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P Lemkens

Publications and source records attributed to P Lemkens.

6 recordsLinked to original sources
PubMed2006

Routine pathological evaluation after tonsillectomy: is it necessary?

OBJECTIVES: There is still no consensus regarding the necessity of sending every tonsil specimen for histological examination following tonsillectomy. To add to this discussion, we assessed the incidence of preoperatively unexpected malignancy in the postoperative tonsil specimens of adults and children in our ENT department. METHODS: We conducted a retrospective study of the histopathology results of all patients who underwent tonsillectomy between January 1999 and February 2006 in the ENT department of East Limburg Hospital in Genk. The charts of patients with postoperative histopathological malignancy were further analysed and reviewed for preoperative indications of the tonsillectomy and for preoperative suspicion of malignancy. RESULTS: A total of 2989 patients were included in the study: 2058 children (defined as 16 years or younger) and 931 adults. No malignancy was found among the children. In 20 adults, malignancy was diagnosed, but in all cases there was a preoperative suspicion of malignancy. No patient without preoperative risk factors was found to have malignancy on pathological evaluation of the tonsils. CONCLUSION: Our results indicate that routine histopathological examination of tonsils removed for benign disease in adults and children is clinically unnecessary. We propose that on an individual basis, the surgeon should decide the need for histological examination depending on preoperative risk factors and peroperative gross examination. Such a strategy will only be medicolegally possible where there are national and scientifically (evidence)based ENT consensus reports or guidelines on this issue.

Adolescent↗
PubMed2006

Tonsillectomy as a day-case surgery: a safe procedure?

UNLABELLED: PROBLEM/OBJECTIVES: To assess the safety of tonsillectomy as a one-day procedure, we retrospectively evaluated complications of tonsillectomy within two weeks after surgery. METHODOLOGY: The study included 1977 patients; 85% of the tonsillectomies were performed as a one-day procedure. Tonsillectomies were performed in Ziekenhuis Oost Limburg by one staff ENT and seven ENT residents between January 1, 1996 and January 1, 2005. We also reviewed the number of tonsillectomies performed as day surgery and their complication rate for Belgium, based on the National Office for Health and Disability Insurance billing, comparing our series with the number of tonsillectomies as day-case surgeries and their complication rate for Belgium. RESULTS: In our study, 26 patients (1.3%) consulted within two weeks of surgery for major or minor complications secondary to tonsillectomy. The only major complication was primary bleeding (bleeding within 24 hours after tonsillectomy), which occurred in five patients, all of whom received a revision for haemostasis. No patient required transfusion. Minor complications (21 patients) were secondary bleeding, fever, and anorexia. During the study period, there were 214,524 tonsillectomies performed in Belgium. Based on invoice information, 4676 cases of postoperative bleeding occurred, requiring a revision for haemostasis. In our centre and generally for Belgium, there was an increase in tonsillectomies as an outpatient procedure without an increase in incidence of subsequent bleeding. Day-case surgery tonsillectomy incidence had risen from 36% in 1996 to 64% in 2004 in Belgium. CONCLUSION: Considering the low bleeding and complication rates, tonsillectomy can safely be performed as a day-case surgery.

Adolescent↗
PubMed2003

Bilateral simultaneous facial paralysis--differential diagnosis and treatment options. A case report and review of literature.

Bilateral facial paralysis or paresis of peripheral origin is a rare condition and therefore represents a diagnostic challenge. We here present a case of a previously healthy woman who was hospitalized for symptoms of meningitis. On the second day of her hospital stay, she developed bilateral facial paresis. Later, the patient developed also tachycardia and dysrhythmias. A thorough diagnostic procedure including lumbar puncture, routine blood investigation with serological tests, MRI of the brain, Holter monitoring and transoesophageal echocardiographia, revealed meningitis with radiculitis, facial paresis and myocarditis. The clinical triad of meningitis, radiculitis and facial palsy is known as the Bannwarth Syndrome (Lyme disease). The patient was treated with ceftriaxone and recovered well. Despite repeatedly taken serological tests, Borrelia burgdorferi immunoglobulins were not detected. Acquired bilateral facial paralysis can occur in several diseases of infectious, neurological, idiopathic, iatrogenic, toxic, neoplastic or traumatic origin. In this article, we review the differential diagnoses and treatment options of bilateral facial paresis and present a scheme that is helpful in the diagnostic evaluation of this condition.

Adult↗
PubMed2001

Septal suturing following nasal septoplasty, a valid alternative for nasal packing?

Septal suturing following nasal septoplasty, a valid alternative for nasal packing? After septal surgery most surgeons still routinely perform nasal packing since this is generally recommended. The aims of packing are numerous: haemostasis, prevention of haematoma, increase septal flap apposition, closure of dead space and prevention of displacement of the replaced cartilage. However, nasal packing is not an innocuous procedure and may lead to cardiovascular changes, continued bleeding, nasal injury, hypoxia, foreign body reaction or infection. The major disadvantage of nasal packing is patient discomfort--usually necessitating hospital stay--and the need to administer antibiotics. Therefore alternatives were sought. Sessions, Lee and Vukovic conceived and reported in the eighties forms of continuous septal suturing, but are not widely used. A similar technique of septal suturing after nasal septoplasty without nasal packing was used in 226 consecutive surgical procedures and reviewed retrospectively. Complications like postoperative episodes of bleeding, infections, septal haematomas, septal perforations or synechia were not noted. On one patient a recurrence of the septal deviation occurred. Patients reported almost no discomfort. Moreover, the septal surgery procedure could be carried out on a day-surgery basis. Readmission of a patient was never necessary. Based on these observations the septal suturing technique is a valid alternative to intranasal packing following septal surgery.

Adolescent↗
PubMed1984

Are postoperative complications more frequent and more serious after irradiation for laryngeal and hypopharyngeal cancer?

In order to improve local cure rates and survival in patients with head and neck cancer, combinations of radiotherapy and surgery are used. Most reports on such treatment results indicate an improvement with combined therapy. However, it is not clear whether it is best to irradiate before or after surgery. There is disagreement in the literature, whether postoperative complications are more frequent when the irradiation is given prior to surgery. The incidence of postoperative complications was studied in 213 patients who had a laryngectomy for laryngeal or hypopharyngeal cancer. The incidence of major complications was 8.5% after a preoperative dose of 40 or 50 Gy. After rescue surgery for radiation failure this percentage was 32%. In our experience, the incidence of postoperative complications after doses up to 50 Gy/5 weeks is comparable to what can be expected after surgery alone. When higher doses are given, these complications are more frequent. In designing treatment plans, such considerations should be kept in mind.

Combined Modality Therapy↗