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Biomedical subjects

A Vos

Publications and source records attributed to A Vos.

At least 91 records · Page 5Linked to original sources
PubMed1994

Prognostic factors in surgery for pulmonary metastases in children.

BACKGROUND: A retrospective analysis was performed of the results of surgical excision of lung metastases in children to identify prognostic factors. METHODS: From 1970 to 1992, 139 thoracotomies were performed in 91 patients between 1 and 19 years of age with metastases of osteogenic sarcoma (40 patients), nephroblastoma (24 patients), Ewing sarcoma (12 patients), and various other tumors (15 patients). RESULTS: There were no perioperative deaths and only one serious complication, chylothorax necessitating reoperation. Twenty-three patients (25%) are currently alive, two with residual disease. Twelve patients (50%) with nephroblastoma are alive; 7 patients (18%) with osteogenic sarcoma and 4 (27%) with other tumors are alive. Negative prognostic factors were incomplete excision, primary tumor not controlled, or metastases developing during treatment. The number of metastases, the disease-free interval, unilateral versus bilateral metastases, preoperative and postoperative adjuvant treatment, and the number of thoracotomies performed were not of significant influence on outcome. CONCLUSIONS: The most important prognostic factor is the type of primary tumor. Excision of lung metastases in children with Ewing or soft tissue sarcoma is not warranted. All other patients who are able to withstand a major operation should not be denied the chance because the surgical risks appear minimal and the outcome cannot be predicted beforehand.

Adolescent↗
PubMed1993

The influence of soyfibre supplemented tube feeding on the occurrence of diarrhoea in postoperative patients.

We investigated the occurrence of diarrhoea in postoperative patients on tube feeding, with or without soyfibre supplementation. The patients also received antibiotic treatment. 60 postoperative patients were assigned to either a fibre free formula diet (FFF) or a soyfibre supplemented formula diet (SSF). The tube feeding was supplied continuously through a nasogastric or a jejunal tube (mean volume 1775 ml a day). The consistency and frequency of the bowel evacuations were recorded for a period of 5 days. A daily diarrhoea score (DS) was obtained by adding a consistency score (formed stools 1, loose 3, and watery 5 points) for every evacuation. The major finding of this study is that the total DS of the FFF group was 1.7 times higher than the SSF group (ANOVA, p = 0.05). We conclude that soyfibre enriched tube feeding has a beneficial and significant influence on the occurrence of diarrhoea in a selected group of postoperative patients.

Journal Article↗
PubMed1993

Urogenital rhabdomyosarcoma in children: is a conservative surgical approach justified?

Between 1970 and 1990, 23 patients were treated for embryonal rhabdomyosarcoma of the bladder (8), prostate (7), uterus (4) or vagina (4). One girl underwent exenteration without chemotherapy. Of the patients 22 received chemotherapy as initial treatment. There was 1 treatment-related death. A total of 21 patients completed the first phase: 4 were treated with chemotherapy alone and 17 subsequently underwent an operation. Three boys underwent total cystoprostatectomy and local resection was performed in 14 patients. One boy was lost to followup. Mean followup was 11.2 +/- 6.3 years in 15 survivors. Complete remission was achieved in 19 patients, while 11 (53%) had relapse at an interval of 3 to 102 months. Of 13 patients with bladder and prostate tumors 8 had relapse and 7 survived. Of 8 patients with uterus and vagina tumors 3 had relapse and all survived. Six patients died of recurrent disease (overall mortality rate 32%). The interval from initial diagnosis until death was always less than 5 years. The mortality rate was greater in boys (5 of 12) than in girls (1 of 9). Preservation of pelvic organs in girls was 75%, while of the boys 44% retained the bladder. Since disease relapsed in patients in whom no tumor was found in the resection specimen after chemotherapy, we conclude that a conservative surgical approach combined with chemotherapy towards urogenital rhabdomyosarcoma is justified. Although late relapses do occur, they can usually be salvaged by a combination of chemotherapy, radiotherapy and surgery.

Adolescent↗
PubMed1992

[Experiences in the treatment of intestinal invagination in children].

Intussusception is one of the more common causes of an acute abdomen in infancy. There is discussion about the appropriate method of treatment, and especially about the criteria for hydrostatic reduction. To evaluate the effectiveness of treatment of patients with intussusception presenting at the Paediatric Surgical Centre in Amsterdam, a retrospective study was carried out. 84 Cases were seen between 1980-1990. Three quarters of the children were operated, one-third without prior barium enema. In half the cases an attempt at hydrostatic reduction was made, and this succeeded in only 43%. Ultrasound was only rarely used diagnostically. The literature shows that the use of air to attempt reduction is more likely to be effective and less likely to cause complications than barium.

Barium Sulfate↗
PubMed1992

Hypertension associated with skeletal traction in children.

Since traction-associated hypertension seems to be a relatively unknown phenomenon, a survey was done of its incidence in children treated with skeletal traction for fractures and orthopaedic diseases. The correlation with hypercalcaemia, a possible aetiological factor, was also explored. Blood pressure was recorded three times a day with an automatic oscillometric unit during the stay in the hospital. Serum calcium, creatinine and total protein concentrations were measured once a week. Patients with pre-existing diseases or renal trauma were excluded. Arterial hypertension (systolic and/or diastolic) was found in 31/50 children (62%). In almost half of these the rise in systolic blood pressure was 10 mmHg or more above the 95th percentile. Hypertension occurred in most cases within the first 3 weeks of treatment; in 7 children it developed after 3 or more weeks of traction. All children became normotensive within 1 week after discontinuation of traction. Clinical symptoms were rare: two children complained of headache. In no instance had traction to be discontinued before the planned date because of hypertension. In the hypertensive group were more preschool children and more humeral fractures as compared to the normotensive group (n = 19). Hypercalcaemia occurred in 11 children and was equally distributed in hypertensive and in normotensive children. It is concluded that arterial hypertension is a frequent finding in children in traction, but its clinical relevance is uncertain. Hypercalcaemia is not a rare finding in immobilized children, but probably plays no causative role in traction-related hypertension.

Adolescent↗
PubMed1992

Correspondence.

Explore the source record for details and available documents.

Letter↗
PubMed1992

Jejunal atresia related to the use of methylene blue in genetic amniocentesis in twins.

OBJECTIVE: To calculate the incidence of jejunal atresia in newborns in The Netherlands. To study the relation between the occurrence of jejunal atresia and genetic amniocentesis to determine a possible iatrogenic cause for the unexpected high incidence of this anomaly in twins. DESIGN: Retrospective study. SUBJECTS: Eighty-nine consecutive twin pregnancies in which amniocentesis had been performed for prenatal diagnosis. In 86 methylene blue solution had been used to mark the amniotic cavity that was punctured first. MAIN OUTCOME MEASURE: The occurrence of jejunal atresia in one of the two twin infants. RESULTS: The incidence of jejunal atresia at birth in The Netherlands is estimated to be 1 in 14,000. This anomaly occurred in 17 out of 89 twin pregnancies (19%). In 15 of the 17 it was possible to determine which of the two children had been exposed to intra-amniotic methylene blue. In all 15 pregnancies, the infant exposed to the dye was suffering from jejunal atresia. CONCLUSION: A causal relation between the use of methylene blue in second trimester amniocentesis and the occurrence of jejunal atresia is strongly suggested. We recommend that no dyes should be injected into the amniotic sac.

Amniocentesis↗
PubMed1991

Cellular and humoral anticorneal immune response in corneal transplantation.

Immunologic responses play a role in the rejection process of corneal transplants. Both histocompatibility antigens and tissue-specific antigens may be potential targets for such an immune response. To identify relevant responses, the humoral immune response against corneal tissue and the cellular immune response against one specific corneal protein were determined in patients before and after corneal transplantation. The results were compared with known risk factors for corneal transplantation, but no correlations were observed. A conversion from negative to positive in cellular immune response against the cornea-specific protein was seen in patients who had experienced an inflammatory episode during the time interval between measurements. The anticorneal protein response may therefore be the result of an intraocular inflammatory response, but not a prognostic factor to help predict the patients at risk for rejection.

Adolescent↗
PubMed1991

Anterior gastropexy prevents gastrostomy-induced gastroesophageal reflux: an experimental study in piglets.

There is evidence that gastrostomy can induce gastroesophageal reflux (GER). We used pH monitoring in piglets to evaluate GER after gastrostomy and to assess the effect of anterior gastropexy. Oesophageal pH studies were performed before and after gastrostomy with (8) and without (9) anterior gastropexy. The reflux score was the percentage of time that pH was below 4.0. Short episodes (mean reflux score 2.6%; range, 1.6% to 30%) of GER occurred in half of the animals before surgery. After gastrostomy, reflux episodes occurred more frequently (77% of animals) and were more prolonged (mean reflux score 35.2%; P less than .001). Anterior gastropexy with gastrostomy prevented GER in all 6 piglets with an intact gastropexy. In two animals with reflux after gastrostomy with gastropexy the gastropexy appeared dehiscent at autopsy. Microscopic ulcerative esophagitis was present in more than half the animals with a positive pH study. We conclude that (1) piglets demonstrate short episodes of spontaneous GER; (2) gastrostomy increases the duration and incidence of the GER episodes; (3) anterior gastropexy prevents gastrostomy-induced GER in piglets; and (4) gastrostomy in piglets is a suitable model for studying GER. We advocate protective anterior gastropexy when performing a feeding gastrostomy.

Animals↗
PubMed1991

Assessment of the filtration reserve capacity of the kidney in workers exposed to cadmium.

It has been assessed whether an internal dose of cadmium (Cd), as reflected by a Cd concentration in urine not yet sufficient to induce a significantly increased urinary excretion of various plasma proteins (microproteinuria defined as beta 2-microglobulin in urine greater than 300 micrograms/g creatinine, or retinol-binding protein in urine greater than 300 micrograms/g creatinine, or albumin in urine greater than 15 mg/g creatinine, or a combination of these), may affect the filtration reserve capacity of the kidney. The last was determined by measuring the difference between the baseline creatinine clearance and the maximal creatinine clearance after an acute oral load of protein (400 g of cooked red meat). In total 215 men were examined of whom eventually 87 Cd exposed workers (concentration of Cd in urine greater than 2 micrograms/g creatinine) from zinc/cadmium smelters and 92 control workers (concentration of Cd in urine less than 2 micrograms/g creatinine, absence of microproteinuria, normal fasting serum creatinine) were retained for data analysis performed separately for workers aged less or more than 50 years. Microproteinuria was present in 20 Cd workers, all older than 50. This study confirmed the previous observation that the age related decline of the baseline glomerular filtration rate (GFR) is accelerated in male workers with Cd induced microproteinuria; the same observation was made for the maximal GFR. It was found, however, that a renal Cd burden that had not yet caused microproteinuria did not impair the filtration reserve capacity of the kidney. This study therefore validates the previous estimate of the threshold effect concentration of Cd in urine (10 micrograms/g creatinine) that is intended to prevent the occurrence of microproteinuria in male Cd workers. It should be kept in mind, however, that because of the likely interference of the healthy worker effect, this conclusion may not be directly extrapolated to the general population.

Adult↗
PubMed1991

Amoxicillin-clavulanate prophylaxis against wound infections after clean-contaminated surgery. A controlled, randomized, prospective study.

In a single-blind, prospective randomized and controlled trial, amoxicillin-clavulanate was compared with gentamicin plus clindamycin as perioperative prophylaxis for 24 hours in clean-contaminated abdominal surgery. Proven infections of the abdominal incision occurred in one of 59 evaluable patients given amoxicillin-clavulanate and one of 43 with gentamicin/clindamycin. In the latter group there was also one incisional perineal wound infection. At follow-up enquiry by telephone around postoperative day 30, four patients in the amoxicillin-clavulanate group reported minor wound discharge for which they had not sought medical attention. Intraperitoneal infection occurred in one patient of that group, and in three of the gentamicin/clindamycin group. Both regimens thus were effective and safe as prophylaxis in clean-contaminated abdominal surgery.

Adult↗
PubMed1991

[Results of a standardized approach for various forms of hypospadias].

Hypospadias is a congenital malformation of the penis, in which the external meatus is ventrally situated. Proximal localisation and chordee result not only in cosmetic-psychologic but also in functional disturbances. Complete operative correction (a straight penis with the meatus on top) is performed around the second year. Various procedures are used depending on the localisation of the meatus. Glandular and coronal forms are managed in our series by the MAGPI operation. In the more proximal forms a preputial island flap operation, either as an onlay or as tube, is performed. The results of the MAGPI were good: only 3 of 27 children needed a second procedure. After island onlay operations a second operation was necessary in 5 of 8 children. Six of 7 patients with an island tube operation developed a fistula which was closed subsequently. The final result was good in all children, both from cosmetic and functional point of view.

Child↗