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Biomedical subjects

J Bouma

Publications and source records attributed to J Bouma.

At least 55 records · Page 3Linked to original sources
PubMed1990

Prognostic significance of single versus multiple lymph node metastases in cervical carcinoma stage IB.

From January 1, 1970, to December 31, 1985, 51 patients with stage IB (FIGO) carcinoma of the cervix with lymph node metastases were treated at the University Hospital, Groningen, The Netherlands. The survival rate was 54% and the average duration of follow-up was 78 months (range 47-132). Important clinical variables for survival were investigated retrospectively: the survival rate in patients with a single lymph node metastasis (with tumor confined to the node itself) (n = 23) appeared to be much better than that of patients with multiple node involvement and/or single nodes with extranodular tumor infiltration (n = 28); survival was 85 and 24%, respectively (P less than 0.001). The same applied to patients with only occult lymph node involvement: the survival rate in patients with occult involvement of the hypogastric, external iliac, or obturator nodes was 87% in 19 patients with a single metastasis and 53% in 15 patients with multiple node involvement (P less than 0.02). The survival rate in 8 patients with adenomatous histological components was 42%. In 42 patients with squamous cell carcinoma, the survival rate was 56%. This difference was not statistically significant. Treatment complications and the effect of treatment on the site of recurrence were investigated.

Carcinoma, Squamous Cell↗
PubMed1990

Risks and benefits of cisplatin in ovarian cancer. A quality-adjusted survival analysis.

Both the efficacy and toxicity of short intensive cisplatin-based chemotherapy was established in an unselected group of patients with stage III-IV ovarian cancer. The impact of this treatment on quality of life (QOL) was assessed by the TWIST index, expressed as Time Without Symptoms of Treatment and Disease, in relation to the individual length of progression free survival (PFS). Sixty-eight patients were treated with six cycles of a combination of cyclophosphamide, Adriamycin and cisplatin (CAP-5), every 4 weeks. Patients with a clinical response to treatment were evaluated by second look laparotomy (SLL), which could be performed in 52 patients. There were 20 pathological CR, seven microscopic disease, 17 PR and eight SD in these 52 patients. Median follow up at evaluation was 22 months. The median progression free survival (PFS) was 18 months and the median overall survival 22 months. The median duration of TWIST was 10 months, indicating that about 8 months were lost to symptoms due to treatment or hospital admissions for chemotherapy or laparotomy. Of 45 patients receiving six cycles, only eight patients had no symptoms of peripheral neuropathy, and four patients were free of nephropathy at the end of treatment. The overall survival for this limited duration of treatment is similar to that after more protracted treatment. Despite its limited duration, however, about 28% of the cumulative period of progression free survival is consumed by the treatment and its side-effects. Correction of PFS by TWIST may be a suitable instrument to compare the impact of different cytotoxic schedules on quality of life.

Adult↗
PubMed1990

Intraperitoneal human recombinant interferon alpha-2b in minimal residual ovarian cancer.

Twenty evaluable patients with minimal residual ovarian cancer at second look laparotomy were treated with human recombinant interferon alpha-2b (IFN) intraperitoneally. The dose administered was 50 x 10(6) units once weekly for 8 weeks. Seventeen patients were evaluated by a relaparotomy: five had a pathological complete remission, four a partial response, six patients disease stabilization and two patients had progression. Three patients, two stable and one with clinical progression, had no laparotomy. Nine of the 11 patients with residual tumor smaller than 5 mm had a response, while no response was found in six patients with residuals over 5 mm. The median duration of CR is 11+ months (6-13+ months) after evaluation. For toxicity, 156 treatment cycles could be studied. Fever was seen in 80% of all cycles within 24 h following administration of IFN, in 58 cycles (37%) over 38 degrees C and in 65 cycles (43%) over 39 degrees C. Abdominal pain was slight in 32% and moderate in 3% of all cycles. The peripheral blood leukocyte counts dropped after 52% of all cycles, in 27% below 4.0, in 22% below 3.0, and in one patient below 2.0 x 10(9)/l. IFN dosage was not reduced for leukopenia, but in one patient reduction was necessary for thrombopenia, resulting from insufficient marrow reserve after a previous autologous bone marrow transfusion. Pharmacokinetic studies showed i.p. IFN levels 50-100 times the blood levels. Blood levels were still elevated 2 days after i.p. infusion, but normalized within 1 week on repeated administration. At the second instillation, lower peak serum levels were reached. In conclusion, high doses of i.p. IFN appear to be active in patients with minimal residual disease, with ongoing response in CR patients. Apart from general malaise on the day of treatment, toxicity was acceptable. IFN may be active in patients with minimal residual ovarian cancer through local as well as systemic effects.

Adult↗
PubMed1990

Detection, prevalence, and prognosis of asymptomatic carcinoma of the cervix.

Between 1979-1986, 82 of 407 patients (20%) treated for infiltrative carcinoma of the cervix were asymptomatic at the time of diagnosis. Sixteen (20%) of these 82 patients had stage IA, 60 (73%) had stage IB, and six (7%) had stage IIA disease. Asymptomatic patients represented 16 of 23 (70%) of stage IA, 60 of 196 (31%) of stage IB, and six of 77 (8%) of stage IIA. In the Netherlands, population screening for cervical carcinoma is conducted on women aged 35-55 years. To examine the prevalence of asymptomatic cervical carcinoma and the way in which it was detected in different age groups, we studied the patients referred to our department. Among the patients younger than 35 years with cervical carcinoma, 20 of 70 (29%) were asymptomatic with disease detected by incidental screening, whereas eight of 177 (5%) in the group 55 years or older had been detected by incidental screening. In the age category 35-55 years, 54 of 160 (34%) were asymptomatic. Patients aged 35-55 years had undergone population screening or incidental screening. In the patients 55 years or older, asymptomatic disease was significantly less prevalent than in younger patients. Only one of the 66 asymptomatic patients in stage IB or higher suffered tumor recurrence. Among symptomatic patients, 25 of 136 (18%) with stage IB and 17 of 71 (24%) with stage IIA had tumor recurrence. Despite the favorable prognosis of patients with asymptomatic carcinoma, asymptomatic presentation could not be shown to be a significant prognostic factor, as were tumor diameter and lymph node status.

Adenocarcinoma↗
PubMed1990

Clinical pilot study on new dental filling materials and preparation procedures in developing countries.

Conservative dentistry in developing countries often poses a problem because of lack of expensive dental equipment. This survey was undertaken to test two more appropriate filling materials in vivo. In 94 secondary school students (in Mzuzu, Malawi) with two or more cavities, one cavity was prepared in the conventional way using drilling equipment and then filled with amalgam, and one cavity was prepared using hand instruments only and filled with either cermet ionomer or "miracle mix". Models of the filled teeth (99 amalgam, 53 "miracle mix", 54 cermet ionomer; all of them Class 1) were made and evaluated by three examiners after 6 months and after 1 yr. The fillings were given a score on a four-point scale. One year later all types of filling materials had significantly decreased in quality, but only five fillings (one amalgam, one "miracle mix", and three cermet ionomer) needed replacement. Compared to the amalgam filling in the same mouth, more cermet ionomer and "miracle mix" fillings performed poorly, but these differences were not statistically significant after 1 yr. Both cermet ionomer and "miracle mix" are very promising alternatives for Class I tooth cavities in areas without dental equipment.

Adolescent↗
PubMed1990

Radical surgery compared with intracavitary cesium followed by radical surgery in cervical carcinoma stage IB. Analysis of patients less than or equal to 45 years of age with small tumors with regard to treatment results and ovarian preservation in the primary surgery group.

Forty-nine patients aged less than or equal to 45 years, with cervical carcinoma stage IB (less than or equal to 3 cm) were treated with either primary radical surgery (n = 26), or intracavitary irradiation followed by radical surgery (n = 23). With primary surgery, ovarian function had been preserved in 15 of the 25 patients, who were alive and well. Seven of the primary surgery patients were irradiated postoperatively and 2 others with a central recurrence were cured by irradiation. One other patient, who was not irradiated postoperatively, had an intestinal metastasis and died of the disease. If any of the adverse prognostic factors (as reported in the literature) had been considered as an indication for postoperative irradiation, 17 patients instead of 7 would have been irradiated after primary radical surgery. In the comparable group of 23 patients treated by intracavitary irradiation and radical surgery (and in 4 cases postoperative irradiation as well) there was no recurrence. There was no significant statistical difference between the treatment results in the cesium + surgery group and those who underwent primary radical surgery. Young patients with early cervical carcinoma without prognostic indicators for postoperative irradiation can benefit from primary radical surgery, because their ovarian function can be preserved.

Adenocarcinoma↗
PubMed1989

Inhibin as a marker for granulosa-cell tumors.

Inhibin is a peptide hormone normally produced by ovarian granulosa cells. It reaches a peak of 772 +/- 38 U per liter in the follicular phase of the menstrual cycle and is undetectable in the serum of menopausal women. To determine whether measurements of serum inhibin levels would provide a biochemical marker of the presence or progression of ovarian granulosa-cell tumors and their metastases, we measured the serum immunoreactive inhibin concentrations in six women with such tumors. Three women had been treated by hysterectomy and bilateral salpingo-oophorectomy. In the two women with residual or recurrent disease, the serum inhibin levels were abnormally elevated 5 and 20 months before the clinical manifestations of recurrence became evident. The maximal concentrations approached 3000 U per liter. The serum inhibin level remained undetectable in one patient who was disease-free for 11 years. Serum inhibin concentrations were also elevated in three women with amenorrhea and infertility that resulted from small granulosa-cell tumors. After the removal of the tumors, the serum inhibin levels in these women became normal, and fertility returned. There was a significant negative correlation between the serum concentrations of inhibin and follicle-stimulating hormone, in a manner consistent with the autonomous production of inhibin by granulosa-cell tumors. We conclude that granulosa-cell tumors produce inhibin. Since serum inhibin levels reflect the size of the tumor, measurements of inhibin can be used as a marker for primary as well as recurrent disease.

Adult↗
PubMed1989

Significance of serum SCC antigen as a tumor marker in patients with squamous cell carcinoma of the vulva.

The significance of serum SCC antigen as a tumor marker was investigated in 94 women with squamous cell carcinoma of the vulva. The incidence of elevated serum SCC levels varied from 10% in FIGO stage I to 40% in FIGO stage IV. We did not observe a correlation between elevated pretreatment SCC values and the presence of lymph node metastases. During follow-up, elevated serum SCC values were observed in 8 of 19 patients (42%) with recurrent or progressive disease. It is concluded that the determination of serum SCC levels does not provide additional information in the staging of squamous cell vulvar carcinoma, but can be useful for the early detection of recurrent disease during follow-up in some patients. However, elevated serum SCC levels were also found in 25% of patients without demonstrable tumor activity during follow-up and benign skin disorders were recognized as a cause of false-positive SCC results.

Antigens, Neoplasm↗
PubMed1989

Role of an early second-look laparotomy in ovarian cancer.

Of a group of 68 patients treated with standard polychemotherapy (CAP-5), 52 were evaluated by an early second-look laparotomy, preferably after three cycles of treatment. Of 21 patients with initial tumor residuals smaller than 2 cm, only 5 had residual tumor, and of 31 patients with tumor larger than 2 cm, 27 had residuals, which could be surgically debulked in 9 patients. Surgical evaluation led to termination of treatment in 6 patients with stable disease and to intensification of treatment in 5 younger patients with microscopic or bulky residuals. Thus, the second-look influenced therapeutic decisions and treatment policy in a total of 20 patients. The procedure went without severe complications for the duration of anesthesia; there was no difference between biopsy and debulking, but a larger amount of blood was lost during debulking surgery. Second-look laparotomy is well tolerated but should be performed only in selected cases, depending on the therapeutic options available.

Adult↗
PubMed1989

Ovarian metastasis from squamocellular cervical cancer, stages IB and IIA.

Ovarian metastasis from early stage squamous cervical cancer is rare. In a series of 393 surgically treated patients with squamous cervical cancer, stages IB and IIA, 2 had unsuspected ovarian metastasis. These cases are reported. In younger patients, ovarian extirpation instead of conservation of the ovaries must only be considered in histologically unfavorable tumors extending high up in the endocervix, especially on suspicion of lymph node metastasis.

Adult↗
PubMed1989

[Dental treatment need of the edentulous patient].

The gradually decreasing percentage of adults wearing complete dentures in The Netherlands might easily lead to misunderstandings concerning the future prosthetic treatment need. If the percentage edentulous people aged 65 years and older, for example, would be the same as in 1983, then as a consequence of the ageing of the population, the number of edentulous persons in 2020 will be 2.3 million (in 1983: 1.4 million). It is, therefore, concluded that the prosthetic treatment need will not diminish in the next 40 years, but probably will increase strongly.

Adolescent↗
PubMed1989

The clinical value of lymphography in cervical cancer, FIGO-stage Ib-IIa.

We report the limited value of lymphography in detecting lymphnode-metastases in 54 patients with operable cervical cancer, FIGO-stage Ib-IIa. A low predictive value of the positive lymphogram and low sensitivity of lymphography were found. This was not affected by the use of strict criteria in assessing the lymphograms. Analysis of the sensitivity of lymphography showed poor ability of the radiologist in localising a metastasis in a patient. High accuracy of lymphography and high specificity were found relatively easy to achieve. They are of minor clinical importance. Only 29 percent of patients with proved lymphnode-metastases had lymphographical evidence at the site of these metastases. It was decided not to continue the routine use of lymphography in this group of patients.

Adenocarcinoma↗
PubMed1988

Recurrent acute leg cellulitis in patients after radical vulvectomy.

Recurrent acute leg cellulitis (ALC) known to occur in patients with impaired venous or lymphatic circulation was studied in 126 patients after radical vulvectomy with lymphadenectomy through the years 1973 to 1985. Among these patients surveyed for a total period of 6153 patient months, 33 (26%) experienced 75 episodes of ALC. Recurrent attacks were frequently observed. Although antimicrobial treatment was often started, clinical signs resolved also in 9 patients without antimicrobial treatment. To prevent recurrencies penicillin prophylaxis was given to 23 patients. Only 1 of them had once a mild attack of ALC, whereas recurrent attacks occurred frequently in those patients not receiving penicillin prophylaxis. Although penicillin prophylaxis was successful in preventing the recurrence of ALC the risk-benefit ratio of this approach has not been ascertained. The etiology and pathogenesis of recurrent ALC is discussed. Analysis of a number of assumed risk factors for ALC showed that the frequency of ALC was significantly higher in patients colonized with beta-hemolytic streptococci, mainly group B, than in patients not colonized with these microorganisms just prior to surgery. This suggests that non-group A beta-hemolytic streptococci are involved in the onset of ALC in patients after radical vulvectomy. However, portals of entry for microorganisms were not apparent in any of our patients.

Acute Disease↗
PubMed1988

Total abdominal irradiation in stage I and II carcinoma of the ovary.

In the period from 1981 to 1986, 85 patients with ovarian carcinoma stage I and II were treated in a prospective study. All patients underwent primary surgery: bilateral salpingo-oophorectomy, hysterectomy and omentectomy followed by a staging procedure. In 46 patients, the staging was completed by a retroperitoneal lymph-node dissection, whereas in 39 patients, this procedure was omitted. Total abdominal irradiation (25 Gy/1.50 Gy per fraction) was followed by a pelvic boost dose (25 Gy/1.75 Gy per fraction). Patients with stage I and IIa well differentiated tumours received no adjuvant radiotherapy and are not reported here. The 5-year actuarial recurrence-free survival rate for the irradiated group was 75%. Stage according to FIGO appeared to be of significant prognostic influence. There was no difference in survival between completely and incompletely staged patients. Serious (small) bowel complications occurred however in 6 out of 45 patients who had undergone complete staging.

Adult↗
PubMed1988

Significance of dental problems to the public and their comparability with general health problems.

A group of 109 subjects received a short questionnaire concerning their general health status. The subjects were invited to recall all the (health) problems experienced in the foregoing 6 months. Every participant in this study had visited the dentist, in the 6 months preceding the investigation, because of a dental problem. If these dental problems were important for the respondents they would recall them spontaneously, when a general question regarding health problems was posed. Only eight subjects mentioned dental problems spontaneously, of which seven concerned "pain-complaints". Only in two cases had the dental complaints been experienced more than 3 months ago. Eighteen respondents said that they could not remember the dental visit or their specific dental problem. Thirteen of these 18 persons visited their dentist because of an aesthetic problem. The results indicate that the impact of (some) dental problems on a person's feeling of being healthy was small. On the other hand, this study shows that the comparability of (most) dental problems and general health problems is limited. A typology of the significance of dental problems for the public and comparability with the concept of general health is presented and discussed in this study.

Adolescent↗
PubMed1988

Chemotherapy-resistant gestational trophoblastic neoplasia treated successfully with cisplatin, etoposide, and bleomycin.

This report describes a 53-year-old white woman with metastatic gestational trophoblastic neoplasia that recurred after evacuation of an accidental pregnancy and did not respond sufficiently to treatment with a combination of methotrexate, actinomycin D, and chlorambucil. After second-line treatment with a combination of cisplatin, etoposide, and bleomycin, there was a complete remission. Afterward, the patient suffered from a moderate bleomycin pneumonitis, which resolved spontaneously. She is now free of disease and feeling well 60 months after her last treatment.

Antineoplastic Combined Chemotherapy Protocols↗