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Biomedical subjects

H van Slooten

Publications and source records attributed to H van Slooten.

9 recordsLinked to original sources

Management of an anterior defect with a removable partial denture supported by implants and residual teeth: a case report.

The treatment of a patient with a major defect in the anterior region of the mandible is described. A large part of the anterior dental arch and underlying mandibular bone was involved in the defect. A removable partial denture supported by implants as well as residual teeth was used to restore the defect. Compared with a traditional removable partial denture, which was used by the patient for several years as an interim prosthesis, the application of implants resulted in improved functional comfort and stability.

Adult

Morphologic characteristics of benign and malignant adrenocortical tumors.

Differentiation between benign and malignant tumors of the adrenal cortex was studied by means of seven histologic parameters. Each separate criterion was significantly different in two groups, one consisting of patients without metastases within 10 years after operation and one of patients with metastatic tumors. Discrimination on the basis of single parameters in individual patients, however, was of little value. When a histologic index was calculated using the same parameters but after "weighing," a much better discrimination was obtained. The histologic index and, to a lesser degree, the mitotic activity seems to be related to the survival time of the patients with adrenal cortical carcinoma. The authors conclude that the calculation of a histologic index based on a summation of different parameters makes it possible to differentiate between malignant and benign adrenal cortical tumors. As single parameters, tumor weight and mitotic activity have the highest discriminating value.

Adrenal Cortex Neoplasms

Complete response of metastasized adrenal cortical carcinoma with o,p'-DDD. Case report and literature review.

This study concerns the history of a male patient with hormone-producing adrenal cortical carcinoma. Six months after resection of the primary tumor, lymph node metastases were detected and treatment with o,p'-DDD [1,1 dichloro-2-(o-chlorophenyl)-2-(p-chlorophenyl)ethane] (Lysodren/mitotane) was started. After 2 years, a complete histologically proven response was confirmed at laparotomy and is still sustained 2 years after the discontinuation of treatment. As a consequence of insufficient steroid replacement the patient suffered bouts of adrenal insufficiency. After 1 year of treatment, the measurement of the plasma levels of o,p'-DDD showed an accumulation of the drug. At that time, progressive major central nervous system toxicity occurred, which proved to be reversible on discontinuation of the treatment.

Adrenal Cortex

The treatment of adrenocortical carcinoma with o,p'-DDD: prognostic implications of serum level monitoring.

Thirty-four patients with adrenocortical carcinoma were treated with o,p'-DDD. Twenty-eight patients presented with metastases at entry, and spillage of tumour cells occurred at surgery in 6 other patients. Eight patients had objective tumour regression, of whom 7 had serum levels over 14 micrograms/ml. The 3 patients with a lasting remission had levels of greater than 15, greater than 25, greater than 25 micrograms/ml respectively during prolonged periods. Increased survival times were found in the group of 14 patients with o,p'-DDD serum levels higher than 14 micrograms/ml when compared with patients not treated after discovery of metastases. In the patients with levels less than or equal to 10 micrograms/ml no therapeutic effect was seen. Levels of over 20 micrograms/ml are associated with symptoms of reversible neuromuscular toxicity. Monitoring of serum levels during treatment is mandatory. It is suggested that serum levels of about 25 micrograms/ml during longer periods may be curative.

Adrenal Cortex Neoplasms

CAP (cyclophosphamide, doxorubicin, and cisplatin) regimen in adrenal cortical carcinoma.

Eleven patients with advanced progressive metastatic adrenal cortical carcinoma, for whom no further standard therapy was available, were entered into a phase II study of cyclophosphamide, doxorubicin, and cisplatin (CAP) combination chemotherapy. Two partial responses and six disease stabilizations were observed. Patients with partial responses survived 18+ and 23 months; the median survival of patients with disease stabilization was 10+ months. The total group had a median survival of 10+ months. These results, together with the modest toxicity, suggest that further study of the combination is warranted.

Adolescent

Blood levels of o,p'-DDD following administration in various vehicles after a single dose and during long-term treatment.

Plasma levels of o,p'-DDD were measured after ingestion of a single oral dose. At the onset of therapy o,p'-DDD was administered as commercially available tablets and granules and in milk, chocolate, and an oil emulsion to 9, 12, 14, 10, and 6 patients, respectively. Following administration in chocolate, emulsion, and milk significantly higher mean plasma levels were recorded in the first 5- and 10-h periods than after tablets. Granules gave significantly lower plasma levels than all other forms. Plasma levels were also measured during maintenance therapy, when a total of 200 g o,p'-DDD was administered to 22 patients with adrenocortical carcinoma. The plasma disappearance rate after termination of long-term therapy was found to be between 18 and 159 days. The recovery of o,p'-DDD from faeces was about five times higher after ingestion of tablets than after administration in oil emulsion and milk. As far as the rapid increase in plasma levels and patient compliance are concerned, the best results were obtained with the milk powder mixture.

Administration, Oral