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Biomedical subjects

T Kuipers

Publications and source records attributed to T Kuipers.

At least 19 recordsLinked to original sources
PubMed2005

Psoas abscess: report of a series and review of the literature.

We describe a series of twelve patients with a psoas abscess seen in a three-year period in a university hospital and a large teaching hospital in the Netherlands. In our series, five of the 12 patients had a primary psoas abscess. The predisposing conditions were intravenous drug use, diabetes mellitus, prostate carcinoma and haematoma in the psoas muscle in a patient with haemophilia A. Seven of the 12 patients had a secondary psoas abscess. Five cases were due to vertebral osteomyelitis including two cases of tuberculosis. In the other two cases it was due to colitis and urinary tract infection. It is remarkable that in our series there was only one patient with a psoas abscess secondary to a disease of the digestive tract, while this is the most common cause of a secondary psoas abscess in the literature. There were two cases of tuberculosis which is an emerging disease again.

Adult↗
PubMed2001

Single-stage defect repair with latissimus dorsi free flap after extensive resection of terebrant ulcer of the head: three case reports.

Three cases of advanced ulcerating basal cell carcinoma (terebrant ulcer or ulcus terebrans) of the head are reported. Neglected basaliomas had deeply destroyed larger parts of the skull in three women ages 78, 69, and 65 years when the patients were first admitted for treatment. Death due to meningitis, hemorrhage, or brain damage was imminent. Wide resection and coverage by free latissimus dorsi flaps was carried out in single-stage procedures. The latissimus dorsi, a versatile and very reliable free flap with its constant vascular anatomy and long pedicle, is the ideal flap for the coverage of large defects on the head. The donor site can usually be closed primarily, and the functional deficit is acceptable. All three patients recovered completely. Although only palliative resection could be achieved, the procedures could be justified by the increased survival time and gain in quality of life.

Aged↗
PubMed2001

HDR brachytherapy applied to cervical carcinoma with moderate lateral expansion: modified principles of treatment.

BACKGROUND AND PURPOSE: In order to meet the deficiencies of endocavitary applications, a combined technique was introduced with the aim of achieving better target coverage for improvement of loco-regional tumour control. In high dose rate (HDR) endocavitary applications with tandem and ovoids, enlargement of the distance between the ovoids, shifting of dwell times and also optimization often fail to achieve sufficient expansion of the cervical parametrial area encompassed by the reference isodose. MATERIALS AND METHODS: The Deventer method, whereby HDR endocavitary and HDR interstitial brachytherapy are applied in the same session, was applied for tumours with a lateral expansion of 25 mm or more from the axis of the cervical canal. For the addition of HDR interstitial brachytherapy, each ovoid was provided with a channel which allowed insertion of an afterloading needle into the cervix up to a fixed depth. The dose specifications and dosimetry in neighbouring organs are presented in detail. RESULTS: Seventy-six combined applications were given to 41 patients. The follow-up averaged at 23 months, with a maximum of 59 months. No severe early or persistent late complications were observed. In stage IIB tumours, the most important evaluation of the merits of this technique, the disease-free 3-year survival determined with the Kaplan-Meier method was 75% (n=20). CONCLUSIONS: The Deventer method of HDR endocavitary and HDR interstitial brachytherapy applied in the same session is a feasible method for enlargement of the reference isodose envelope in the cervical parametrial area. The 3-year disease-free survival in stage IIB patients and the low complication rates in all stages together, justify its continuation.

Adult↗
PubMed1999

[Clinical aspects and therapy of benign symmetrical lipomatosis--Madelung disease].

The clinical picture, diagnosis, therapy, and theories on the etiology of benign symmetric lipomatosis (Madelung disease) are outlined. Personal experience from 62 operations on 28 patients is compared to the literature. Up to now, there is only palliative surgical treatment for this sporadically appearing disease of unknown etiology. Liposuction--a less traumatic treatment--has considerably facilitated the treatment of the circumscribed fatty hyperplasias. The surgical characteristics of different anatomical regions are pointed out.

Adult↗
PubMed1998

[Effect of anesthesia technique on blood loss in breast reduction-plasty. A study of 56 patients operated on by one surgeon].

Since we had the impression that there was an increase in blood loss during mammaplasties after a change in the anesthesiology department responsible, we conducted a study to compare 28 cases from each anesthesiology department. All operations were carried out by the first author in succession using the same operative technique. The two groups did not differ in age, BMI, operative time, weight of resected tissue or preoperative laboratory. Blood loss was calculated from the perioperative drop in hemoglobin and patient's blood volume. Blood pressure, heart rate, medication and intravenous fluid supply were obtained from the anesthetic protocols. RESULTS (MEANS AND STANDARD DEVIATIONS): Group I (n = 28) and [Group II (n = 28)]: total resected tissue 1862 +/- 928 g [1912 +/- 791 g]; Hb-preop. 13.6 +/- 0.9 g/dl [13.8 +/- 0.8 g/dl]; Hb-postop. 10.8 +/- 1.3 g/dl [9.7 +/- 1.3 g/dl] P = 0.006; Blood loss 970 +/- 339 ml [1443 +/- 456 ml] P < 0.001. After exclusion of surgical or biological causes hemodynamic effects of the anesthetic techniques were suspected as the reason for the significant difference in blood loss. MAP was elevated only initially, while the heart rate was considerably elevated throughout the procedures in group II. During anesthesia with nitrous oxide and enflurane, the dose of enflurane in group I could be limited to 0.3-0.5% after initial i.v. administration of 60 to 100 micrograms sufentanil, while in group II without opioids doses of 0.5-2% were required. The well-known dose-dependent effect of enflurane on the peripheral vascular tone was not masked by vasoconstrictors at the operative site. CONCLUSIONS: Blood loss during mammaplasties can be affected considerably by the anaesthetic technique--even without deliberate hypotension. Sufentanil can indirectly reduce the blood loss by lowering the necessary dose of enflurane. Blood transfusions can be avoided at mammaplasties.

Adult↗
PubMed1995

[Costs and long-term results of plastic surgery treatment of decubitus ulcers in paraplegic patients].

Costs and long-term results of plastic surgical procedures were evaluated in 17 paraplegics with a mean age of 39 years and Campbell-Grade 5 pressure sores. Seven sacral, nine ischial and one trochanteric ulcers were treated by myocutaneous or fasciocutaneous flaps. The mean hospitalization period was 82 days: up to 44 days in the plastic surgical department, 29 days in referring hospitals. During the follow-up period, averaging 18 (6 to 33) months, four patients suffered recurrences, all of them ischial sores. Evaluated regarding occupational resumption or duration of wheelchair mobility, eleven patients achieved full and two patients partial rehabilitation. The success rate justifies the operative procedures. Cost reduction by shortened hospitalization could be achieved through earlier transfer of patients to specialized units since preoperative preparation requires rarely more than one week and surgical relief can usually be achieved within a confined period of time. Orthopaedic deformities contributed to the majority of sores and to all recurrences.

Adult↗
PubMed1994

Cognitive disorders and negative symptoms as correlates of motivational deficits in psychotic patients.

The problem of a possible lack of motivation to perform cognitive tasks, which is often encountered in psychotic patients, has been approached from the perspective of the 'energetics' of cognition (Hockey et al. 1986) and from the broader clinical context of psychosis as an 'amotivational syndrome' and its related negative symptoms. The presence of motivational deficits was investigated in a group of psychotic in-patients (N = 73, and 40 had schizophrenia) compared with a control group of non-psychotic psychiatric in-patients (N = 23). The motivational deficit was operationalized in terms of Sanders's (1983) cognitive-energetic model as a large effect of 'time-on-task' during a simple, monotonous reaction test. Significantly more psychotic patients than control patients showed evidence of this type of motivational deficit. The deficit appeared to be related with negative but not with positive symptoms of psychosis. Furthermore, the deficit was shown to be related to the cognitive disorders of psychosis, which have been amply documented in the literature, i.e. disorders of vigilance, verbal memory and distractibility. These results suggest that the cognitive disorders of psychosis are not of a 'computational' but of an 'energetical', i.e. motivational nature.

Adolescent↗
PubMed1992

Procedural learning of cognitive and motor skills in psychotic patients.

Two kinds of procedural learning, viz. learning of a sequence of simple motor responses and learning to solve a rather complex problem (Tower of Hanoi), as well as declarative learning (word list learning) were investigated in a group of psychotic inpatients (n = 67) and a control group of non-psychotic psychiatric inpatients (n = 19). Within the psychotic group, correlations of the task variables with positive and negative symptoms were explored. There was no difference between both groups in motor procedural learning. Psychotic patients were less efficient than controls in solving the Tower problem, but both groups again showed an equal amount of procedural learning. Consistent with the literature, however, a clear difference between both groups was found in declarative learning. The memory tasks did not correlate significantly with psychotic symptoms. These findings are interpreted as another indication that automatic information processing in psychotic patients is intact. The results are discussed with reference to neuropsychological research on procedural learning in neurological patients.

Adult↗
PubMed1992

Implicit learning in psychotic patients.

Implicit verbal learning of psychotic patients (n = 59) and non-psychotic control patients (n = 20) was studied using stem completion and association tasks in lexical and semantic priming paradigms. Performance on these tasks was contrasted with explicit memory on Rey's verbal learning test. Furthermore, correlations of these aspects of memory with positive and negative symptoms of psychosis were examined. Symptom ratings were based on an interview by a psychiatrist using the CPRS and SANS. As expected, the lexical and semantic priming effects in both patient groups were not significantly different, whereas the psychotic patients compared to the controls were impaired in explicit learning. None of the memory variables was significantly correlated with negative or positive symptoms. These findings are explained by the fact that priming effects, as opposed to explicit learning, depend on automatic memory processes, which do not require conscious effort. Moreover, the findings suggest the intactness of posterior cortical functions in psychotic patients.

Adult↗
PubMed1986

Technical aspects of bladder dosimetry in intracavitary irradiation of cervix carcinoma.

The area of the bladder base where late radiation reactions following intracavitary irradiation of a cervix carcinoma most frequently occur is not well indicated by means of the balloon of a Foley catheter which is commonly used as a marker for dosimetry. Therefore, a thin metal chain is inserted and positioned at this part of the bladder base. Dosimetry is performed with the aid of sets of precalculated isodoses on transparencies placed upon the laterally taken radiograph. On the average, the dose predicted with aid of the chain is found at an 11% higher level compared to the dose determined with the balloon. In order to avoid the insertion of a chain, which is less easy than that of a balloon, it has been proposed to replace the marker point of the balloon by another point obtained by shifting over 10 or 15 mm into cranial direction. However, measurements from 50 applications showed that this replacement does not provide reliable results.

Brachytherapy↗
PubMed1982

Stereo X ray photogrammetry applied for prevention of sigmoid-colon damage caused by radiation from intrauterine sources.

Radiation therapy of cervix carcinoma is applied in this Institute by means of a modified Stockholm method in combination with external beam irradiation. In 1968, parametrial portals were replaced by large planparallel opposed fields extending cranially to LIII/LIV with central shielding in order to avoid overdosage in the area of intracavitary treatment. This resulted in a marked increased incidence of severe sigmoid-colon radiation lesions from 0.25% to 4%; predominantly in Stage I and II patients. Therefore two measures have been introduced: beginning in 1972 measures were taken to prevent the cranial displacement of the uterus during intracavitary treatment in order to avoid shortening the distance between the radioactive sources and the sigmoid-colon; from 1972 stereo X ray photogrammetry (SMR) was applied for dose determinations at points of the sigmoid-colon, which were seen to be located close to the applicator. When SRM data indicated that a high dose at the sigmoid-colon might occur, treatment modifications enabled prevention of radiation damage. Change of position of the applicator was the first to be considered. In the last seven years no surgical intervention had to be performed because of a sigmoid-colon lesion resulting from an unexpected high radiation dose delivered by intrauterine sources. The local recurrence rate was not increased following treatment modifications for prevention of sigmoid-colon radiation damage.

Brachytherapy↗
PubMed1976

Report on treatment of cancer of the ovary.

A malignant ovarian tumour has been diagnosed in 373 patients referred to the R.R.T.I. from January 1966 to Jun 1972. Serious ovarian carcinoma was the commonest type and occurred in 254 patients. The results in these patients are studied in detail after staging according to F.I.G.O. recommendations. Following surgery and postoperative radiotherapy, chemotherapy was started immediately in all patients with progressive disease and after randomization also in 50 per cent of the others. The three-year survival rate in Stage II patients tended to be more favourable following irridation ofthe pelvis and lumboaortic nodes (55 per cent ) than following radiotherapy restricted to the pelvic area (40 per cent). The dose should be 5-6 krad. The five-year survival was 68 per cent for Stage I, 26 per cent for Stage II and nearly zero for Stages III and IV, as well as for patients referred for treatment of a recurrence. In spite of whole-abdomen irradiation 50 per cent of the patients in the latter three groups were deceased within eight months; therefore chemotherapy should be preferred. The main problem in ovarian cancer is late diagnosis. Evaluation of results is difficult because numerous variable factors concerning pathology and treatment make it necessary to sub-divide the patients into groups too small for statistically reliable conclusions. Each treatment factor should be studied by a group of hospitals.

Cyclophosphamide↗