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J B Trimbos

Publications and source records attributed to J B Trimbos.

At least 73 records · Page 4Linked to original sources
PubMed1993

[Laparoscopic cystectomy of the ovary; results of a new technique].

The results of a prospective study of laparoscopic management of ovarian cysts are discussed. This technique of minimally invasive surgery was introduced at the department of Gynaecology of the Leiden University Medical Centre in 1991. Only premenopausal women with unilocular ovarian cysts smaller than 10 cm in diameter and with sonographically benign characteristics were included in this study. In a period of one year, 25 cystectomies and one ovariectomy were performed. 88% of the cysts were initially treated with hormone therapy. Mean age of the patients was 30 years (range: 21-54), average size of the cysts was 6 cm (range: 4-10) and mean operating time was 80 minutes (range: 35-120), there were no complications during operation or in the postoperative period. No laparotomies had to be performed. Three times (11.5%) pathological specimen examination revealed a corpus luteum cyst. The other 23 were non-functional cysts. No carcinoma was detected. The results of this minimally invasive surgery for removal of ovarian cysts are encouraging. Morbidity compared with the conventional cystectomy by laparotomy is low as appears from a shorter hospital stay and quicker recovery. Cystectomy of the ovary, compared with laparoscopic aspiration and fenestration, has a better therapeutic effect and the histological evaluation is more reliable. Persistent, unilocular ovarian cysts, which fulfill the criteria used in our study, are best treated by laparoscopic removal instead of laparotomy.

Adult↗
PubMed1993

The case against aspirating ovarian cysts.

BACKGROUND: Developments in ultrasonographic technology have increased the possibilities of ovarian cyst aspiration. The risk of an extension of indications for ovarian cyst aspiration, however, is iatrogenic spread of malignant cells. METHODS: In this article, the diagnostic accuracy and therapeutic effectiveness of ovarian cyst aspiration are discussed, and the potential risk from different forms of tumor spill are considered. RESULTS: Two cases are presented in which a laparoscopic puncture and aspiration of a malignant ovarian cyst were performed. In both cases, there were diagnostic problems with the cytologic assessment. In one case, aspiration of an apparently benign cyst, based on ultrasonographic and laparoscopic findings, yielded cytologically negative fluid, but 8 weeks later an extensively disseminated ovarian carcinoma was found at laparotomy. It is postulated that the time interval between first tumor spill and eventual removal of the diseased ovary is the most important determinant of prognosis. CONCLUSIONS: The conclusion of these case reports is that aspiration of ovarian cysts, except for the purposes of oocyte retrieval, is potentially dangerous and should not be regarded as routinely acceptable clinical practice.

Contraindications↗
PubMed1993

Prognostic factors in well-differentiated early-stage epithelial ovarian cancer.

BACKGROUND: The prognosis of patients with early ovarian cancer is good as compared with that of patients with advanced disease. However, there are no methods for predicting prognosis of early ovarian cancer, on which treatment decisions can be based. METHODS: The prognostic significance of DNA flow cytometric and morphometric analysis was evaluated in 64 surgically treated patients with well-differentiated early-stage (International Federation of Gynecology and Obstetrics [FIGO] Stage IA, IB, IC, and IIA) epithelial ovarian cancer. The extent of the well-defined staging procedure was assessed strictly in every patient. RESULTS: Only five patients died of recurrent ovarian cancer; all of these patients belonged to the inaccurately staged group. No significant relationship was found between clinicopathologic characteristics, such as menopausal status, FIGO stage, histologic cell type, and 5-year disease-free survival rate. Forty-two of the tumors had a mitotic activity index (MAI) of less than 30, and 43 of the tumors showed a volume percentage epithelium (VPE) of less than 65. Neither as a single parameter nor in combination did MAI and VPE correlate significantly with disease-free survival. Thirty-two tumors (50%) were DNA diploid, 15 were considered wide-CV-diploid, and 17 were aneuploid. Nearly 90% of the tumors showed DNA indices (DI) of 1.40 or less. The 5-year disease-free survival rate was significantly lower (61%) for patients with DI greater than 1.40 than for those with DI of 1.40 or less (96%) (P < 0.005). From the total number of five patients who died of their disease, three had tumors with DI in the tetraploid range.

Adult↗
PubMed1993

Pelvic failure rate and radiation toxicity in relation to total dose of radiation alone for the treatment of cancer of the uterine cervix.

Seventy-four patients presenting between 1978 and 1989 with carcinoma of the uterine cervix were analysed to compare our results with the published literature, especially with regard to the pelvic failure rate and radiation toxicity. Overall 5-year survival reached 41%. Overall 2-year survival rate for Stage IIB was 85% and Stage IIIB was 32%. For Stage IIB the results agreed with those reported in the literature. Pelvic control was related to total dose and the application of intracavitary irradiation. For Stage IIIB the results were disappointing, partly due to a large number of bulky tumours and also to a relatively low paracentral dose and dose to the pelvic side wall. Percentages of radiation side-effects were low compared with those reported in the literature, probably also due to the relatively low total dose.

Brachytherapy↗
PubMed1993

Management of vulvar carcinoma radiation toxicity, results and failure analysis in 44 patients (1980-1989).

A retrospective analysis was performed on 44 patients with squamous carcinoma of the vulva (1980-1989). Patients were divided into two subgroups, group I (n = 39) treated with curative intent with surgery alone or with surgery combined with radiotherapy and group II (n = 5) treated with palliative intent with irradiation alone. The five-year cancer-specific survival rate for group I was 65%. Although this is a group of elderly patients, it was concluded that curative therapy should be aggressive and concessions which lead to suboptimal treatment should be avoided. It is essential to achieve free surgical margins. If it is decided to irradiate, no concessions should be made with respect to dose or overall treatment time. Poor results were obtained in the group treated with palliative intent with a six week treatment scheme of five fractions/wk. All irradiated patients suffered from moist desquamation as acute side-effect. Serious late side-effects did not occur.

Adult↗
PubMed1993

Amount of suture material needed for continuous or interrupted wound closure: an experimental study.

OBJECTIVE: To design an experimental model by which it would be possible to measure exactly the total amount of suture material required for interrupted and continuous closure of the abdominal fascia. DESIGN: Laboratory study. MATERIAL: 160 Patches of 1 mm thick synthetic material (silicone) 25 x 8 cm in which a midline incision had been made and sutured with absorbable sutures, either braided polyglycolic acid or monofilament polyglyconate, using a standard knot under standard tension. MAIN OUTCOME MEASURES: Length of suture material used when sutures placed either 2 or 1.5 cm from the cut edge and with 1 or 1.5 cm left between sutures. Each series of measurements was made 10 times. RESULTS: When the distance from the cut edge, the distance between sutures, and the suture material were standardised continuous suturing used less material than interrupted. Slightly less polyglycolic acid was needed than polyglyconate. More suture material (9-15%) was required for continuous sutures 1 cm apart compared with interrupted sutures 1.5 apart, when both were inserted 1.5 cm from the cut edge, but the difference was smaller when polyglyconate was used than when polyglycolic acid was used. CONCLUSION: The differences in lengths of suture material required do not outweigh the mechanical advantages of continuous closure of the fascia.

Abdominal Muscles↗
PubMed1993

Cosmetic result of lower midline laparotomy wounds: polybutester and nylon skin suture in a randomized clinical trial.

OBJECTIVE: To compare the cosmetic outcome of lower midline laparotomy scars using either nylon or polybutester suture for skin closure. METHODS: A randomized clinical trial compared polybutester skin suture with nylon for lower midline laparotomy wounds in 50 women undergoing gynecologic surgery. Scar hypertrophy, scar width, scar color, the presence of cross-hatching marks, and a total score were assessed in all patients at 18 months following surgery and compared by nonparametric statistical tests. RESULTS: The wounds closed with polybutester suture were significantly less hypertrophic than those closed with nylon. Regardless of the suture material used, the lower part of the laparotomy scar showed an inferior cosmetic result compared with the upper part underneath the umbilicus for scar hypertrophy, scar width, and the total scar score. CONCLUSIONS: Polybutester skin suture diminishes the risk of hypertrophic scarring because of its special properties allowing it to adapt to changing tensions in the wound. Increased closure tension of the skin in the midline region above the pubic bone may be caused by a relative immobility of the skin. Scar cosmetics in this area may be improved by extra subcuticular suture support.

Cicatrix↗
PubMed1992

[Morbidity and results of 100 radical hysterectomies performed in an oncology center].

One hundred consecutive radical hysterectomies performed in a Dutch oncology centre during a five and a half year period between 1984 and 1990, were analysed. The operations were performed in a uniform manner by the same three surgeons. Surgical mortality was nil. Mean operating time was 4 hours and mean blood loss amounted to 1200 ml. One patient developed a vesicovaginal fistula. Long lasting urinary symptoms occurred in 32% of patients, sex problems in 13%. The latter situation was encountered significantly more frequently when surgery was combined with radiotherapy. Eighty-two of the 100 patients had a primary cervical carcinoma and were analysed further. Distribution according to stage was as follows: stage IA: 3, IB: 64, IIA: 13, IIB: 2. Postoperative external and intracavitary pelvic radiation was given in 34 patients (41%). Three-year survival of these patients amounted to 86%. One-third of patients had a large primary tumour (diameter greater than 4 cm). Three-year survival rate in this subgroup of patients was 78%. Lymph node metastases were found in 14 patients (17%). Three-year survival rates for patients with and without lymph node metastases were 64% and 94%, respectively (p less than 0.0001). Results and complications of this series were compared with the current literature data and found to be comparable and sometimes even better than recent literature data. These findings may serve to advocate further centralisation of this kind of surgery in oncological centres in the Netherlands.

Adolescent↗
PubMed1992

A randomized clinical trial comparing two methods of fascia closure following midline laparotomy.

Three hundred forty women undergoing midline laparotomy were randomized into an interrupted suture (polyglactin 910, size 1) or a continuous suture (polyglyconate, size 0) closure group. The two groups were well balanced with respect to various risk factors for postoperative wound complications. Early evaluation revealed no differences between the continuous and interrupted suture groups with respect to wound infection (3% vs 1%), superficial wound dehiscence (2% vs 4%), and deep wound dehiscence (0.6% vs 0%). Late evaluation showed no differences between the two groups either. Continuous polyglyconate and interrupted polyglactin 910 sutures had a similar incidence of suture fistula (0% vs 2%), wound pain (1% vs 2%), and incisional hernia (3% vs 4%). Continuous closure was done faster and resulted in less foreign-body suture material. Despite its smaller diameter, the polyglyconate suture also retains a higher tensile strength after surgery than does the quicker-degrading polyglactin 910 suture. Results of this study lead to the conclusion that a running polyglyconate suture is the better choice for closure of the abdominal-wall fascia following midline laparotomy.

Abdominal Muscles↗
PubMed1992

A randomized clinical trial on the benefit of adhesiolysis in patients with intraperitoneal adhesions and chronic pelvic pain.

OBJECTIVE: To see whether surgical adhesiolysis would improve pelvic pain in women with pelvic adhesions. DESIGN: Randomized clinical trial comparing surgery (adhesiolysis) with no surgery with final analysis of results after 9-12 months. SETTING: Department of Gynecology, Leiden University Medical Center, the Netherlands. SUBJECTS: 48 women known by laparoscopy to have stage II-IV pelvic adhesions. INTERVENTIONS: Midline laparotomy and surgical adhesiolysis. MAIN OUTCOME RESULTS: Pelvic pain assessed by the McGill pain score, subjective pain assessment and disturbance of daily activities. RESULTS: 24 women were randomly allocated to undergo surgical adhesiolysis and 24 to a control group who did not have surgery. After 9-12 months there were no significant differences between the two groups overall with regard to pelvic pain. A subgroup of women with severe, vascularized and dense adhesions involving bowel (stage IV) had significantly less pelvic pain after adhesiolysis for two of the three methods of assessment. CONCLUSIONS: Adhesiolysis for the treatment of pelvic pain is not indicated in women with light or moderate degree pelvic adhesions. It may be beneficial in those with severe adhesions involving the intestinal tract.

Adult↗
PubMed1992

Adoptive immunotherapy of ovarian carcinoma with bs-MAb-targeted lymphocytes: a multicenter study.

A bispecific monoclonal antibody (bs-MAb) (OC/TR) was produced in large quantities for the intraperitoneal (i.p.) treatment of ovarian cancer. The bs-MAb recognizes the folate-binding protein on ovarian cancer cells on the one hand and the CD3 activation site on T lymphocytes on the other. T lymphocytes were expanded ex vivo, targeted with OC/TR in vitro and administered to the i.p. cavity in the presence of soluble OC/TR. All patients developed human anti-mouse-antibodies (HAMA). In the Dutch study, 2 complete remissions (CR) were seen, 2 partial regressions (PR), I stable disease (SD) and I progressive disease (PD). In the Italian study 3 CR, I PR, I SD and 2 PD were seen.

Antibodies, Monoclonal↗
PubMed1991

Watch and wait after careful surgical treatment and staging in well-differentiated early ovarian cancer.

Patients with well-differentiated epithelial ovarian cancer Stages Ia, Ib, Ic, and IIa (FIGO 1976) were observed after surgical treatment without adjuvant therapy. Careful surgical staging was required, and the extent of the staging procedure was assessed in each individual patient. There were 107 patients entered in the study by nine Dutch oncology centers. Of these 107, 21 did not fulfill all of the inlet criteria of the study and were excluded. Central pathologic review was performed in the remaining 86 cases, revealing that there was borderline tumor in seven patients, moderately or poorly differentiated tumor in nine patients, and tumor of nonepithelial histologic cell type in one patient. In two cases, no material for histologic review was available. After exclusion of these 19 cases, 67 patients were further analyzed. None of these 67 patients was lost during the follow-up period that ranged from 19 to 99 months (mean, 50 months). Tumor recurrence was found in four patients after 11, 25, 34, and 34 months of follow-up, all of whom died shortly after diagnosis of the recurrence without satisfactory response to secondary treatment. For the patients who underwent the most extensive staging procedure, disease-free 5-year survival was 100%. For the patients who were inaccurately staged, disease-free 5-year survival was 88%. It was concluded that well-differentiated early stage (Ia-IIa) ovarian cancer carries an excellent prognosis after surgical treatment and complete surgical staging, with the possible exception of patients with Stage Ic disease with malignant peritoneal washings. Furthermore, it was considered that the application of more objective and consistent ways of assessing tumor grade should be encouraged. Surgical staging should be regarded as the golden standard in defining subsets of low-risk patients and should be included and clearly defined in future trials on early ovarian cancer.

Adult↗
PubMed1991

The accuracy of frozen section diagnosis of ovarian tumors.

We compared all frozen section examinations of ovarian tumors during a 6-year period in our institute with the final diagnosis from paraffin sections. In this period, 946 ovarian tumor specimens were removed for histologic assessment; 176 (18.6%) had frozen section examination. Final histological diagnosis was divided into benign (55.1%), borderline malignant (10.3%), and malignant (34.6%). Sensitivity of the frozen section method for malignant or borderline disease was 83.5% and specificity for a benign lesion, 92.8%. Predictive values and 95% confidence intervals were computed: 100% (93-100%) for malignancy, 62% (32-86%) for borderline malignancy, and 92% (85-96%) for a benign disease. Diagnostic problems occurred in large borderline tumors of mucinous cell type. Analysis of the 12 false negative diagnoses revealed that a sampling error was involved in 11 cases. A judgment error was made in the only false positive and in 1 out of 12 false negative frozen section diagnoses. It is concluded that when surgeons and pathologists are aware of the limitations of frozen section diagnosis of ovarian tumors, peroperative histologic examination can be worthwhile and prevent under- and overtreatment of gynecologic patients.

Adolescent↗
PubMed1991

Tissue reaction to suture materials revisited: is there argument to change our views?

Tissue reactivity to ten different suture materials (silk, plain catgut, chrome catgut, tevdek, ticron, ethibond, vicryl, dexon, maxon and prolene) was evaluated on the basis of conventional microscopic assessment of eight histologic parameters at 7 days following surgery in the rat. Each suture material was placed at different localizations in the abdominal facial layer of 6 rats, thus a total of 60 rats were operated on. A completely standardized and reproducible system of microscopic assessment was used. Weighed discriminant sum values of these parameters showed no systematic differences between tissue reaction to these sutures. The computed addition of all possible magnitudes of weighing factors to the tissue reactivity parameters did not change this negative result. Discriminant analysis showed that it is unlikely that conventional histologic parameters of tissue reaction constitute a single concept like 'tissue reactivity'. It is concluded that at 7 days after surgery the effect of surgical trauma still nullifies the possible differences between suture materials with respect to tissue reaction. Minimizing surgical trauma should, therefore, be reappraised as more important for physiologic wound healing than the use of biocompatible sutures.

Animals↗
PubMed1991

Mechanical knot performance of a new generation polydioxanon suture (PDS-2).

To improve the handling characteristics of synthetic resorbable monofilament PDS (polydioxanon), a second-generation (PDS-2) suture has been developed. The mechanical knot performance of this suture was tested in square knots and sliding knots and compared with other monofilament suture materials. Knot performance was defined by the loop holding capacity (LHC) and expressed in Newton's (N). Maxon (polyglycolid-three-methylene carbonate) had significantly better knot performance than the other sutures. Knot performance of Prolene (polypropylene) was significantly poorer than that of the other sutures. Ordinary PDS (polydioxanon) and PDS-2 (polydioxanon) showed intermediate results. Knot performance of PDS-2 was similar to (square knots) or poorer than (sliding knots) that of ordinary PDS. It was concluded that knot performance of ordinary PDS is not improved by the introduction of PDS-2. It is emphasized that surgeons should be aware of the mechanical properties of newly developed suture materials. Underlying factors and clinical implications of the mechanical performance of PDS-2 are discussed.

Humans↗
PubMed1991

Feasibility of the application of a resorbable polyglycolic-acid mesh (Dexon mesh) to prevent complications of radiotherapy following gynaecological surgery.

The first ten applications of an absorbable polyglycolic-acid mesh to keep small bowel from descending into the pelvis during postoperative radiation treatment, are described. Two of the ten patients developed mild symptoms of (sub)ileus that could be treated conservatively. In two patients GI tract series revealed that a small bowel loop had slipped outside the sling and had descended into the pelvis. To prevent this condition an interlocked running suture to adjust the mesh is recommended. It is concluded that this intestinal sling procedure is a feasible surgical method causing only mild postoperative complaints or no symptoms at all. The sling procedure is effective to keep the small bowel out of the pelvis following surgery in patients who may require postoperative radiation treatment for pelvic malignancy.

Absorption↗