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Biomedical subjects

W F van Tets

Publications and source records attributed to W F van Tets.

14 recordsLinked to original sources
PubMed2006

Categorization of major and minor complications in the treatment of patients with resectable rectal cancer using short-term pre-operative radiotherapy and total mesorectal excision: a Delphi round.

BACKGROUND: To properly balance the benefit (reduction of local recurrence) of short-term pre-operative radiotherapy for resectable rectal cancer against its harm (complications), a consensus concerning the severity of complications is required. The aim of this study was to reach consensus regarding major and minor complications after short-term radiotherapy followed by total mesorectal excision in the treatment of rectal carcinoma, using the Delphi technique. METHODS: A Delphi round was performed in cooperation with 21 colo-rectal surgeons from the Netherlands, United Kingdom and Sweden. The key-question was: 'Which of the predefined complications, caused or substantially aggravated by radiotherapy, are so important (major) that they might lead to the decision to abandon short-term pre-operative radiotherapy (5 x 5Gy) when treating patients with resectable rectal cancer (T1-3N0-2M0)?' RESULTS: After three rounds, consensus was reached for 37 (68%) of 54 complications of which 13 were considered major and 24 considered minor. The following complications were considered to be major: mortality, anastomotic leakage managed by relaparotomy, anastomotic leakage resulting in persisting fistula, postoperative haemorrhage managed by relaparotomy, intra-abdominal abscess without healing tendency, sepsis, pulmonary embolism, myocardial infarction, compartment syndrome of the lower legs, long-term incontinence for solid stool, long-term problems with voiding, pelvic fracture with persisting pain, and neuropathy with persisting pain (legs). Three of 17 complications without consensus showed a tendency to be considered as major: perineal wound dehiscence managed by surgical treatment, small bowel obstruction leading to relaparotomy and long-term incontinence for liquid stool. CONCLUSION: The 13 major and three 'accepted as major' complications can be used to properly balance the benefit and harm of short-term pre-operative radiotherapy in resectable rectal cancer. This may eventually lead to improved treatment strategies for these patients.

Belgium↗
PubMed2005

Surgery for isolated lung metastasis in two patients with bladder cancer.

Two patients presented with an isolated pulmonary lesion on routine x-ray of the thorax almost 2 years after treatment of bladder cancer. Needle biopsy showed squamous cell carcinoma in the first patient but did not classify the lesion in the second patient. No evidence of extrapulmonary disease was found. Lobectomy was performed. Pathologic examination showed similar histologic and immunohistochemical characteristics as the primary bladder carcinoma. Postoperatively, it was decided not to give chemotherapy. One patient died 6 months postoperatively and 1 patient was alive 27 months after metastasectomy without evidence of disease.

Aged↗
PubMed2003

Anal fistulotomy between Skylla and Charybdis.

OBJECTIVE: This study was undertaken to assess the results of anal fistulotomy on faecal continence, recurrence and satisfaction. METHODS: We reviewed the records of 60 patients who underwent anal fistulotomy between 1997 and 2000. Follow-up was by a questionnaire with 46 (77%) patients responding. Mean follow-up was 1-4 years. Fistulas were intersphincteric in 12 patients and transsphincteric in 34 patients. Operative procedure consisted of fistulotomy. RESULTS: Of 11 patients with high fistula, 9 (82%) had impaired continence; Of 17 patients with midanal fistula, 4 (24%) suffered impaired continence. Eighteen patients had a low fistula and 8 (44%) developed impaired continence. In the whole group 50% had suffered faecal incontinence. There were no recurrences and there was satisfaction with the situation in 87% of patients. CONCLUSIONS: Fistulotomy for primary fistula in ano in this retrospective study with a follow-up up to 4 years was associated with no recurrences. Eighty-two percent of patients with a high anal opening have impaired faecal continence, nevertheless patients' satisfaction is high.

Adult↗
PubMed2002

Prospective evaluation of anorectal function after total mesorectal excision for rectal carcinoma with or without preoperative radiotherapy.

OBJECTIVE: Anorectal function is greatly disturbed after rectal surgery with or without radiotherapy (RT). To clarify the underlying mechanisms, we designed a prospective study to evaluate the effect of RT and surgery on anorectal function and clinical outcome of patients with a rectal carcinoma. METHODS: Thirty-four patients with a rectal carcinoma participated in this study. They filled out a symptom questionnaire and underwent anal manometry, anal and rectal mucosal electrosensitivity testing, and a rectal barostat, before surgery, 4 and 12 months postoperatively. Thirteen patients were lost to follow-up, 14 underwent surgery alone (total mesorectal excision [TME]), and seven also received RT (RT + TME). RESULTS: Functional outcome was disappointing in both groups, with at 4 months a significantly higher defecation frequency after RT + TME as compared with TME. Anal sphincter function and rectal sensitivity to pressure-controlled distention were not affected by either treatment. Rectal compliance, however, was significantly reduced after RT + TME at 4 and 1 2 months, resulting in lower rectal volumes at the thresholds for first sensation and desire to defecate. Rectal but not anal mucosal electrosensitivity was higher after TME + RT. CONCLUSIONS: Anorectal function after rectal surgery with or without RT is greatly hampered because of a decreased rectal compliance. After 12 months, partial improvement is shown, especially in the absence of RT.

Adult↗
PubMed1998

Pelvic floor procedures produce no consistent changes in anatomy or physiology.

PURPOSE: Postanal repair was designed to restore both anatomy and function of the anal canal in neurogenic fecal incontinence. In most series, the degree of continence is improved in fewer than 50 percent of patients. Adding anterior levatorplasty and sphincter plication (total pelvic floor repair) is claimed to improve functional results. We performed a randomized trial comparing postanal and total pelvic floor repair for neurogenic incontinence. METHOD: Twenty female patients were studied. All had Type D incontinence (Parks and Browning). Anal manometry, defecography, and grading of the degree of continence were repeated 12 weeks after surgery to assess changes in clinical, manometric, and radiologic parameters. Statistical analysis was done using Wilcoxon's signed-rank test and Wilcoxon's two-sample test. RESULTS: Continence improved in eight patients. Differences among clinical, manometric, and radiologic data were not statistically significant. CONCLUSION: Pelvic floor repair procedures produce no consistent changes in anatomy or physiology. Clinical improvement is caused by creation of a local stenosis or by the placebo effect rather than by improvement of muscle function.

Adult↗
PubMed1997

Influence of Parks' anal retractor on anal sphincter pressures.

PURPOSE: The effects of the Parks' anal retractor on anal sphincter function were studied in a prospective, randomized trial. A closed hemorrhoidectomy was performed intra-anally in 20 patients using the Parks' anal retractor; in 20 other patients, the procedure was done perineally without the use of a retractor. METHODS: Anal manometry was performed before and at 6 and 12 weeks after hemorrhoidectomy. RESULTS: Mean squeeze pressure decreased by 4 percent whether or not a retractor was used. Mean resting pressure decreased by 23 percent after use of Parks' anal retractor (P = 0.01) compared with 8 percent when it was not used (P > 0,05). CONCLUSIONS: The internal anal sphincter is easily damaged with the use of the Parks' anal retractor. When possible, its use should be avoided to obtain better manometric and functional results.

Adult↗
PubMed1996

Biofeedback treatment is ineffective in neurogenic fecal incontinence.

PURPOSE: This study was undertaken to assess biofeedback treatment (active sphincter exercises under direct electromyography vision) in neurogenic fecal incontinence. METHODS: Twelve patients with neurogenic fecal incontinence have been studied prospectively. External sphincter contractions were exercised under direct electromyographic vision twice per day for 30 minutes during 12 weeks. Manometry was done at the beginning and after 12 weeks of training to evaluate objectively changes in sphincter functions. RESULTS: No patient experienced any improvement in fecal control. Mean resting pressure increased from 7 to 9 kPa and mean squeeze pressure from 3.9 to 4.9 kPA, which was of no statistical significance (P = 0.20 and P = 0.46, respectively). CONCLUSIONS: External sphincter contraction exercises under direct electromyographic vision are not effective in neurogenic fecal incontinence. Degree of continence does not improve, and external sphincter function is not increased significantly.

Adult↗
PubMed1995

Internal rectal intussusception--fact or fancy?

PURPOSE: There is still considerable debate whether internal intussusception represents a functional disorder. We have reviewed our results in an effort to define its symptomatology and to assess defecography. METHODS: Rectopexy has been performed for internal intussusception in 37 patients. Eighteen had solitary rectal ulcer syndrome (SRUS), and 31 had anterior rectal wall prolapse. Defecography demonstrated anterior wall prolapse in 13, circular prolapse in 21, and no disorders in 3 patients. Pelvic floor function was normal. Follow-up varied from one to nine years. RESULTS: Twenty-six patients became asymptomatic. Anterior wall prolapses could not be palpated anymore. All SRUS lesions healed. Patients with SRUS (P < 0.001) or circular prolapse (P < 0.001) became significantly more asymptomatic. Results in patients with anterior rectal wall prolapse were significantly worse (P < 0.001). CONCLUSIONS: Internal intussusception is a distinct functional rectal disorder. Its symptomatology and findings during physical examination are aspecific. Characteristic defecographic features and presence of SRUS are indications for surgery, provided pelvic floor function during straining is normal.

Humans↗
PubMed1994

Continence disorders after anal fistulotomy.

PURPOSE: This study was designed to detect factors that predict the occurrence of continence disorders after anal fistulotomy. METHODS: A retrospective study of the charts of 312 patients was undertaken. A questionnaire was sent to all patients, with a response rate of 90 percent. RESULTS: Minor continence disorders occurred in 73 patients, incontinence did not occur. Multivariate analysis (chi-squared test) was performed showing that extensions (P = 0.008), location (P = 0.03), and level (P = 0.029) of the anal opening appeared to be independent factors. CONCLUSION: Patients with high openings, posterior openings, or fistula extensions are at risk to develop continence disorders after anal fistulotomy.

Fecal Incontinence↗
PubMed1992

External fixation for diaphyseal femoral fractures: a benefit to the young child?

External fixation for the treatment of diaphyseal femoral fractures in children seems an attractive alternative, which explains why its application gets more and more advocates. Between 1984 and 1989 15 children aged from 4 to 10 years were treated for a diaphyseal femoral fracture with an external fixation using a small Hofmann system. Fracture healing was without complications. Four children were able to walk on crutches non-weight-bearing after a short period. Six cases had complications, such as pin tract infection, inexplicable pain, or secondary displacement. One patient sustained a supracondylar fracture through one of the distal pin tracts. Hospital stay was longer than expected. In conclusion external fixation for femoral fractures in children is simple and elegant, but has considerable complications, while presumed advantages are not always obtained. In selected cases it is an attractive alternative, but the indications must be restricted.

Child↗
PubMed1992

Intrapelvic intrusion of the lumbosacral spine.

A 34-year-old female fell 7 meters onto her lower back and side, and sustained a nondislocated fracture of the 7th thoracic vertebra, a complex pelvic fracture with symphysiolysis and a left acetabular fracture in combination with a bilateral comminuted sacral fracture and downward intrusion of the lumbosacral spine. There was also a cauda equina-syndrome. Laparotomy with exploration of the lumbosacral area was terminated early because of hemorrhage. Later internal fixation of the fractures was performed by an anterior approach with complete reduction of the bilateral sacral fracture and the lumbosacral spine intrusion. We conclude that an anterior approach to this area gives good visualization, but is hazardous owing to the close proximity of the fractures to the central vessels and retroperitoneal muscles. A posterior approach gives less good visualization but may cause less hemorrhage.

Acetabulum↗
PubMed1991

[Spontaneous pneumothorax; to operate or not?].

Disagreement remains on the best mode of therapy for spontaneous pneumothorax (SP). Treatment options vary from observation alone to thoracotomy depending on the stage of the disease and the preference of the physician. Between 1983 and 1988, 122 patients with SP were treated at the Elisabeth Hospital Tilburg according to a fixed protocol. Of these patients 86 (68%) were primarily treated with observation alone or with intercostal tubes. Seven of these patients (8%) had to be treated surgically after failure of the primary treatment. After thoracoscopical selection and in case of recurrent disease 39 patients underwent surgery: apical pleurectomy and bullectomy, in most cases by the transaxillary approach. In this group morbidity was minimal and there were no recurrences. We conclude that for most patients with spontaneous pneumothorax non-surgical therapy is the therapy of first choice.

Adolescent↗
PubMed1990

Bilateral primary breast carcinoma in a man.

The case history is presented of a 56-year-old man, who had a second primary carcinoma in the contralateral breast after 13 years. Both times, he underwent a modified radical mastectomy. The axillary lymph nodes were free from tumour. The incidence in men is about 1 per cent being bilateral in 14 out of 1,000 of these cases. The therapy for men is the same as for women. Because of the smaller breast volume, tumours in men are earlier discovered and show infiltration. If metastases cannot be detected, the first choice of treatment is surgical. Radiotherapy is indicated in case surgical intervention has not been radical.

Breast Neoplasms↗