Biomedical subjects

Jean H G Klinkenbijl

Publications and source records attributed to Jean H G Klinkenbijl.

6 recordsLinked to original sources

PubMed2006

Peritoneal fibrinolytic response to various aspects of laparoscopic surgery: a randomized trial.

BACKGROUND: Peritoneal fibrinolysis is important in peritoneal wound healing processes and adhesion formation. The peritoneal fibrinolytic response to laparoscopy is merely unknown. In the present study we investigate the effect of short-term laparoscopy on the peritoneal fibrinolytic response and the influence of intra-abdominal pressure, light intensity and choice of dissection device on this response. METHODS: There were 50 patients scheduled for laparoscopic cholecystectomy randomized in five groups operated with various pressures, light intensities, and dissection devices. Peritoneal biopsies were taken at the beginning and the end of the procedure. Tissue concentrations of tissue-type plasminogen activator (tPA), urokinase-type plasminogen activator (uPA), plasminogen activator inhibitor type 1 (PAI-1), and the tPA-activity were measured using ELISA techniques. RESULTS: There were no differences in tPA antigen, tPA-activity, uPA antigen, or PAI-1 antigen concentrations in biopsies taken at the beginning compared to samples taken at the end of the operation. Different intra-abdominal pressures, light intensities and the choice dissection device did not affect any of the measured parameters. CONCLUSION: Short-term laparoscopy does not affect the peritoneal fibrinolytic activity. The used intra-abdominal pressure, light intensity and choice of dissection device do not affect peritoneal activity during short-term laparoscopy.

Adult↗

PubMed2006

Risk factors for non-sentinel lymph node metastases in patients with breast cancer. The outcome of a multi-institutional study.

BACKGROUND: In this multi-institutional prospective study, we evaluated whether we could identify risk factors predictive for non-sentinel lymph node (non-SN) metastases in breast cancer patients with a positive sentinel lymph node (SN). METHODS: In this multi-institutional study, 541 eligible breast cancer patients were included prospectively. RESULTS: The occurrence of non-SN metastases was related to the size of the SN metastasis (P = .02), primary tumor size (P = .001), and lymphovascular invasion (P = .07). The adjusted odds ratio was 3.1 for SN micro-metastasis compared with SN isolated tumor cells, 4.0 for SN macro-metastasis versus SN isolated tumor cells, 3.1 for tumor size (>3.0 cm compared with </=3.0 cm), and 2.0 for lymphovascular invasion (yes versus no). There were no positive non-SNs when the primary tumor size was </=1.0 cm (n = 24) [95% confidence interval (95% CI) 0%-14.0%]. The proportion of positive non-SNs ranged in a prognostic logistic regression model from 9.7% (95% CI 4.0%-23.0%) for patients with SN isolated tumor cells, tumor size of 1.1-3.0 cm, and without vessel invasion, to 72.6% (95% CI 47.0%-89.0%) for patients with SN macro-metastasis, tumor size >3.0 cm, and with vessel invasion. CONCLUSION: We identified three predictive factors for non-SN metastases in breast cancer patients with a positive SN: size of the SN metastasis; primary tumor size; and vessel invasion. We were not able to identify a specific group of patients with a positive SN in whom the risk for non-SN metastases was less than 5%.

Adult↗

PubMed2006

Differences in sentinel lymph node pathology protocols lead to differences in surgical strategy in breast cancer patients.

BACKGROUND: Internationally, there is no consensus on the pathology protocol to be used to examine the sentinel lymph node (SN). At present, therefore, various hospitals use different SN pathology protocols of which the effect has not been fully elucidated. We hypothesized that differences between hospitals in SN pathology protocols affect subsequent surgical treatment strategies. METHODS: Patients from four hospitals (A-D) were prospectively registered when they underwent an SN biopsy. In hospitals A, B, and C, three levels of the SN were examined pathologically, whereas in hospital D, at least seven additional levels were examined. In the absence of apparent metastases with hematoxylin and eosin examination, immunohistochemical examination was performed in all four hospitals. RESULTS: In total, 541 eligible patients were included. In hospital D, more patients were diagnosed with a positive SN (P < .001) as compared with hospitals A, B, and C, mainly because of increased detection of isolated tumor cells. This led to more completion axillary lymph node dissections in hospital D (66.3% of patients (P < .0001), compared with 29.0% in hospitals A, B, and C combined). Positive non-SNs were detected in 13.9% of patients in hospital D, compared with 9.7% in hospitals A, B, and C (P = .70). That is, in 52.4% of patients in hospital D, a negative completion axillary lymph node dissection was performed, compared with 19.3% of patients in hospitals A, B, and C combined. CONCLUSIONS: Differences in SN pathology protocols between hospitals do have a substantial effect on SN findings and subsequent surgical treatment strategies. Whether ultrastaging and, thus, additional surgery can offer better survival remains to be determined.

Adult↗

PubMed2006

The clinical efficacy and cost effectiveness of the vacuum-assisted closure technique in the management of acute and chronic wounds: a randomized controlled trial.

BACKGROUND: Vacuum-assisted closure therapy is a relatively new concept described in the literature that increases wound-healing capacity. The authors aimed to investigate the effect of vacuum-assisted closure therapy on wound healing, granulation tissue formation, bacterial clearance, pain, time involvement of the staff, and total costs in all types of wounds in comparison with modern wound dressings. METHODS: Sixty-five patients with a chronic or acute wound were randomized to initial treatment with vacuum-assisted closure or modern dressings. The authors' primary endpoint was a granulated wound or a wound ready for skin grafting or healing by secondary intention. RESULTS: The time to the primary endpoint with vacuum-assisted closure therapy was not significantly shorter, except for patients with cardiovascular disease and/or diabetics. Vacuum-assisted closure therapy did not result in significantly faster granulation or wound surface reduction or better bacterial clearance, but patient comfort was an important advantage. Time involvement and costs of nursing staff were significantly lower for the vacuum-assisted closure therapy, but overall costs were similar for both groups. CONCLUSIONS: With vacuum-assisted closure therapy, wound healing is at least as fast as with modern wound dressings. Especially cardiovascular and diabetic patients benefit from this therapy. The total costs of vacuum-assisted closure are comparable to those of modern wound dressings, but the advantage is its comfort for patients and nursing staff.

Acute Disease↗

PubMed2002

Early and late morbidity associated with axillary levels I-III dissection in breast cancer.

BACKGROUND AND OBJECTIVES: Axillary dissection may cause substantial morbidity in breast cancer patients. The purpose of this study was to investigate the value of a registration method of morbidity of the arm and shoulder, which is frequently used by surgeons and which includes the measurement of range of movement, strength, and pain. METHODS: We surveyed 148 patients who had received an axillary dissection as part of breast cancer surgery. Of these patients, 77 had undergone axillary dissection 6-12 months ago and 71 patients more than 5 years ago. In all patients, an objective measurement of shoulder movement and a subjective measurement of pain and arm strength was performed. RESULTS: A difference of more than 20 degrees in abduction, ventral elevation, or dorsal elevation occurred in 12% of the patients. Pain or loss of strength were measured in half of the patients. Shoulder movement, pain, and arm strength were not significantly different between the patients who underwent mastectomy or breast conserving surgery. Also, no significant difference could be found in shoulder movement, pain, and arm strength between the patients who underwent axillary dissection 6-12 months ago and those who underwent it more than 5 years ago. CONCLUSIONS: Pain, loss of arm strength, and limitation of shoulder movement are frequent complaints after axillary dissection for breast cancer and appear to be independent of the length of follow-up and the type of surgery (i.e., breast-conservation or mastectomy).

Adult↗

PubMed2002

Laparoscopic adjustable gastric banding: a prospective comparison of two commonly used bands.

BACKGROUND: Surgery for morbid obesity has increased since the introduction of the adjustable gastric bands (AGB), which can be placed laparoscopically. There are two AGB in wide use: the Swedish Adjustable Gastric Band (SAGB, Obtech), and the Lap-Band (Inamed Health). We present the results of a comparative study between the 2 AGB. METHODS: 101 patients with a minimal follow-up of 6 months were included. 49 patients received a Swedish Adjustable Gastric Band (SAGB), and the remaining 52 received the Lap-Band (LB). Postoperative weight loss and complications were compared at set intervals of 3 months in the first postoperative year, and 6 months in the years following. RESULTS: Mean follow-up was 9.9 months for the SAGB and 7.2 months for the LB. All but 5 procedures were performed laparoscopically. Mean operating-time was 102 minutes for the SAGB and 86 minutes for the LB. No significant difference in complications was noted between the 2 AGB. 1 SAGB was repositioned and 2 were removed, compared to 2 repositions and 2 removals of the LB. We excluded 5 patients with leakage of a SAGB due to technical failure. Mean preoperative weight kg/BMI of the SAGB patients was 133/45.3; in the LB patients 138/46.4. Mean weight loss at 6 months was 28 kg with the SAGB and 30 kg with the LB, and mean weight loss at 1 year 36 kg and 38 kg respectively. After 2 years, weight loss was 46 kg and 42 kg respectively. CONCLUSION: There was no significant difference in postoperative weight loss and complications between the SAGB and the LB.

Adolescent↗