[Diagnostic image (304). A woman with microcalcifications at mammography].
A 72-year-old woman had temporary microcalcifications in the nipple area at mammography, possibly caused by skin care products.
Aged↗
Biomedical subjects
T van Dalen
Publications and source records attributed to T van Dalen.
Locoregional recurrence of retroperitoneal soft tissue sarcoma: second chance of cure for selected patients.
BACKGROUND: Locoregional recurrence of a retroperitoneal soft tissue sarcoma (RSTS) may offer a second chance of curative surgical treatment. In a population-based study the proportion of patients developing isolated locoregional recurrences (LR) was determined and the outcome of these patients was analysed. METHOD: In a retrospective nationwide study, data were collected on 142 patients treated between 1 January 1989 and 1 January 1994 for primary RSTS. In patients who had been treated radically for their primary sarcoma (77/142, 54%), the pattern of recurrence was evaluated. Factors predictive of survival for patients with LR were studied. RESULTS: After a median follow-up of 86 (range 60-101) months, 32 patients (42%) had developed LR, and distant metastasis (DM) had been diagnosed in 17 patients (22%). Median disease-free interval between the initial operation and the establishment of LR or DM was 22 and 19 months, respectively. Five-year cumulative survival of patients with established LR was 37% in comparison with 11% for patients with DM (P=0.062). Factors predictive of favourable outcome in patients with LR were the absence of multifocal recurrence (n=13 P=0.01), lipomatous histomorphology (n=20 P=0.02), and a complete resection of recurrent sarcoma (n=17 P=0.04). CONCLUSION: After a median follow-up of 7 years following radical treatment of a primary RSTS, 42% of the patients had developed isolated locoregional recurrences. A complete resection of recurrent disease, lipomatous histomorphology and the absence of multifocal growth influenced prognosis favourably.
Adult↗
[Frequency of postoperative wound infections: an unsuitable parameter for comparison of hospitals].
OBJECTIVE: To evaluate the reliability of registration of wound infections and their contribution to total postoperative morbidity. DESIGN: Prospective. METHOD: During the period from 1 July 1997 through 30 June 1998 of all patients treated in the department of Surgery of the Diaconessen Hospital, Utrecht, the treatment-related complications were recorded during the hospital stay as well as at the first outpatient follow-up. The clinical registration forms were checked and supplemented after discharge, during the transfer and by the hospital hygienist. The precision of registration, the implications of the registered wound infections, and the share of this complication in overall postoperative morbidity were studied. RESULTS: There were 2172 admissions (2004 patients): 996 males and 1176 females (mean age at admission 55 years). The response of registration was 100% during hospital stay and 59.5% in the outpatient department. Postoperative course was complicated in 506 patients (23% of the admissions). Of the 735 registered complications 583 (79%) were recorded during clinical stay. Airway and wound infections were the most frequently registered complications (in 4.4% and 4.3% of the admissions respectively). Of the wound infections 45% were recorded after discharge and 88% fully recovered by conservative means. Both the frequency of wound infections in relation to other postoperative complications and the severity of the registered wound infections varied with the reason of admission. CONCLUSION: The incidence of postoperative wound infections was not reliably measured as a result of low response of registration after hospital discharge. The contribution of wound infections to overall postoperative morbidity and the severity of these infections varied with the reason of admission.
Confounding Factors, Epidemiologic↗
[Clostridium difficile outbreak in surgical wards].
OBJECTIVE: To evaluate the clinical consequences of a hospital outbreak of Clostridium difficile infections in the Netherlands. DESIGN: Descriptive. SETTING: Diakonessen Hospital Utrecht, the Netherlands. METHODS: In the period from 1 August 1995 to 1 September 1996 C. difficile infections were recorded (gastrointestinal symptoms after use of antibiotics and findings at C. difficile toxin assay in faeces, or sigmoidoscopy). The monthly incidence of infections increased to 5 patients in December 1995; at that time strict hygienic measures were implemented and perioperative antimicrobial prophylaxis was adjusted. Data on the clinical course were collected retrospectively from the records of the patients involved. RESULTS: In 20 patients, admitted for various reasons to the surgical wards, hospital stay was complicated by a C. difficile infection. The mean age was 70 years. Eleven patients presented with diarrhoea, eight patients had nausea and vomiting as well. Diagnosis was confirmed by C. difficile toxin determination in most patients (n = 15). Despite antibiotic treatment in 19 patients, recurrences were seen in five patients (25%) and five patients died (25%). The monthly incidence declined to 0-1 per month. CONCLUSION: C. difficile infections in surgical patients carry a significant morbidity and mortality. Preventive hygienic measures are important to control spread of the infection.
Aged↗
CT prediction of irresectability in esophageal carcinoma: value of additional patient positions and relation to patient outcome.
BACKGROUND: To improve computed tomographic (CT) prediction of local irresectability and to correlate preoperative CT findings with patient outcome. METHODS: Eighty-five patients with esophageal carcinoma underwent CT in supine, left lateral decubitus, and prone positions. CT signs that were indicative of local irresectability included (1) an angle of contact >45 degrees with the aorta; (2) obliteration of triangular fat pad between the tumor, aorta, and spine; (3) tumor contiguous with the aorta in all three positions; and (4) indentation of the airway in all three positions. RESULTS: All CT signs indicative for local irresectability concerning the aorta had comparable percentages of false-positive scans (75%) when correlated with surgical findings. When correlated with pathologic findings, >45 degrees angle of contact with the aorta yielded the fewest false-positive cases (9%). Concerning the airway, additional positions changed the staging correctly in 1 of 18 cases. Median survival was 21 and 8 months, respectively, for tumors considered CT resectable or irresectable. CONCLUSION: Additional patient positions do not improve the CT prediction of aortic invasion. Predicted resectability correlates with a significant longer life expectancy.
Adenocarcinoma↗