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Biomedical subjects

R M Roumen

Publications and source records attributed to R M Roumen.

At least 19 recordsLinked to original sources
PubMed2006

Long-term survival of T1 and T2 lymph node-negative breast cancer patients according to Mitotic Activity Index: a population-based study.

Node-negative breast cancer patients have a relatively good prognosis, but eventually one-third will die of the disease. Thus, prognostic factors to identify the high-risk group among these patients are needed. We retrospectively determined the Mitotic Activity Index (MAI) for a large series of node-negative breast cancer patients (n = 468) with tumours smaller than 5 cm, who only received locoregional treatment. Patients were followed for up to 29 years; crude and relative survival were calculated, both univariate and multivariate. Relative survival differed significantly according to MAI (p = 0.05), the difference occurred in the first 5 years after diagnosis and remained constant thereafter. After adjustment, MAI still significantly affected relative survival (RER, 1.9; 95% CI, 1.1-3.5). Tumour size also increased the risk, but this was not statistically significant (RER, 1.5; 95% CI, 0.8-2.7). Survival of patients with a T1 tumour and MAI < 10 was similar to that for the general population in the first 5 years after diagnosis. In conclusion, MAI significantly predicted long-term survival for T1/T2N0 breast cancer. Adjuvant systemic therapy appears to have little benefit for node-negative breast cancer patients with a T1 tumour, regardless of the MAI. For those with a T2 tumour and a MAI > or = 10 systemic therapy might have reduced mortality. The need for close surveillance of node-negative breast cancer patients with a T1 tumour and MAI < 10 seems limited.

Adult↗
PubMed2004

[Inguinal pain without inguinal hernia: what could it be?].

A number of unusual conditions was diagnosed in 6 patients with inguinal pain. A 30-year-old man had iliopectineal bursitis on the right as well as a recurrent left inguinal hernia; many years after a Pfannenstiel incision a woman aged 57 harboured an entrapment of the ilioinguinal nerve; a 26-year-old woman suffered from endometriosis in the round ligament; a man aged 65 had compression of the genitofemoral nerve caused by a left iliac aneurysm; a woman aged 38 demonstrated symptoms of an anterior snapping hip; and a man aged 42 had retroperitoneal compression of nerves caused by a sarcoma. All recovered following appropriate treatment. Knowledge of a variety of clinical entities with associated specific anamnesis and physical examination will lead to a correct diagnosis and treatment in most cases of inguinal pain. In instances of compression, imaging techniques may facilitate the diagnostic work-up.

Adult↗
PubMed2001

Tumor growth pattern and thymidine phosphorylase expression are related with the risk of hematogenous metastasis in patients with Astler Coller B1/B2 colorectal carcinoma.

BACKGROUND: The benefit of adjuvant chemotherapy appears to be limited for patients with Astler Coller B1/B2 colorectal carcinoma but may be better in a subgroup of patients with a high recurrence risk. In the current case-control analysis, the authors evaluated whether patients with a high risk of hematogenous metastasis could be identified by means of a thorough histologic and immunohistochemical examination of the resection specimens. METHODS: A database was built for all patients treated in a general teaching hospital for colorectal carcinoma between 1985 and 1995. From this database, all patients with an Astler Coller B1 or B2 tumor who subsequently had developed hematogenous metastases were taken as cases. For each case, three matched controls (age, Astler Coller, year of diagnosis) without metachronous metastases were selected. The resection specimens of cases and controls were blindly examined by two observers for the following: World Health Organization (WHO) classification; differentiation grade; growth pattern; lymphocytic, fibroblastic, and eosinophilic reaction; angioinvasion; number of lymph nodes examined; expression of E-cadherin, vascular endothelial growth factor and thymidine phosphorylase (TP); P53; microvessel density. RESULTS: Twenty-two cases and 65 controls were included in the analysis. Tumor growth pattern and tumor TP expression both independently contributed to recurrence risk. With these 2 variables, 4 subgroups could be identified with a recurrence risk ranging from 0% to 42%. CONCLUSIONS: Tumor growth pattern and degree of TP expression both appear to be related to the recurrence risk. Prospective trials should point out whether these variables can be implemented in the decision making concerning adjuvant chemotherapy.

Biomarkers, Tumor↗
PubMed2001

Antioxidants reduce oxidative stress in claudicants.

BACKGROUND: Low-grade ischemia-reperfusion in claudicants leads to damage of local tissues and remote organs. Since this damage is partly caused by oxygen-derived free radicals (ODFR), scavenging these ODFR could reduce the local and remote injury. METHODS: Using a new method by which a free radical reaction product (ortho-APOH) of the exogenous marker antipyrine is measured to quantify the oxidative stress, 16 stable claudicants performed a standard walking test before and after administration of vitamin E (200 mg) and vitamin C (500 mg) daily for 4 weeks. FINDINGS: Ortho-APOH was significantly increased during the reperfusion period (P = 0.026) before administration of the vitamins. After 4 weeks of vitamin supplementation no rise was found in the reperfusion period. Malondialdehyde showed no changes in either group. INTERPRETATION: These findings indicate that administering extra antioxidants to claudicants reduces oxidative stress in these patients. This may also have an effect on the remote ischemia-reperfusion damage and reduce cardiovascular morbidity in this group.

Aged↗
PubMed2001

Risk, severity and predictors of physical and psychological morbidity after axillary lymph node dissection for breast cancer.

The aim of this study was to investigate the nature and severity of the arm complaints among breast cancer patients after axillary lymph node dissection (ALND) and to study the effects of this treatment-related morbidity on daily life and well-being. 400 women, who underwent ALND as part of breast cancer surgery, filled out a treatment-specific quality of life questionnaire. The mean time since ALND was 4.7 years (range 0.3-28 years). More than 20% of patients reported pain, numbness, or loss of strength and 9% reported severe oedema. None of the complaints appeared to diminish over time. Irradiation of the axilla and supraclavicular irradiation were associated with a 3.57-fold higher risk of oedema (odds ratio (OR) 3.57; 95% confidence interval (CI) 1.66-7.69) causing many patients to give up leisure activities or sport. Women who underwent irradiation of the breast or chest wall more often reported to have a sensitive scar than women who did not receive radiotherapy. Women <45 years of age had an approximately 6 times higher risk of numbness of the arm (OR 6.49; 95% CI 2.58-16.38) compared with those > or = 65 years of age; they also encountered more problems doing their household chores. The results of the present study support the introduction of less invasive techniques for the staging of the axilla, sentinel node biopsy being the most promising.

Activities of Daily Living↗
PubMed2001

Treatment of 100 patients with sentinel node-negative breast cancer without further axillary dissection.

BACKGROUND: The sentinel node biopsy technique for breast cancer has been validated extensively in phase I and II studies. However, no data from phase III randomized clinical studies are available. It remains controversial whether a histologically negative sentinel node biopsy without further axillary dissection can be considered to be good clinical practice. METHODS: One hundred consecutive patients with breast cancer who had a negative sentinel node biopsy without additional axillary dissection were studied prospectively between 1997 and 2000 in order to identify tumour recurrence and to assess the morbidity of the sentinel node procedure. Special attention was paid to axillary or locoregional recurrence, distant metastases and overall survival. One year after the procedure patients were sent a questionnaire to assess any functional impairment of the arm or shoulder. RESULTS: Median follow-up was 24 (range 16-40) months. One patient had an axillary relapse 14 months after the initial diagnosis of breast cancer. She died after 2 years from metastatic disease. There were no other local axillary recurrences. There was a 94 per cent response rate to the questionnaire. Twelve patients developed mild disabilities, of whom two said that they had to change their hobbies, sports or daily activities owing to the sentinel node procedure. No patient developed lymphoedema or needed physiotherapy after the operation. CONCLUSION: When strict criteria for the sentinel node biopsy procedure are used, the sentinel node biopsy without further axillary dissection after a negative histological investigation is a safe procedure. It may therefore be considered to be the standard of care for the treatment of patients with breast cancer.

Adult↗
PubMed2001

Detection, treatment and outcome of axillary recurrence after axillary clearance for invasive breast cancer.

BACKGROUND: The aim was to gain insight into the diagnosis, treatment and prognosis of axillary recurrence after axillary clearance for invasive breast cancer in a large patient series. METHODS: Between 1984 and 1994, 4669 patients with invasive breast cancer underwent axillary clearance in eight community hospitals in the south-eastern part of the Netherlands. Using follow-up data in a population-based cancer registry, 59 patients with axillary recurrence were identified. RESULTS: The median interval between treatment of the primary tumour and the diagnosis of axillary recurrence was 2.6 (range 0.3-10.7) years. In 51 patients (86 per cent), axillary recurrence was found by palpation during routine follow-up. Surgery was part of the treatment of recurrence for 41 of 59 patients. Regional control (complete eradication of axillary recurrence) was achieved in 34 patients (58 per cent). The 5-year actuarial survival rate was 39 (95 per cent confidence interval 25-53) per cent. Patients with negative axillary lymph nodes at the time of diagnosis of the primary tumour and complete eradication of axillary recurrence had the best prognosis. CONCLUSION: Patients with axillary recurrence had a poor prognosis, except when complete eradication was achieved and axillary lymph nodes were negative at the time of diagnosis of the primary tumour.

Adult↗
PubMed2001

Determinants of axillary recurrence after axillary lymph node dissection for invasive breast cancer.

AIM: This study was undertaken to gain insight into the risk factors for axillary recurrence among patients with invasive breast cancer who underwent breast-conserving treatment or mastectomy and axillary lymph node dissection. METHODS: In a matched case-control design, 59 patients with axillary recurrence and 295 randomly selected control patients without axillary recurrence were compared. Matching factors included age, year of incidence of the primary tumour and postsurgical axillary nodal status. RESULTS: For patients with negative axillary lymph nodes, those with a tumour in the medial part of the breast had a 73% (95% CI: 4-92%) lower risk of axillary recurrence compared to those with a tumour in the lateral part of the breast. For the patients with positive axillary lymph nodes the risk of axillary recurrence was 65% (95% CI: 16-86%) lower for those who had received axillary irradiation compared to those without axillary irradiation. Within the age group <50 years, the risk or axillary recurrence was 82% lower (95% CI: 45-94%) for patients with more than six lymph nodes found in the axillary specimen compared to those with six or less than six lymph nodes. CONCLUSIONS: Although based on a small number of patients, this study indicates that axillary irradiation is effective in reducing the risk of axillary recurrence for patients with positive lymph nodes. This favourable effect only applies to the subgroup with extranodal extension or nodal involvement in the apex of the axilla, as these were the only patients receiving axillary radiation during the study period.

Adult↗
PubMed2001

Differences in renal response between endovascular and open repair of abdominal aortic aneurysms.

OBJECTIVES: to determine the difference in renal and systemic response between open and endovascular aneurysm repair. MATERIALS AND METHODS: we studied prospectively 22 patients undergoing open repair (OR) and 15 patients undergoing endovascular repair (ER). Blood and urine samples were taken preoperatively (T0) and before clamping of the aorta or femoral artery (T1) and 5 min (T2), 1 h (T3), 6 h (T4), 24 h (Day 1) and 48 h (Day 2) after declamping. Albumin/creatinin ratio (AC ratio) in urine, serum albumin, serum creatinin, serum C-reactive protein and serum lactate were determined. RESULTS: the urinary AC ratio in ER was significantly lower than in OR (p<0.001). In both groups the rise in urine albumin/creatinin ratio after declamping (T2, T3) was significant (p<0.001). C-reactive protein was raised significantly at day 1 and 2 in both groups (p<0.001) with no difference between the groups. Serum lactate values were significantly higher in OR. There was a significant increase in serum lactate 6 h after declamping in the ER group. CONCLUSIONS: after endovascular repair renal damage is less compared to open repair. There is a significant systemic reaction to the endovascular repair causing mild, short-lasting damage to the kidney. This systemic response is most probably induced by a combination of ischaemia reperfusion injury and the surgical trauma of the procedure. Other possible explanations are discussed.

Aged↗
PubMed2000

[Summary of the guideline 'Sentinel node biopsy in breast cancer.' Dutch Work Group 'Sentinel Node Biopsy for Breast Cancer'].

The team Sentinel Node Biopsy Breast Cancer issued guidelines for the performance of the sentinel node procedure. The team took into account the problems resulting from the introduction of the technique. The eligible group consists mainly of women with demonstrated breast cancer with a diameter of < or = 2 cm without palpable axillary nodes. Contraindications include presence of more than one tumour, pathological nodes in the ipsilateral axilla and previous treatment of breast or axilla. After injection of a radioactive substance, the sentinel node is detected during the operation using a gamma probe. The tracer is injected 2 to 24 hours before the operation in or near the tumour. Shortly before the incision, patent blue is injected as well, improving the detectability of the sentinel node. One or several sentinel nodes are examined histologically. The pathology report meets minimal requirements. In the planning and introduction of the technique in a hospital a locally responsible radiation expert should be involved. The procedure should be performed a number of times and evaluated with reference to a histopathological result before it is decided to draw clinical conclusions from the procedure. For the necessary evaluations of the procedure central registration is an absolute condition.

Breast Neoplasms↗
PubMed2000

[Prognostic benefits evaluated: new guidelines for systemic adjuvant therapy for axillary node-negative breast cancer vs. implementation of sentinel node biopsy procedure].

The new guidelines for adjuvant systemic therapy in patients with resectable breast cancer adopted by the Dutch National Breast Cancer Platform (NABON) and the Dutch Society for Medical Oncology (NVMO) have as a prerequisite that adjuvant treatment must increase the expected absolute number of patients with 10-year survival by 5% or more. It is therefore apparently considered justifiable to treat 20 patients in order to obtain 10-year survival for one extra of these. This view appears to be in contrast to the view held by adversaries of implementation of the sentinel node biopsy procedure who consider it justifiable to submit 650 patients to a mutilating complete axillary lymph node dissection for disease-staging purposes in order to gain only one extra patient with a 10-year survival.

Antineoplastic Agents↗
PubMed2000

"Dog ear" formation after double-stapled low anterior resection as a risk factor for anastomotic disruption.

PURPOSE: The aim of this study was to investigate the possible deleterious effect of the lateral intersecting margins (so-called dog ears) on anastomotic disruption after experimentally performed double-stapled anastomoses. METHODS: Two groups of double-stapled side-to-end anastomoses were performed using pig small intestines. Group A consisted of 35 circular anastomoses and Group B of 32 double-stapled anastomoses with a bilateral dog ear. In both groups bursting pressures were tested using a water-filled, pressure-controlled automatic pumping system (Hamou Endomat), and special attention was paid to the location(s) in the anastomoses were the disruption(s) occurred. RESULTS: In Group A bursting pressures were significantly higher than in Group B (median pressure, 90 vs. 60 mmHg; P < 0.001, Mann-Whitney U test). Remarkably, in Group B in 13 cases (42 percent) the first disruption occurred at the corner of a dog ear. CONCLUSIONS: We conclude that the lateral intersections of double-stapled anastomoses are a structural weak spot and that the currently most often applied double-stapled anastomosis is a less effective type of anastomosis than a complete circular one. Resolving this technical problem might help to reduce the number of anastomotic disruptions after low anterior resections.

Anastomosis, Surgical↗
PubMed2000

The risk of nodal metastases in breast cancer patients with clinically negative lymph nodes: a population-based analysis.

A population-based study was performed to assess the likelihood of axillary lymph node metastases in patients with clinically negative lymph nodes, according to patient age, tumor size and site, estrogen receptor status, histologic type and mode of detection. Data were obtained from the population-based Eindhoven Cancer Registry. During the period 1984-1997, 7680 patients with invasive breast cancer were documented, 6663 of whom underwent axillary dissection. Of the 5125 patients who were known to have clinically negative lymph nodes and underwent axillary dissection, 1748 (34%) had positive lymph nodes at pathological examination. After multivariate analysis, histologic type, tumor size, tumor site and the number of lymph nodes in the axillary specimen remained as independent predictors of the risk of nodal involvement (P < 0.001). Lower risks were found for patients with medullary or tubular carcinoma, smaller tumors, a tumor in the medial part of the breast and patients with less than 16 nodes examined. This study gives reliable estimates of the risk of finding positive lymph nodes in patients with a clinically negative axilla. Such information is useful when considering the need for axillary dissection and to predict the risk of a false-negative result when performing sentinel lymph node biopsy.

Adult↗
PubMed1999

[Pulmonary damage after radiotherapy for breast cancer].

Radiation therapy for breast cancer can cause pulmonary damage. This was diagnosed in two patients aged 75 and 57 years respectively. They had different types of radiation pneumonitis. The first patient presented with a so-called bronchiolitis obliterans organizing pneumonia (BOOP), four months after radiation therapy. Characteristic in BOOP are the bilateral and migrating lung infiltrates that are distributed predominantly in the middle and lower lung zones. The second patient developed a pneumonitis that classically was confined to the area of irradiation four months after radiation therapy. The two types of radiation pneumonitis can be treated successfully with corticosteroids. If symptomatic radiation pneumonitis is diagnosed early it can be treated well and than has a good prognosis.

Adrenal Cortex Hormones↗
PubMed1999

In search of the true sentinel node by different injection techniques in breast cancer patients.

AIMS: To evaluate two different injection techniques (peri-tumourally and intradermally) used in search for the sentinel node(s) in patients with breast cancer. METHODS: Ninety-nine patients were peri-tumourally injected with 2 ml 60 MBq 99m-Tc-Nanocoll and underwent lymphoscintigraphy about 18 h later to detect focal accumulations. Next, they were injected intradermally with 0.2 ml 15 MBq 99m-Tc-Nanocoll either in the skin overlying the tumour or para-areolarly in the quadrant of the tumour. Dynamic and static images were taken to visualize the (intradermal) lymphatic spread and accumulations. Special attention was paid to match or mismatch of hot spots visualized by both techniques. RESULTS: Ninety-four patients had positive peri-tumoural and/or intradermal accumulations which could be compared. In 30 patients only peri-tumoural, and in nine only intradermal, identification was successful. Of the remaining 55 patients, in 52 there was complete concordance of the axillary hot spots. However, there was a so-called < > in nine of these patients concerning the internal mammary nodes. In the three remaining patients there was a sequential mismatch in the axilla: before draining lymph to the peri-tumourally visualized hot spot, an interposed node was encountered first after the intradermal injection technique. CONCLUSIONS: Intradermal injection is complementary to peri-tumoural injection for visualization of focal accumulations in patients with breast cancer. The two different injection techniques have a small number of sequential mismatches for hot spots in the axillary region. This means that it may be unclear which separate route leads to the true sentinel node. Internal mammary nodes visualized after peri-tumoural injection are not visualized by the intradermal technique. Para-areolar intradermal injection of Nanocoll for detection of sentinel nodes in patients with breast cancer needs further evaluation, because it seems to be a more practical procedure.

Adult↗
PubMed1999

Complications and management of Meckel's diverticulum--a review.

OBJECTIVE: To review the anatomy, symptomatology, diagnosis, complications and management of symptomatic and asymptomatic Meckel's diverticula. DESIGN: Retrospective study. SETTING: Teaching hospital, The Netherlands. SUBJECTS: 27 consecutive patients who underwent resection of a Meckel's diverticulum during the 16 year period 1 January 1981-31 August 1997. MAIN OUTCOME MEASURES: The symptomatology and histopathological findings. RESULTS: 15 patients had symptoms and 12 did not. Haemorrhage and inflammation were the most common presenting symptoms. All histopathological signs of inflammation were found in those with symptomatic diverticula. Resected asymptomatic Meckel's diverticula were abnormal in only two occasions: one contained an adenocarcinoma and one a faecolith. CONCLUSION: All symptomatic Meckel's diverticula should be resected. The surgical treatment of asymptomatic Meckel's diverticula is still controversial.

Adolescent↗
PubMed1999

Factors related to outcome after pneumonectomy: retrospective study of 62 patients.

OBJECTIVE: To find out which risk factors affect outcome after pneumonectomy. DESIGN: Retrospective study. SETTING: Teaching hospital, The Netherlands. SUBJECTS: 62 patients who were treated for bronchial cancer by pneumonectomy between 1984 and 1995. MAIN OUTCOME MEASURE: Hospital mortality and postoperative complications. RESULTS: Hospital mortality increased with age, being 5/51 (10%) in the 40-69 age group and 4/11 (36%) in patients aged 70 or more. In the American Society of Anesthesiologists (ASA) class I group hospital mortality was 8% (2/26), in class II 12% (3/26) and in class III 40% (4/10). Hospital mortality was highest when the FEV1:FVC-ratio was below 55%. Cardiac arrhythmias developed in 8 (13%), early bronchopleural fistulas in 7 (11%), and postpneumonectomy syndrome in 5 (8%). These major complications had a high mortality. CONCLUSION: Respiratory function, ASA class, and age over 70 years are the main prognostic factors for hospital morbidity and mortality after pneumonectomy.

Adult↗