PubMed Health⌕ Search

Biomedical subjects

J B Trimbos

Publications and source records attributed to J B Trimbos.

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

Long-term analysis of peritoneal plasminogen activator activity and adhesion formation after surgical trauma in the rat model.

OBJECTIVE: Recent literature has shown that a common pathway in postsurgical adhesion formation is a transient reduction in local plasminogen activator activity, shortly after peritoneal trauma. This deficit in fibrinolysis permits deposited fibrin to become organized into fibrous, permanent adhesions. Although adhesion formation is a process that continues beyond the first postoperative days, long-term analysis of this theory has not been performed. DESIGN: A standardized peritoneal adhesion model in the rat. MAIN OUTCOME MEASURE(S): Long-term analysis of the peritoneal fibrinolytic activity (extraction technique) was related to the extent of postsurgical adhesion formation, up to 1 year postoperatively. RESULT(S): Total and tissue plasminogen activator activity were significantly increased at days 3 and 8, and 1 month postoperatively. A mean adhesion percentage of 75% per peritoneal defect was found to persist throughout all evaluation times, which was directly related to the increase of fibrinolysis. CONCLUSION(S): In contrast to the classical concept that adhesion formation is related to a reduction in fibrinolysis, an impressive increase of the fibrinolysis was found to be associated with the persistence of adhesions.

Animals↗
PubMed1996

Tumor-associated eosinophilic infiltrate of cervical cancer is indicative for a less effective immune response.

The local inflammatory tumor infiltrate related to cervical carcinoma has been shown to consist mainly of T lymphocytes and macrophages. In 5% to 40% of the cases, eosinophilic granulocytes from a major part of the tumor-infiltrating cells. The presence of a high percentage of eosinophilic granulocytes in the infiltrate might reflect a less effective antitumor response, resulting in a worse overall survival. In the present study, histological slides from 83 patients who had been treated for cervical squamous carcinoma were reviewed. Special emphasis was put on the presence of eosinophils in the tumor infiltrate and correlated with clinical outcome as a parameter of the strength of the host-antitumor response. Multivariate analysis showed that the presence of a large amount of eosinophils among the infiltrate was an independent parameter, predicting a worse overall survival in patients with tumor-negative lymph nodes and tumor-negative resection margins (n = 61). The presence of eosinophilic granulocytes might represent a less appropriate immune response based on a disturbed equilibrium between Th-1- and Th-2-mediated immune response.

Adult↗
PubMed1996

High tissue factor concentration in the omentum, a possible cause of its hemostatic properties.

The hemostatic properties of the pedicled omentoplasty turned out to be helpful in difficult hemorrhages in extensive surgery. As suggested by others, a high concentration of tissue factor (TF) in the omentum could be responsible for this favourable property. The authors investigated the nature of that property in 11 patients who underwent laparotomy. In omentum and striated muscle (controls) the TF-concentrations in both tissues were estimated by the ELISA method. A significant difference between TF-concentration in omentum and striated muscle could be demonstrated.

Adult↗
PubMed1996

The current status of therapeutic HPV vaccine.

Cervical carcinoma is the second most common cause of cancer-related deaths in women worldwide. Recurrences occur in 15% of the patients after optimal treatment of low-risk early-stage disease. Treatment results of recurrent disease are relatively poor and for this reason new therapeutic strategies are warranted. Viral infection with human papillomavirus seems to have an essential part in the aetiology of cervical carcinoma. Evidence for the assumption that cervical carcinoma, among other malignancies such as melanomas, renal malignancies and Kaposi sarcoma, are immunogenic is provided by the fact that these malignancies grow more rapidly in the presence of systemic immunosuppression. Spontaneous regression for these tumour types is also described and immunohistochemical studies show extensive infiltrates in the tumour, consisting of immunocompetent cells. It is thus postulated that cellular immunity, and mainly the T-cell system plays an important role in the antitumour defence in cervical carcinoma. This review describes the rationale for the use of immunotherapy as treatment for cervical carcinoma as well as the results of recent developments in tumour immunology and its implications for the clinical use of immunotherapeutical approaches.

Animals↗
PubMed1995

Clinical value of pretreatment serum Cyfra 21-1, tissue polypeptide antigen, and squamous cell carcinoma antigen levels in patients with cervical cancer.

BACKGROUND: The clinical value of pretreatment serum concentrations of cytokeratin 19 fragments, measured by Cyfra 21-1, was compared with tissue polypeptide antigen (TPA) and squamous cell carcinoma antigen (SCC-Ag) in 78 patients with squamous cell cervical cancer. METHODS: Serum levels were compared with tumor stage, size, lymph node status, parametrial involvement, and prognostic data. The clinical performance of the different tests was evaluated by their receiver operating characteristic (ROC) curves. RESULTS: Serum levels of all markers were related significantly to tumor stage and size. Elevated serum levels of these markers were not found to be predictive for the presence of lymph node metastases. In contrast, a positive relation was found between quantitative serum Cyfra 21-1, TPA, and SCC-Ag levels and the presence of either lymph node metastases or parametrial involvement (i.e., extracervical disease). An elevated, i.e. positive, serum Cyfra 21-1 level was related significantly to the presence of extracervical disease (P = 0.020). The clinical performance of each serum marker in predicting lymph node metastases or parametrial involvement appeared to be similar as expressed by their ROC curves. In the univariate analysis, Cyfra 21-1, TPA, and SCC-Ag showed prognostic value with respect to disease free interval and survival. Elevated serum levels were associated with a poor prognosis. However, after adjusting for tumor stage and size, none of these markers remained statistically significant. CONCLUSIONS: Cyfra 21-1 may be of additional value in assessing stage of disease, tumor size, and the presence of extracervical disease in patients with cervical cancer. Determining its value during follow-up warrants further study.

Adult↗
PubMed1995

The omentoplasty: a neglected ally in gynecologic surgery.

Although the omentum is extensively used in general, reconstructive and thoracic surgery as a pedicled omentoplasty, little information exists about the utility of such a procedure in general and radical gynecologic surgery. In this paper we review the properties of the omentum which may be useful in gynecologic surgery. The omentum is highly vasculated and rich in thromboplastin, an excellent property for treating difficult to handle abdominal or pelvic abscesses and for inducing hemostasis. Furthermore, it appears that the omentum has a trophical effect on the surrounding tissue, making it very useful in reconstruction procedures. Moreover, elevating the small intestines out of the true pelvis paves the way for high dose (brachy)radiotherapy with less radiation enteritis. The technique of the pedicled omentoplasty is straightforward and takes 20-30 min extra operating time. We use pedicled omentoplasty for covering large operating fields instead of reperitonealization, to prevent radiation enteritis, as a matrix for grafting, to treat serious intraperitoneal infections and to facilitate hemostasis. Our experience of 48 omentoplasty procedures in gynecology is described.

Enteritis↗
PubMed1995

Quantitative analysis of the inflammatory reaction surrounding sutures commonly used in operative procedures and the relation to postsurgical adhesion formation.

Inflammatory reaction as well as the extent of postsurgical adhesion formation are described as varying according to suture material or diameter used. Whether the inflammatory reaction influences the formation of adhesions or is a mere consequence of surgical trauma itself or of type and amount of foreign body material used has never been elucidated entirely. In this study a quantitative analysis of both variables was therefore performed, according to previously described techniques, and correlated within 120 peritoneal defects of a standard side wall-uterine horn adhesion model in the rat. Three different suture characteristics, material (Prolene, Vicryl, Catgut), diameter (USP gauges 3/0, 5/0, 6/0) and knot configuration (2 = 2, S x S x S x S x S) were analysed for this purpose. Both the inflammatory reaction and the adhesion percentage showed significant differences within and in between suture characteristics, but no significant correlation between the two variables was found after statistical analysis. The conclusion is made that, when evaluated after 14 d, the extent of postsurgical adhesion formation is not related to the inflammatory reaction.

Analysis of Variance↗
PubMed1995

Knotting abilities of a new absorbable monofilament suture: poliglecaprone 25 (Monocryl).

OBJECTIVE: To study the mechanical knotting abilities of the new synthetic absorbable monofilament suture poliglecaprone 25 (Monocryl) compared with other absorbable suture materials. DESIGN: Experimental laboratory study. MATERIAL: Knotted loops (3/0 USP) of five synthetic absorbable sutures: Monocryl (poliglecaprone 25), PDS-2 (polydioxanone), Maxon (polyglyconate), Vicryl (polyglactin-910) and Dexon-Plus (polyglycolic acid). Three different knots were tested in a total of 150 experiments. MAIN OUTCOME MEASURES: Mean loop holding capacity (LHC) of 10 experiments, expressed in Newtons (N). RESULTS: Monofilament Maxon tied significantly more secure knots than the other sutures. Sliding knots of Monocryl (poliglecaprone 25) were similar to, and three-throw square knots were less secure than those tied with monofilament PDS-2. Braided Dexon-Plus was superior to Monocryl for sliding knots but comparable for square knots. Braided Vicryl did not differ significantly from Monocryl. CONCLUSION: The mechanical knot performance of Monocryl is identical to that of Vicryl, less than that of one other synthetic absorbable monofilament suture (Maxon) and comparable to or somewhat less than the other alternative (PDS-2). These findings, together with other characteristics such as degradation rate, should be used to define the application of Monocryl.

Dioxanes↗
PubMed1995

Mechanical factors influencing the incidence of burst abdomen.

OBJECTIVE: To compare laparotomy closure with interrupted polyglactin 910 (Vicryl) and continuous polydioxanone (PDS II), and assess the mechanical and other factors that influenced the incidence of burst abdomen. DESIGN: Retrospective study. SETTING: University hospital, The Netherlands. SUBJECTS: A random sample of 346 patients who did not burst their abdomens, taken from the total of 3768 patients who underwent primary midline laparotomy from 1986-1990, together with the 45 (1%) from the total series who did burst their abdomens. MAIN OUTCOME MEASURES: Incidence of burst abdomen, and the association with mechanical and others risk factors. RESULTS: There were no differences in the incidence of burst abdomen between those sutured with interrupted polyglactin 910 and those sutured with continuous polydioxanone (p = 0.12). Layered closure resulted in significantly more burst abdomens than any other method of closure (p < 0.001 in each case). Postoperative wound infection (14/43, 33%, compared with 33/343 10%) and pulmonary complications (25/43, 58%, compared with 44/344, 13%) were also significantly associated with the development of burst abdomens (p < 0.001). CONCLUSIONS: A continuous, monofilament, absorbable suture should be used to close a laparotomy incision. Elastic suture material, loop sutures, an the continuous figure-of-eight technique should be investigated.

Abdomen↗
PubMed1994

Prognostic significance of serum antibodies to human papillomavirus-16 E4 and E7 peptides in cervical cancer.

BACKGROUND: The objective of this study was to investigate the prognostic significance of serum antibodies to human papillomavirus (HPV)-16 peptides in patients with squamous cell cervical cancer. METHODS: Pretreatment sera from 78 patients and 198 control women were tested by an enzyme-linked immunosorbent assay technique for reactivity with HPV-16 E4 (E401p) and E7 (E701p) synthetic peptides. The presence and serum level of these antibodies were correlated with tumor stage, histologic features, and prognostic parameters. RESULTS: The median follow-up was 65 months (range, 6-97 months). Antibodies to E401p peptide were found in 5 of the 198 (3%) control subjects, 4 of the 43 (9%) patients with low tumor stage (International Federation of Gynecology and Obstetrics [FIGO] Ia, Ib, IIa), and 7 of the 35 (20%) patients with advanced tumor stage (FIGO IIb, III, IVa). Antibodies to E701p were found in 25 (13%), 11 (26%), and 11 (31%) women, respectively. The differences between patients and control subjects were significant (P < 0.002). Seropositivity against these peptides showed no correlation with tumor stage. Antibody levels to both peptides were significantly higher in patients compared with control subjects (P < 0.05). Furthermore, antibody levels to E401p were higher in patients with advanced tumor stage versus patients with low tumor stage (P = 0.0097). Such a relation was not found for anti-E701p antibodies. In the univariate analysis, a high level of anti-E701p antibodies was associated with a shorter disease free interval (P = 0.012) and poor survival (P = 0.049). However, this variable possessed no prognostic value after adjusting for FIGO stage and tumor size. CONCLUSIONS: The authors' findings indicate that the prognostic significance of serum antibodies to the HPV-16 E4 and E7 peptides used in this study of patients with cervical cancer is limited.

Adult↗
PubMed1994

Metastasis of breast carcinoma to a primary mucinous cystadenocarcinoma of the ovary.

A case of a patient with breast cancer metastatic within the tumor stroma of a primary ovarian carcinoma is presented. This finding is to the best of our knowledge the first case reported. The encountered diagnostic problems are discussed. A distinct peroperative frozen section diagnosis on the large, cystic, partially necrotic ovarian mass was not possible because of sampling problems. A comparable immunohistochemical staining pattern of cells being CEA negative, OC-125 negative, and HMFG-1 positive was found in both the primary breast tumor and in the solid epithelial parts in the tumor stroma of the left-sided ovarian carcinoma, as well as in the stroma of the right ovary. Immunohistochemical findings in the left-sided epithelial cystic ovarian tumor showed, as expected, apical reactivity with antibodies directed against CEA, whereas OC-125 and HMFG-1 were negative. Ploidy analysis showed that the primary breast carcinoma and the stromal part of left ovarian malignancy had the same aneuploid stemlines (DNA index = 1.18). The epithelial lining of the cystic ovarium carcinoma not showing the presence of metastatic lesion in the stroma showed the presence of a diploid GO,1 population only. These results show that DNA flow cytometry and immunohistochemistry may be helpful in assessing the origin of the malignancies in this unusual double presentation of both metastatic breast cancer and primary ovarian carcinoma.

Aneuploidy↗
PubMed1994

Anterior rectocele: assessment with radiographic defecography, dynamic magnetic resonance imaging, and physical examination.

PURPOSE: The aim of this study was to devise a measuring method for an anterior rectocele on standardized defecographies and magnetic resonance images (MRI) to quantify anterior rectocele and to test whether this could substantiate clinical decision making for operative treatment for anterior rectocele. METHODS: Quantitative analysis by the measuring method as proposed was compared with qualitative scores on defecographies and MRI from the same patients. Thirty-eight patients with symptoms compatible with an anterior rectocele were subjected to physical examination in the left decubitis position and supine position and to defecography. Findings on defecography were compared with findings on physical examination. Thirteen patients were examined before and after surgical correction of the anterior rectocele for a total of 51 qualitative and quantitative examinations. The group of operated patients was analyzed for treatment results. Nineteen controls were included. RESULTS: Sixty-six radiographs of 33 defecographies were qualified in three grading classes and quantified with the proposed method by two observers. The mean measured value of the anterior rectocele in the three subjective grading classes is significantly different (P < 0.001). Anterior rectoceles qualified as severe had a measured value of 20 mm or more in 96 percent of the radiographs. Lower gradings were never > 20 mm. On MRI severe anterior rectoceles were not scored and measured values did not correlate with qualitative scores. When findings on physical examination were compared with defecographic measurement, the coefficient of correlation (r) between the radiologic assessment and clinical examination in the left decubitis position is r = 0.87, for the examination in the supine position, r = 0.77. All 15 cases scored as severe anterior rectocele in the left decubitis position had a measured anterior rectocele of > or = 20 mm. In the 13 cases that received surgery, there was a significant reduction of the anterior rectocele (P < 0.001) and clinical improvement. Patients with small or moderate anterior rectocele on physical examination with a size > or = 20 mm on defecography were cured by surgical correction. None of the controls had an anterior rectocele on physical examination or an anterior rectocele > or = 20 mm on defecography. CONCLUSIONS: An anterior rectocele with a size of 20 mm or more corresponds with a qualitative score of "severe" on radiographic defecography. Physical examination for anterior rectocele in the left decubitis position corresponds best with quantitative radiographic assessment and anterior rectocele with a size > or = 20 mm on defecography is pathologic. Patients with complaints compatible with anterior rectocele can be assessed in objective and quantitative terms by radiography and can be successfully surgically treated, even if at physical examination the anterior rectocele is not classified as large, provided that dynamic defecography shows an anterior rectocele of > or = 20 mm. The potential of dynamic MRI with regard to anterior rectoceles presently seems absent.

Adult↗
PubMed1994

The pedicled omentoplasty, a simple and effective surgical technique to acquire a safe pelvic radiation field; theoretical and practical aspects.

A substantial number of patients need radiotherapy after surgery for pelvic malignancy. Approximately 15% of them will experience radiation enteritis. After omentoplasty, reduction of irradiated bowel volume may be obtained. We evaluated the pedicled omentoplasty during gynaecologic surgery as a technique to improve safe irradiation of the pelvic region.

Case-Control Studies↗
PubMed1994

A semiquantitative rat model for intraperitoneal postoperative adhesion formation.

A reproducible and semiquantitative rat model for the evaluation of therapeutic modalities used for the prevention of postoperative adhesion formation is designed within three experiments. In all experiments, a standard peritoneal defect was excised, sutured and adhesion formation was evaluated after 2 weeks according to the extent. Variation in extent of adhesions and type of tissue involved depended on the experimental design. While neither cecum nor colon descendens participated in the adhesions after a clamping trauma, the uterine horn was found to participate in almost all cases, especially when sutured proximally and distally to the peritoneal defect. The peritoneal defect/uterine horn model proved to be valid and reproducible and allowed a semiquantitative scoring. Additionally, the amount of blood loss as graded did not influence the presented rat adhesion model.

Animals↗
PubMed1994

Persistent cervical intraepithelial neoplasia after incomplete conization: predictive value of clinical and histological parameters.

In a group of 316 conizations performed from January 1984 to July 1991, 68 patients (22%) revealed no free margins of cervical intraepithelial neoplasia (CIN). They were divided into two groups with: 'negative follow-up' [normal cytology or less than two smears suggesting CIN I (class IIIa)] and 'positive follow-up' [at least two smears suggesting CIN I or one smear suggesting CIN II (class IIIb) or worse]. Forty-five patients (66%) fulfilled the criteria of negative follow-up. All patients with CIN I at the cone margin (18) were found in this group. The other 23 patients were in the positive follow-up group. Patients with positive follow-up were significantly younger (p = 0.04). Intervention after incomplete cone biopsy was necessary in approximately 10% (7/68) of cases. Cytology was thereby a reliable indicator for residual disease. Higher grade of CIN involved at the cone margin predicted a higher chance of positive follow-up. Semiquantitative measurement of CIN in the cone specimen showed a severe involvement of CIN II and CIN III in the positive follow-up group. In sum, our study showed that CIN I at the margin of the cone biopsy has no clinical significance. However, CIN II or III at the margin needs a careful cytologic follow-up, and appropriate action should be taken in case of cytologic abnormalities.

Adult↗
PubMed1994

The absence of human papilloma virus (HPV) related parameters in sexually non-active women.

In to order to investigate the prevalence of HPV related parameters in sexually non-active women, smears of 75 virgins were microscopically reviewed for alterations caused by HPV i.e. koilocytosis, parakeratosis and multinucleinization. In none of these smears were the mentioned parameters seen together, so the diagnosis of HPV infection could not be assessed. In an age-matched control population consisting of 75 sexually active women smears were reviewed. In this group 10 smears (13%) were found positive for HPV infection, well in accordance with literature.

Adolescent↗