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Biomedical subjects

F J Hilgers

Publications and source records attributed to F J Hilgers.

At least 91 records · Page 5Linked to original sources
PubMed1993

Long-term results of vocal rehabilitation after total laryngectomy with the low-resistance, indwelling Provox voice prosthesis system.

A low-resistance indwelling prosthesis for vocal rehabilitation after total laryngectomy, Provox was developed in the Netherlands Cancer Institute 5 years ago. The long-term results in 132 patients using this prosthesis are now reported. The mean and median device life of the prosthesis in the 75 patients in long-term follow-up are 235 and 141 days respectively. Good to fair vocal rehabilitation was achieved in 92% of the patients. Statistical analysis revealed a significant relationship of the device life with the original tumour site (P = 0.0078). Radiotherapy had a borderline (P = 0.0652) negative influence on the device life but not on prosthesis-related complications. Increasing follow-up time has a positive influence on the device life of the prosthesis (P < 0.0001).

Adult↗
PubMed1993

Primary lymphoma of mucosa associated lymphoid tissue (MALT) in the parotid gland.

Malignant lymphoma of the parotid gland is a rare condition. In a series of 365 malignant lymphomas of the head and neck seven cases (1.9%) presented with a stage I/II MALT lymphoma of the parotid gland, originating from Mucosa Associated Lymphoid Tissue (MALT) and exhibiting the histological criteria of a centrocyte-like cell proliferation, surrounding reactive B-cell follicles. There were six men and one woman with a mean age of 50.1 years. In four patients the parotid mass was present for more than one year. Complete remission was obtained by radiotherapy (40 Gy). Prognosis for this group was found to be favourable with a follow-up ranging from 1.5 to 10 years.

Adult↗
PubMed1993

T3 laryngeal cancer, primary surgery vs planned combined radiotherapy and surgery.

The Dutch Co-operative Head and Neck Oncology Group performed a retrospective, nationwide study of laryngeal cancer between 1975 and 1984. The results for T3 laryngeal cancer treated with primary laryngectomy (n = 137) with post-operative radiotherapy when indicated or planned combined (pre-operative) radiotherapy with laryngectomy (n = 113) are analysed. The disease-free survival independent prognostic factors were treatment modality (planned combined treatment fared better, P = 0.001), incomplete resection of disease (P = 0.006), positive lymph nodes in the neck dissection specimen (P = 0.03) and poor differentiation (P = 0.04). Local control (95% vs. 85%, P = 0.01) as well as regional control (96% vs. 79%, P = 0.0001) was improved in the combined group compared with the primary laryngectomy group. Regional control was 69% for N0 patients if the neck nodes were not treated electively, compared with 98% for the planned combined treatment group. It is concluded that elective treatment of the neck nodes in T3 laryngeal cancer is mandatory. Radiotherapy is preferred, since as well as regional control, local control will also improve.

Female↗
PubMed1993

Improvements in respiratory and psychosocial functioning following total laryngectomy by the use of a heat and moisture exchanger.

A prospective clinical study in 61 patients was undertaken to investigate the subjective and objective influence of a heat and moisture exchanger (HME) on the respiratory and psychosocial problems following total laryngectomy. Although statistical comparisons failed to detect significant differences between the experimental and the control groups, there was a clear trend toward improvements in respiratory and psychosocial functioning in the experimental group. Analyses of differences over time within the HME user group showed significant reductions in the incidence of coughing, the mean daily frequency of sputum production, forced expectoration, and stoma cleaning. Significant improvements were also found in shortness of breath, fatigue and malaise, sleep problems, levels of anxiety and depression, and perceived voice quality. Pulmonary function tests showed significant improvements in inspiratory flow and volume values following use of the HME. This objective improvement in inspiratory pulmonary function reflects the decrease in sputum production reported by the patients.

Aged↗
PubMed1992

Late effects of radiotherapy on hearing.

The effect of radiotherapy on hearing was studied in 30 patients who were treated by surgery and radiotherapy for a parotid neoplasm. Functions of the irradiated ear were compared with those of the non-irradiated ear in the same patient. Tympanometry showed a small but significant reduction of static compliance on the irradiated side when compared with the non-irradiated side. Audiometry showed a significant increase in hearing loss in the 1-2, 4-8 and 10-20 kHz ranges that increased with frequency. This hearing loss was mainly sensorineural in contrast to hearing loss at 250-500 Hz, where it was more of a conductive type. There appeared to be a significant dose-effect relation in sound perception at 4-8 kHz. Doses to the cochlea of less than 55 Gy seldom caused a hearing loss, in contrast to doses exceeding 65 Gy. Overall, radiotherapy was found to cause significant, mainly sensorineural hearing losses, which were partly dose-dependent.

Acoustic Impedance Tests↗
PubMed1992

Prognostic factors for survival in patients with T3 laryngeal carcinoma.

In a total of 511 patients with T3,N0-3,M0 laryngeal carcinoma, 24 possible prognostic factors were analyzed retrospectively. The factors were age, sex, mode of treatment, duration of several clinical symptoms, the presence of sore throat, otalgia, dyspnea, and dysphagia, previous tracheotomy, tumor extension, lymph node status (five items), histologic grading, smoking habits, and alcohol intake. For 300 patients in whom surgery was part of the primary treatment, pathologic staging of the primary tumor and of lymph nodes in neck dissection specimens, cartilage invasion, radicality of the operation, differentiation grade, and subglottic extension ware also evaluated. In a univariate analysis for the whole group, tumor extension (limited to the glottic region), lymph node status (clinically palpable lymph nodes, cytologically confirmed positive lymph nodes), level of lymph node metastasis (high and midjugular site), histologic grading (poor differentiation grade), and treatment modality (planned combined therapy) were considered to be prognostic factors of corrected actuarial survival. In the group that underwent surgery, all factors derived from specimens of the larynx and neck dissections had prognostic significance. Multivariate analysis revealed that the glottic site of the tumor, the presence of cyto- and histopathologically proven metastatic lymph nodes, pretreatment tracheotomy, positive resection margins, and planned combined treatment had a significant influence on corrected actuarial survival.

Adult↗
PubMed1992

Rhabdomyosarcoma of the head and neck in children.

Twenty-two children, 9 male and 13 female, with a non-orbital rhabdomyosarcoma of the head and neck, treated between 1970 and 1988, have been reviewed. Since 1972, treatment has consisted of combination chemotherapy, and where necessary radiotherapy and/or surgery. Complete clinical remission after initial chemotherapy was observed in 21 children. Six children were cured after primary treatment but 15 developed recurrent disease. Thirteen children had a parameningeal localized tumour, with eventual meningeal involvement in 5. Survival in this group was worse than in the non-meningeal group. Lymph node metastasis at first presentation (5 patients) had no influence on prognosis, whereas development of lymph node metastases during follow-up resulted in 100% mortality. All patients were retrospectively classified according to both the IRS-classification and TNM-descriptive system. No correlation with either system could be established. Fourteen of 15 children with recurrent disease were treated, 4 of whom were cured. Thus, 10 out of 22 (45%) children were long-term survivors.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

Staging and prognostic factors in carcinoma of the base of the tongue.

During the period 1966-1985, 66 patients were submitted for curative treatment of a carcinoma of the base of the tongue in the Netherlands Cancer Institute. Treatment consisted of radiotherapy (59 patients), surgery and post-operative radiotherapy (4 patients) and surgery alone (3 patients). Patients were staged according to the UICC (1982) and UICC (1987)/AJCC (1988) criteria. Regrouping by the latter system caused enlargement of the N2-group and of stage IV. The crude 5-year survival was 22%, the 5-year tumour control was 36% and the locoregional control was 47%. The most important prognostic factors for the tumour-free interval are the T-category (P = 0.01) and stage grouping (UICC 1982) (P = 0.022). The same factors predict the locoregional control (P = 0.005 and 0.02 respectively). Crude survival is lower in smokers, and in patients in poor general condition (P = 0.04 and 0.007 respectively).

Adult↗
PubMed1992

T3 laryngeal cancer: a retrospective study of the Dutch Head and Neck Oncology Cooperative Group: study design and general results.

511 Patients with T3 N0-3 M0 squamous cell carcinoma of the larynx, treated in the Netherlands from 1975 until 1984, were retrospectively analysed. Four different treatment policies were followed: primary surgery, planned combination of radiotherapy and surgery, primary radical radiotherapy, and selective radiotherapy. General results are presented. Local control rate was 72%. Regional control rate was 90% for clinically N0 patients and 78% for clinically N+ patients. Salvage therapy was overall successful in 38%. Surgical salvage for local radiation failures (with regional relapse) was successful in 69%, and for regional failures (without local relapse) in 46%. Ultimate locoregional control was 78% and, due to 8% distant metastases, 5-year actuarial corrected survival was 70%. Prognosis did not improve over the years. Corrected survival was independently correlated with tumour extension, involvement of neck nodes and treatment strategy. Corrected survival was similar for primary radiotherapy and primary surgery, but significantly better for planned combined therapy. Multiple primary tumours occurred significantly more often in male (19.5%) than in female patients (7.3%) (P = 0.05), the bronchus being most commonly affected. Cumulative actuarial risk for metachronous tumour was 15% after 5 years and 30% after 10 years so prevention and early detection of these second tumours may play the most important role in improving overall survival rates in the future.

Adult↗
PubMed1991

The influence of a heat and moisture exchanger (HME) on the respiratory symptoms after total laryngectomy.

The influence of a heat and moisture exchanger (HME) on the respiratory symptoms after total laryngectomy was studied in 42 patients. A significant reduction was found in the mean daily frequency of sputum production, forced expectoration in order to clean the airway and stoma cleaning after use of the HME for 6 weeks. Symptoms of fatigue and malaise decreased significantly, while social contact improved. Patients using oesophageal speech or an electrolarynx benefited more than patients using a voice prosthesis. The findings indicate that respiratory problems after total laryngectomy can be reduced significantly with the use of a device with heat and moisture exchanging properties. In turn, reduction of respiratory symptoms results in an improved quality of life.

Adolescent↗
PubMed1991

Free muscle transfer with split thickness skin graft coverage in head and neck reconstructive surgery.

Sixteen patients (eight females and eight males) who underwent microsurgical free tissue transfers for head and neck reconstruction are reviewed. In this series, the flap reconstruction was completed on eleven patients with extra-oral defects and five with intra-oral defects. Split thickness skin graft coverage was used in all cases. The rectus abdominis free muscle flap was used in nine patients and the latissimus dorsi free muscle flap in seven patients. The choice of tissue reconstruction was decided by the size of the surgical defect. There were no failures of the tissue transfers and skin grafts. In skilled hands, free tissue transfer provides a reliable method of head and neck reconstruction, with a low incidence of recipient and donor site complications. In extra-oral defects, coverage of free muscle transfer with split thickness skin grafts, results in a better colour match than musculocutaneous flaps, and complements the appearance and pliability of the free muscle flap.

Adult↗
PubMed1990

[Physical and psychosocial sequelae of total larynx extirpation and the use of a heat and moisture exchanger].

The incidence and severity of respiratory symptoms after total laryngectomy and their influence on everyday life were studied in 59 patients. Almost all patients (98%) have daily complaints of excessive sputum production and 64% of coughing. More than half the patients (57%) use forced expectoration more than 5 times a day in order to clear the airways and 37% have to clean the stoma more than 5 times a day. Respiratory problems appear to impair the quality of the voice, social contacts and psychological wellbeing and are associated with increased fatigue and sleep problems. In a prospective study the effect of a heat and moisture exchanger (HME) was measured in 42 patients. The frequency of sputum production, forced expectoration to clear the airways and stoma cleaning diminished significantly. As a result, feelings of fatigue decreased and social contacts improved. Respiratory problems after total laryngectomy deserve more attention. Treatment with an HME can in selected cases improve several other physical and psychosocial problems associated with this operation.

Adaptation, Psychological↗
PubMed1990

Physical and psychosocial consequences of total laryngectomy.

The incidence and severity of respiratory symptoms after total laryngectomy and their influence on daily living were studied in 59 laryngectomized patients. Daily sputum production was the principal complaint of these patients (98%), followed by coughing (64%) and the need for frequent forced expectoration (more than 5 times a day) in order to clear the airway (57%). Frequent stoma cleaning (more than 5 times a day) was required by 37% of the patients. Significant correlation was found between respiratory symptoms, voice rehabilitation and several aspects of daily living, including fatigue, sleep problems, social contacts and psychological distress. These findings indicate that respiratory symptoms after total laryngectomy are both frequent and troublesome. The development of effective methods for minimizing and/or preventing such respiratory problems would contribute significantly to improving the quality of life of laryngectomized patients.

Aged↗
PubMed1990

Carcinoma of the tonsillar region: comparison of two staging systems and analysis of prognostic factors.

Between 1966 and 1985, 92 patients with local or locoregional tonsillar carcinoma were treated in the Netherlands Cancer Institute. Treatment consisted of radiotherapy in 79 patients, combination of surgery and postoperative radiotherapy in 10 patients, and surgery alone in 3 patients. The 5-year crude survival rate was 43% and the disease-free interval 57%. Patients were classified according to the UICC 1982 and the UICC 1987/AJCC 1988 criteria. The changes in the lymph node classification proposed in UICC 1987 lead to inversion in sizes of N1 and N2 groups, and of stages III and IV. The most important prognostic factor for disease-free interval is T stage (P = .03). Prognosis is significantly worse in stage IV (UICC 1982) compared to stages I to III (41% vs. 65%, respectively, P = .03). Crude survival is lower in males (P = .031) and in patients who smoked (P = .019).

Adult↗
PubMed1990

A new low-resistance, self-retaining prosthesis (Provox) for voice rehabilitation after total laryngectomy.

Prosthetic rehabilitation of voice after total laryngectomy has gained wide acceptance in the last 10 years. Several reliable voice prostheses have been developed and used successfully. Priorities for further development of the methods and instruments for prosthetic voice rehabilitation have led to the design of a low-resistance, self-retaining voice prosthesis (Provox) and an adapted replacement method. The results obtained in 79 patients are described. In vivo airflow resistance ranged from 1.0 to 3.8 kPa (mean = 1.9 kPa). Speech quality was good in 91% of the patients. The self-retaining properties of the prosthesis appeared to be satisfactory. The average device-life was more than 5 months. Replacement of the prosthesis with a new disposable guide wire was done quickly as an outpatient procedure. Maintenance of the prosthesis by the patient was simple. The new low-resistance, self-retaining Provox voice prosthesis and the modified replacement method appeared to further improve the results of prosthetic voice rehabilitation after total laryngectomy.

Adult↗
PubMed1988

Postoperative nasogastric tube feeding in patients with head and neck cancer: a prospective assessment of nutritional status and well-being.

The effects of controlled continuous nasogastric tube feeding with a non-elemental liquid diet (Nutrison high energy) were studied 1 day before, and 1 week and 3 weeks after radical surgery mostly for cancer of the tongue or floor of the mouth in 20 patients. Since the actually administered 89% of a planned dose of 32 kcal/kg body weight/day given to the first eight patients (group A) proved inadequate to prevent a decrease of body fat mass, the energy dose given to 12 successive patients (group B) was increased. The administration of 95% of 43 kcal/kg body weight/day to group B patients appeared to be sufficient. A marked decrease of the 24 h urinary excretion of creatinine and 3-methylhistidine was observed at 1 week and still existed at 3 weeks after operation in both groups. The decrease was significant in group A amounting to some 40% for both metabolites. In group B creatinine excretion decreased by some 20% (n.s.) and 3-methylhistidine by some 35% (n.s.). These findings suggest diminished muscle protein breakdown, even in the presence of an ample nutritional supply of energy and protein. A transient decrease of serum albumin, iron and zinc in all patients is likely not to be related to nutritional intake, but to surgery itself. Analysis of trace minerals and vitamins in blood and amino acids in serum and urine showed no deficiencies or amino acid imbalance. Assessment of the psychosocial impact of the nasogastric tube feeding regimen revealed gastro-intestinal complaints in a minority, and feelings of being deprived of the act of eating and drinking in the majority of patients.

Aged↗