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Biomedical subjects

M Eeftinck Schattenkerk

Publications and source records attributed to M Eeftinck Schattenkerk.

At least 19 recordsLinked to original sources
PubMed2006

Rectal carcinoma treated with short-term preoperative radiotherapy followed by abdominoperineal resection. Significantly more presacral abscesses with absence of local recurrence.

BACKGROUND: Treatment of choice for rectal carcinoma is short-term preoperative radiotherapy (5 x 5 Gy) followed by a total mesorectal excision (TME) of the rectum. This treatment has led to a reduction in local recurrence 2 years after surgery from 8.2 to 2.4%. Side effects of this treatment seem to be marginal and of no consequence. After introduction of short-term preoperative radiotherapy we noticed a rise in the postoperative presacral abscess formation which is difficult to treat and results in readmissions and prolonged hospital stay. Research was needed to investigate whether short-term preoperative radiotherapy can be held accountable for the presumed rise in presacral abscess formation in the treatment of rectal carcinoma. METHODS: A retrospective study was performed over the period January 2000-October 2004. Two groups were formed. Group 1 existed of 30 patients who underwent a TME of the rectum without short-term preoperative radiotherapy. Group two existed of 35 patients who underwent a TME of the rectum with short-term preoperative radiotherapy. RESULTS: Statistical analysis showed a significant increase in presacral abscess formation (13 vs. 40%) after introduction of short-term preoperative radiotherapy. Radiotherapy proved to be an important risk factor. Reduction in incidence of local recurrence was not evident. CONCLUSION: We found a significant increase in presacral abscess formation strongly suggestive due to the introduction of short-term preoperative radiotherapy in the treatment of rectal carcinoma. We noticed no reduction in incidence of local recurrence. We advocate that additional research is needed in order to formulate extra patient selection criteria for the use of preoperative radiotherapy in the treatment of rectal cancer.

Aged↗
PubMed2005

[A patient with sclerosing autoimmune pancreaticocholangitis as the cause of recurrent cholangitis following a pylorus-sparing pancreaticoduodenectomy].

A pylorus-sparing pancreaticoduodenectomy was performed in a 67-year-old man because of indications for a carcinoma of the distal common bile duct. Histology of the postoperative specimen, however, revealed a sclerosing inflammation of the distal common bile duct and the surrounding pancreatic parenchyma. Initial postoperative recovery was followed by recurrent cholangitis. Stenosis of the choledocho-jejunostomy could not be demonstrated. Instead, repeated endoscopic retrograde cholangiopancreaticography revealed extensive sclerosis of the intrahepatic bile ducts, which suggested a sclerosing cholangitis associated with an autoimmune pancreatitis: sclerosing autoimmune pancreaticocholangitis. This disorder was recently described; it is characterised by a disorder in the pancreas that is indistinguishable from malignancy by imaging techniques and that is followed by a sclerosing inflammation of the bile ducts. The disease responds well to steroids. The patient described demonstrated a complete clinical and biochemical recovery after initiation ofprednisone therapy.

Aged↗
PubMed2005

[The use of a self-expanding stent as palliation or before elective surgery in patients with obstructive colorectal carcinoma].

OBJECTIVE: To evaluate the use of colorectal stents. DESIGN: Retrospective. METHOD: Data were collected on all patients treated at the Deventer Hospital, the Netherlands, between 1 April 1996 and 31 December 2003 in whom the placement of a self-expanding colorectal stent was attempted. Each patient's physician was contacted to inquire about the patient's status, including quality of life with the stent in situ. RESULTS: Stent placement was attempted in 57 patients as palliation (n = 45) or before elective surgery (n = 12). Of the 57 patients, 29 were men and 28 were women, and the mean age was 71 years (range: 46-94). All patients had colorectal carcinoma, except 1 patient with stenosis following ischaemic colitis. Passage of air and faeces occurred immediately after stent expansion in 55 of the 57 patients (96%). Perforation during stent placement occurred in 2 patients, who subsequently underwent colostomy. 4 additional patients required a colostomy due to stent migration within a few hours or days after placement (n = 3) or obstruction by tumor growth after 65 days (n = 1). Patients in the palliative group had an acceptable quality of life. Those who received a stent before elective surgery were able to undergo resection, did not require colostomy, and had no postoperative complications. One patient did not undergo surgery because of extensive metastases. CONCLUSION: A colorectal stent can be used in the palliative treatment of terminal patients with colorectal carcinoma before colostomy is considered. Experiences with stents before elective surgery were also positive.

Aged↗
PubMed2003

Magnetic resonance cholangiopancreaticography as a diagnostic tool for common bile duct stones: a comparison with ERCP and clinical follow-up.

BACKGROUND/AIMS: The diagnostic potential of magnetic resonance cholangiopancreaticography (MRCP) has improved as a result of evolving technique. MRCP has the advantage of negligible morbidity and mortality in contrast to endoscopic retrograde cholangiopancreatography (ERCP). This study was performed to evaluate MRCP as a replacement for diagnostic ERCP for the suspicion of common bile duct (CBD) stones. METHODS: From 1998 to 2001, MRCP was performed in 202 patients with a suspicion of CBD stones based on medical history (MH), cholestatic liver function tests (CL), both MH and CL or other reasons. ERCP was performed in all patients where MRCP indicated the presence of CBD stones and in those patients with a persistent strong clinical suspicion for CBD stones despite a negative MRCP. RESULTS: In 25 patients, MRCP suggested CBD stones which were proven with ERCP in 24 patients. Despite a negative MRCP, 27 patients had a subsequent ERCP. None of these patients appeared to have CBD stones. In this group, MRCP resulted in 100% sensitivity and 96% specificity in detecting CBD stones. Follow-up of all patients revealed 5 more patients with persistent clinical suspicion or cholestatic liver function values. Assuming CBD stones in these patients, MRCP had a sensitivity of 83 % and a specificity of 99% for this diagnosis. CONCLUSION: In the case of CBD stone suspicion, MRCP should be the diagnostic procedure of choice.

Adult↗
PubMed2000

[Unusual form of ileus, except in elderly patients?].

Two women aged 88 and 92, recently admitted to hospital, were diagnosed with gallstone ileus. Over a longer period of time they had suffered intermittently from abdominal pain related to a migrating and impacting stone. This disease is mostly diagnosed correctly during exploratory laparotomy for persistent intestinal obstruction. CT scanning, however, is a new and helpful way to early diagnosis. Both women had successful surgery. Gallstone ileus is a disease of the elderly; its early diagnosis is important. CT can be very helpful in this respect.

Aged↗
PubMed1997

[Alleviation of inoperable malignant colon stenosis using endoscopic placement of an endoprosthesis].

Treatment modalities for patients with an obstruction due to an irresectable malignant stenosis of the colon are: a palliative colostomy proximal of the obstruction, radiotherapy, laser therapy, cryosurgery, and photodynamic therapy. In 4 patients, 3 men and 1 woman of 70, 66, 74, and 38 years respectively with obstruction ileus caused by an irresectable distal colonic carcinoma, a self-expanding wallstent was successfully placed endoscopically in the stenosis of the latter three as a palliative measure, resulting in the unimpeded passage of faeces and intestinal gas.

Adult↗
PubMed1994

Randomised controlled trial comparing transfusion of leucocyte-depleted or buffy-coat-depleted blood in surgery for colorectal cancer.

In retrospective studies, perioperative blood transfusions were associated with poor prognosis after surgery for cancer and were a major independent risk factor for postoperative bacterial infection. Leucocyte-depleted, in contrast to buffy-coat-depleted, blood has no immunosuppressive effects in transplantation and so might lack detrimental effects on cancer prognosis and postoperative infections. We studied this hypothesis in a controlled trial by randomly allocating patients to receive either leucocyte-depleted red cells or packed cells without buffy coat when blood was needed. Between 1987 and 1990, 871 eligible patients with colorectal cancer, including 697 patients operated upon with curative intent, were randomised in the 16 participating hospitals. Neither the eligible group nor the curative group showed significant differences between the two trial transfusions in survival, disease-free survival, cancer recurrence rates, or overall infection rates after an average follow-up of 36 months. Patients who had a curative resection and who received blood of any sort had a lower 3-year survival than non-transfused patients (69% vs 81%, p = 0.001) and a higher infection rate (39% vs 24%, p < 0.001). Colorectal cancer recurrence rates, however, were not influenced by blood transfusion (30% vs 26%, p = 0.22). These combined observations confirm the association between blood transfusion and poor patient survival but indicate that the relation is not due to promotion of cancer.

Adenocarcinoma↗
PubMed1986

A nonelemental versus an elemental diet for early postoperative enteral feeding by needle catheter jejunostomy.

In a prospective randomised study the use of an elemental versus a nonelemental diet for early postoperative enteral feeding by needle catheter jejunostomy was investigated. After extensive gastrointestinal surgery, 25 patients received an elemental and 24 patients a nonelemental diet. The incidence of diarrhoea, the effects of the feeding and the costs were evaluated. The occurrence of diarrhoea was observed more frequently in the elemental diet group (14 25 ) compared to the nonelemental diet group (7 24 ), although this difference was statistically not significant (p > 0.05). No difference was found between the two groups in postoperative restoration of total protein and serum albumin levels and the extent of the postoperative weight loss. The costs showed a clear difference: the nonelemental diet was three times cheaper than the elemental diet. For early postoperative enteral feeding by needle catheter jejunostomy we therefore recommend the use of a nonelemental diet.

Journal Article↗
PubMed1984

Haemorrhage from the pancreatic duct: a rare form of upper gastrointestinal bleeding.

Recurrent upper gastrointestinal haemorrhage arising from the pancreatic duct presents diagnostic difficulties. Bleeding can be secondary to pancreatic disease (pancreatitis, pseudocysts) or vascular disorders (aneurysms of the splanchic arteries). Of the 5 cases reported here, 3 involved a ruptured aneurysm of the splenic artery and 2 chronic pancreatitis. Attacks of colicky pain in the left epigastric region associated with haematemesis and/or melaena were characteristic symptoms. Pancreatectomy controlled the bleeding in 4 and ligation of the splenic artery and the pancreatic duct in one. Fifty-five patients with similar pathology have been previously reported, suggesting that this syndrome should be borne in mind when gastrointestinal haemorrhage of obscure origin is encountered. If routine endoscopy does not reveal the site of the haemorrhage and there are no signs of cholestasis, endoscopic retrograde pancreatography (ERP) and selective coeliac arteriography should be performed to evaluate the possibility of haemorrhage from the pancreatic duct. Surgical management depends on the site of the causative lesion.

Adult↗
PubMed1984

Treatment of pancreatic injuries.

Between 1972 and 1983 14 patients with pancreatic injuries have been treated. The diagnosis was often difficult and only made at laparotomy in most patients. Peritoneal lavage and serum amylase levels were of little help in diagnosis. Even at laparotomy, the diagnosis was initially missed in one patient. Six patients had injuries of the pancreatic head and were treated either by Whipple pancreatoduodenectomy (one patient), drainage with gastric and jejunal decompression (two patients) or simple drainage (three patients). Six patients had injuries of the pancreatic body, necessitating distal pancreatectomy and splenectomy in four cases. Two patients with contusion of the pancreatic tail were treated by drainage, followed by development of an infected pancreatic pseudocyst in one case. Six patients died (43%). It is concluded that complete inspection of the pancreas and peripancreatic hematoma is mandatory in the diagnosis and treatment of pancreatic injuries.

Accidents, Traffic↗
PubMed1984

The role of early surgery in the treatment of acute hemorrhagic necrotizing pancreatitis (AHNP).

A retrospective study of the effect of surgical treatment and the value of different biochemical criteria in the early identification of AHNP in 33 patients with this condition, as proven by laparotomy, is presented. Biochemical criteria were not specific for AHNP and could only infrequently be used for assessment of the severity of acute pancreatitis. Surgical treatment consisted of pancreatic resection in 22 patients and drainage in 11 patients. Twenty-six of the 33 patients died regardless of the type of surgery. Mortality was due to multiple organ failure, either shortly after operation (eight patients) or after a protracted septic clinical course (18 patients). In total AHNP early subtotal pancreatectomy is probably not the treatment of choice since it did not improve the outcome.

Acute Disease↗
PubMed1983

Needle catheter jejunostomy (NCJ) for early postoperative feeding: experience in 210 patients.

Enteral feeding has many advantages over total parenteral nutrition (TPN) in the early postoperative period. The risk of sepsis is small, the nutrients are cheap and metabolic problems are rare. In the period April 1980 to January 1983, needle catheter jejunostomy (NCJ) was applied in 210 patients after surgery of the oesophagus, stomach, duodenum, liver or pancreas. All but 14 of these patients were fed by NCJ for a certain period postoperatively, NCJ feeding being initiated within 48 hours after the operation in 63% of the cases. In 14 patients, it was decided not to use NCJ feeding because of counter-indications observed postoperatively. The mean duration of the feeding by NCJ was 17 days (range two to 84 days). The complications observed were intraperitoneal leakage in four patients (1.9%), ileus in seven patients (3.3%) and diarrhoea in 54 patients (25.7%). The total number of feeding days was 2,906. This form of feeding resulted in savings of Dfl. 115,00 per patient per day compared with TPN, for a 12,600 Joule intake. NCJ feeding is a relatively safe, economical procedure that can be applied as a matter of routine after abdominal surgery.

Adolescent↗
PubMed1983

Surgical treatment of chronic pancreatitis by distal pancreatectomy.

No consensus exists on the best surgical treatment for chronic pancreatitis. In a retrospective study on 29 patients it was found that pain caused by chronic pancreatitis can be treated effectively by a 95% DP or a 40-80% DP. However, after a 40-80% DP the incidence of endocrine and exocrine pancreatic insufficiency is less frequent than after a 95% DP. Therefore, distal pancreatectomy can be advised as a treatment of pain, caused by chronic pancreatitis. In order to minimize the chance of pancreatic insufficiency resection should be done as conservatively as possible.

Chronic Disease↗
PubMed1980

Clinical experience with the medical anti-shock trousers (MAST) treatment of hemorrhage, especially from compound pelvic fracture.

The experience and results of treatment with external counterpressure for uncontrollable bleeding in 11 patients with compound pelvic fractures and 7 other patients with various subdiaphragmatic bleeding sites are reported. In 11 cases (61%) the bleeding could be arrested with medical anti-shock trousers (MAST). 9 patients died: 5 due to hemorrhagic shock and 4 of related disorders. Treatment with MAST was unsuccessful in 7 cases of major arterial tears. In patients with compound pelvic fractures the acute blood loss may necessitate further treatment by either arterial embolization, an operation for concomitant traumata, or both. Complications of the use of MAST were minor. The (clinical) use of this garment can therefore be strongly advised in patients with otherwise intractable bleeding.

Adolescent↗
PubMedDate not supplied

Therapy of esophageal carcinoma. Results from the Joint Group on Esophageal Carcinoma in Rotterdam.

During the period 1978-1981 172 patients were referred to the Rotterdam Joint Group on Esophageal Carcinoma. Ninety-one patients were considered for combined therapy, comprising radiation therapy and surgery, and 10 patients refused surgery. The figures given in this material are actuarial survival values corrected for intercurrent death (the actuarial overall survival in parentheses). The 4-year survival in 69 patients who completed this treatment was 39 per cent (26%) (significantly better for women compared with men; significantly better for tumors less than 2 vertebrae compared with tumors greater than or equal to 2 vertebrae). The resectability rate was 85 per cent and the operation mortality rate 20 per cent. Thirty-eight patients had curative radiation therapy with a 4-year corrected survival of 5 per cent (3%). For palliative treatment, radiation therapy and endoscopic introduction of a Celestin tube were mostly used. The results of curative as well as of palliative treatment of esophageal carcinoma have shown improvement during the past decade compared with an earlier period.

Actuarial Analysis↗