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Biomedical subjects

G L Beets

Publications and source records attributed to G L Beets.

At least 19 recordsLinked to original sources
PubMed2004

A needle-localised open-breast biopsy for nonpalpable breast lesions should not be performed for diagnosis.

BACKGROUND: The achievement of tumour-free margins on excision of nonpalpable breast lesions that have aroused only an intermediate or low level of suspicion before surgery and do turn out to be malignant is a challenge for the surgeon. The purpose of this study was to determine factors that influence the probability of obtaining tumour-free margins after needle-localised excision of a nonpalpable breast carcinoma. METHOD: During a 10-year period all needle-localised breast biopsies (NLBB) carried out in the Department of Surgery were retrospectively analysed. Possible influential factors considered included: age of the patient, year of NLBB, appearance of the lesion on imaging, preoperative diagnostic index, method of localisation, surgeon's level of experience, specimen size and radiology of the specimen, and all these were analysed in a multivariate logistic regression analysis. RESULTS: In all, 400 needle-localised breast biopsies had been performed. Excision with tumour-free margins was more often achieved, and the final intervention less often took the form of a mastectomy, when the lesion was classified preoperatively as malignant (P = 0.02). CONCLUSION: The outcome of treatment of a needle-localised breast cancer excision is better when the breast lesion is known to be malignant before surgery.

Adult↗
PubMed2003

[The 'Inguinal Hernia' guideline of the Association of Surgeons of the Netherlands].

The 'Inguinal hernia' guideline was written over a period of two years by nine surgeons (including one epidemiologist) from all regions of the Netherlands with demonstrable clinical and scientific expertise in the area of inguinal surgery after a training course on 'The development of evidence-based guidelines'. A draft of the guideline was on the website of the Association of Surgeons of the Netherlands for a period of three months, during which time the members of the society could comment on its contents interactively. The guideline comprises chapters on risk factors and prevention, diagnostics, indications for treatment, treatment, day surgery, antibiotics, thrombosis prophylaxis, training, anaesthesia, postoperative pain control, complications, costs, aftercare, and specific aspects of inguinal hernia in children. For the treatment of adult patients a mesh technique is recommended. The Lichtenstein technique is recommended as the first choice for uncomplicated primary inguinal hernia. Laparo-endoscopic techniques can be used by trained teams for specific indications. Other techniques have not been compared with the current methods of treatment sufficiently. It is recommended that the operations be carried out in daycare and that the use of local anaesthesia should be considered more often. The diagnosis of inguinal hernia in a child is based on the physical examination. It is recommended that the surgeon should not rely solely on the history but confirm the presence of a hernia personally. The treatment of a paediatric inguinal hernia is always operative. Generally, the younger the child, the more urgent the operation because of the increased risk of incarceration in infants, particularly premature babies. There is no indication for routine exploration of the contralateral groin. If an incarcerated hernia cannot be reduced, emergency operation is necessary and referral to a paediatric surgical centre must be considered. The implementation and effectiveness of the guideline will be measured by taking an inventory of all inguinal hernia operations performed in the Netherlands before and after its publication.

Adult↗
PubMed2003

Rectal cancer: how accurate can imaging predict the T stage and the circumferential resection margin?

BACKGROUND: One of the concerns after rectal cancer surgery is the local recurrence rate. Randomized trials have shown that the best local control rate for rectal cancer patients overall is obtained by a short preoperative course of radiotherapy followed by a total mesorectal excision, but there are however subgroups of rectal cancer patients with varying risks of recurrences. DISCUSSION: At one end of the continuum are patients with stage I disease who are at very low risk of local recurrence. At the other end are the patients with locally advanced tumor who are at very high risk, and who would benefit from a more extensive neoadjuvant treatment schedule. This kind of differentiated treatment can be performed only when there is an accurate tool to identify preoperatively the different risk groups. There is recent evidence, suggesting that MRI can serve for this purpose, because it accurately predicts the tumor free circumferential resection margin at TME. CONCLUSION: This article provides a literature review of the value of preoperative imaging in rectal cancer surgery.

Endosonography↗
PubMed2003

Interexamination variation of whole breast ultrasound.

The purpose of this study was to determine the interexamination agreement of ultrasound of the breasts. This includes the complete process of performing whole breast ultrasound and interpreting the dynamic scanning and the static images by one person. In a prospective study, 58 patients with a clinical indication for mammography underwent an ultrasound examination of both breasts by three independent sonographers. The sonographers had full knowledge of the physical and mammographic findings. Histology and 12 month follow-up were used as the reference standard. Interobserver variability for both mammography and breast ultrasound was measured using linearly weighted kappa statistics. Receiver operator characteristic curves were constructed to compare the diagnostic performance of the observers. The interexamination agreement for the score of the probability of malignancy after mammography was substantial (kappas ranged from 0.63 to 0.65). The interexamination agreement for the final score of the probability of malignancy after mammography and ultrasound examination was slightly better (kappas ranged from 0.72 to 0.75). The area under the receiver operating characteristic curves after mammography and ultrasound examination ranged from 0.97 to 0.98. Ultrasound examination of the whole breast shows a substantial interexamination agreement. Ultrasound examination of the breast adds consistency to mammography and physical examination.

Adolescent↗
PubMed2002

The role of ultrasonography as an adjunct to mammography in the detection of breast cancer. a systematic review.

The aim of this review was to summarise the diagnostic performance of ultrasonography as an adjunct to mammography in the detection of breast cancer and to identify clinical indications. A systematic review was performed of all publications in MEDLINE and EMBASE between 1990 and 2000 on the role of ultrasonography as an adjunct to mammography. 22 studies were included, showing a large variety of indications for ultrasonography and variations in the diagnostic performance of mammography and ultrasonography. There were six studies comparing a combined diagnosis of mammography and ultrasonography together with mammography alone, of which three studies had an increased sensitivity at the cost of a lower specificity. The methods of selecting the study population and interpretation of ultrasonography significantly influenced the diagnostic performance of mammography and ultrasonography relative to each other (P=0.003, P=0.03, respectively). Based on the studies reviewed, little evidence-based support was found to confirm the well recognised value of ultrasonography as an adjunct to mammography in the detection of breast cancer in clinical practice. Furthermore, no clinical indications for additional ultrasonography could be defined. The heterogeneity in the diagnostic performance in these studies may be explained by the methods of patient selection and ultrasonography interpretation, as well as by their poor quality.

Breast Neoplasms↗
PubMed2001

Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery.

BACKGROUND: Incomplete surgical removal of the circumferential tumour spread is believed to be the main cause of local recurrence after resection of rectal cancer. This study assessed the accuracy of magnetic resonance imaging (MRI) with a phased-array coil for preoperative staging and prediction of the distance of the tumour from the circumferential resection margin in a total mesorectal excision. METHODS: 76 patients with primary rectal cancer were preoperatively assessed by MRI at 1.5 T, with a phased-array coil. Two observers independently scored, on two occasions, the tumour stage and measured the distance to the mesorectal fascia. Their findings were compared with the final histological findings. FINDINGS: The MRI tumour stage agreed with the histological stage in 63 (83%) of 76 patients (weighted kappa=0.77 [95% CI 0.66-0.89]) for observer 1, and in 51 (67%) patients (weighted kappa=0.52 [0.37-0.67]) for observer 2. The intraobserver agreement on the tumour stage was good (kappa=0.80 [0.69-0.91]) for observer 1 but moderate (kappa=0.49 [0.34-0.65]) for observer 2. The interobserver agreement was moderate (kappa=0.53 [0.38-0.69]). In 12 patients with an obvious T4 tumour, a margin of 0 mm was correctly predicted. Of 29 patients for whom the pathologist reported a distance of at least 10 mm without specifying the actual distance, a distance of at least 10 mm was predicted in 28 by observer 1 and 27 by observer 2. For the remaining 35 patients, a regression curve was constructed; from this, a histological distance of at least 1.0 mm can be predicted with high confidence when the measured distance on MRI is at least 5.0 mm. INTERPRETATION: MRI with a phased-array coil showed moderate accuracy and reproducibility for predicting the tumour stage of rectal cancers. The clinically more important circumferential resection margin can, however, be predicted with high accuracy and consistency, allowing preoperative identification of patients at risk of recurrence who will benefit from preoperative radiotherapy, more extensive surgery, or both.

Adult↗
PubMed2001

Preoperative MR imaging of anal fistulas: Does it really help the surgeon?

PURPOSE: To evaluate the accuracy of magnetic resonance (MR) imaging with a quadrature phased-array coil for the detection of anal fistulas and to evaluate the additional clinical value of preoperative MR imaging, as compared with surgery alone. MATERIALS AND METHODS: Fifty-six patients with anal fistulas underwent high-spatial-resolution MR imaging. Twenty-four had a primary fistula; 17, a recurrent fistula; and 15, a fistula associated with Crohn disease. MR imaging findings were withheld from the surgeon until surgery ended and verified, and surgery continued when required. RESULTS: MR imaging provided important additional information in 12 (21%) of 56 patients. In patients with Crohn disease, the benefit was 40% (six of 15); in patients with recurrent fistulas, 24% (four of 17); and in patients with primary fistulas, 8% (two of 24). The difference between patients with or without Crohn disease and between patients with a simple fistula versus the rest was significant (P <.05). The sensitivity and specificity for detecting fistula tracks were 100% and 86%, respectively; abscesses, 96% and 97%, respectively; horseshoe fistulas, 100% and 100%, respectively; and internal openings, 96% and 90%, respectively. CONCLUSION: High-spatial-resolution MR imaging is accurate for detecting anal fistulas. It provides important additional information in patients with Crohn disease-related and recurrent anal fistulas and is recommended in their preoperative work-up.

Adolescent↗
PubMed2001

Measurement of anal sphincter muscles: endoanal US, endoanal MR imaging, or phased-array MR imaging? A study with healthy volunteers.

PURPOSE: To compare endoanal ultrasonography (US), endoanal magnetic resonance (MR) imaging, and phased-array MR imaging for anal sphincter muscle measurement. MATERIALS AND METHODS: Sixty healthy volunteers underwent 1.5-T phased-array MR, endoanal MR, and endoanal US examinations. Sphincter muscle thicknesses were measured. Measurement reliability was analyzed, and correlations among the imaging methods were calculated. Multivariate analysis was performed to assess the influence of age, weight, height, sex, parity, and obstetric trauma on sphincter dimensions. RESULTS: Both MR methods had good reliability for measurements of all sphincter components, whereas endoanal US was reliable for internal sphincter measurement only. There was little correlation between the techniques, except between the two MR techniques, with a strong correlation for total sphincter and perineal body thickness. The internal sphincter thickened significantly (P =.002) with age at endoanal US and endoanal MR imaging but not at phased-array MR imaging. There were small sex-based differences in sphincter muscle measurements at phased-array MR imaging only. CONCLUSION: Endoanal US enables reliable measurement of only internal sphincter thickness, whereas both MR imaging methods enable reliable measurement of all sphincter components. Sphincter measurement with phased-array MR imaging is as reliable as that with endoanal MR imaging.

Adult↗
PubMed1999

Pseudomyxoma peritonei in the pleural cavity: report of a case.

PURPOSE: Pseudomyxoma peritonei is a rare disease characterized by mucinous ascites and associated with ruptured mucocele, cystadenoma, and low-grade carcinoma arising from the appendix, ovaries, or colon. Metastases and extraperitoneal involvement are extremely rare events. METHOD: This is a case report of a patient with pseudomyxoma peritonei with pleural involvement. RESULTS: A 38-year-old male patient with a pseudomyxoma peritonei from appendiceal origin underwent an extensive cytoreduction procedure. During the operation pleural involvement was noted. This was later confirmed by thoracoscopy. An expectant policy was followed until the patient became symptomatic with progressive disease in the abdomen and both pleural cavities. With systemic chemotherapy (5-fluorouracil and leucovorin), a good clinical response was obtained, and the patient was alive with stable disease 2.5 years after the first diagnosis. CONCLUSIONS: Involvement of the pleural cavity by pseudomyxoma peritonei is rare and carries an unfavorable prognosis. Whenever possible, the same guidelines as for intra-abdominal disease should be followed: extensive cytoreductive procedures with local and/or systemic chemotherapy. In our patient we hope to achieve a prolonged palliation with systemic chemotherapy.

Adult↗
PubMed1999

Open or laparoscopic preperitoneal mesh repair for recurrent inguinal hernia? A randomized controlled trial.

BACKGROUND: Giant prosthetic reinforcement of the visceral sac (GPRVS), an open preperitoneal mesh repair, is a very effective groin hernia repair. Laparoscopic transabdominal preperitoneal repair (TAPP), based on the same principle, is expected to combine low recurrence rates with minimal postoperation morbidity. METHODS: Seventy-nine patients with 93 recurrent and 15 concomitant primary inguinal hernias were randomized between GPRVS (37 patients) and TAPP (42 patients). Operating time, complications, pain, analgesia use, disability period, and recurrences were recorded. RESULTS: Mean operating time was 56 min with GPRVS versus 79 min with TAPP (p < 0. 001). Most complications were minor, except for a pulmonary embolus and an ileus, both after GPRVS. Patients experienced less pain after a laparoscopic repair. Average disability period was 23 days with GPRVS versus 13 days with TAPP (p = 0.03) for work, and 29 versus 21 days, respectively (p = 0.07) for physical activities. Recurrence rates at a mean follow-up of 34 months were 1 in 52 (1.9%) for GPRVS versus 7 in 56 (12.5%) for TAPP (p = 0.04). Hospital costs in U.S. dollars were comparable, with GPRVS at $1,150 and TAPP at $1,179. CONCLUSIONS: Laparoscopic repair of recurrent inguinal hernia has a lower morbidity than GPRVS. However, laparoscopic repair is a difficult operation, and the potential technical failure rate is higher. With regard to recurrence rates, the open preperitoneal prosthetic mesh repair remains the best repair.

Adult↗
PubMed1998

Cost-effectiveness of open versus laparoscopic repair for primary inguinal hernia.

A cost-effectiveness (CE) analysis was performed of Bassini versus laparoscopic repair for primary inguinal hernia. Incremental costs per 1-year recurrence-free patient were calculated for the societal and hospital perspective. From the hospital perspective, the incremental CE ratio of laparoscopic repair is 5.348 guilders. From the societal perspective, laparoscopic repair is both less costly and more effective than Bassini repair. Results were sensitive to assumptions about recurrence rates, laparoscopic operating time, and return to work. Laparoscopic repair should replace Bassini repair in order to benefit society. From the hospital perspective, the decision to accept laparoscopic repair depends on the willingness to pay.

Adult↗
PubMed1998

Bassini repair compared with laparoscopic repair for primary inguinal hernia: a randomised controlled trial.

OBJECTIVE: To compare the effectiveness of open and laparoscopic primary inguinal hernia repair. DESIGN: Randomised controlled trial. SETTING: University hospital, The Netherlands. SUBJECTS: 87 patients had 103 open repairs and 88 patients had 114 laparoscopic repairs between November 1993 and July 1995. INTERVENTIONS: Laparoscopic repair by the transabdominal preperitoneal (TAPP) technique and open repair by the Bassini technique. MAIN OUTCOME MEASURES: Recurrence, morbidity, pain, and duration of convalescence. RESULTS: Operating time was longer for laparoscopy (mean (SD): 82 (28) compared with 45 (15) minutes p < 0.001). Patients in the Bassini group had higher postoperative pain scores (mean (SD)VAS: 2.9 (1.6) compared with 2.0 (1.6) p=0.002), used more analgesics (median total intake: 2 (0-54) compared with 0 tablets (0-42) p=0.008), and needed a longer convalescence time (mean (SD) time to return to work: 22 (12.6) compared with 14 (10.1) days p < 0.001; mean (SD) time to return to physical activities: 27 (12.6) compared with 17 (12.2) days p < 0.001). Mean follow up was 24 months. Recurrence rates were 21% (22/ 103) after Bassini and 6% (7/114) after laparoscopic repair (p=0.001). CONCLUSION: Laparoscopic hernia repair is a safe operation, which has obvious advantages over the Bassini repair in terms of pain, use of analgesic drugs, resumption of activities, and recurrence. A disadvantage of the laparoscopic repair is the longer operating time.

Analgesics↗
PubMed1997

[Pseudomyxoma peritonei].

Pseudomyxoma peritonei was diagnosed in 3 men aged 38, 66 and 54 years with weight loss and distension of the abdomen. Pseudomyxoma peritonei results from seeding of the peritoneal cavity with mucus-producing epithelium. The disease is traditionally characterized by accumulation of huge amounts of mucinous ascites, relatively long survival and absence of distant, extraperitoneal metastases. Mostly, the primary tumour is an appendicular adenoma or adenocarcinoma. Sometimes, the primary tumor is localized in the ovaries. Extensive surgical debulking with postoperative intraperitoneal chemotherapy appears to be the treatment of choice.

Adult↗
PubMed1997

Longterm followup (12-15 years) of a randomized controlled trial comparing Bassini-Stetten, Shouldice, and high ligation with narrowing of the internal ring for primary inguinal hernia repair.

BACKGROUND: Shouldice repair for primary inguinal hernia is reported to have better results than classic Bassini-type repairs. The indirect inguinal hernia with a firm posterior wall is often assumed to be adequately treated by high ligation and ring narrowing. STUDY DESIGN: This double randomized controlled trial compared high ligation and ring narrowing with Bassini-Stetten repair for the indirect inguinal hernia with a firm posterior wall, and Shouldice with Bassini-Stetten repair for the inguinal hernia with a weakened posterior wall, direct or indirect. This report focuses on longterm (12-15 years) recurrence rates. RESULTS: From July 1980 to May 1983, 102 indirect primary inguinal hernias with a firm posterior wall (group I) and 263 primary inguinal hernias with a weakened posterior wall (group II) were included. By 1995, 89 patients with 100 hernia repairs had died, and for 30 repairs the patients could not be located. In 41 hernia repairs, a recurrence had been established previously. Of the remaining 194 hernia repairs, followup was updated by physical examination in 179 (92%) and by telephone interview in 15 (8%). A total of 83 recurrences were recorded, 42% of which were asymptomatic at the time of diagnosis. Seventy-three percent of the recurrences happened > 2 years after the operation. The life-table method showed the following longterm (12-15 years) recurrence rates: group I, Bassini-Stetten 33% versus ring narrowing 34%; group II, Bassini-Stetten 32% versus Shouldice 15% (p = 0.033). CONCLUSIONS: The Shouldice is the best type of hernia repair, although the 15% recurrence rate is high. Bassini-Stetten and high ligation with ring narrowing are inadequate repairs, regardless of the type of hernia.

Aged↗
PubMed1996

Long-term results of giant prosthetic reinforcement of the visceral sac for complex recurrent inguinal hernia.

The results of recurrent inguinal hernia repair in a prospective cohort study were evaluated. From May 1986 to December 1990 75 patients with 150 hernias (24 primary, 126 recurrent) were operated using a technique based on Stoppa's preperitoneal mesh repair (giant prosthetic reinforcement of the visceral sac; GPRVS). All patients were at high risk for recurrence: they all had bilateral hernias, mostly bilateral recurrent and often repeatedly recurrent. All patients had a physical examination 1 week, 6 weeks and 1 year after operation. Sixty patients (94 per cent of surviving patients) had a physical examination after a mean follow-up of 5.7 (range 4-9) years. There were no major complications. There was one deep infection that healed without removing the mesh. One of the 75 patients (1 per cent) had a recurrence 2 months after the operation, due to a technical failure. Because of the excellent results, the ease of the procedure and the low complication rate, GPRVS is the authors' operation of choice for any recurrent inguinal hernia.

Aged↗
PubMed1996

Foreign body reactions to monofilament and braided polypropylene mesh used as preperitoneal implants in pigs.

OBJECTIVES: To compare the foreign body reaction of the monofilament polypropylene (Prolene) mesh, and the multifilament Surgipro mesh. Both types of mesh are widely used in laparoscopic inguinal hernia repair. DESIGN: Prospective experimental study. SETTING: University hospital, The Netherlands. MATERIAL: Six female Yorkshire & Dutch landway pigs. INTERVENTION: Laparoscopic transabdominal implantation of six Surgipro meshes and six Prolene meshes in 12 inguinal sites. MAIN OUTCOME MEASURES: At 3, 6, and 12 weeks after implantation the foreign body reaction was measured by counting multinucleated giant cells at the mesh-tissue interface. RESULTS: At all times the numbers of multinucleated giant cells at the mesh tissue interface were significantly larger with Surgipro than with Prolene (p < 0.001). CONCLUSIONS: There is significantly more foreign body reaction after implantation of Surgipro than Prolene mesh.

Animals↗