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Biomedical subjects

J B Trimbos

Publications and source records attributed to J B Trimbos.

At least 109 records · Page 6Linked to original sources
PubMed1987

Randomized trial comparing two combination chemotherapy regimens (CHAP-5 v CP) in advanced ovarian carcinoma.

One hundred ninety-one patients with advanced epithelial ovarian carcinoma were treated with either a combination of doxorubicin and a five-day course of cisplatin alternating with cyclophosphamide and hexamethylmelamine orally for 14 days (CHAP-5) or cyclophosphamide and cisplatin both administered intravenously (IV) on a single day at 3-week intervals (CP). At a median follow-up time of 45 months, treatment with each of these combinations resulted in the same remission rates (80% and 74%, respectively) and exactly the same progression-free survival and overall survival (median, 26 months). Despite adequate hydration, more renal toxicity was encountered in the CP-treated patients than in those who received CHAP-5. Disabling neurotoxicity and severe myelosuppression were encountered more frequently in the patients treated with CHAP-5. Because the toxicity was lower and CP treatment required shorter hospitalization, the single-day regimen was considered preferable for future use. The Karnofsky index was the only independent predictor for response, whereas both this index and the size of residual tumor before chemotherapy were predictive of survival. After correcting for other prognostic factors, it was determined that tumor size associated with improved survival was less than 1 cm. The site of metastases in International Federation of Gynecology and Obstetrics (FIGO) stage IV patients did not influence survival within this category. The results of this study confirm our previous findings that patients with microscopic remnants at second-look have a survival similar to that of patients who are histopathologically free of disease. This makes the significance of so-called pathologically confirmed complete remission questionable. The survival benefit of debulking surgery performed during chemotherapy seems only minimal for patients in whom debulking has already been attempted before treatment. Like others, we have found the CP regimen to have a good therapeutic index.

Altretamine↗
PubMed1986

Performance of sliding knots in monofilament and multifilament suture material.

Three different sliding knots were tested using five recently developed monofilament and multifilament suture materials. The resorbable materials were polyglactin-910 (Vicryl), polyglycolic-acid (Dexon-Plus), polyglyconate (Maxon), and polydioxanone (PDS), and the nonresorbable material was polypropylene (Prolene). For each type of sliding knot, three or five throws of suture were tested. Knot strength was determined by the loop holding capacity, which was defined as the strength at which the knot broke, or at which slippage in the knot amounted to more than 2 mm. When the three kinds of sliding knots were compared, identical sliding knots with identical throws around a single suture were found to be the most unreliable. Nonidentical and parallel sliding knots differed little with respect to knot reliability. Five-throw knots were generally stronger than three-throw knots. However, the effect of adding two extra throws to three-throw sliding knots was only significant if monofilament suture material was used. Comparison of the different suture materials revealed major differences in knot holding ability. These findings indicate that knot strength is dependent on both the type of knot and the type of suture material, and surgeons should be cognizant of these variables.

Polydioxanone↗
PubMed1986

Magnetic resonance imaging of the genitourinary tract.

This is an overview of the current applications of magnetic resonance imaging (MRI) in the genitourinary tract based on the experience with the 0.5-Tesla MR scanner (Gyroscan, Philips) at the Leiden University Hospital and on reports in the literature. MRI appears to share some of the limitations of CT. MRI cannot reliably differentiate between a malignant and a benign tumor. In the staging of ovarian malignancies by means of MRI, bowel preparation would be desirable. On the other hand, the soft-tissue contrast resolution of MRI is superior to that of CT and images can be obtained in any plane. Thus MRI promises to be an accurate method for staging malignancies. The results in the examination of transplant kidneys are encouraging. We expect that there will be a place for MRI as a complementary technique to ultrasonography in the diagnosis of scrotal disease.

Female↗
PubMed1985

Knot security of synthetic absorbable suture material; a comparison of polyglycolic acid and polyglactin-910.

To compare the knot reliabilities of two kinds of synthetic absorbable suture material, twelve different knots commonly used in surgical practice were tested. Twenty tests were performed on each knot, i.e., ten with Dexon-S (uncoated) and ten with Vicryl (coated). The knots made with Dexon-S were found to slip less frequently, to be significantly stronger, more consistent, and more reproducible than those made with Vicryl. It was concluded that uncoated Dexon-S is superior to coated Vicryl with respect to know reliability. The practical implications of these findings for surgical performance are discussed. It is emphasized that surgeons should be more aware of the relationship of the holding power of surgical knots to not only the knot-typing technique but also the kind of suture material used.

Absorption↗
PubMed1985

Adhesion formation after tubal surgery: results of the eighth-day laparoscopy in 188 patients.

First-look laparoscopy (FL) on the eighth day after salpingostomy, fimbrioplasty, or adhesiolysis was performed in 188 patients. Behavior of postoperative adhesions and the occurrence of pregnancy after tubal surgery were compared with a similar group of 127 patients in whom no FL was performed. In greater than 50% of the cases (104/188), adhesions were found on the eighth postoperative day around both adnexa or the only remaining adnexum. Adhesions were mainly located between the ampulla and the ovary and between the ovary and the lateral pelvic wall or broad ligament. More than half of the adhesions that were separated at FL did not recur. It was concluded that FL significantly diminished the occurrence of permanent pelvic adhesions. The incidence of ectopic pregnancy after salpingostomy was significantly lower when FL was performed. FL on the eighth postoperative day can be regarded as a well-accepted procedure with few complications.

Adnexal Diseases↗
PubMed1984

Hemodynamic measurements in preeclampsia: preliminary observations.

Ten patients with preeclampsia were monitored with a Swan-Ganz thermodilution catheter before the start of treatment. Reference data were obtained by right-heart catheterization in four normal pregnant women. In the preeclamptic group the effects of volume expansion and vasodilatation were studied. All patients showed a low cardiac index, low pulmonary capillary wedge pressure, and a high systemic vascular resistance. Following volume expansion the pulmonary capillary wedge pressure and cardiac index rose to normal pregnant values whereas blood pressure showed no significant change and systemic vascular resistance decreased, but normal pregnant values were not obtained. Vasodilatation with dihydralazine resulted in a further decrease in systemic vascular resistance, a fall in blood pressure accompanied by a further increase in cardiac index with a stable pulmonary capillary wedge pressure. It is concluded that pregnant women with preeclampsia are unable to cope with a circulating volume necessary to maintain a cardiac index and ventricular filling pressure which is considered to be physiologic in normal pregnancy. In preeclampsia the capacity for vasodilatation is inadequate.

Adult↗
PubMed1984

Pregnancy rates after laparoscopy for infertility.

To obtain prognostic data on the likelihood of pregnancy in infertile women with no observable abnormalities at diagnostic laparoscopy, the occurrence of pregnancy was studied in a series of 229 patients. The cumulative conception rate during a follow-up period of at most 5 yr was 50%. The probability of pregnancy proved to decline with age and duration of infertility. The cumulative conception rate during the first year after laparoscopy was approx. 30%, and there was no significant difference between the patients that were treated with respect to other sub-optimal fertility factors (subfertile group) and the patients in whom no rational treatment could be instituted (unexplained infertility group). Implications of these findings with respect to the treatment of long-term infertility are discussed. Knowledge of pregnancy rates after infertility laparoscopy seems important for the evaluation of results of therapy in unexplained infertility.

Female↗
PubMed1984

Security of various knots commonly used in surgical practice.

Twelve kinds of knots commonly used in surgical practice were tested with respect to holding power, expressed as loop-holding capacity. Two synthetic absorbable suture materials were used: nonlubricated polyglycolic acid (Dexon-S) and lubricated polyglactin-910 (Vicryl). The knots were selected on the basis of an inquiry among 25 experienced gynecologists, well known in the field of gynecologic surgery. Five of the 12 knots were sliding knots, four were square knots, and the remaining three were surgical knots. Sliding knots were routinely used by 20 of the 25 respondents (80%). The loop-holding capacity of various knots differed widely, ranging from 5 to 65% of the tensile strength of the unknotted thread. Square knots were stronger than sliding knots, and, in general, the holding power could be increased by adding extra throws to the knot. The findings revealed that the properties of various knots used in surgical practice differ considerably. Therefore, sufficient knowledge about knot configuration and knot strength seems to be an important and basic aspect of surgical handicraft.

Efficiency↗
PubMed1983

Cryosurgical treatment of cervical intraepithelial neoplasia (CIN III) in 102 patients.

Results of cryosurgical treatment in 102 patients with a histologically confirmed diagnosis of severe dysplasia or carcinoma in situ of the uterine cervix (CIN III) are presented. The colposcopic evaluation performed in all patients required full visualization of the squamocolumnar junction. In 95 of the 102 patients no significant cytological abnormalities were found during the follow-up period, which amounts to a success rate of 93%. In seven patients (7%) treatment was considered to have failed because cervical smears persistently suggested CIN II or III. In five of them this was in all probability due to a residual lesion, since the abnormal smears occurred within 12 weeks after cryosurgery. It is concluded that in selected cases cryosurgery is a safe alternative for conisation in the treatment of CIN III. However, thorough colposcopic expertise is essential for adequate preoperative screening, as is careful selection of patients, and the latter may result in the withholding of cryosurgical therapy from 30% of patients with CIN III.

Adult↗
PubMed1983

Right to left shunt, with severe hypoxemia, at the atrial level in a patient with hemodynamically important right ventricular infarction.

This report describes a patient with a massive right ventricular infarction, complicated by severe hypoxemia. Contrast echocardiography demonstrated a right to left shunt through a previously asymptomatic atrial septal defect. This phenomenon should be considered as a possible cause of hypoxemia in the presence of right ventricular infarction.

Echocardiography↗
PubMed1983

Reliability of cytological follow-up after conization of the cervix; a comparison of three surgical techniques.

A retrospective analysis was made of 154 consecutive conizations between 1974 and 1982. Three surgical methods were compared: (A) Sturmdorf sutures; (B) interrupted vertical sutures; and (C) an 'open' method using only cauterization and no additional stitches. The mean blood loss during conization was not reduced by ligation of descending branches of the uterine arteries. Post-conization haemorrhage occurred in only 3% and did not differ between the three groups. Cervical smears with only ectocervical squamous epithelium or too little material to allow diagnosis were considered inadequate. Unreliable follow-up was defined as inadequacy of more than 25% of a patient's smears. Thirty per cent of all follow-up smears were inadequate (group A 33%; B 41%; C 16%). In 46% of the patients, cytological follow-up was unreliable (group A 48%; B 61%; C 18%) and additional measures such as dilatation of the cervix, endocervical curettage, or hysterectomy were required. The differences between group C and the other two groups were statistically significant (P less than 0.01; chi 2 test).

Adult↗