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Biomedical subjects

I H Borel Rinkes

Publications and source records attributed to I H Borel Rinkes.

At least 19 recordsLinked to original sources
PubMed2001

[Diagnostics in clinically occult, radiologically suspect breast lesions more often surgery than needle diagnostics with image monitoring].

OBJECTIVE: To inventory the diagnostic methods used in patients with clinically occult, radiologically suspect breast lesions. DESIGN: Enquiry. METHOD: The departments of radiology of all Dutch hospitals were sent a list in January 2000 containing questions concerning the number of thread localizations in 1999 and the use of cytological or histological needle diagnostics with image monitoring prior to surgical intervention in clinically occult, radiologically suspect breast lesions. Of the 120 questionnaires mailed, 74 (62%) were completed and returned by clinics throughout the country. RESULTS: Fifty-one of the 74 hospitals (69%) had prior to operation carried out histological or cytological examinations and in these 51 hospitals this was done in 1743 of the 2857 lesions (61%): fine-needle aspiration cytology was performed in 1046 (/1743 = 60%; /4140 lesions in all 74 hospitals = 25%) and/or histological needle biopsy in 784 (45%; /4140 = 19%). CONCLUSION: In less than half of all non-palpable breast abnormalities non-surgical methods of diagnosis are used, histological needle biopsy less often than fine needle aspiration cytology.

Biopsy↗
PubMed2001

Cost comparison between stereotactic large-core-needle biopsy versus surgical excision biopsy in The Netherlands.

Yearly, approximately 7200 Dutch women with non-palpable breast lesions are referred for a diagnostic surgical excision biopsy. Recently, less invasive alternatives such as stereotactic large-core-needle biopsy have emerged. The aim of this study was to compare the costs of surgical excision biopsy and large-core-needle biopsy. As stereotactic equipment is expensive, the costs of large-core-needle biopsy depend on the extent of centralisation of this facility. Therefore, we assessed the extent of economies of scale in four different scenarios of (de)centralisation. We collected cost data in five Dutch hospitals. The cost of surgical excision biopsy amounted to 1184 Euros. In cases where large-core-needle biopsy would be employed decentralised in all 114 hospitals in The Netherlands, the average costs were estimated to be 1186 Euros compared with 572 Euros in a centralised scenario with involvement of 10 hospitals. Therefore, centralisation of stereotactic equipment for core-needle biopsies would be advisable from an economic perspective.

Biopsy↗
PubMed2001

Major liver resection results in a changed plasma amino acid pattern as reflected by a decreased Fischer ratio which improves by bactericidal/permeability increasing protein.

BACKGROUND/AIMS: Major liver resection results in a high morbidity and mortality, and endotoxin plays a role in post-resection hepatic failure. Severe hepatic failure as seen in hepatitis and cirrhosis may be accompanied by hepatic encephalopathy and is characterized by a typical plasma amino acid pattern reflected by a decreased Fischer ratio. This study was performed to evaluate the plasma amino acid pattern in patients undergoing major liver surgery receiving placebo or the endotoxin-neutralizing agent bactericidal/permeability-increasing protein (rBPI21). PATIENTS AND METHODS: Forty-eight patients were randomized in this phase II, dose escalation, multicenter trial. Plasma amino acid profiles were determined preoperatively, and on the first (day 1) and third (day 3) postoperative day. RESULTS: In the placebo group the Fischer ratio decreased significantly on both postoperative days. Administration of rBPI21 also resulted in a decreased Fischer ratio on day 1, but not on day 3. Highly elevated alanine plasma levels were observed on day 1 in placebo-treated patients, whereas rBPI21 prevented this elevation. Plasma alanine levels on day 1 correlated with the duration of post-resection hepatic failure. CONCLUSIONS: Major liver resection results in a decreased Fischer ratio and a rise in plasma alanine levels. Plasma levels of alanine on the first postoperative day correlated with the duration of the post-resection hepatic failure. rBPI21 improved the Fischer ratio and prevented the rise of plasma alanine levels.

Adult↗
PubMed2001

Impact of stereotactic large-core needle biopsy on diagnosis and surgical treatment of nonpalpable breast cancer.

INTRODUCTION: Stereotactic large-core needle biopsy is increasingly replacing needle-localized breast biopsy for the diagnosis of nonpalpable breast disease. In this prospective study, the impact of the introduction of this technique on diagnosis and surgical treatment of nonpalpable breast cancer was assessed in two hospitals in The Netherlands. PATIENTS AND METHODS: A total of 84 patients with nonpalpable breast cancer, diagnosed by means of stereotactic large-core needle biopsy (needle biopsy group) were compared with 80 patients diagnosed with nonpalpable breast cancer before the introduction of large-core needle biopsy. These patients were diagnosed by means of needle-localized open breast biopsy (control group). Clinical outcome measures evaluated included: duration of diagnostic and therapeutic intervals and number of surgical procedures required for complete surgical treatment. Subgroup analysis was performed for the category of microcalcifications without tissue distortion. RESULTS: For the needle biopsy group, the median interval between initial referral to the surgeon and the availability of histological diagnosis was 9 days and the interval between initial referral and complete surgical treatment was 31 days. These intervals were significantly longer for the control group (19 days and 44 days respectively); 75% of patients in the needle biopsy group were treated in a single step surgical procedure compared to 16% of the patients in the control group (67 vs 25% respectively for the subgroup). The mean number of surgical procedures required to complete surgical treatment was 1.31 for needle biopsy group vs 1.91 for the open biopsy group (1.46 vs 1.84 for the subgroup). CONCLUSION: Introduction of stereotactic large-core needle biopsy leads to a reduction of the time to diagnosis and the time to complete surgical treatment of nonpalpable breast cancer. It also reduces the number of surgical procedures required for complete surgical treatment of nonpalpable breast cancer. The benefits of large-core needle biopsy may also be anticipated for patients with microcalcifications without tissue distortion.

Adult↗
PubMed2001

Hepatocyte growth factor and melanoma: gene transfer studies in human melanocytes.

Hepatocyte growth factor (HGF), a fibroblast-derived protein that affects the growth, motility and differentiation of epithelial cells, is a mitogen for human melanocytes and has recently been implicated as an important factor for the development and dissemination of melanomas. To better define the possible role of HGF in the multi-step progression from melanocyte to melanoma cell, we used retrovirus-mediated gene transfer to introduce the gene encoding human HGF into normal human melanocytes, thus causing these cells to produce a growth factor they do not normally express and creating a new autocrine loop as sometimes occurs in melanoma cells. Cells were transduced with an efficiency of 6%, and the modified cells synthesized and secreted significant levels of HGF (6.6 ng/10(7) cells per 24 h) in vitro. Cells expressing HGF had a higher rate of proliferation when compared with unmodified cells and formed large, dense, melanin-positive colonies on a plastic surface. Immunostaining showed HGF-positive melanocytes with varying levels of expression, and HGF protein was detected throughout the whole cell. Although proliferation of HGF-expressing melanocytes was enhanced, they failed to form colonies in a soft agar assay. These results suggest that expression of HGF, by virtue of its ability to enhance proliferation and cell clustering, may play a role in the multi-step process of transformation, but an autocrine signal of HGF alone is not sufficient for malignant transformation.

Cell Differentiation↗
PubMed2001

Coagulopathy following major liver resection: the effect of rBPI21 and the role of decreased synthesis of regulating proteins by the liver.

This prospective study investigated the role of reduced hepatic synthesis of regulating proteins in coagulopathy after partial hepatectomy (PH) compared with major abdominal surgery (MAS) without involvement of the liver. Furthermore, we studied the effect of rBPI21, an endotoxin-neutralizing agent, on coagulopathy after PH was studied. Compared with MAS, PH resulted in significantly elevated levels of thrombin-antithrombin-III and plasmin-alpha2-antiplasmin complexes. Levels of antithrombin-3, alpha2-antiplasmin, fibrinogen, plasminogen, alpha2-macroglobulin (alpha2-M), and C1-inhibitor remained lower following PH. Treatment with rBPI21 led to significantly lower levels of tissue-type plasminogen activator (t-PA). Post-operative disseminated intravascular coagulation (DIC) was associated with significantly higher bilirubin and t-PA plasma levels and significantly lower levels of alpha2-M. This study indicates that PH induced hepatic failure results in decreased synthesis of hepatic regulating plasma proteins and subsequent activation of coagulation and fibrinolysis. Prevention of t-PA release by rBPI21 may have important clinical implications. Decreased availability of alpha2-M may be a factor in post-operative DIC.

Abdomen↗
PubMed2001

Risk factors for cancellation of stereotactic large core needle biopsy on a prone biopsy table.

Among patients undergoing stereotactic needle biopsy of the breast on a prone biopsy table, a substantial proportion of planned procedures are terminated prematurely. This study was undertaken to identify risk factors for cancellation of these procedures and to derive a clinical rule for predicting cancellation. Risk factors for cancellation were assessed in a group of 476 consecutive patients with non-palpable lesions planned for large core needle biopsy. 64 (13%) of these planned procedures were cancelled. Multivariate regression analysis was applied to identify independent risk factors for cancellation. Validation took place by applying the logistic rule on a validation set, including 5 cancelled and 35 successful biopsy procedures. Mammograms that were difficult to interpret owing to extremely dense breast tissue, axillary location of the non-palpable lesion, body mass index below 20, less than 15 mm distance from the lesion to the chest wall or the presence of more than one non-palpable lesion were identified as independent risk factors. The logistic rule discriminated patients with successful and cancelled biopsy procedures with a receiver operator characteristic (ROC) area of 0.72. In the validation set, the area under the ROC curve was 0.92. The prediction rule, based on mammographic and clinical findings, discriminated patients with successful and cancelled needle biopsy procedures to a certain extent. The risk of cancellation of the stereotacic biopsy procedure is considerable in cases of very dense breast tissue or the presence of multiple risk factors.

Biopsy, Needle↗
PubMed2001

Peroperative measurement of PTH in the management of primary hyperparathyroidism.

UNLABELLED: This study was performed to prospectively evaluate the efficacy of a newly developed, non-expensive and non-commercial perioperative PTH-assay as indicator of successful surgery in minimally invasive adenomectomy (MIA) for primary hyperparathyroidism (pHPT). METHODS: A chemoluminescence-based PTH-assay was modified to significantly shorten the incubation time, producing results in a total of 45-60 minutes. Its reliability was tested in 19 patients undergoing MIA for pHPT. Patients were selected for MIA based on preoperative imaging including ultrasound and CT. After verification of its reliability, the PTH assay was incorporated into our treatment protocol and its results registered and correlated with serum calcium levels and surgical outcome. RESULTS: The PTH assay was found to fully correlate with the current gold standard, i.e. serum calcium levels on the first postoperative day after MIA. It was subsequently used in 55 patients selected for MIA, as well as in 26 patients undergoing conventional neck exploration (CNE). In all cases it correctly indicated surgical failure/success. The conventional re-exploration that was required in 3 patients after unsuccessful MIA, was also correctly interpreted on the basis of the PTH-assay. In 2 cases an unexpected delay was encountered in the decline of PTH-levels following adenomectomy. CONCLUSION: The perioperative PTH-assay described is a reliable, inexpensive, and relatively fast predictor of surgical outcome, and should be considered essential for minimally invasive surgery in patients with pHPT.

Adult↗
PubMed2001

Angiostatin inhibits pathological but not physiological retinal angiogenesis.

PURPOSE: Antiangiogenic treatment is a promising new therapy for angiogenesis-dependent diseases. In the current study, the biologic effects on pathologic and physiological angiogenesis in the retina of angiostatin, a very potent angiogenesis inhibitor were determined. In addition, the effects of angiostatin on the growth and development of newborn mice were examined. METHODS: Oxygen-induced retinopathy was induced by subjecting mice postnatal day (P)7 to hyperoxic conditions (5 days) followed by normoxic conditions (relative hypoxia). Mice were treated with angiostatin (intravitreal or systemic). Retinal blood vessels were visualized by fluorescein angiography. Retinal neovascularization was assessed by counting intravitreal endothelial cell nuclei. Growth and organogenesis were determined between P0 and P14. RESULTS: Relative hypoxia resulted in intravitreal proliferation of retinal blood vessels. However, proliferation was inhibited completely by systemic administration of angiostatin without affecting normal retinal vascularization. After intravitreal injection of angiostatin, pathologic proliferation of the retinal blood vessels was impaired by 62%. Neither systemic nor intravitreal treatment impaired the development or growth of organs throughout the body. CONCLUSIONS: Angiostatin inhibits oxygen-induced intravitreal pathologic retinal angiogenesis without affecting the development of physiological retinal vascularization, development, and growth of newborn mice. Therefore, antiangiogenic treatment may be a useful tool in the treatment of proliferative retinopathies.

Angiostatins↗
PubMed2000

Continuous administration of angiostatin inhibits accelerated growth of colorectal liver metastases after partial hepatectomy.

Human plasminogen-derived angiostatin is one of the most potent antiangiogenic agents currently known. However, it is unclear whether angiostatin is also effective against accelerated tumor growth induced by local up-regulation of growth factors, including angiogenesis stimulators, such as in regenerating liver. Prior to addressing this question, we tested, in mice, whether continuous administration of angiostatin could improve its biological effects. This assumption was based on the relatively short half-life of angiostatin in mice, as well as on the theoretical necessity to suppress tumor-induced angiogenesis continually. The findings presented here clearly indicate continuous administration to be superior to the conventional twice-daily bolus injections. Using the maximally effective regimen of 100 mg/kg/day via s.c. pump infusion, we found angiostatin to not only suppress s.c. primary tumors but also to significantly inhibit the outgrowth of colorectal hepatic metastases in resting liver and even to inhibit accelerated tumor growth in regenerating liver after 70% partial hepatectomy. In conclusion, angiostatin could play an important role in patients subjected to partial hepatectomy to prevent outgrowth of residual micrometastases, provided it is administered continuously to obtain maximal biological effects.

Angiostatins↗
PubMed2000

No effect of nadroparin prophylaxis in the prevention of central venous catheter (CVC)-associated thrombosis in bone marrow transplant recipients.

Complications of CVCs in 382 consecutive patients receiving a stem cell transplantation (SCT) were analysed. Early complications were pneumothorax (3.6%), haematothorax (0.5%), dislocation (3%) and dysfunction (3.6%). Eighty-seven-associated infections (22%) were observed, leading to removal of the CVC in 26 patients. More bacteraemias were associated with double- or triple-lumen CVCs, 19% vs 5% in single lumen CVCs (P < 0.0001). Coagulase-negative staphylococci were the predominant microorganisms in 72%. A special point of investigation was CVC-associated thrombosis and the prophylactic value of nadroparin. Two consecutive regimens with nadroparin were used and compared; 7 days 2850 IE nadroparin and 10 days 5700 IE nadroparin. The incidence of CVC-associated thrombosis was 6.9% in 382 patients with 390 catheters. The incidence was 8% in patients receiving one of the prophylactic nadroparin regimens compared to 6% in a comparable control group without prophylaxis. A short course of nadroparin was unable to prevent thrombotic complications after discontinuation.

Bone Marrow Transplantation↗
PubMed2000

Diagnostic accuracy of needle-localized open breast biopsy for impalpable breast disease.

BACKGROUND: Needle-localized open breast biopsy (NLBB) is considered the gold standard procedure for the diagnosis of impalpable breast disease. In an observational follow-up study the sensitivity and negative predictive value of this procedure was determined in a clinical population with long-term follow-up. METHODS: Some 199 consecutive patients with a benign histological diagnosis on NLBB were followed for the occurrence of breast cancer, using information from the Dutch National Morbid-Anatomical Record Department. Based on a review of mammograms and histological slides, an expert panel decided whether the carcinomas detected during follow-up were newly developed, or were present already at the time of the NLBB. RESULTS: After a median follow-up of 60.5 months, seven carcinomas were detected. At panel review, six appeared to have been missed by NLBB. The sensitivity of NLBB was 99 per cent after 2 years of follow-up, but dropped to 96 per cent after 5 years. Similarly, the negative predictive value dropped from 99 per cent after 2 years to 94 per cent after 5 years of follow-up. CONCLUSION: NLBB is an accurate diagnostic procedure for the evaluation of impalpable breast disease. However, with longer follow-up the accuracy becomes lower than generally reported.

Adult↗
PubMed2000

Diagnostic accuracy of large-core needle biopsy for nonpalpable breast disease: a meta-analysis.

For the evaluation of non-palpable lesions of the breast, image-guided large-core needle biopsies are increasingly replacing needle-localized open breast biopsies. In this study, the diagnostic accuracy of this minimally invasive technique was evaluated by reviewing the available literature. Five cohort studies were included in a meta-analysis. Sensitivity rate, histological agreement between needle biopsy and subsequent surgery or long-term mammographic follow-up and clinical consequences for different disease prevalences were assessed. The sensitivity rate of large-core needle biopsy for the diagnosis of breast cancer was high (97%). The reclassified agreement rate between core biopsy and subsequent surgical biopsy or long-term mammographic follow-up was also high (94%). In case of 20% breast cancer prevalence among women referred after screening (as in the US), the risk of breast cancer despite benign large-core needle biopsy result is less than 1%. In European countries, however, prevalence of breast cancer among referred women is 60-70%. This would result in a risk of breast cancer despite benign large-core needle biopsy result of 4-6%. The results of this meta-analysis indicate that the image guided large-core needle biopsy is a promising alternative for the needle localized breast biopsy. However, additional research is needed to explore the limiting factors of the technique. Without such detailed knowledge, a benign histological diagnosis on large-core needle biopsy in countries with high prevalence of malignancy among referred women should be interpreted with caution.

Biopsy, Needle↗
PubMed2000

Role of intraoperative ultrasound of the liver with improved preoperative hepatic imaging.

OBJECTIVE: To find out whether intraoperative ultrasound (IOUS) of the liver should still be considered a routine procedure for patients having hepatic resections as their preoperative investigation has become so much better with the standard use of triphasic spiral computed tomograms (CT). DESIGN: Retrospective study. SETTING: University medical centre, Utrecht, The Netherlands. PATIENTS: 26 consecutive patients undergoing liver resection. MAIN OUTCOME MEASURES: How much additional information was given by IOUS, and its influence on operative strategy; how IOUS facilitated the hepatic resection. RESULTS: IOUS revealed additional information over triphasic CT in 13/26 patients, which led to a change in the surgical procedure in 4 (15%). For all 4 patients the change in surgical approach proved to be correct as judged by histology and clinical outcome. In 12 patients IOUS facilitated the resection by providing helpful three-dimensional anatomical insight. CONCLUSION: Despite recent improvements in preoperative investigation, IOUS should still be recommended as a routine procedure in patients having hepatic resections. In addition to aiding the ultimate decision about which part to resect, it also gives insight into the hepatic anatomy.

Female↗
PubMed2000

Direct, minimally invasive adenomectomy for primary hyperparathyroidism: An alternative to conventional neck exploration?

OBJECTIVE: To evaluate the feasibility and efficacy of a direct, minimally invasive adenomectomy (MIA) as an alternative to conventional neck exploration (CNE) in patients with primary hyperparathyroidism. SUMMARY BACKGROUND DATA: Because primary hyperparathyroidism is caused by a solitary adenoma in 85% to 90% of patients, a direct adenomectomy through a mini-incision would theoretically suffice whenever an adenoma is correctly localized on preoperative imaging. If effective, a less invasive method could spare the patient an unnecessary bilateral neck exploration, thus saving time and rendering future surgical procedures in the neck less problematic. METHODS: Between October 1994 and October 1998, 110 consecutive patients with biochemically proven primary hyperparathyroidism who were to undergo surgery were enrolled in this study. Ultrasound and spiral CT were routinely performed as standard preoperative imaging modalities in the first series of 65 patients. In the second series of 45 patients, ultrasound was performed as the sole initial modality; it was supplemented by CT only in case of inconclusive test results. If test results were unequivocal (one adenoma), the patient was offered MIA. CNE was performed if the results were equivocal or if multiglandular disease was suspected. RESULTS: Overall, 84 patients were selected for MIA and 26 for CNE. In the first series, 2 MIA procedures (2/51) were converted to CNE because of negative perioperative findings. All 65 procedures resulted in normocalcemia. In the second series, all but five (4/33 MIAs, 1/12 CNEs) resulted in normocalcemia. A reexploration (CNE) was performed in three patients, resulting in normocalcemia after resection of a second or third adenoma. Two patients are still awaiting reexploration. In both series together, 78 of the 110 patients were successfully treated with MIA and spared CNE. CONCLUSION: MIA is a safe and effective alternative to CNE that may replace CNE in approximately two thirds of all patients.

Adenoma↗
PubMed1999

[Peroperative parathyroid hormone assay: assurance of successful surgical treatment of primary hyperparathyroidism].

OBJECTIVE: To study the reliability and applicability of a rapid parathormone (PTH) test as predictor of successful surgical treatment of primary hyperparathyroidism. DESIGN: Prospective. METHOD: All 35 consecutive patients undergoing surgery for primary hyperparathyroidism in the University Hospital Utrecht, the Netherlands, in august 1997-august 1998, were tested just prior to surgery, and immediately following adenomectomy. The rapid PTH test consisted of a modification of the computerized immunometric detection by chemoluminescence. The decrease of serum PTH as estimated with the rapid test was correlated with surgical findings as well as postoperative serum calcium levels. In the first 25 patients (group A) the reliability of the test was investigated. In the next 10 patients (group B) the PTH test results were allowed to have implications for surgical management, i.e. an insufficient (< 50%) decrease of serum PTH following adenomectomy resulted in immediate re-exploration. RESULTS: The 35 patients, 22 women and 13 men, had a median age of 58 years (range: 22-80). The results obtained with our rapid PTH test correlated fully with both conventional PTH measurement techniques and postoperative serum calcium levels. In group A 21/25 patients showed adequate (> 50%) decrease of their serum PTH levels; the 4 patients without such decrease were the ones displaying persistent postoperative hypercalcaemia. In group B 9/10 patients had adequate PTH decrease immediately following adenomectomy, while in one patient this was only attained after further exploration and excision of a second adenoma. No false-positive or false-negative measurements were encountered. CONCLUSION: The rapid PTH test used is a reliable predictor of successful adenomectomy for primary hyperparathyroidism, also in minimally invasive surgery.

Adult↗