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J C Wereldsma

Publications and source records attributed to J C Wereldsma.

At least 19 recordsLinked to original sources
PubMed2001

Prospective randomized trial of open versus percutaneous surgery for trigger digits.

Various methods for the treatment of trigger digits exist. This study was designed to compare the results of an open surgical technique with those of a percutaneous surgical technique for the treatment of trigger digits. Ninety-six patients with 100 trigger digits were randomized to either open (n = 46) or percutaneous (n = 54) surgical release of the first annular pulley. Operation time, duration of postoperative pain, recovery of motor function, and surgical complications were assessed. Trigger digits were successfully treated in 98% of the cases using the open surgical technique and in 100% of the cases using the percutaneous technique. Mean operation time was significantly longer using the open technique. Mean duration of postoperative pain and time to recovery of motor function were significantly shorter for patients treated with the percutaneous method. No serious complications were observed in either group. We conclude that percutaneous correction of trigger digits is a quicker procedure, is less painful, and shows significantly better results in rehabilitation than open surgery.

Adult↗
PubMed2000

A comparison of suture repair with mesh repair for incisional hernia.

BACKGROUND: Incisional hernia is an important complication of abdominal surgery. Procedures for the repair of these hernias with sutures and with mesh have been reported, but there is no consensus about which type of procedure is best. METHODS: Between March 1992 and February 1998, we performed a multicenter trial in which we randomly assigned to suture repair or mesh repair 200 patients who were scheduled to undergo repair of a primary hernia or a first recurrence of hernia at the site of a vertical midline incision of the abdomen of less than 6 cm in length or width. The patients were followed up by physical examination at 1, 6, 12, 18, 24, and 36 months. Recurrence rates and potential risk factors for recurrent incisional hernia were analyzed with the use of life-table methods. RESULTS: Among the 154 patients with primary hernias and the 27 patients with first-time recurrent hernias who were eligible for the study, 56 had recurrences during the follow-up period. The three-year cumulative rates of recurrence among patients who had suture repair and those who had mesh repair were 43 percent and 24 percent, respectively, with repair of a primary hernia (P=0.02; difference, 19 percentage points; 95 percent confidence interval, 3 to 35 percentage points). The recurrence rates were 58 percent and 20 percent with repair of a first recurrence of hernia (P=0.10; difference, 38 percentage points; 95 percent confidence interval, -1 to 78 percentage points). The risk factors for recurrence were suture repair, infection, prostatism (in men), and previous surgery for abdominal aortic aneurysm. The size of the hernia did not affect the rate of recurrence. CONCLUSIONS: Among patients with midline abdominal incisional hernias, mesh repair is superior to suture repair with regard to the recurrence of hernia, regardless of the size of the hernia.

Adult↗
PubMed2000

Outcome after hemi-arthroplasty for displaced intracapsular femoral neck fracture related to mental state.

This study was performed to assess mortality and functional outcome after hemi-arthroplasty for displaced intracapsular femoral neck fractures in relation to mental state. Between 1991 and 1995, 202 consecutive patients over 70 years of age were followed for at least two years or until death. Thirty-nine patients were known with senile dementia at the time of admission. The four-month mortality rate was 11.7% for the mentally normal patients and 33.3% for the mentally impaired patients. After one year the mortality rate was 19. 6% for the mentally normal patients and 43.6% for the mentally impaired patients. This difference is statistically significant (p<0. 001). Of the 141 surviving mentally normal patients, who had been mobile before operation, 16 (11.3%) were not mobile four months after operation. Of the 24 surviving mentally impaired patients, who had been mobile before operation, 18 (75.0%) were not mobile four months after operation. This difference is statistically significant (p<0.001). The conclusion of our study is that mental state has a statistically significant effect on mortality and functional outcome after hemi-arthroplasty for displaced intracapsular femoral neck fractures. For demented patients, hemi-arthrplasty is a too major operation and less invasive methods of internal fixation should be considered.

Activities of Daily Living↗
PubMed2000

Cannulated screws versus hemiarthroplasty for displaced intracapsular femoral neck fractures in demented patients.

BACKGROUNDS AND AIMS: There are no randomised trials comparing internal fixation and hemiarthroplasty for a displaced intracapsular femoral neck fracture in relation to mental state. MATERIAL AND METHODS: To establish what should be the treatment of first choice, a prospective randomised clinical study was performed on 60 demented patients with displaced intracapsular femoral neck fractures, comparing internal fixation (n = 31) with hemiarthroplasty (n = 29). RESULTS: There was no significant difference in the mortality rate of both groups. Hemiarthroplasty was associated with significantly more loss of blood and more wound complications. Reoperation for secondary displacement of the fracture after internal fixation occurred in four patients. Although not-statistically significant, failure of internal fixation seemed to be higher after an inadequate osteosynthesis. CONCLUSION: Postoperative mortality is high and the chance of successful rehabilitation very small for both types of treatment in this group of patients. In our opinion, demented patients should not be treated with a major surgical procedure like hemiarthroplasty. Internal fixation should be considered the treatment of choice, because it is a smaller operation than prosthetic replacement, with less morbidity. If adequate reduction can not be achieved, a primary hemiarthroplasty should be performed.

Activities of Daily Living↗
PubMed1998

Parotid mass as first symptom of a malignant lymphoma.

BACKGROUND AND OBJECTIVES: Primary malignant lymphoma in the parotid gland is rare and seldom described in the literature. We studied the medical history and outcome of seven patients with a primary malignant parotid lymphoma. We looked for prognostic variables and for different behavior of these lymphomas in comparison to lymphomas in the usual sites. METHODS: Between 1985 and 1995, we conducted a retrospective study of the medical histories of malignant parotid tumors operated at our hospital. There were 18 malignancies, of which 7 were primary malignant lymphomas. We classified them according to Rosenberg et al. [Blood 1994;84: 1359-1392]. Outcome and survival time were compared with malignant lymphomas in usual sites. Further we looked for possible prognostic factors. RESULTS: We found an unusually high percentage of primary malignant lymphomas in the parotid gland in our series: 38% of all malignancies. Histological workup showed one Hodgkin lymphoma, two marginal zone B-cell non-Hodgkin lymphomas, two lymphoplasmocytoid non-Hodgkin lymphomas, and two follicular non-Hodgkin lymphomas. The clinical course of these lymphomas is comparable to that in lymphomas in the usual sites. CONCLUSIONS: Primary malignant lymphomas in the parotid gland have no different behavior compared to lymphomas in usual sites. There are no prognostic variables that distinguish a malignant lymphoma in the parotid gland. The only difference is a rather difficult operation to obtain a histologic specimen.

Aged↗
PubMed1997

Incisional hernia recurrence following "vest-over-pants" or vertical Mayo repair of primary hernias of the midline.

A series of 68 primary midline incisional hernias with a vertical Mayo repair was evaluated retrospectively. Patients without documented hernia recurrence following this repair were invited for physical examination. Life-table methods were used for statistical analysis. The 1-, 3-, 5-, and 10-year cumulative recurrence rates were 35%, 46%, 48%, and 54%, respectively. Also, generally accepted risk factors were studied. Multivariate analysis identified the size of the hernia (p = 0.02) and the use of steroids (p = 0.04) as the most important independent risk factors of first time recurrent incisional hernia. Considering the high recurrence rates found, the results of this study strongly suggest that the vest-over-pants repair should no longer be used for closure of midline incisional hernias.

Adult↗
PubMed1997

Clinical and financial aspects of cholecystectomy: laparoscopic versus open technique.

Clinical and financial aspects of laparoscopic (LC) (n = 119) and open (OC) (n = 117) cholecystectomy are compared in a retrospective study. The number and nature of perioperative complications do not differ importantly between these techniques. In favor of LC, significant differences are observed regarding the numbers of days severe pain was suffered (mean 1.7 days versus 5.4 days), the total number of days pain was suffered (mean 7.0 days versus 12.2 days), the number of postoperative days in hospital (mean 3.1 days versus 8. 8 days), the extent of perioperative monitoring performed, and the number of days before patients could return to (every day) work (mean 12.8 days versus 34.8 days). In this study total charges for LC (hospital and professional charges) are significantly lower than the total charges for OC [means, in dutch guilders (DG) were 4425 for LC versus 9215 for OC; $1 US = 1.93 DG]. The difference is the result of fewer days of postoperative hospitalization and reduced perioperative screening for LC. Furthermore, hospital charges for LC in The Netherlands (DG 3655) are less expensive than average hospital charges reported so far (US $1894 compared to $4948). For the hospital itself, however, on an annual base LC might well be more expensive than OC because of a maximum quota-annex-budgetizing system installed by the government to keep national health care costs controllable and low. In conclusion, LC has clear advantages over OC in clinical, social, and financial respects. Unjustly, the hospital does not seem to gain financial benefit from this fact.

Adult↗
PubMed1997

Association between age and local recurrence of rectal cancer: results from a retrospective study of 902 patients.

Due to the ageing of the general population, there has been a relative increase of elderly patients with rectal cancer. The relation between age and the risk of local recurrence after apparently curative surgery for cancer of rectum and rectosigmoid was studied in a retrospective study of 902 patients, diagnosed from 1984 through 1991 in the southwestern part of the Netherlands. Three age-groups were defined: 15-64 (n = 328), 65-74 (n = 327) and 75 and over (n = 247). After exclusion of postoperative deaths and controlling for unrelated causes of death, 5-year survival rates were similar in the three age-groups (70%, 71% and 75%, respectively). Local recurrence rates, however, decreased with age from 23% to 18% and 14%, respectively. In multivariate analysis, the hazard ratios were 1, 0.84 and 0.66, respectively. These results suggest that local recurrence occurs less frequently in the elderly, which needs confirmation from prospective studies and warrants consideration in decisions about the use of adjuvant treatment.

Adolescent↗
PubMed1996

The influence of age on resection rates and postoperative mortality in 6457 patients with colorectal cancer.

Due to the ageing of the general population, the proportion of elderly patients with colorectal cancer has increased. In a registry-based study, we evaluated the influence of age and other variables on resection rates and operative risk. Resection rates and postoperative mortality rates (30-day) were analysed in 6457 patients with colorectal cancer, diagnosed from 1985 through 1992 in hospitals connected to the Rotterdam Cancer Registry. Overall, 87% of the patients underwent resection but resection rates were lower for patients older than 89 years (67%) and for patients with rectal cancer (83%). The postoperative mortality rate was 1% for patients younger than 60 years and steadily increased with age. For patients 80 years and older the operative risk was 10%. According to multivariate analysis gender, age, subsite and stage were defined as independent prognostic factors. In view of the lack of alternatives, elderly patients with colorectal cancer should not be denied surgery on account of chronological age alone. Even in patients over 90 years of age resections can be performed with acceptable risk.

Adult↗
PubMed1994

Effect of mental state on mortality after hemiarthroplasty for fracture of the femoral neck. A retrospective study of 543 patients.

OBJECTIVE: To assess mortality and functional results of Thompson's hemiarthroplasty for fractured neck of femur in patients with and without senile dementia. DESIGN: Retrospective study. SETTING: District hospital. SUBJECT: 543 Unselected patients who had intracapsular fractures of the femoral neck treated by hemiarthroplasty between 1979 and 1988. MAIN OUTCOME MEASURES: Mortality and functional results during a median follow up period of 14.9 months (range 0.0-111) for patients with senile dementia and 27.4 months (range 0.1-131) for patients who were not demented. RESULTS: 156 of 215 demented patients (73%) died during the follow up period compared with 169 of 328 of those who were not demented (52%). Of the 109 patients with dementia who were mobile before operation only 59 were mobile after operation (54%), compared with 199 of the 215 patients (93%) who were not demented (p < 0.001). Senile dementia seemed to be the only coexisting condition that had a significant effect on mortality. CONCLUSION: Hemiarthroplasty is probably too major an operation with which to treat fractures of the femoral neck in demented patients.

Aged↗
PubMed1991

Postoperative radiation therapy for rectal cancer. An interim analysis of a prospective, randomized multicenter trial in The Netherlands.

The authors assessed the potential benefit of postoperative radiation therapy for rectal cancer in a two-arm, prospective multicenter trial. One hundred seventy-two patients who had undergone surgical resection for rectal adenocarcinoma were randomly assigned to either treatment consisting of external irradiation to a dose of 5000 cGy in 5 weeks or a control group (no adjuvant therapy). It was assumed that the number of cells remaining after radical surgery would be low and that the dose of 5000 cGy would be adequate in eradicating the majority of those cells. The number of local recurrences was lower in the treated group of patients, but the difference was not statistically significant. It was assumed that if a significant reduction in the number of local recurrences could be obtained, improved (disease-free) survival would result. No influence on disease-free or overall survival could be detected. These results were in agreement with those reported in Europe and the US, and it was concluded that postoperative radiation therapy alone cannot be justified as a routine procedure in the primary management of resectable rectal cancer.

Adenocarcinoma↗
PubMed1991

Neuroendocrine carcinoid tumours of the breast: a variant of carcinoma with neuroendocrine differentiation.

Carcinoid tumours most frequently develop in the gastrointestinal tract but have been described in many organs of the body. In 1977 the first cases were reported in the mamma, followed by descriptions of argyrophilic carcinoid-like, neuroendocrine mammary tumours by many investigators who performed immunohistochemical and ultrastructural examinations. The existence of true carcinoids in the mamma is still a controversial issue. Eight mammary neoplasms with monomorphous cytonuclear features, five of the small cell carcinoid-like variety and three composed of larger cells, were examined by immunohistochemical and ultrastructural examination. We believe this kind of tumours are ductal or lobular carcinomas with focal or more extensive neuroendocrine features and are the result of a dual differentiation of neoplastic precursor stem cells along epithelial and endocrine lines. Consequently, we consider that treatment of such cases should not be different from that of the ordinary type of mammary carcinomas.

Adult↗
PubMed1990

Adjuvant portal liver infusion in colorectal cancer with 5-fluorouracil/heparin versus urokinase versus control. Results of a prospective randomized clinical trial (colorectal adenocarcinoma trial I).

This prospectively randomized clinical trial was carried out in four Dutch hospitals to reduce the development of metachronous liver metastases and to get a better survival in patients with colorectal malignancies after surgically radical en bloc resection of the primary tumor and the regional lymph nodes. Three hundred seventeen patients were randomized to participate in three trial arms. One group of patients was treated by surgery alone (control group); in the other patients a catheter was placed in the dilated umbilical vein and advanced until the tip was lying in the left branch of the portal vein. Fifty percent of these patients got immediate postoperative portal infusion with 1 g 5-fluorouracil (5-FU) and 5000 U heparin daily for 7 days; the others received portal vein infusion with urokinase 10.000 U/hour for 24 hours only. Three hundred four patients were eligible. Overall hospital mortality was 3.6% (11 patients) and was not influenced by adjuvant treatment. After a median follow-up of 44 months 66 patients have died with relapse and 21 as a result of other causes. The chance of developing liver metastases and other distant metastases after portal infusion with 5-FU/heparin was one third of the chance in the control group (P less than 0.001). Only an insignificant reduction of the average death rate in the 5-FU/heparin group was found. In the urokinase group no significant effect in reducing metastases or in survival was noted. Before recommending cytotoxic portal infusion as an adjuvant treatment in patients with colorectal cancer, detailed analysis of other ongoing portal infusion studies has to be awaited and careful calculations have to be made regarding how many patients really can be saved by this treatment.

Adenocarcinoma↗
PubMed1989

Colonic malignancy mimicking an appendiceal mass.

The records of 99 patients admitted for inflammatory appendiceal mass were evaluated. Eight of these patients (8%) had a malignancy of the right colon with, in four cases, secondary inflammation of the appendix. Remnants of inflammation limited to the appendix were present in 64 patients. These two groups were compared to a group of 21 patients treated in the same period for a palpable malignancy of the right colon. In patients older than 50 years absence of pain, symptoms which last more than one week, a painless palpable mass in the right lower abdomen and the presence of anemia indicate (underlying) colonic malignancy. Barium enema of the colon remains the most reliable method for a correct preoperative diagnosis of colonic malignancy and should be done in every patient older than 50 years who presents with an appendiceal mass, as well as in younger patients with a protracted course of the disease.

Adenocarcinoma↗
PubMed1986

Carotid body tumor: familial occurrence.

Four patients are presented with a carotid body tumor and three patients who may have had a carotid body tumor, all from one family of 81 members. This confirms the familial incidence of this tumor. A short review of the literature is presented. An autosomal dominant inheritance seems most likely in familial carotid body tumor. Screening family relatives of patients to diagnose a carotid body tumor at an early stage should make surgery easier and reduce the complication rate associated with surgery.

Adult↗