PubMed Health⌕ Search

Biomedical subjects

R F van der Sluis

Publications and source records attributed to R F van der Sluis.

At least 19 recordsLinked to original sources
PubMed1994

MR characterization of suspicious breast lesions with a gadolinium-enhanced TurboFLASH subtraction technique.

PURPOSE: To assess the utility of gadolinium-enhanced dynamic magnetic resonance (MR) imaging with turbo fast low-angle shot (TurboFLASH) technique in the differentiation of benign from malignant lesions of the breast. MATERIALS AND METHODS: Contrast material-enhanced MR images were obtained at intervals of 2.3 seconds for 2 minutes. After the first four images were obtained, contrast medium was intravenously injected within 10 seconds. Lesions that enhanced within 11.5 seconds after the aorta opacified were regarded as malignant. Lesions that enhanced more than 11.5 seconds after the aorta were regarded as benign. A centrifugal pattern of enhancement was regarded as a sign that a lesion was benign. RESULTS: Eighty-seven lesions were evaluated. Histologic examination showed 65 lesions were malignant and 22 were benign. Gadolinium-enhanced TurboFLASH imaging had a sensitivity of 95%, a specificity of 86%, and an overall accuracy of 93% in differentiating benign from malignant lesions. CONCLUSION: Gadolinium-enhanced TurboFLASH imaging is a valuable method in the examination of breast lesions suspected of being malignant.

Breast↗
PubMed1989

Residual tumour after biopsy for non-palpable ductal carcinoma in situ of the breast.

In a group of 40 patients with non-palpable ductal carcinoma in situ (DCIS) of the breast, 41 breast specimens were available for studying residual tumour after biopsy. In one group of ten patients seen before 1977, simple histological examination revealed a 9 per cent incidence of residual tumour. However, after thorough examination residual foci of DCIS were found in 77 per cent of a subsequent group of 30 patients. This means that the majority of patients would have had to undergo reoperation if a breast-saving procedure had been performed. This fact must be taken into account when planning treatment of patients with non-palpable DCIS.

Adult↗
PubMed1989

Role of gastroenterostomy in the palliative surgical treatment of pancreatic cancer.

The records of 72 consecutive patients with unresectable pancreatic cancer treated between 1974 and 1986 were evaluated to determine whether gastroenterostomy should be performed on a routine basis at initial intervention or on a therapeutic basis. Fourteen patients underwent an explorative laparotomy, 41 patients underwent biliary bypass, and 17 patients required biliary bypass and therapeutic gastroenterostomy at initial laparotomy. The mortality and morbidity rates in this last group were 18 and 59%, respectively. The most common complication was delayed gastric emptying (29%). Of the 37% of patients who required gastroenterostomy after initial biliary bypass, the mortality rate was 50% and delayed gastric emptying occurred in 57%. The mean survival after biliary bypass was 9.4 months while survival after therapeutic gastroenterostomy averaged 4.2 months. These findings suggest that gastroenterostomy should be performed on a prophylactic basis at initial intervention, unless a limited survival is expected.

Adolescent↗
PubMed1989

[Extra-long plate osteosynthesis in femoral fractures].

Of 252 femoral shaft fractures seen within a 9-year period, 32 (13%) were treated by internal fixation with an extra long DC plate, mainly because of severe comminution or fractures at two or more levels. Depending on the localization of the fracture, extra long, straight or angled plates were used. Half of the 32 patients showed multiple other injuries (mean ISS 39). Delayed union was seen in 4 patients, necessitating repeat osteosynthesis in 2. Postoperative osteitis was seen in 1 patient. The average time for consolidation was 22 weeks (10-50 weeks). The mean duration of hospitalization was 31 days. Apart from specific complications resulting from other severe injuries in 2 patients, the overall functional results were good.

Adolescent↗
PubMed1987

Localization and excision of nonpalpable breast lesions. A surgical evaluation of three methods.

Three methods of excising nonpalpable breast lesions have been evaluated: (1) "blind" method, using mammographic coordinates; (2) preoperative localization with the Frank needle; and (3) Frank needle localization aided by a multiperforated compression plate. Successful removal at first attempt occurred in about 80% with any method. The size of the biopsy specimens did not differ significantly among the three groups and is most probably a function of the breast volume. The failure rate was seven (2.1%) of 332 biopsies. Since three of the six repeated biopsies yielded specimens with malignancy, the persistence of a radiographically suspicious lesion on follow-up mammogram of the operated-on breast is an urgent indication for reoperation.

Adult↗
PubMed1987

Mammographic and histopathologic correlation of nonpalpable lesions of the breast and the reliability of frozen section diagnosis.

During a period of ten years, 118 (32.9 per cent) instances of carcinoma were found in 359 specimens taken at biopsy for nonpalpable mammographic lesions. In recent years, the positive predictive value has increased from 68 per cent due to the development of magnification mammography and the use of a mammographic grid. Correlating mammographic and histopathologic data, the rate of malignant disease was 12.7 per cent for instances of a circumscribed or nodular mass, 32.4 per cent for clustered microcalcifications as the only suspect finding, 28.6 per cent when a mass with microcalcifications was present and 66.7 per cent when a stellate-shaped mass was found. Of 188 instances of carcinoma, 40 were noninvasive: 32 instances of ductal carcinoma (27.1 per cent) and eight of lobular carcinoma in situ (6.8 per cent). The possibility of frozen section diagnosis was studied retrospectively by comparison with the paraffin section reports. A correct diagnosis, whether benign or malignant, was achieved in 68 per cent. No frozen section examination was done in 17.3 per cent and the diagnosis was deferred to results of paraffin section in 12.2 per cent. False-negative results were encountered in seven patients (1.9 per cent) and false-positive results in two (0.6 per cent). Both of these patients had florid sclerosing adenosis. Although frozen section diagnosis is feasible in nonpalpable lesions of the breast, it is recommended that this method not be used in instances of pure microcalcifications and tiny solid masses of 5 millimeters or less.

Adult↗
PubMed1987

The effect of familiality on clinical presentation and survival in mammary carcinoma.

In a series of 467 patients treated for mammary carcinoma 96 (20%) had a family history for this tumour. Sixty-eight (71%) had at least one first degree, 28 (29%) a second or third degree family member. Only the mean age of the second degree relative group differed significantly from that of the non-familial group. The size of the primary tumour at first presentation did not differ significantly in the familial and non-familial group, as the estimated survival. So patients with a family history for mammary carcinoma did not present themselves in an earlier stage of disease. Because of the higher risk of developing this type of tumour in female relatives we have to instruct this potential patient group more explicitly.

Adult↗
PubMed1986

Thyroid cancer mimicking thyroiditis.

Two patients with thyroid cancer, who presented with clinical and biochemical features of subacute thyroiditis, are reported, Confusion in diagnosis delayed therapy from 3 to 8 months. The relation between thyroiditis and thyroid cancer is discussed.

Adult↗
PubMed1986

Multicentricity in nonpalpable breast carcinoma and its implications for treatment.

During a 9 year period, 300 consecutive women underwent breast biopsies solely because of nonpalpable, mammographically suspicous findings. One hundred clinically occult breast carcinomas were found, 65 of which were invasive and 35 noninvasive. Eighty-three mastectomy specimens were evaluable for evidence of multifocal carcinoma in another quadrant of the breast or at a distance of 5 cm and residual cancer outside the excisional biopsy cavity. Multicentricity was present in 47 percent and residual tumor in 60 percent of the whole group. When only clinically occult invasive carcinomas were considered, other foci of invasive carcinoma were demonstrated in 26 percent of the patients and residual invasive cancer in 35 percent. The rate of bilaterality was 14 percent, occurring synchronously in 11 percent of the patients. Any therapeutic procedure for nonpalpable breast carcinoma, whether invasive or noninvasive ductal carcinoma, should be directed to the whole breast. Mammography of the contralateral side should be an integral part of the preoperative work-up of patients with palpable lesions ipsilaterally.

Adult↗
PubMed1986

The significance of microcalcifications without palpable mass in the diagnosis of breast cancer.

Microcalcifications constitute an important part of nonpalpable breast lesions and may be the first sign of a breast carcinoma. Between 1975 and 1984, 150 consecutive patients with clusters of at least five microcalcifications without palpable findings as the only indication for biopsy were treated. One hundred seventy-three groups of microcalcifications were excised and 51 malignancies were detected (29.5%). Most of the malignant lesions were noninfiltrating (56%). Axillary or distant metastases occurred in 11% of the fully evaluable cases. This warrants the expectation that these patients have a very favorable prognosis. Breast biopsy for nonpalpable-clustered microcalcifications is a feasible and valuable procedure. Close cooperation is required between the surgeon, radiologist, and pathologist.

Adult↗
PubMed1985

Total thyroidectomy: the treatment of choice in differentiated thyroid carcinoma?

A review of 46 patients with differentiated thyroid cancer, diagnosed and treated in the St. Radboud Hospital from 1977 till 1984, is presented. The age of the patients ranged from 16 to 80 years. There were 39 women and 7 men. Thirty of 31 patients with papillary carcinoma and 13 of 15 patients with follicular carcinoma underwent total thyroidectomy. If less than total thyroidectomy had been performed, 13 (43%) patients with papillary cancer and 2 (15%) with follicular cancer would have had cancer left in the residual lobe. The complication rate was acceptable, two cases of permanent hypoparathyroidism, one recurrent nerve palsy. During a short follow-up period of 7 years maximum already 6 patients older than 60 years with papillary carcinoma had died, 5 of widespread cancer (16.6%) and one of an unrelated disease. Three patients developed local recurrences, on in the trachea and 2 outside the thyroid bed. One patient with follicular carcinoma, who had undergone a lobectomy, developed recurrent disease. These figures plus the increased risk of complications in a second neck exploration suggest that total thyroidectomy is the treatment of choice for patients with differentiated thyroid cancer. Total thyroidectomy can be done without mortality and without significant morbidity.

Adenocarcinoma↗
PubMed1984

Removal of the massive spleen: a surgical risk?

The results of splenectomy for hematologic disorders have been reviewed with special attention to problems possibly associated with massive spleens (1,500 g or more). The mortality rate in the group of patients with massive spleens did not differ from that in the group of patients with smaller spleens (2 percent and 3 percent, respectively). The complication rate, however, in the group of patients with massive spleens (43 percent) was twice that in the patients with smaller spleens (43 percent and 22 percent, respectively). The most frequent complication was postoperative hemorrhage in the splenic bed, usually caused by thrombocytopenia, perisplenitis , or both. Postoperative morbidity is seen as a function of the underlying disorder and of the general condition of the patient and not of the weight of the spleen per se.

Adolescent↗