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Biomedical subjects

J M Weerts

Publications and source records attributed to J M Weerts.

At least 19 recordsLinked to original sources
PubMed2002

The sentinel lymph node biopsy in breast cancer.

OBJECTIVE: To evaluate the possibility and accuracy of this new diagnostic approach to the breast cancer disease in our centre. MATERIAL AND METHODS: Since March 1999, every patient presenting with a cT1-T2 N0 breast carcinoma was scheduled for a sentinel lymph node search. An injection of Tc-99 labelled nanocolloïd with a dose of 1 mCu was injected either intramammary or intradermally. The patients have been divided into two groups: in group I, they received their injection intramammarily the day before the operation; because of several failures in identifying the sentinel lymph node (SLN), the protocol was modified, the patients receiving their injection the day of operation, intradermally (group II). Once a lymphoscintigraphy done, the SLN was identified at operation using a detection probe, after the primary tumour had been removed. A routine axillary dissection was then performed to remove the rest of the lymph nodes. All the nodes were then checked routinely for metastatic cells. The SLN was also screened by semi-serial slides and by immuno-assay. RESULTS: From March 1999 till March 2001, sixty patients presented consecutively with a T1 or T2 biopsy proven breast carcinoma with no clinical lymph nodes. They were all scheduled for a sentinel lymph node search according to the protocol. Mean tumour size was 9.9 mm (ranging from 4 to 23 mm). Fourteen patients (group I) received their injection intramammarily but we failed to identify the sentinel node in five patients (35%). The remaining forty-two patients (group II) received their injection intradermally. Sentinel nodes were then identified in forty-three patients (93%). Positive SLN were discovered in eleven cases by routine examination (13 positive nodes among 104 harvested sentinel nodes, i.e. 13%). Micro metastases were discovered in three other SLN by immunohistology. In total, 605 lymph nodes were evaluated through the axillary dissection, representing a mean number of 10.08 lymph nodes per patient. For four patients, positive lymph node were discovered in the axillary dissection while SLN were negative (6.6% of false negative). CONCLUSIONS: During this learning curve period, it appears that the method for screening the SLN is reliable, since the figures encountered are similar to those of the literature. By adding a perioperative blue dye injection, it might be possible to reduce the percentage of false negative results. It is difficult to assess, at present, the impact SLN could have on survival.

Adult↗
PubMed2000

[Adenocarcinoma of the pancreas. Preoperative staging].

The authors assess the value of laparoscopy in the preoperative staging of the adenocarcinoma of the pancreas to prevent unnecessary pancreatic resections in a disseminated disease. By laparoscopy, a macroscopic evaluation, a peroperative liver and pancreas ultrasonography as well as biopsies are possible and are more accurate in assessing the extent of the disease than other means.

Biopsy↗
PubMed2000

[Adenocarcinoma of the pancreas. Palliative surgery].

In case of unresectable adenocarcinoma of the pancreas, laparoscopy can allow to perform gastric and biliary by-pass which will improve the quality of life at a lower cost than conventional surgery for the patients.

Adenocarcinoma↗
PubMed1996

Causes of failures of laparoscopic antireflux operations.

BACKGROUND: Three factors determine the successful outcome after an antireflux operation for gastroesophageal reflux disease (GERD): indication for surgery, choice of the operative procedure, and quality of the operation. Laparoscopic treatment has not changed these concepts. The factor most likely to have been modified is the technical quality of the operative procedure. We evaluated 26 patients presenting with failure after laparoscopic antireflux surgery to determine the causes. METHODS: Nineteen patients came from our series of 503 laparoscopic antireflux procedures and seven patients were referred from other centers. Preoperative, peroperative, and postoperative data were retrospectively reviewed to analyze the responsible factor(s). RESULTS: Nine patients presented with a sphincter mechanism failure to control reflux, 14 patients had severe dysphagia, 3 patients presented with severe epigastric pain. The first operation was a Nissen-Rossetti fundoplication in 17 patients. The technical quality of the operative procedure was the responsible factor in 22/26 patients. The choice of the type of operation was questionable in five patients. Eight patients underwent successful endoscopic treatment, reoperation was necessary in 10 patients. Four patients underwent medical therapy, and four patients had no treatment. CONCLUSIONS: The laparoscopic Nissen-Rossetti fundoplication was associated with a higher rate of failures, in terms of recurrent disease or severe dysphagia. The use of this technique was related to the laparoscopic inexperience of the surgeon, leading to a wrong application of the original procedure. Partial posterior fundoplication and total fundoplication with division of the short gastric vessels are obviously associated with a better outcome, if the selection of the operation is based on a strict preoperative physiopathological evaluation of the disease.

Adult↗
PubMed1994

Laparoscopic highly selective vagotomy.

Between February 1991 and August 1992, 35 patients underwent laparoscopic highly selective vagotomy (HSV) for recurrent duodenal ulcer disease. An antireflux procedure was also performed in 25 of these patients. There was no 30-day mortality and morbidity. The mean operating time was 110 (range 85-205) min for HSV and 155 (range 100-300) min for vagotomy and antireflux repair. Follow-up is short but initial postoperative gastric acid secretion studies have demonstrated results similar to those obtained after conventional open HSV. The main advantage of laparoscopic HSV is the reduction of 70 per cent in hospital stay and 50 per cent in the overall recovery period compared with open surgery.

Adolescent↗
PubMed1994

Laparoscopic gastric vagotomies.

Recurrent duodenal ulcer remains a continuing challenge for medical care. Once popular, operations have almost vanished from surgical wards due to efficient medical treatment. The onset of laparoscopy and minimal invasive surgery has caused several teams to reconsider the position of surgical treatment in the disease. Various procedures are actually used, and, as no long-term follow-up is available, it is difficult to estimate which technique would be advisable. The authors compare the different procedures and the theoretical advantages and disadvantages of each one. The best technique has to be applicable in laparoscopy and achieve the best results for the patient.

Duodenal Ulcer↗
PubMed1993

Laparoscopic Nissen fundoplication: detailed analysis of 132 patients.

With the world-wide use of laparoscopy, new applications have been found, particularly in the field of esophageal and gastric surgery. From January 1991 through April 1992, 132 patients underwent laparoscopic Nissen fundoplication. The indication for laparoscopic intervention was symptomatic gastroesophageal reflux disease (GERD) not responding to medical treatment. The preoperative assessment included esophagogastroscopy, barium meal, esophageal manometry, and, in selected cases, 24 h pH studies. There was no operative-related mortality. The overall morbidity was 7.5%. Ninety-eight patients were seen 3 months after surgery and evaluated for control of reflux symptoms. One patient complained of mild recurrence of reflux symptoms; however, endoscopic examination revealed no evidence of recurrent esophagitis. Three complained of occasional dysphagia and two, of mild dysphagia. One individual required reoperation for persistent, severe dysphagia. The excellent results observed so far with this procedure have led us to believe that laparoscopic Nissen fundoplication is the procedure of choice for patients with intractable GERD.

Adolescent↗
PubMed1991

Laparoscopic Nissen fundoplication: preliminary report.

Twelve patients presenting with symptomatic esophagitis associated with hiatal hernia and gastroesophageal reflux underwent operative management under laparoscopic guidance. The antireflux procedure employed was the Nissen fundoplication. The authors completed the operation laparoscopically in nine patients. Postoperatively, patients were evaluated with repeat fiberoptic endoscopy, esophageal manometry, and barium contrast studies. Postoperative results were considered excellent on the basis of these studies and complete control of symptoms. The mortality rate was 0%. The only major operative complication was a pneumonia that occurred in one patient. At 1 month follow-up, six patients were totally asymptomatic. The authors conclude that laparoscopic treatment of gastroesophageal reflux associated with a hiatal hernia is feasible by a procedure that has already proven its value during open surgery.

Adult↗
PubMedDate not supplied

Nationalities in Europe: the risk of war and medical responsibility.

War is often considered to be a way of solving political or economic problems. On the psychological level, war and acts of war are correlated with fear and guilt. In dealing with fear and guilt projection is a common defence mechanism, whereby others are scapegoated as the cause for one's own problems. This article presents an analysis of the relations between socio-political and economic problems, fear and guilt, and armed conflicts and wars. An alternative strategy is described, whereby people accept responsibility for the situation and work out solutions, based on a mature identity and by democratic processes. Conditions to promote this strategy are discussed. In the introduction some consequences of the last world war and of the work of the National Institute for the Victims of War in the Netherlands are described.

Aged↗
PubMedDate not supplied

[Cholecystectomy using celioscopy: analysis of 368 operations].

The management of calculous disease of the biliary tract has undergone significant changes during the past decade. Yet, the only radical method of treatment remains cholecystectomy. The surgical option has been improved by the development of laparoscopic cholecystectomy. From February 1990 to February 1991, we performed 368 laparoscopic cholecystectomies, with no mortality and a morbidity rate of 3.8%. There were 283 women and 85 men, with a mean age of 56.2 years (range 18 to 92 years). Two patients were asymptomatic but presented with a growing gallbladder polyp. All the other patients were symptomatic: biliary colic (63.8%), dyspepsia (18.6%), or acute cholecystitis (17.6%); 36 patients had an history of stone migration to the main biliary tract. Mean operating time was 58.3 minutes (22 to 180 minutes) and mean postoperative stay was 3.4 days. There were four systemic complications and 10 local technically related complications: two have been controlled by a laparoscopic approach (one hemorrhage and one biliary leak), one by laparotomy (bile duct injury). The other 7 local complications resolved spontaneously (4 biliary fistulas) or by percutaneous punction (3 subphrenic abscesses). Twenty-six patients (7%) required conversion to open cholecystectomy because of technical difficulties with the dissection or main biliary tract stones. We conclude that laparoscopic cholecystectomy is a safe and effective procedure.

Adolescent↗