnostic strategies and for treatment. Diagnostic efforts in PET scanning and dynamic MRI need to be expanded to detect early recurrences. Firm pathological diagnosis remains the basis for further treatment strategy. Wide surgical excision, if feasible, in combination with radiotherapy is the treatment of choice.

Adult↗
PubMed1995

Soft tissue sarcomas of the head and neck associated with surgical trauma.

Soft tissue sarcomas in the head and neck are rare. Aetiological factors relating to these tumours have not yet been identified. The association with von Recklinghausen's disease and with irradiation is however well recognized. In the literature it has been speculated that trauma may also play a role in the development of soft tissue sarcomas. In this article we present five patients with a history of surgical trauma at the site where a sarcoma later developed. Although we cannot prove a causal relationship, the relatively high incidence of possibly trauma-related soft tissue sarcomas in a series of 60 patients we have seen over a 30-year period, suggests that such a relationship could exist.

Aged↗
PubMed1995

Radiation-induced tumours of the head and neck.

In order to study the induction of malignancy in normal tissues due to ionizing radiation, we reviewed the files of 2500 patients with a tumour of the head and neck treated at the Netherlands Cancer Institute (Antoni van Leeuwenhoek Ziekenhuis), Amsterdam, from 1977 to 1993. We then checked whether or not these patients had been previously irradiated. Patients with a thyroid carcinoma or skin cancer were excluded from the study, since it is generally known that previous irradiation is a risk factor in these tumours. Eighteen patients were found to have a malignancy within a previously irradiated area (0.70 per cent). The mean interval between radiation and diagnosis of the head and neck tumour was 36.5 years. There were five soft tissue sarcomas, nine squamous cell carcinomas and four salivary gland tumours. Fourteen patients were operated upon whereas four received palliative treatment only. The median survival of the total group was 3.5 years. Particularly, in young patients because of the better cancer therapy and prolonged survival one must be aware of the increased risk of radiation-induced tumours.

Adenoma, Pleomorphic↗
PubMed1995

Management of carotid artery exposure with pectoralis major myofascial flap transfer and split-thickness skin coverage.

The risk for post-operative exposure of the carotid artery due to skin flap necrosis after major head and neck surgery is increased after previous radiation and in severely malnourished patients. Eight patients are described who presented with an (imminent) carotid exposure one to eight weeks after surgery. Pectoralis major myofascial flap transfer with split thickness skin graft coverage was used for protection of the carotid artery. All cases were managed successfully and healed primarily in two to four weeks with acceptable cosmesis. We advocate immediate treatment in the event of an exposed carotid (or imminent exposure) by a pectoralis major myofascial flap with split-thickness skin grafting.

Adult↗
PubMed1995

Fibromatosis of the head and neck.

Fibromatosis is a locally infiltrative fibrous tissue proliferation with a tendency to recur locally. From a large series of head and neck patients treated between 1977 and 1994 in our institute, we retrieved the records of nine adult patients diagnosed with this disease. They serve as examples to demonstrate this rare entity in the head and neck. Five out of nine lesions were localized in level V (posterior triangle of the neck). The majority of patients were treated by surgery in combination with radiotherapy. None of the patients died of the disease.

Adult↗
PubMed1995

Heat and moisture exchangers as a treatment option in the post-operative rehabilitation of laryngectomized patients.

A multi-institutional, prospective clinical study was undertaken to investigate whether the use of a heat and moisture exchanger (HME) in the period following total laryngectomy could prevent the development or reduce the severity of respiratory symptoms. Fifty-nine patients from three hospitals were provided with HMEs, either immediately post-surgery or, in the case of post-surgical radiotherapy, upon completion of the radiotherapy. For the total sample (n = 59) statistically significant improvements over time (between 3 and 6 months) could be found in forced expectoration (P < 0.05), in the perceived voice quality (P < 0.001), social anxiety (P < 0.001), social interactions (P < 0.001) and in feelings of anxiety and depression (P < 0.05). Repeated measures analysis of variance indicated statistically significant group differences over time in forced expectoration and stoma cleaning (P < 0.05). No statistically significant differences over time were noted between the regular and non(regular) HME user groups in voice quality or in various aspects of daily living.

Humans↗
PubMed1995

Long-term pulmonary function after total laryngectomy.

In 58 laryngectomized patients pulmonary function tests were performed during a routine visit to the outpatient clinic. The assessment of pulmonary function with an extratracheal device could easily and reliably be accomplished in all instances. The results show that in long-term follow-up post-laryngectomy expiratory lung function values are significantly lower than predicted. Of the various subjective respiratory complaints, only a higher frequency of coughing was statistically significantly associated with decreased lung function values (P < 0.01). Neither time since surgery (> 1 year vs < 1 year), nor radiation therapy seemed to be correlated with the pulmonary function outcomes. In contrast, the age of the patient did have a significant influence. Although an age-related decline in pulmonary function is a well documented phenomenon, an additional adverse effect was suggested by the present series in the group who was over 65 years of age. Bronchodilator treatment was found to significantly ameliorate several pulmonary function parameters in a sub-group of 18 patients. It may be concluded, that after total laryngectomy significant abnormalities in pulmonary function have to be anticipated. We have found that these disturbances seem to be more pronounced with increasing age.

Age Factors↗
PubMed1995

Carcinoma of the pyriform sinus: a retrospective analysis of treatment results over a 20-year period.

One hundred and one patients with pyriform sinus carcinoma treated at the Netherlands Cancer Institute were studied retrospectively. The patients were staged according to the UICC criteria of 1987: there were no stage I, 23 stage II, 30 stage III, and 48 stage IV patients. The treatment consisted of radiotherapy (n = 45), a planned combination of surgery and post-operative radiotherapy (n = 47) or surgery alone (n = 9). The crude 5-year survival was 27%, whereas the 5-year disease-free survival was 37%. The locoregional disease-free survival was 52%. Stage according to the UICC 1987 criteria is an important prognostic variable (P = 0.0026). Furthermore, significantly less locoregional recurrences and a better disease-free survival were seen in the combined surgery and radiotherapy group than in the exclusively irradiated group (P < 0.0001).

Adult↗