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Biomedical subjects

J B Trimbos

Publications and source records attributed to J B Trimbos.

At least 127 records · Page 7Linked to original sources
PubMed1982

Management of infertile patients with unilateral tubal pathology by paradoxical oophorectomy.

Removal of a severely pathologic adnex to improve fertility in patients with strictly unilateral tubal disease is called paradoxical oophorectomy. This procedure was carried out in nine patients in our department. Seven of them became pregnant (78%). Four of these pregnancies occurred within a year, two during the 2nd year, and one during the 3rd year after the operation. These results were compared with the pregnancy rates in 15 patients with comparable tubal disease who were not operated on. Only four of these women became pregnant (27%); this difference is significant (P less than 0.05). Theoretic considerations and practical implications concerning paradoxical oophorectomy are discussed. We advise a wait of at least 2 years after diagnostic laparoscopy before performing paradoxical oophorectomy.

Castration↗
PubMed1981

Reliability of ultrasound as compared to direct fetal electrocardiography for antepartum cardiotocography.

Eighty-five pairs of simultaneously recorded external and internal cardiotocograms (CTGs) were coded and evaluated with a ten-point scoring system routinely used for the assessment of antepartum CTG. The highest consistency in interpretation between the external ultrasound and the internal fetal scalp CTG was found for basal heart rate followed by decelerations. Oscillatory amplitude and frequency were interpreted differently in 14 per cent of CTGs and accelerations in 16 per cent. When differences in interpretation arose, there was certainly no tendency for the external CTG to present an optimistic image of the fetal heart rate variables. With the exception of oscillatory amplitude all variables, including oscillatory frequency and the total CTG score, were more frequently underestimated than overestimated on external CTGs. When accelerations were present on only one recording, there was an 85 per cent chance for these to be absent on the external CTG. The study abolishes fears that the routine clinical assessment of antepartum CTGs of adequate technical quality provides overrated and more optimistic data than would by achieved by direct fetal scalp monitoring.

Electrocardiography↗
PubMed1981

Clinical significance of suspicious antepartum cardiotocograms: a study of normal and high-risk pregnancies.

Analysis of 594 antepartum cardiotocograms (CTGs) from 91 strictly normal pregnancies and of 2770 CTGs from 405 high-risk pregnancies showed a suspicious pattern in 7.2 and 17.4 per cent respectively. Careful analysis of these CTGs shows that they cannot be considered as either normal or abnormal, whereas their value for predicting the outcome of pregnancy is too limited to be of a direct clinical significance. Although their characteristics vary little between normal and high-risk pregnancy, their recurrence rate is much higher in high-risk pregnancy. During high-risk pregnancy this pattern was obtained on at least two consecutive recordings in 13.3 per cent and on at least three consecutive recordings in 6.2 per cent of patients, as compared to respectively 3.3 and 1.1 per cent during normal pregnancy. Although a single or even repeat occurrence of a suspicious CTG does not justify intervention during pregnancy, our study shows that an adequate follow-up of repeat CTGs will usually be able to distinguish pregnancies that are in need of intervention from those that are not.

Female↗
PubMed1980

Assessment of antepartum cardiotocograms in high-risk pregnancy.

A ten-point scoring system was used to assess 2770 antepartum cardiotocograms (CTGs) obtained in 405 pregnancies at risk. There were 284 pregnancies with a last CTG within 24 hours before labour, Caesarean section or intrauterine death; these were analysed separately and their outcome correlated well with the last CTG score, better than with individual CTG criteria. The relationship between CTG score and fetal condition at birth was particularly close for pregnancies with growth retardation, rhesus isoimmunisation or hypertension. A score of 8 to 10 reliably predicted good condition at birth in 95 per cent of pregnancies which ended within 24 hours and in 88 per cent of those which ended after three or four days. A score of 5 points or less invariably indicated poor fetal condition with little chances of a normal outcome unless the cause could be effectively treated. The score provides a highly specific but moderately sensitive test for fetal well-being with virtually no false positive and only few false negative results. However, almost 15 per cent of CTGs, scoring 6 or 7 points, provide too little information on fetal well-being to be of clinical value.

Apgar Score↗
PubMed1978

Significance of antepartum cardiotocography in normal pregnancy.

Antepartum cardiotocographs (CTGs) were obtained at weekly intervals from 34 weeks onwards and twice weekly from 40 weeks onwards in 91 strictly normal pregnancies. The Fischer score was used to assess the 594 CTGs obtained. Ominous patterns were not encountered but 7.2 per cent of CTGs showed a suspicious pattern. Absence of accelerations and an oscillatory amplitude of less than 10 beats/minute contributed to respectively 95 and 88 per cent of these patterns. The combination of reduced variability and absence of accelerations accounted for 84 per cent of suspicious CTGs. This pattern is compatible with normal pregnancy even when fetal movements are present. One-third (37 per cent) of perfectly normal pregnancies had a suspicious CTG on at least one occasion and in 9 per cent of cases it was found twice or more. This should be borne in mind when using antepartum CTG in the surveillance of high-risk pregnancy.

Adult↗
PubMed1977

Nonspecific decelerations in fetal heart rate during high-risk pregnancy.

Solitary nonspecific decelerations in fetal heart rate occurring in three patients during antepartum cardiotocography are described. The decelerations were nonspecific in that they were neither variable nor late nor associated with maternal hypotension. All occurred in pregnancies complicated by hypertension and placental insufficiency. In the three patients described, the fetus lived for at least three days after the first nonspecific deceleration was observed. Although solitary nonspecific decelerations may indicate may indicate danger to the fetus from placental insufficiency, these decelerations should not be considered as an indication for immediate delivery.

Adult↗
PubMedDate not supplied

Avoiding long-term disturbance to bladder and sexual function in pelvic surgery, particularly with rectal cancer.

Urinary and sexual dysfunction are common problems after rectal cancer surgery, and the likely cause is damage to the pelvic autonomic nerves during surgery. In recent years, attention has been focused on preserving the autonomic nerves through a technique which is usually combined with total mesorectal excision or radical pelvic lymphadenectomy. The autonomic nerves consist of the paired sympathetic hypogastric nerve, sacral splanchnic nerves, and the pelvic autonomic nerve plexus. We will demonstrate the anatomy of the pelvic autonomic nerves and the relation of these nerves to the mesorectal fascial planes, and review the medical literature on sexual and urinary dysfunction after rectal cancer surgery with and without autonomic nerve preservation.

Autonomic Nervous System↗
PubMedDate not supplied

A nerve-sparing radical hysterectomy: guidelines and feasibility in Western patients.

Surgical damage to the pelvic autonomic nerves during radical hysterectomy is thought to be responsible for considerable morbidity, i.e., impaired bladder function, defecation problems, and sexual dysfunction. Previous anatomical studies and detailed study of surgical techniques in various Japanese oncology centers demonstrated that the anatomy of the pelvic autonomic nerve plexus permits a systematic surgical approach to preserve these nerves during radical hysterectomy without compromising radicality. We introduced elements of the Japanese nerve-preserving techniques and carried out a feasibility study in ten consecutive Dutch patients. The technique involved three steps: first, the identification and preservation of the hypogastric nerve in a loose tissue sheath underneath the ureter and lateral to the sacro-uterine ligaments; second, the inferior hypogastric plexus in the parametrium is lateralized and avoided during parametrial transsection; third, the most distal part of the inferior hypogastric plexus is preserved during the dissection of the posterior part of the vesico-uterine ligament. The clinical study showed that the procedure is feasible and safe, except possibly when used with very obese patients and patients with broad, bulky tumors. Surgical preservation of the pelvic autonomic nerves in radical hysterectomy deserves consideration in the quest to improve both cure and quality of life in cervical cancer patients.

Adenocarcinoma↗
PubMedDate not supplied

Postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate groin incisions.

The focus of this study was to document postoperative complications after vulvectomy and inguinofemoral lymphadenectomy using separate incisions. Data from 172 consecutive patients with newly diagnosed carcinoma of the vulva were studied. One hundred and one patients primarily treated with modified radical vulvectomy and complete inguinofemoral lymphadenectomy using separate groin incisions (n = 187) were included in this study. One or more complications were documented in 77 of the 101 (76%) patients. Complications after groin dissection were observed in 66% of the patients. The main complications were wound breakdown (17%) and/or infection (39%) of the groin, lymphocyst formation (40%), and lymphedema (28%). In 98 of 187 (52%) groin dissections, one or more complications were documented. The presence of lymph node metastases, postoperative radiation, age older than 65 years, and removal of the vena saphena magna were not significant risk factors for the occurrence of complications. The occurrence of early complications after groin dissection was significantly related to the late-complication lymphedema (P = 0.002). Our results confirm relatively high rates of wound breakdown, infection, lymphocyst formation, and lymphedema even with separate groin incisions. The occurrence of early complications was related to lymphedema. No other risk factors could be identified.

Age Distribution↗
PubMedDate not supplied

Cervical carcinoma: do fast SE and fat suppression techniques improve MR tumor staging at 0.5 T?

PURPOSE: Our goal was to compare fast SE (FSE) with T2-weighted conventional SE (CSE) MRI of cervical carcinoma and to evaluate the potential advantage of fat suppression technique. METHODS: We compared the tissue contrasts between cervical carcinoma and the surrounding tissues in 24 patients. The following MR sequences were obtained at 0.5 T: T1-weighted CSE (450/20 ms), T2-weighted CSE (2,500/45, 90), and T2-weighted FSE (4,800/120), the latter with and without fat suppression using fat-selective prepulses. RESULTS: T2-weighted FSE MRI provided significantly better contrasts between tumor and normal cervical stroma (p < 0.001) and between tumor and rectum wall (p < 0.05) than T2-weighted CSE MRI. T1-weighted SE MRI gave the highest tissue contrast between tumor and parametrial tissue (p < 0.001). Fat suppression did not further improve tissue contrasts. CONCLUSION: MR staging of cervical carcinoma is best done with the combination of T1-weighted SE and T2-weighted FSE images, without additional fat suppression.

Cervix Uteri↗
PubMedDate not supplied

The efficiency of the Cytobrush versus the cotton swab in the collection of endocervical cells in cervical smears.

In 30 patients whose last cervical smear had lacked endocervical cells, two new samples were collected, one with a cotton-tipped applicator and the other with the recently developed Cytobrush cervical brush. With the cotton swab, no endocervical cells were present in the repeat smears of 21 patients, as compared with only 3 Cytobrush smears lacking endocervical cells; the difference is statistically significant (P less than .001). Quantitatively, the cellular yield with the Cytobrush was larger. It is concluded that the use of the cervical brush to collect material for cervical smears is more effective and provides a higher yield of cells than the use of the conventional cotton swab. The importance of the presence of endocervical cells in a smear as evidence that the transformation zone has been properly sampled is also discussed.

Adult↗