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Biomedical subjects

A A Peters

Publications and source records attributed to A A Peters.

33 records · Page 2Linked to original sources
PubMed1992

A randomized clinical trial on the benefit of adhesiolysis in patients with intraperitoneal adhesions and chronic pelvic pain.

OBJECTIVE: To see whether surgical adhesiolysis would improve pelvic pain in women with pelvic adhesions. DESIGN: Randomized clinical trial comparing surgery (adhesiolysis) with no surgery with final analysis of results after 9-12 months. SETTING: Department of Gynecology, Leiden University Medical Center, the Netherlands. SUBJECTS: 48 women known by laparoscopy to have stage II-IV pelvic adhesions. INTERVENTIONS: Midline laparotomy and surgical adhesiolysis. MAIN OUTCOME RESULTS: Pelvic pain assessed by the McGill pain score, subjective pain assessment and disturbance of daily activities. RESULTS: 24 women were randomly allocated to undergo surgical adhesiolysis and 24 to a control group who did not have surgery. After 9-12 months there were no significant differences between the two groups overall with regard to pelvic pain. A subgroup of women with severe, vascularized and dense adhesions involving bowel (stage IV) had significantly less pelvic pain after adhesiolysis for two of the three methods of assessment. CONCLUSIONS: Adhesiolysis for the treatment of pelvic pain is not indicated in women with light or moderate degree pelvic adhesions. It may be beneficial in those with severe adhesions involving the intestinal tract.

Adult↗
PubMed1991

[Migrating clips; a complication following sterilization].

Almost twenty thousand laparoscopic sterilizations are performed in the Netherlands yearly. The use of clips (Filshie clips) is increasingly common and has replaced coagulation in many institutes. In spite of the fact that the method is known to provide a permanent form of contraception, women and gynaecologists are uneasy about the method, as a result of the publicity around some pregnancies having occurred after tubal sterilisation and the ensuing liability suits. The laparoscopic findings in two patients with migrating clips are presented. It is indicated how accuracy and documentation of the laparoscopic sterilisation may be increased. This is of utmost importance in view of the legal consequences of failure.

Adult↗
PubMed1991

The accuracy of frozen section diagnosis of ovarian tumors.

We compared all frozen section examinations of ovarian tumors during a 6-year period in our institute with the final diagnosis from paraffin sections. In this period, 946 ovarian tumor specimens were removed for histologic assessment; 176 (18.6%) had frozen section examination. Final histological diagnosis was divided into benign (55.1%), borderline malignant (10.3%), and malignant (34.6%). Sensitivity of the frozen section method for malignant or borderline disease was 83.5% and specificity for a benign lesion, 92.8%. Predictive values and 95% confidence intervals were computed: 100% (93-100%) for malignancy, 62% (32-86%) for borderline malignancy, and 92% (85-96%) for a benign disease. Diagnostic problems occurred in large borderline tumors of mucinous cell type. Analysis of the 12 false negative diagnoses revealed that a sampling error was involved in 11 cases. A judgment error was made in the only false positive and in 1 out of 12 false negative frozen section diagnoses. It is concluded that when surgeons and pathologists are aware of the limitations of frozen section diagnosis of ovarian tumors, peroperative histologic examination can be worthwhile and prevent under- and overtreatment of gynecologic patients.

Adolescent↗
PubMed1991

Mechanical knot performance of a new generation polydioxanon suture (PDS-2).

To improve the handling characteristics of synthetic resorbable monofilament PDS (polydioxanon), a second-generation (PDS-2) suture has been developed. The mechanical knot performance of this suture was tested in square knots and sliding knots and compared with other monofilament suture materials. Knot performance was defined by the loop holding capacity (LHC) and expressed in Newton's (N). Maxon (polyglycolid-three-methylene carbonate) had significantly better knot performance than the other sutures. Knot performance of Prolene (polypropylene) was significantly poorer than that of the other sutures. Ordinary PDS (polydioxanon) and PDS-2 (polydioxanon) showed intermediate results. Knot performance of PDS-2 was similar to (square knots) or poorer than (sliding knots) that of ordinary PDS. It was concluded that knot performance of ordinary PDS is not improved by the introduction of PDS-2. It is emphasized that surgeons should be aware of the mechanical properties of newly developed suture materials. Underlying factors and clinical implications of the mechanical performance of PDS-2 are discussed.

Humans↗
PubMed1991

Feasibility of the application of a resorbable polyglycolic-acid mesh (Dexon mesh) to prevent complications of radiotherapy following gynaecological surgery.

The first ten applications of an absorbable polyglycolic-acid mesh to keep small bowel from descending into the pelvis during postoperative radiation treatment, are described. Two of the ten patients developed mild symptoms of (sub)ileus that could be treated conservatively. In two patients GI tract series revealed that a small bowel loop had slipped outside the sling and had descended into the pelvis. To prevent this condition an interlocked running suture to adjust the mesh is recommended. It is concluded that this intestinal sling procedure is a feasible surgical method causing only mild postoperative complaints or no symptoms at all. The sling procedure is effective to keep the small bowel out of the pelvis following surgery in patients who may require postoperative radiation treatment for pelvic malignancy.

Absorption↗
PubMed1991

A randomized clinical trial to compare two different approaches in women with chronic pelvic pain.

One hundred six patients with chronic pelvic pain were randomly allocated to one of two treatment groups. In the standard-approach group, organic causes of pelvic pain were excluded first and diagnostic laparoscopy was routinely performed. If no somatic cause could be found, attention was given to other causes such as psychological disturbances. In the second group an integrated approach was chosen. From the beginning equal attention was devoted to somatic, psychological, dietary, environmental, and physiotherapeutic factors. In this group, laparoscopy was not routinely performed. Both groups were similar with respect to clinical characteristics of the patients and the severity of their pain as assessed by various pain parameters. Postcoital pain was reported by 27% of the patients. Twenty percent of the patients had had negative sexual experiences such as childhood sexual abuse or rape. Evaluation of the pain 1 year after the institution of treatment revealed that the integrated approach improved pelvic pain significantly more often than the standard approach for three out of four pain parameters (P less than .01). Laparoscopy played no important role in the treatment of pelvic pain. It is concluded that equal attention to both organic and other causative factors from the beginning of therapy is more likely to result in a reduction of pelvic pain than is a standard approach.

Adolescent↗
PubMed1989

Abnormalities of the uterus and cervix after diethylstilbestrol exposure: correlation of findings on MR and hysterosalpingography.

We determined the value of MR for detecting abnormalities of the uterus caused by in utero exposure to diethylstilbestrol in patients in whom such abnormalities were evident on hysterosalpingography. Of 200 women with a history of diethylstilbestrol exposure in utero, 12 had undergone hysterosalpingography as part of an infertility workup. Five of these volunteered to undergo MR imaging of the pelvis. Hysterosalpingography showed abnormalities in all five patients. Abnormalities included hypoplasia of the uterine cavity (3/5), a T-shaped uterine cavity (3/5), constrictions of the uterine cavity (3/5), irregular margins of the uterine cavity (2/5), bilateral hydrosalpinges (2/5), and a diverticulum of a fallopian tube (1/5). MR images showed abnormalities in all five patients. These included hypoplasia of the uterine cavity, uterine corpus, and cervix (3/5); a T-shaped uterine cavity (3/5); constrictions of the uterine cavity (3/5); and bilateral hydrosalpinges (2/5). There was an excellent correlation between the findings on MR images and those on hysterosalpingograms. A thick junctional zone was identified on MR as the cause of constrictions of the uterine cavity seen on hysterosalpingography. MR failed to show the irregular margins of the uterine cavity in two of five cases and a diverticulum of the fallopian tube. We conclude that MR can be used to detect hypoplasia and other congenital abnormalities of the uterus in women with a history of diethylstilbestrol exposure in utero.

Adult↗
PubMed1988

Analysis of tumor heterogeneity in a patient with synchronously occurring female genital tract malignancies by DNA flow cytometry, DNA fingerprinting, and immunohistochemistry.

A case of a patient with bilateral ovarian cancer and a uterine malignant mesodermal mixed tumor with ascites and metastatic disease is presented. Flow cytometry, DNA fingerprinting, and immunohistochemistry were performed to assess the origin of these malignancies. Ploidy analysis showed that both ovarian tumors had different aneuploid stemlines (DNA index [DI] = 1.64, 1.85, right ovary and DI = 1.73, left ovary) indicating independent origins. One of the stemlines in the right ovary (DI = 1.64) was also present in the ascites cells, whereas omentum metastases showed the same stemline (DI = 1.73) as the left ovarian tumor. The uterine malignancy contained three aneuploid stemlines. The highest stemline was associated with epithelial differentiation, but a metastatic origin from the left ovarian tumor seems unlikely. DNA fingerprinting analysis revealed a common change in restriction fragment length pattern in the DNA from all tumor localizations as compared with the patient's constitutional DNA. These results indicate that DNA flow cytometry can be helpful in discriminating intragenital metastatic disease from multiple primary tumors.

Aged↗
PubMedDate not supplied

A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients.

Surgical damage to the pelvic autonomic nerves during radical hysterectomy is thought to be responsible for considerable morbidity, i.e., impaired bladder function, defecation problems, and sexual dysfunction. Previous anatomical studies and detailed study of surgical techniques in various Japanese oncology centers demonstrated that the anatomy of the pelvic autonomic nerve plexus permits a systematic surgical approach to preserve these nerves during radical hysterectomy without compromising radicality. We introduced elements of the Japanese nerve-preserving techniques and carried out a feasibility study in ten consecutive Dutch patients. The technique involved three steps: first, the identification and preservation of the hypogastric nerve in a loose tissue sheath underneath the ureter and lateral to the sacro-uterine ligaments; second, the inferior hypogastric plexus in the parametrium is lateralized and avoided during parametrial transsection; third, the most distal part of the inferior hypogastric plexus is preserved during the dissection of the posterior part of the vesico-uterine ligament. The clinical study showed that the procedure is feasible and safe, except possibly when used with very obese patients and patients with broad, bulky tumors. Surgical preservation of the pelvic autonomic nerves in radical hysterectomy deserves consideration in the quest to improve both cure and quality of life in cervical cancer patients.

Adenocarcinoma↗