Biomedical subjects

A T Claassen

Publications and source records attributed to A T Claassen.

5 recordsLinked to original sources

PubMed2001

[Melanoma of the skin: excision policy and pathology report writing in the 'Integraal Kankercentrum Zuid' region is in accordance with the guideline in slightly more than half of the patients].

OBJECTIVE: To determine the extent to which the guidelines for cutaneous melanoma had been implemented in the diagnostic and treatment approach of general hospitals. DESIGN: Retrospective, descriptive. METHOD: Patients were selected via the cancer registration system of the 'Integraal Kankercentrum Zuid' (Integral Cancer Centre South, the Netherlands). They were submitted through the pathology laboratory by 1 of the 16 general hospitals in the region. Data was collected from the pathology (PA) reports of the 573 patients for whom a cutaneous melanoma was diagnosed in 1988, 1993 and 1997. The treatment policy and the PA reports were compared with the recommendations in the guidelines concerned and the revised versions of these published in 1985, 1990 and 1997. The patients studied were 212 men (37%) and 361 women (63%) with an average age of 51 years (range 13-96). RESULTS: A diagnostic excision was performed in 485/573 patients (85%). Invasiveness was assessed in 99% of the preparations; in 14% a melanoma was encountered in situ. Invasive melanomas were less often seen in the head and neck region than on the trunk or limb. Thickness of the tumour was not determined in 8% of all 493 invasive tumours and in 19% the pathology report did not state whether the diagnostic biopsy was performed radically. In accordance with the guidelines, diagnostic excision biopsy was first performed in 59% of patients with a subsequent re-excision if necessary; 77% of the PA reports satisfied the fundamental recommendations from the guidelines. For 55% of the patients the diagnostic and therapeutic procedures as well as the pathology report were completed in accordance with the guideline recommendations. Modest improvement occurred over time. CONCLUSION: The excision and re-excision policies as well as the pathology report writing concurred with the recommendations in the consensus for cutaneous melanoma in slightly more than half of the patients who were diagnosed within the IKZ region in the years 1988, 1993 and 1997.

Adolescent↗

PubMed2001

Colectomy for slow-transit constipation: preoperative functional evaluation is important but not a guarantee for a successful outcome.

PURPOSE: This study was designed to assess the results of preoperative functional evaluation of patients with severe slow-transit constipation in relation to functional outcome. METHODS: Four hundred thirty-nine patients with chronic intractable constipation were evaluated by marker studies. Twenty-one patients underwent colectomy and ileorectal anastomosis for slow-transit constipation. Mean colorectal transit time was 156 hours (normal, <45 hours). Small-bowel transit time was normal in ten patients and delayed in five patients. Six were nonresponders. Morbidity was 33 percent. Small-bowel obstruction occurred in six patients; relaparotomy was done in four patients. Follow-up varied from 14 to 153 (mean, 62) months. RESULTS: After three months, defecation frequency was increased in all. Mean stool frequency improved from one bowel movement per 5.9 days to 2.8 times per day. Sixteen patients felt improved after surgery. Seventeen continued to experience abdominal pain, and 13 still used laxatives and enemas. Satisfaction rate was 76 percent (16 patients). After one year, defecation frequency was back at the preoperative level in five patients. An ileostomy was created in two more patients because of incontinence and persistent diarrhea. Eleven patients (52 percent) still felt improved. A relation between small-bowel function and functional results could not be demonstrated. CONCLUSIONS: Preoperative evaluation is important but not a guarantee for, successful outcome. Colectomy remains an ultimate option for patients with disabling slow-transit constipation, but patients should be informed that, despite an increased defecation frequency, abdominal symptoms might persist. Any promiscuous use of colectomy to treat constipation should be discouraged.

Anastomosis, Surgical↗

PubMed1998

[Measurement of colon transit time useful in the evaluation of functional constipation].

OBJECTIVE: To determine the colon transit time (CTT) in patients complaining of functional constipation and the correlation between abnormal transit times and the types of constipation and of the symptoms. DESIGN: Retrospective, descriptive. SETTING: Department of Surgery, University Hospital, Nijmegen, the Netherlands. METHOD: The signs and symptoms of 112 patients with infrequent or difficult defaecation, 93 (83%) of them women, with a median age of 42 years (range: 16-72), were recorded by means of a questionnaire. After ingestion of radiopaque markers per day for 10 days, an abdominal survey X-ray was made on day 11. The numbers of markers in the X-ray and per segment (right and left hemicolon and rectosigmoid) were counted; the CTT in hours was calculated by multiplying this number by 2.4. Slowness was defined as more than 45 h for the total CTT and as more than 15 h for the segmental CTT. RESULTS: The total CTT was normal in 33 patients (29%) and prolonged in 79 (71%). The CTT was prolonged only in the rectosigmoid in 14 patients with a normal CTT (42%) and in 50 patients with a prolonged total CTT (63%). Of the patients with a normal total CTT, 13 (39%) had a normal segmental CTT. No statistically significant correlation could be demonstrated between the presence of any symptom and a prolonged CTT. CONCLUSION: Functional constipation may be associated with a normal CTT. Disorders of colonic motility and of rectal evacuation could be distinguished by measuring the total and the segmental colonic transit times.

Adolescent↗

PubMed1997

The evaluation and treatment of functional constipation.

Constipation and defecation may be considered as the last taboo. The inability to defecate or to achieve this only by digital evacuation has never been a popular topic among patients and doctors. Application of tests from the colorectal laboratory has made it possible to study the function of the different parts of the colon and the mechanism of continence. We consider transit studies, defecography, EMG, and anal manometry, all useful as diagnostic procedures for functional constipation. Several causes of functional constipation can be distinguished in slow transit and difficult evacuation or colonic inertia, spastic pelvic floor syndrome, rectocele and intussusception. This article presents our view of the assessment and management of functional constipation.

Anal Canal↗

PubMed1995

Amputation for reflex sympathetic dystrophy.

We have reviewed 28 patients with reflex sympathetic dystrophy (RSD) who had 34 amputations in 31 limbs. The amputations had been performed for untenable pain (5), recurrent infection (14) or to improve residual function (15). Only two patients were relieved of pain by amputation, and this could not be predicted. Ten of 14 patients were cured of infection and 9 of 15 patients had improvement of residual function. In 28 of the amputations, RSD recurred in the stump, especially after amputation at a level which was not free from symptoms. Because of recurrence of RSD in the stump or severe hyperpathia only two patients wear a prosthesis. Despite this 24 patients were satisfied with the results.

Activities of Daily Living↗