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H W Schreuder

Publications and source records attributed to H W Schreuder.

At least 19 recordsLinked to original sources
PubMed2004

[Acute traumatic spinal cord injury and cardiovascular complications due to neurogenic shock: a possible threat for functional recovery].

Three men aged 18, 18 and 24 years, developed hypotension and bradycardia following an acute traumatic cervical or thoracic spinal cord injury. After treatment in intensive care and 1-12 months of rehabilitation they still suffered from considerable neurological disorders. Hypotension and bradycardia are common phenomena following acute traumatic cervical and thoracic spinal cord injury. Awareness of cardiovascular complications as a possible threat for functional recovery and adequate insight in the neurological cause of hypotension and bradycardia are important issues in the acute treatment of patients with spinal cord injury. It seems sensible to admit these patients to a medium-care or intensive-care department where they can be monitored and treated by a specialised team in accordance with an adequate protocol.

Acute Disease↗
PubMed2001

Fibrous dysplasia of bone: management and outcome of 20 cases.

BACKGROUND AND OBJECTIVES: Fibrous dysplasia of bone is difficult to manage because of its variable clinical course with many different methods of treatment reported. Therefore we report on our experience. METHODS: We reviewed a series of 20 patients with 32 lesions included. The average age at the time of diagnosis was 32 years for monostotic disease, 26 years for polyostotic disease, and 3 years for McCune-Albright syndrome. The median follow-up period was 6 years. Functional and radiographic outcomes were scored. RESULTS AND CONCLUSIONS: Monostotic disease mostly presented with a circumscribed lesion and monitoring was often sufficient. Symptomatic circumscribed lesions showed satisfactory outcome when treated with curettage, cryosurgery and bone grafting. Lesions of the extended type were most of all seen in polyostotic disease and eventually needed operative treatment. In case of bony deformity, corrective osteotomies and rigid internal fixation were performed in addition to curettage, cryosurgery, and bone grafting. In polyostotic disease, expected outcomes were good, but in McCune-Albright syndrome, results were uniformly poor. J. Surg. Oncol. 2001;76:157-166.

Adolescent↗
PubMed2001

Deterioration of balance control after limb-saving surgery.

OBJECTIVE: Evaluation of the changes in balance control observed in patients after limb-saving surgery for malignant tumors of the lower limb. DESIGN: Case series. RESULTS: In 11 patients who underwent limb-saving surgery and 10 healthy, age-matched controls, displacement of the amplitude of the center of pressure (ACP) and velocity of the center of pressure (VCP) during normal standing and standing on a balance board were registered. Adding such constraints as standing with eyes closed and performing a Stroop task made standing more complex. During normal standing and on the balance board, both groups showed comparable ACP and VCP values. With eyes closed, both patients and controls showed a higher amplitude and velocity in the anterior-posterior direction. In the patient group, the Stroop task affected the ACP (4.5 +/- 0.8 mm) compared with normal standing (2.9 +/- 0.4 mm) and VCP (18.6 +/- 3.0 mm/sec) compared with normal standing (11.9 +/- 1.0 mm/sec). During balance board standing, the authors found a difference in the VCP for both groups whose eyes were closed and who performed under dual-task conditions (controls, 23.2 +/- 3.3 and 14.9 +/- 2.9 mm/sec; patients, 80.1 +/- 12.9 and 23.6 +/- 3.4 mm/sec). CONCLUSIONS: Although the patient group showed impressive upright standing after limb-saving surgery, upright standing become more difficult under higher visual and cognitive loads. This finding indicates that the level of postural automatism is not complete in these patients.

Adolescent↗
PubMed2000

Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone.

BACKGROUND AND OBJECTIVES: The functional results and the complications after several limb-saving and ablative treatments because of lower extremity bone sarcoma were evaluated. METHODS: Seventy-seven surviving patients were evaluated according to the MSTS (American Musculoskeletal Tumor Society) functional rating system. Fifty-two patients had limb-saving and 25 had ablative therapy. Median follow-up was 97 months in the limb-saving group and 112 months in the ablative group. RESULTS: Functional results in the limb-saving group were significantly better than in the ablative group (P = 0.0001). Functional results in patients with tumors about the knee joint were significantly better (P = 0.0064) after limb-saving surgery (i.e., endoprosthesis, knee arthrodesis, or rotationplasty) compared to functional results after ablative surgery (i.e., hip or knee disarticulation or above-the-knee amputation). Complications were 3 times more common after limb-salvage procedures and 4 times more common after endoprosthetic reconstructions compared to after ablative procedures. Complications after limb-saving therapy were fewest in tumors about the knee joint. In 3/28 patients, the endoprosthetic reconstruction had to be converted to an amputation. CONCLUSIONS: Functional results were significantly better after limb-saving compared to after ablative therapy. Complications, however, were more common after limb-saving therapy.

Adolescent↗
PubMed2000

The saddle prosthesis in pelvic primary and secondary musculoskeletal tumors: functional results at several postoperative intervals.

The first purpose of this study was to evaluate the saddle prosthesis in patients with periacetabular tumors in terms of the functional results obtained after several postoperative intervals. The second purpose was to evaluate the complications and how they might be prevented in the future. Functional results according to the MSTS functional rating system were evaluated at several postoperative intervals in 15 patients treated with internal hemipelvectomy and reconstruction with the saddle prosthesis because of periacetabular primary (n = 9) or secondary (n = 6) malignancies. All complications were evaluated. Three months postoperatively, 7/9 patients with a primary tumor and 2/4 patients with a secondary tumor were able to walk outside without pain. Median functional results 3 and 6 months postoperatively were 40% and 50%, respectively. Deep infection occurred in 4 patients and fracture of the iliac remnant in 2. Heterotopic ossifications along the interpositional component were seen in 5 patients, but they did not negatively influence the functional outcome. Three (relative) contraindications to reconstruction with the saddle prosthesis could be ascertained: osteoporosis, extended involvement of the iliac wing by tumor, and insufficient soft-tissue quality after previous procedures. (Short-term) functional results after reconstruction with the saddle prosthesis are satisfactory if the above-mentioned contraindications are taken into consideration.

Acetabulum↗
PubMed2000

Gait and electromyographic analysis of patients recovering after limb-saving surgery.

OBJECTIVE: Control of gait after limb-saving surgery.Design. Case series study. BACKGROUND: At the moment little is known about adaptations in patients' gait after limb-saving surgery. METHODS: Nineteen patients who underwent limb-saving surgery at least 1 yr earlier and 10 normal subjects were studied during treadmill walking. The main outcome measures were walking speed, step parameters and angular displacement of both legs and EMG of the biceps femoris, rectus femoris and medial gastrocnemius in the affected leg. RESULTS: Preferred walking speed in the patients was lower than in the controls (0.7 versus 1.1 m/s). Furthermore, stance phase of the non-affected leg was lengthened. All patients showed reduced stance phase knee flexion in the affected leg, while during the swing phase no difference was seen. The EMG signals of the rectus femoris and biceps femoris show changes, which are related to the location of surgery. CONCLUSIONS: The results showed that the gait pattern of the patients differed compared to normal gait. The reduced stance phase knee flexion in the hip group is based on a high degree of co-contraction between quadriceps and hamstring activity, while in the knee group this is based on the quadriceps avoidance pattern. The finding that there is still side-to-side asymmetry indicates that there is no complete reorganisation following the massive loss of input and output of the leg. It is possible that some reprogramming of the locomotor process occur. RELEVANCE: Gait and electromyographic analysis are essential for the quantitative assessments of the functional outcome in this type of surgery.

Adult↗
PubMed1999

[Beneficial effects of cryosurgical treatment in benign and low-grade-malignant bone tumors in 120 patients].

BACKGROUND: Benign and low-grade malignant bone tumours are generally treated with intralesional curettage. At microscopic level tumour cells are left behind and may be responsible for a recurrence. Therefore adjuvant local treatment is necessary. METHOD: By spraying liquid nitrogen into the remaining cavity, tumour cells are frozen very rapidly. Ice crystals formed in the (tumour) cell will mechanically damage the cell resulting in cell necrosis. This combined treatment of surgery and freezing is called cryosurgery. RESULTS: In 120 patients with a follow-up of at least 1 year the treatment results were good. The tumours were: aneurysmatic bone cyst (n = 32), simple bone cyst (n = 13), chondroid tumour (n = 43), giant-cell tumour (n = 13), eosinophilic granuloma (n = 7) and monostotic fibrous dysplasia (n = 12). There were 10 recurring tumours, some of them very small; 6 recurrences were treated successfully by cryosurgery again; in 2 recurrences marginal resection was carried out; 2 recurrences remained (as yet) untreated. CONCLUSION: Cryosurgery as a therapy of benign and low-grade malignant bone tumours yields results nearly as good as marginal resection, and has the advantage that segmental bone resections, which need extensive reconstructions are avoided.

Adult↗
PubMed1999

Osteosarcoma: oncologic and functional results. A single institutional report covering 22 years.

BACKGROUND AND OBJECTIVES: The oncologic and functional results in patients treated because of osteosarcoma (OS) were evaluated. METHODS: Fifty-one patients with high-grade OS were treated between 1974 and 1996 at our hospital. All patient records were studied, and the surviving patients were evaluated according to the American Musculoskeletal Tumor Society functional rating system. The majority of patients received adjuvant chemotherapy (prior to 1983) or neoadjuvant chemotherapy (from 1983). Until 1987, all patients with extremity OS had ablative surgery; from 1987, the majority had limb-saving surgery. Lung metastases were resected in most cases. RESULTS: Overall 2-year and 5-year disease-free survival (DFS) rates were 27 of 51 and 16 of 42, respectively. Patients with vertebral or pelvic OS or contaminated margins after resection had a very bad outcome. In all other subgroups, including patients with various types of chemotherapy, response to chemotherapy, diameter of tumor, presence or absence of metastatic spread, and location of tumor, a 5-year DFS of about 50% was found. Recurrent disease in patients who had achieved a 2-year disease-free interval was relatively low (4/23 patients). CONCLUSIONS: Survival in our series was worse than in most other studies. A very bad outcome was found in patients with vertebral or pelvic OS or with contaminated margins after resection.

Adolescent↗
PubMed1999

Cryosurgery in long bones; an experimental study of necrosis and revitalization in rabbits.

Cryosurgery is an established adjuvant treatment of bone tumors which reduces the local recurrence rate. In this study, cryosurgical experiments were carried out in rabbits to study the temperature field, the extent of necrosis, and the revitalization process in order to optimize treatment. Intramedullary freezing of long bones with a closed liquid nitrogen cryoprobe and three consecutive sessions induces osteonecrosis down to the -10 degrees C isotherm without compromising the soft tissues. The application of a tourniquet does not influence the thermodynamics. The revitalization process is distinguished into an osteogenic and a remodelling phase. In rabbits, there is an obvious periosteal osteogenesis starting from 1 week after operation and overlapping the remodelling phase, which starts between 3 and 5 weeks after operation. Two out of eight rabbits sustained a pathologic fracture within 3 weeks of cryosurgery. No pathologic fractures were encountered during the remodelling phase, probably because of the profuse periosteal bone apposition that added mechanical strength. In clinical practice, no profound periosteal bone apposition and a high risk for pathologic fractures during the remodelling phase were noted. Future research should focus on bone strength during the remodelling phase of cryosurgically treated long bones, to decide on the role of preventive osteosynthesis or postoperative restrictions. This animal model is not advised for these biomechanical experiments because of its profuse periosteal bone apposition.

Animals↗
PubMed1998

Revisions of endoprosthetic reconstructions after limb salvage in musculoskeletal oncology.

Of 91 limb-salvage procedures using prosthetic reconstructions because of primary or metastatic bone and soft-tissue tumors 26 revisions were performed in 16 patients. Revision was due to polyethylene wear (9 cases), aseptic loosening (8 cases), recurrent hip dislocation (3 cases), prosthetic stem fracture (2 cases), infection (2 cases), leg length discrepancy (1 case), and traumatic dislocation of a saddle prosthesis (1 case). The follow-up period for tumor control varied from 1.5 to 22 years with a median of 13.5 years. The follow-up period after the last revision operation varied from 0.5 to 12 years with a median of 3 years. At the last follow-up, the functional results had deteriorated compared with after the primary operation in 5 patients and had improved in 2 patients. In the remaining patients, the results did not change.

Adolescent↗
PubMed1998

Treatment of benign and low-grade malignant intramedullary chondroid tumours with curettage and cryosurgery.

AIMS: To shed light on the controversy surrounding the methods of evaluating, staging and final treatment of intramedullary chondroid lesions. Controversy particularly exists for enchondroma and low-grade chondrosarcoma located in the extremities, because their accurate distinction is hampered by their radiographical and histological similarity. METHODS: Since 1991 we have treated 22 patients (mean age: 39.6 years) with 26 lesions (three chondroblastomas, 14 enchondromas and nine grade 1 chondrosarcomas) with curettage, cryosurgery and bone grafting. RESULTS: After a mean follow-up of 26 months no recurrences were observed. Complications consisted of two post-operative fractures, one wound infection and one intraoperative venous gas embolism. All bone grafts incorporated, resulting in full weight-bearing capacity and excellent functional results. CONCLUSION: The usefulness of a combination of curettage and cryosurgery as adjuvant therapy is considered to be equal to marginal resection according to orthopaedic oncological principles. The pre-operative assessment of these lesions and cryosurgical technique is described in detail.

Adult↗
PubMed1998

Eosinophilic granuloma of bone: results of treatment with curettage, cryosurgery, and bone grafting.

Intralesional instillation of steroids is currently the first choice of treatment for eosinophilic granuloma of bone. However, some lesions fail to respond or are unsuitable for injection therapy due location, pending pathologic fracture, and soft tissue intrusion. The authors treated six patients with these lesion characteristics using curettage, cryosurgery, and bone grafting. After a mean follow-up of 34.3 months, all lesions healed completely, although one femoral fracture occurred 8 months after the operation. In selected cases of eosinophilic granuloma of bone, a primary surgical treatment seems feasible. The use of cryosurgery as adjuvant treatment extends the surgical margin and is of value in averting local recurrence.

Adult↗
PubMed1997

Monitoring during cryosurgery of bone tumors.

BACKGROUND: Cryosurgery is used in orthopaedic oncology as adjuvant treatment after intralesional excision of bone tumors to induce cell death at and beyond the surgical margin. Monitoring freeze/thaw cycles during cryosurgery is beneficial in controlling a cryosurgical procedure and in preventing an unwarranted local extent of the freeze. METHOD: We conducted a study of 15 cryosurgical procedures with the use of a protocolized temperature measuring system wit peroperative graphic visualization. RESULTS: Using a liquid nitrogen spray, intralesional temperatures of -150 degrees C were achieved, which are, according to the literature, associated with cell death. Extralesional temperature measurements showed no sub-zero temperatures of surrounding important tissues. CONCLUSIONS: Temperature recordings in and outside the lesion during cryosurgery in orthopaedic oncology are of importance to monitor the freeze/thaw cycles and are helpful in facilitating an effective cryosurgical procedure and in controlling the extent of the freeze, avoiding local complications.

Adolescent↗
PubMed1997

Aneurysmal bone cysts treated by curettage, cryotherapy and bone grafting.

We treated 26 patients with 27 aneurysmal bone cysts by curettage and cryotherapy and evaluated local tumour control, complications and functional outcome. The mean follow-up time was 47 months (19 to 154). There was local recurrence in one patient. Two patients developed deep wound infections and one had a postoperative fracture. We compared our results with previous reports in which several different methods of treatment had been used and concluded that curettage with adjuvant cryotherapy had similar results to those of marginal resection, and that no major bony reconstruction was required. We recommend the use of cryotherapy as an adjuvant to the surgical treatment of aneurysmal bone cysts. It provides local tumour control. Combination with bone grafting achieved consolidation of the lesion in all our patients.

Adolescent↗
PubMed1997

Excisional biopsy of impalpable soft tissue tumors. US-guided preoperative localization in 12 cases.

We present a technique to facilitate excisional biopsy of impalpable soft tissue tumors. A modified Kopans localization needle is positioned preoperatively under ultrasound-guidance (7.5 MHz). The needle contains a hookwire with an over-bent hook that springs open when protruded beyond the needle tip and anchors the wire in the lesion. The technique was used in 12 patients and facilitated excisional biopsy in all of them.

Adolescent↗
PubMed1995

[Chronic recurrent multifocal osteomyelitis].

In a 9-year-old girl chronic recurrent multifocal osteomyelitis was diagnosed, a rare disease mostly affecting children of which the aetiology remains obscure. It is usually diagnosed around the age of II years. The patient suffers from exacerbations and remissions for an average of 2.9 years. Awareness and recognition of the disease is of importance to avoid unnecessary diagnostic procedures and treatment. The prognosis is good.

Child↗
PubMed1995

Venous gas embolism during cryosurgery for bone tumors.

Cryosurgery using liquid nitrogen is a method for treating benign- and low-malignant skeletal tumors. The advantage of preserving the supportive function of bone should be compared to the risk for its complications; postoperative fracture is well known, but less so the occurrence of intraoperative venous gas embolism. This paper describes 17 patients: 2 patients who had serious hemodynamic complications during cryosurgery and a study of 15 patients in whom end-tidal N2 tension was measured in an attempt to investigate the clinical incidence of venous gas embolism during cryosurgery. In the 15 cases analyzed, we did not detect any exhaled N2 during cryosurgery.

Adolescent↗