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Biomedical subjects

R M Butzelaar

Publications and source records attributed to R M Butzelaar.

At least 19 recordsLinked to original sources
PubMed2001

Inguinal hernia repair in the Amsterdam region 1994-1996.

In the Netherlands, approximately 30,000 inguinal hernia repairs are performed yearly. At least 15% are for recurrence. New procedures are being introduced creating discussion on which technique is the best. Currently it is not possible to choose on evidence alone because of the long follow-up that is needed. In 1996 an inventory was taken of all inguinal hernia repairs that were performed in the Amsterdam region (9 hospitals). These results were compared with the results from a similar study performed in 1994. Major changes in treatment strategy were noted. The Bassini repair was replaced by Shouldice and Lichtenstein techniques. There was a significant increase in the use of prostheses for both primary and recurrent inguinal hernias. There was no significant decrease in the percentage of operations performed for recurrent hernia from 19.5% to 16.8%. However, there was a significant decrease in operations performed for early recurrences (5.1%-3.4%) (p = 0.05). These results suggest that the Shouldice and Lichtenstein repairs may be superior to the Bassini repair in terms of early hernia recurrence.

Adolescent↗
PubMed2000

[Circumcision from a historical perspective].

Male circumcision has been practiced by many tribes in different continents. The oldest image of a circumcision dates from 2300 BC and was found in Egypt. In the Jewish religion circumcision symbolizes the covenant between God and Abraham. Despite the fact that Jesus of Nazareth was circumcised, circumcision has never been part of Christianity. Circumcision is not mentioned in the Koran; the practice of circumcision in Islam is attributed to Abraham, who is considered by muslims to be one of the prophets. From the middle of the nineteenth century circumcision was performed for medical reasons. Throughout the centuries, from the time of the Bible, many methods for performing circumcision have been described, and a few to undo it by restoring the prepuce.

Christianity↗
PubMed1999

[Interaction between breast cancer, psychosocial stress and the immune response].

Awareness of the interactive relation between psychosocial stressors, neuroendocrine and immunological processes, and tumour progression in patients with breast cancer appears to be important for clinicians. However, it is not established yet how the available knowledge can be applied therapeutically. Hormonal factors play a part in the carcinogenesis of breast cancer. Growth of the breast tumour is influenced by endocrine hormones. Antioestrogen therapy is effective in the treatment of breast cancer. Several components of the immune system are related to the course of disease in breast cancer patients. Psychosocial stressors influence neuroendocrine (corticotrophin-releasing hormone (CRH), cortisol, oestrogen) and immunological functions. Psychosocial stressors may be linked to recurrence or survival. Certain coping mechanisms (even those of a negative nature) and the social network of the patient may have prognostic values. Since recurrence of the disease is still possible many years after curative surgery, multifactorial effects on the course of disease are likely.

Adaptation, Psychological↗
PubMed1998

Laparoscopic evaluation of patients with suspected acute appendicitis.

BACKGROUND: High error rates are reported in the clinical diagnosis of acute appendicitis. This study was undertaken to discover what additional value laparoscopy has in the diagnosis of suspected acute appendicitis. METHODS: From April 1995 to November 1996, a diagnostic laparoscopy, before open appendicectomy, was performed in 100 consecutive patients with suspected acute appendicitis. Appendicectomy was performed only if the appendix showed signs of inflammation at laparoscopy or if the appendix could not be visualized. RESULTS: Twenty-four patients were spared an appendicectomy, and in half of them a new diagnosis was established during laparoscopy. The rate of misdiagnosis was 41% in female patients of reproductive age and 8% in male patients. There were no cases of missed appendicitis in this trial, and all removed appendices showed signs of inflammation at histology. CONCLUSIONS: It is safe to rely on the diagnosis made at laparoscopy. Its use for establishing diagnosis before appendicectomy in women of reproductive age is recommended.

Acute Disease↗
PubMed1997

Breast cancer and reduction mammoplasty: the role of routine pre-operative mammography.

Occasionally breast cancer is accidentally discovered in specimens from patients undergoing reduction mammoplasty. We present the cases of two patients, both over 50 years of age. Because a reduction mammoplasty distorts the architecture of the breast, the post-operative discovering of a carcinoma renders mastectomy the only treatment option possible. We recommend the use of a pre-operative mammography for all women over 50 years of age who are scheduled for a breast reduction.

Breast Neoplasms↗
PubMed1997

Low intercellular adhesion molecule 1 and high 5T4 expression on tumor cells correlate with reduced disease-free survival in colorectal carcinoma patients.

The purpose of this study was to investigate the prognostic value of the expression of intercellular adhesion molecule 1 (ICAM-1), leukocyte function antigen 3 (LFA-3), human leukocyte differentiation antigen (HLA)-ABC, HLA-DR, and 5T4 with regard to disease-free survival in Dukes' B and C colorectal carcinoma patients. Forty-one patients (28 Dukes' B and 13 Dukes' C) were entered into this study. Immunocytochemistry was performed on cytospin preparations of enzymatically digested colorectal carcinoma cell suspensions. The frequency of metastases and the duration of disease-free survival were compared between the 25% lowest expressers and the 75% remaining patients for ICAM-1, LFA-3, HLA-ABC, and HLA-DR, and between the 25% highest expressers and the 75% remaining patients for 5T4. Low numbers of ICAM-1-expressing tumor cells were associated with a shorter disease-free survival (P < 0. 001), independent of Dukes' stage. High numbers of 5T4-expressing tumor cells were associated with shorter disease-free survival in Dukes' B patients (P = 0.04). Cox proportional hazard analysis indicated that low numbers of ICAM-1(+) and high numbers of 5T4(+) cells were independent prognostic factors with relative risks of 13. 0 (P = 0.0002) and 4.7 (P = 0.02), respectively. The combination of 5T4 and ICAM-1 marker information identified subgroups of patients with a good (high ICAM-1) or poor (low ICAM-1/high 5T4) prognosis. Neither a lack of HLA-ABC and LFA-3 expression nor the presence of HLA-DR on the tumor cells gave additional prognostic information. These findings demonstrate that low ICAM-1 and high 5T4 expression on tumor cells are prognostic markers, additional to Dukes' stage, for reduced disease-free survival in Dukes' B and C colorectal carcinoma patients.

Aged↗
PubMed1990

Mesenteric venous thrombosis caused by deficiency of physiologic anti-coagulants: report of a case.

Mesenteric venous thrombosis is a clinical entity, which is rarely recognized on admission. The patients are admitted with vague abdominal complaints and, eventually, abdominal sepsis might occur requiring laparotomy. Nowadays, underlying hypercoagulable states such as antithrombin-III, protein-C and protein-S deficiencies are recognized more frequently as a distinct cause of mesenteric venous thrombosis. In this paper, a case of mesenteric venous thrombosis due to protein-C deficiency is presented. The patients generally have a history of thromboembolism of the deep veins of the legs at young age. The combination of vague abdominal complaints and a history of thrombosis of the deep veins of the legs should arouse the suspicion of mesenteric venous thrombosis. In these cases, contrast-enhanced computerized tomography is a non-invasive diagnostic means which may provide the diagnosis. If infarction of the gut is present, resection is mandatory and a second-look operation should be performed. After surgery, heparinization is essential. This must be followed by administration of oral anticoagulants for an indefinite period in case of an underlying antithrombin III, protein-C or protein-S deficiency.

Adult↗
PubMed1986

Acute pseudo-obstruction of the colon.

Five patients were treated for pseudo-obstruction of the colon. The symptoms, diagnostic procedures and treatment of Ogilvie's syndrome are discussed. A definitive diagnosis can be established only at laparotomy when no mechanical obstruction is found to be present. Progression of ileus and signs of peritonitis constitute an indication for laparotomy. Delay in operative therapy implies the risk of (coecal) perforation with increased mortality. Coecostomy is an adequate therapy that spares the patient a second procedure for closure of a colostomy.

Aged↗
PubMed1985

Correlation between a positive gallbladder culture and subsequent wound infection after biliary surgery--a retrospective study of 840 patients.

The possible correlation between a positive culture of samples from the gallbladder wall and/or bile at the time of cholecystectomy and subsequent wound infections was retrospectively studied in a series of 840 patients. Positive cultures were present in 138 patients (16.4) and 19 different bacterial species could be identified. Cultured bile showed Escherichia coli in 36% of cases. The wound infection rate was 9% (72 patients) with Staphylococcus aureus cultured from the infected wounds in 64%. Fifty-eight of these 72 patients (80%) were at high risk. In contrast with the literature, no correlation existed between a positive bile culture and subsequent wound infection. In view of these results there is no need to evaluate a Gram-stain during surgery. Antimicrobial prophylaxis should be restricted to high-risk patients and the antibiotics used must be effective against exogenic wound contaminants.

Adult↗
PubMed1984

Bone scintigraphy in patients with operable breast cancer stages I and II. Final conclusion after five-year follow-up.

A 5-yr follow-up study was performed in 90 patients with stage I and II breast cancer who had a routine preoperative bone scan. The percentage of positive preoperative scans was 3.4%. Twenty-four of the 90 patients died within 5 yr. In all patients except five a follow-up scan was obtained. The results of our first study were confirmed. In only one of the three patients with a positive preoperative scan suspicious for bone metastases did bone metastases develop in this 5-yr follow-up study. One patient with an equivocal preoperative scan developed bone metastases. In 14 of the 16 patients with bone metastases and a positive scan in the follow-up period the preoperative scan was negative. From the preoperative and follow-up scan results we conclude that in stage I and II breast cancer there is no value in preoperative bone scanning. Routine bone scanning in the follow-up period appears to have little value in the asymptomatic patient.

Bone Neoplasms↗
PubMed1984

The diagnosis of gallstones--a prospective comparison of oral cholecystography and real-time ultrasound.

A prospective study was made to compare the diagnostic value of ultrasound and oral cholecystography. 256 Patients were examined, 143 of whom were operated on. Ultrasound proved to have less chance of missing gallstones, whereas oral cholecystography showed a high percentage of false-positive results at first examination. Ultrasound is recommended as the method of choice for screening gallstones.

Cholecystography↗
PubMed1981

Results of hemipelvectomy for soft tissue sarcoma.

From a series of 89 patients treated with hemipelvectomy at the Memorial Sloan-Kettering Cancer Center during the period 1972--1976, 16 patients with soft tissue sarcoma are discussed. Three patients were operated on for palliative reasons. Most of the remaining 13 patients underwent a hemipelvectomy after other more conservative procedures had failed to control the disease. Mortality rate was zero; the morbidity 50%, but all complications responded to conservative treatment except for two patients with postoperative hemorrhage. The results are discussed, as is the rehabilitation of the patients. Hemipelvectomy seems to have a place in palliative treatment of patients with soft tissue sarcoma. The one-year cumulative survival rate of 69.2% and the five-year cumulative survival rate of 42.6% appear to justify hemipelvectomy for highly selected patients with soft tissue sarcoma who cannot otherwise be treated successfully.

Adult↗
PubMed1981

Computerized tomography and radionuclide scan in surgical patients -- a comparative prospective study in detecting liver metastases.

A prospective study was carried out in 100 patients with carcinoma of the digestive tract, in whom a CT-scan and a radionuclide scan were made prior to operation. The CT-scan and the radionuclide scan had the same degree of diagnostic relaibility (about 80% correct diagnoses). Routine pre-operative CT or isotope scans do not in our experience alter the surgical management. From the in vitro investigation in which the liver is cut into the same slices as the computerized tomography, it appears that liver metastases larger than 3.5 cm diameter are always seen, while smaller metastases may be missed. The alkaline phosphatase and the gamma CT are no reliable estimations in establishing the diagnosis of liver metastases.

Diagnostic Errors↗