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Biomedical subjects

J M Hendriks

Publications and source records attributed to J M Hendriks.

18 recordsLinked to original sources

[Complications within 30 days following placement of a carotid stent with cerebral protection in patients with considerable symptomatic carotid stenosis; Erasmus MC, Rotterdam, 1999-2004].

OBJECTIVE: To describe the complications that occur within 30 days following the placement of a stent in the carotid artery in patients with considerable symptomatic carotid stenosis. DESIGN: Retrospective. METHOD: Data were collected on 98 patients who received a carotid stent due to symptomatic carotid stenosis of > or = 70% of the lumen at the Erasmus MC, Rotterdam, the Netherlands, in the years 1999-2004. A filter, distal occlusion balloon or the Parodi anti-embolism system was used to prevent cerebral embolism. Outcome measures were complications within 30 days following intervention. RESULTS: Four patients were excluded in the period between diagnosis and stenting. Major complications occurred in 3 patients: 1 died due to cerebral haemorrhage and 2 experienced cerebral infarction. Transient neurological complications occurred in 4 patients who recovered completely. Dissection of the renal artery occurred in 1 patient, which necessitated a stent. Vascular damage of the internal carotid artery was not observed in any patient. The 3 major adverse events and 3 of the 4 minor adverse events occurred in the first 47 patients treated. None of the last 47 patients treated developed major adverse events.

Aged↗

Shrinkage of abdominal aortic aneurysm after successful endovascular repair: results from single center study.

AIM: In the literature, the behavior of the aneurysm sac after endovascular grafting has been the subject of significant speculation. It has been suggested that shrinkage of the abdominal aortic aneurysm (AAA) is different for various endografts. This study was undertaken to evaluate endograft-specific differences in aneurysm sac shrinkage and to evaluate other factors that may influence AAA shrinkage. METHODS: Forty patients with an AAA treated with endovascular grafts with a complete 18 months follow-up and complete CT angiography (CTA) follow-up were available for analysis. All patients with a persistent endoleak, endograft migration or any other reason for intervention or conversion were excluded from this analysis. Shrinkage was defined as a reduction in the AAA diameter of 5 mm or more. Chi-squared tests were used to test whether shrinkage was different for the kind of stent graft used (Gore Excluder vs Cook-Zenith), preexistent AAA diameter (<65 mm vs =or>65 mm), and AAA status (ruptured vs non-ruptured) (two-sided; a= 0.05). RESULTS: At 18 months after treatment, shrinkage was observed in 14 patients (52%) of the 27 patients treated with a Gore Excluder endograft and in 8 patients (62%) of the 13 patients treated with a Cook Zenith endograft (P=0.74). In 31 patients with a diameter <65 mm, shrinkage was observed in 19 patients (61%) whereas of the 9 patients with a diameter =or>65 mm, shrinkage was observed in 3 patients (33%) (P=0.253). Of the 34 patients with a non-ruptured AAA, shrinkage was observed in 18 patients (53%) versus of the 6 patients with a ruptured AAA shrinkage was observed in 4 patients (66%) (P=0.673). CONCLUSIONS: From this study can be concluded that the influence of the endograft on shrinkage of the AAA sac might be less prominent than suggested in the literature. Furthermore, our study shows that other factors such as preexistent AAA diameter may influence AAA shrinkage after endovascular repair.

Aged↗

Accuracy of duplex evaluation one year after varicose vein surgery to predict recurrence at the sapheno-femoral junction after five years.

OBJECTIVE: To investigate whether the results of duplex examination 1 year after sapheno-femoral junction (SFJ) ligation might be helpful in predicting long-term results after 5 years. PATIENTS AND METHODS: Follow-up data concerning patients operated on for primary or recurrent varicose veins of the great saphenous vein were studied 1 year and 5 years after surgery, focusing on the thigh and groin region. Clinical examination was undertaken to detect recurrent thigh varicose veins. The site of SFJ ligation was carefully screened for any signs of neovascularisation by duplex ultrasound. Sensitivity, specificity, positive and negative predictive value of the 1-year duplex scan were calculated, based upon the outcome of a further duplex scan 5 years following surgery. RESULTS: A total of 100 limbs were studied: 50 limbs operated on for primary varicose veins and 50 limbs for recurrent varicose veins. The 1-year duplex ultrasound of the SFJ ligation site had a sensitivity of 80%, a specificity of 91%, a positive predictive value of 70% and a negative predictive value of 95% in assessing the 5 year recurrence rate. CONCLUSION: A postoperative duplex scan of the SFJ 1 year after varicose vein surgery to the great saphenous vein predicts which patients are most likely to have a good outcome 5 years after surgery. The 1-year duplex scan is a reliable diagnostic tool for future studies evaluating the effect of new methods of treating sapheno-femoral incompetence.

Adult↗

Current management of spontaneous pneumothorax.

Spontaneous pneumothorax is divided into primary, when there is no underlying lung disease, and secondary, mainly caused by chronic obstructive pulmonary disease. A variety of different non-invasive and invasive treatment options exist. Due to the lack of large randomised controlled trials no level A evidence is present. A first episode of a primary spontaneous pneumothorax is treated by observation if it is < 20% or by simple aspiration if it is > 20%, but recurrences are frequent. For recurrent or persisting pneumothorax a more invasive approach is indicated whereby video-assisted thoracic surgery provides a treatment of lung (resection of blebs or bullae) and pleura (pleurectomy or abrasion). In patients with a secondary spontaneous pneumothorax related to chronic obstructive pulmonary disease, there is an associated increased mortality and a more aggressive approach is warranted consisting of initial thoracic drainage followed by recurrence prevention by thoracoscopy or thoracotomy in patients with a low or moderate operative risk. Talc instillation by the thoracic drain is preferred for patients with a high operative risk.

Humans↗

Carotid stenting.

Carotid angioplasty and stenting (CAS) has developed as an alternative for carotid endarterectomy (CEA) for the treatment of carotid artery disease. As technology has improved, procedural risks have declined and are approaching those reported for CEA. The benefits and durability of CAS compared with CEA are still being studied in ongoing randomised controlled trials. This review discusses the evolution of techniques and materials and the results of randomised trials and observational studies.

Blood Vessel Prosthesis Implantation↗

Cerebral protection during percutaneous carotid intervention: wich device should be used ?

Embolic complications remain the major and unpredictable clinical event during carotid angioplasty and stenting. Cerebral protection devices could play an important role in the prevention of such emboli. Protection devices such as occlusion balloons, filters and reversed flow devices are currently undergoing clinical evaluation and appear to be promising in reducing the incidence of embolic events. This article provides an overview of the three different types of embolic protection devices.

Angioplasty↗

Effect of gentamicin-containing sponges on the healing of colonic anastomoses in a rat model of peritonitis.

OBJECTIVE: To study the influence of gentamicin-containing sponges on the healing of colonic anastomoses in a rat model of peritonitis. DESIGN: Controlled laboratory study. SETTING: University hospital, Belgium. MATERIALS: 40 male Wistar rats. INTERVENTIONS: Peritonitis was caused by implantation of a gelatin capsule containing faeces and barium sulphate. The rats then had a colonic anastomosis. They were divided into 4 groups (n = 10 in each). The control group (no additional treatment); a second group in which a plain collagen sponge was wrapped around the anastomosis; a third group in which a gentamicin-containing collagen sponge was wrapped around the anastomosis; the last group in which the animals were given an intramuscular dose of gentamicin. MAIN OUTCOME MEASURES: Operative mortality, weight loss and anastomotic bursting pressure four days after the anastomosis. RESULTS: Seven rats died before necropsy but none in the last group. Peritonitis developed in all rats Weight loss was significantly higher in the plain collagen group. Bursting pressures were similar in the control and two gentamicin groups. In the plain collagen group all the anastomoses but one had broken down. CONCLUSION: There was no difference in bursting pressure between rats treated with gentamicin sponges or systemically, and controls. Healing was severely compromised when a plain collagen sponge was used.

Anastomosis, Surgical↗

Peripheral vascular brachytherapy: an introduction.

The response of cells to ionising radiation has been extensively studied for the past 30 years. When radiation is absorbed in biological material, it can directly ionise a critical site (direct effect) or interact with other molecules to produce reactive free radicals, which can subsequently damage critical biological molecules (indirect effect). DNA is considered the critical target damaged by ionising radiation by both direct and indirect processes. Since radiotherapy had proven to be effective in the treatment of non-malignant proliferative processes, it was assumed that this adjunctive treatment would also inhibit vascular restenosis. The major difference between external and intravascular radiation is dose distribution. Intravascular delivery results in extremely high doses to the lumen with a fall-off in dose as a function of distance from the source; whereas, external beam would deliver a uniform dose over the entire volume of tissue treated. Unlike in the coronary circulation most of the peripheral vessels treated are greater than 3 mm in diameter; in fact many are 7 to 10 mm in diameter. Since beta radiation is related to lower penetration properties and more heterogeneous distribution of radiation in comparison to gamma radiation, it is therefore necessary to use a gamma radiation source because it would be difficult to irradiate the sub-intimal tissue with a beta source centred in a large vessel. Radiation can and does have the potential to destroy blood vessels. The challenge in vascular brachytherapy is to treat blood vessels to a point where restenosis is inhibited; yet the vessel is not irreparably damaged.

Animals↗

Homeobox proteins as signal transduction intermediates in regulation of NCAM expression by recombinant human bone morphogenetic protein-2 in osteoblast-like cells.

The role of homeobox genes in signaling of recombinant human bone morphogenetic protein-2 (rhBMP-2) was studied in osteoblast-like cells. Expression of several homeobox genes was decreased by rhBMP-2. The finding that this regulation of homeobox gene expression by rhBMP-2 was not dependent on protein synthesis suggests that homeobox proteins can act as direct intermediates in signal transduction of BMPs. Therefore, we studied the regulation of neural cell adhesion molecule (NCAM), which has previously been described as a target gene of both rhBMP-2 and homeobox proteins. We now show that in osteoblast-like cells, rhBMP-2 inhibits NCAM expression, while HOXC6 increases its expression, both acting via the same region of the promoter. As overexpression of HOXC6 could abolish effects of rhBMP-2 on NCAM promoter activity, these data show for the first time that members of the homeobox gene family may form direct functional intermediates in the signaling mechanism of the TGF-beta superfamily.

Animals↗

Experimental study of intraperitoneal suramin on the healing of colonic anastomoses.

INTRODUCTION: The effect of the antiangiogenic agent suramin on the healing of colonic anastomoses was studied in a rat model. METHODS: Rats underwent an end-to-end colonic anastomosis and its healing was tested by measuring bursting pressure, hydroxyproline content and number of newly formed vessels. For the bursting pressure experiment suramin was given intraperitoneally in a dose of 200 mg/kg (maximal tolerable dose) and 100 mg/kg. Hydroxyproline content and vessel density were only tested at 100 mg/kg since the toxicity at this dose was lower whereas bursting pressure was still diminished. RESULTS: There were no deaths. On the fourth day after operation bursting pressure in the control group was significantly higher than that in rats treated with suramin 200 mg/kg (P = 0.006) and 100 mg/kg (P = 0.002). Rupture occurred at the anastomotic line. On day 7, this difference was not statistically significant. Four days after the operation, the hydroxyproline content and vessel density were significantly below that in control segments (hydroxyproline: 10.3 versus 7.8 microg per mg dry weight; vessel content: 85.7 versus 49.6 vessels per x 100 field for control and suramin-treated rats respectively). On the seventh day no difference in hydroxyproline levels was seen but the vessel density was still diminished significantly (P = 0.04). CONCLUSION: Experimentally, suramin significantly inhibits and delays healing of colonic anastomoses. Presented in part to the XXXII Congress of the European Society for Surgical Research in Corfu, Greece, May 1997

Anastomosis, Surgical↗

Bilateral pulmonary resection for lung metastases: report of two cases.

Resection of bilateral pulmonary metastases is exceptional. However, in carefully selected patients extensive resections might be successfully performed. We report two patients who underwent a pneumonectomy and excision of pulmonary metastases in the other lung, via a left wedge resection for patient 1 and left segmentectomy for patient 2. Resections were carried out for metastases of a malignant fibrous histyocytoma and for a teratocarcinoma. Both patients are still alive 9 months and 4 years after their last metastasectomy, respectively.

Adult↗

Modified technique of isolated left lung perfusion in the rat.

Isolated lung perfusion is a novel therapy for the treatment of pulmonary metastases to increase current low survival rates. Due to tumor heterogeneity, perfusion has to be evaluated in different rat species for efficacy and ideal drug regimens. The revised technique of isolated left lung perfusion as described by Wang and originally performed in the Fisher rat resulted in a high morbiditity in the Wag/Rij rat in our laboratory. Therefore, we modified techniques for intubation and anesthesia, and developed a new approach of catheterization with improved results.

Anesthesia↗

Isolated lung perfusion with melphalan prolongs survival in a rat model of metastatic pulmonary adenocarcinoma.

INTRODUCTION: Survival after isolated lung perfusion (ILuP) with melphalan was tested in a model of unilateral pulmonary adenocarcinoma. METHODS: On day 0, rats were randomized into four groups: Group 1 (n = 9) received tumor cells intravenously for induction of bilateral lung metastases, whereas groups 2-4 (n = 21) underwent a 10-min occlusion of the right pulmonary artery during tumor cell injection for induction of unilateral left lung metastases. On day 7, groups 1 and 2 received no treatment. Group 3 underwent left ILuP with melphalan (2.0 mg/kg) while group 4 received melphalan intravenously (0.5 mg/kg). The end point of the study was death from metastatic disease. RESULTS: Median survival of ILuP-treated animals (81 +/- 12 days) was significantly longer compared to group 1 (18 +/- 1 days; p = 0.0001), group 2 (28 +/- 3 days; p = 0.0002) and group 4 (37 +/- 6; p = 0.0004). CONCLUSIONS: ILuP with melphalan prolongs survival in the treatment of experimental metastatic pulmonary carcinoma.

Adenocarcinoma↗

Rebound thymic hyperplasia after chemotherapy in a patient treated for pulmonary metastases.

A 38-year-old patient presented with an anterior mediastinal mass after chemotherapeutic and surgical treatment for lung metastases from a malignant histiocytoma. Because of the risk for tumour recurrence the thymic mass was resected. Thymic hyperplasia was found on pathological examination. In this case thymic hyperplasia is a rebound phenomenon aflcer chemotherapy. It appears to atrophy during the administration of chemotherapy and regrow afterwards. Surgical resection provides the definitive diagnosis and treatment.

Adult↗

Isolated lung perfusion with melphalan and tumor necrosis factor for metastatic pulmonary adenocarcinoma.

BACKGROUND: Isolated left lung perfusion with melphalan and human tumor necrosis factor-alpha for pulmonary metastatic adenocarcinoma in the WAG/Rij rat was studied. METHODS: Survival was determined for melphalan, human tumor necrosis-alpha. Lung, pulmonary effluent, and serum melphalan were analyzed by chromatography after isolated lung perfusion or intravenous injection. On day 0, rats were injected with 2.0 x 10(6) CC531S cells intravenously. On day 7, rats underwent sham thoracotomy, received melphalan intravenously, or underwent isolated left lung perfusion with saline, melphalan, tumor necrosis factor, and a combination of the latter two. On day 14, tumor nodules were counted. RESULTS: For the doses of 400 microg tumor necrosis factor, 1,000 microg tumor necrosis factor, or both melphalan and tumor necrosis factor (2 mg + 200 microg), survival rates after contralateral pneumonectomy were 33%, 17%, and 80%, respectively. Survival in all other groups was 100%. Left lung melphalan level was significantly higher after isolated lung perfusion compared to intravenous administration. Significantly fewer left lung nodules were found for 0.5 mg isolated lung perfusion with melphalan (28+/-17) compared to isolated administration (200+/-0) (p = 0.001), and for 1.0 mg intravenous lung perfusion with melphalan (16+/-10) compared to controls (171+/-65) (p = 0.00047). Tumor necrosis factor showed no significant effect. CONCLUSIONS: Isolated lung perfusion with melphalan is an effective treatment for pulmonary metastases from adenocarcinoma in the rat.

Adenocarcinoma↗

Isolated lung perfusion for the treatment of pulmonary metastases.

Today, pulmonary metastasectomy is the treatment of choice for many patients with lung metastases from various solid tumors. Prognostic factors for a better survival are patients with germ cell tumors, long disease-free intervals and single metastases. Nevertheless, 5-year survival after surgical resection is low due to relative insensitivity to currently available chemotherapy. Isolated lung perfusion as a regional therapy proved to be a technique that can deliver a higher drug level within the tumor mass without apparent systemic toxicity. In addition, isolated lung perfusion in animal models proved to be more effective compared to intravenous therapy. In this way, isolated lung perfusion seems very promising although optimal regimens in patients are still unknown.

Animals↗

Improved ventilatory function after combined operation for pulmonary emphysema and lung cancer.

BACKGROUND: Smoking is the leading cause of both lung cancer and emphysema. Therefore, some patients with stage I and II disease will present with contra-indications to resection including a predicted postoperative FEV1 of less than 0.81 or a VO2max of less than 10 ml/kg/min. Recently, lung volume reduction surgery (LVRS) has re-emerged in the management of emphysema with excellent results. METHODS AND PATIENTS: 2 patients are reported with lung cancer in the left lower lobe and emphysematous destruction in both upper lobes. They, respectively, had a predicted postoperative FEV1 of 0.9211 and 0.6851. No metastases were present. Pre-operatively, a COPD index of 0.9 and 0.7 was calculated. A left lower lobectomy together with volume reduction of the left upper lobe was performed through a standard posterolateral thoracotomy. RESULTS: Pathological examination showed, respectively, stage IIb and stage Ib disease. The postoperative course was uneventful and 3 months later a FEV1 of 1.441 for patient 1 and 1.041 for patient 2 were recorded. CONCLUSION: These findings suggest that pulmonary function criteria for pulmonary resection have to be revised when patients can undergo simultaneous lung cancer resection and LVRS. The pre-operatively calculated COPD index can be used to predict which patients may not have a decrease in ventilatory function.

Aged↗

Long-term results of surgical resection of lung metastases.

Between 1990 and 2000, 56 consecutive patients underwent lung resection for removal of metastatic disease. Mortality, disease-free interval, and overall survival were studied. Only patients with a complete follow-up were included and data were collected conform the protocol of the International Registry of Lung Metastases. The primary tumour in our series was an epithelial tumour in 25 patients (45%), sarcoma in 15 (27%), germ cell tumours in 11 (19%) and melanoma in 5. Operative mortality was 1.4% (1 out of 73 procedures). Germ cell tumours had the best survival (76% at 5 years), and melanoma the worst (0% at 5 years). Multivariate analysis showed that survival for patients who underwent 2 or more metastasectomies was surprisingly good with a 5-year survival rate of 46%. Survival was not related to disease-free interval, multiple lung metastases, or pneumonectomy. It is in accordance with some reports that a short disease-free interval, numerous lung metastases, or recurrence after the first metastasectomy should not preclude patients from operation.

Adolescent↗