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Biomedical subjects

J Bouma

Publications and source records attributed to J Bouma.

At least 73 records · Page 4Linked to original sources
PubMed1988

Is there a role for simple hysterectomy after irradiation for bulky cervical carcinoma?

Twenty eight patients with bulky cervical carcinoma, who were treated by irradiation and simple hysterectomy, were studied. Eight of these patients had non-radical pre-operative irradiation. The patients had various FIGO-stages. The prognostic significance of morphologically intact tumor cells in the hysterectomy specimen and the relationship between pre-operative irradiation dosage, intact tumor cells and recurrences is discussed. Positive pelvic lymph-nodes obtained by sampling had more prognostic significance than intact tumor cells in the hysterectomy specimen. The role of adjunctive hysterectomy in local tumor control was not evident. Non-radical pre-operative irradiation proved to be inadequate.

Adult↗
PubMed1988

Sexual functioning following treatment of cervical carcinoma.

Women faced with cervical carcinoma usually feel an increased need for support and attention, in particular from their partners as, at the same time an important part of the partner relation, sexual interaction often becomes problematic. In this research the eventuality of a reduced sexual motivation in cervical carcinoma patients was investigated. It was found that sexual interaction is valued significantly less by women treated for cervical carcinoma than by women from a non-patient control group. After treatment no changes in overt sexual behaviour occur. Furthermore an effort was made to identify the most important psychosexual variables underlying the reduction in sexual motivation. It was found that a considerable decrease in the appraisal of oneself as a sexual partner is generally basic to the problem. Apparently women try to cope by conforming to the sexual demands of their partners and with that of prevailing sexual norms. It was concluded that cervical carcinoma treatment has a strong negative effect on the sexuality of the patients and that it often amplifies the already existing ambivalence towards sexual interaction in women.

Adult↗
PubMed1987

Long-term survival after vinblastine, bleomycin, and cisplatin treatment in patients with germ cell tumors of the ovary: an update.

Thirteen patients with a malignant germ cell tumor of the ovary have been treated with a combination of vinblastine, bleomycin, and cisplatin (VBP). In 12 patients a complete remission was reached, which was maintained in 10 of these patients. One patient with large tumor residues and a partial remission became CR after surgery. The tumor recurred in 2 patients after 6 and 27 months. Overall, 11 of these patients are in long-term remission, from 14 to 84 months after the start of treatment. VBP is an effective treatment for malignant germ cell tumors of the ovary, even in patients with large tumor residuals.

Adolescent↗
PubMed1987

Serum CA 125 levels in epithelial ovarian cancer: relation with findings at second-look operations and their role in the detection of tumour recurrence.

Pre-operative serum CA 125 levels were elevated (greater than 35 U/ml) in 44 of 46 (96%) patients with epithelial ovarian cancer. Their serum CA 125 levels ranged from 36 to 8670 U/ml and a correlation with tumour stage was found. Also, during progressive disease, 49 of 53 patients showed elevated levels. At the time of second-look operations, elevated serum CA 125 levels indicated the presence of tumour. However, the presence of small tumour residues (less than 2 cm) and of microscopically detectable tumour in biopsies were not associated with raised CA 125 levels, only a few patients (2 of 13 and 2 of 17, respectively) showed levels higher than 35 U/ml before the second-look operation. Rising levels preceded the clinical discovery of a relapse in 15 of the 22 patients with a median lead time of 3.5 months (1-17 months), and in three patients rising levels were found at the time the tumour recurrence was detected. It is concluded that CA 125, despite its general usefulness, is unable to detect tumour nodules of less than 2 cm in size, but it proved to be a sensitive and early indicator of tumour recurrence and progression.

Adenocarcinoma↗
PubMed1987

Recurrent acute leg cellulitis after hysterectomy with pelvic lymphadenectomy.

Recurrent acute leg cellulitis known to occur in patients with impaired venous or lymphatic circulation was surveyed prospectively in 270 patients after radical hysterectomy with pelvic lymphadenectomy and in 66 patients after hysterectomy with pelvic lymphadenectomy from 1977 to 1985. Among them, six (2%) and three (4%) patients experienced a total of 17 episodes of acute leg cellulitis, respectively. Analysis showed that postoperative percutaneous radiation therapy of the pelvic area was a highly significant risk factor. Penicillin prophylaxis is recommended for patients experiencing recurrent attacks.

Acute Disease↗
PubMed1987

Relative importance of periodontal disease for full mouth extractions in the Netherlands.

In order to determine the relative importance of periodontal disease, caries and non-disease reasons for full mouth extractions, a combined sociodental study was carried out in an urban and a rural area in the Netherlands. In the largest proportion of patients (57%) caries was the predominant disease. In only a small group (13%) was periodontal breakdown the predominant characteristic. In 16% of the patients non-disease factors possibly played a role because in this group no generalized periodontal disease or caries was found. It was concluded that in urban and rural areas and in all age groups caries and not periodontal disease was the most important reason for full mouth extractions. Non-disease factors may play a role in the decision to carry out full mouth extractions. Patients living in areas with different dentist-population ratios have a comparable caries status and periodontal condition at the time of full mouth extractions.

Adult↗
PubMed1987

Dentists' and patients' opinions of the dental condition at moment of full clearance.

Reasons for full mouth extraction in an urban and a rural area in The Netherlands (dentist-patient ratio 1:2500 and 1:5700 respectively) have been studied. Patients who participated in this combined sociodental research project were those who received full mouth extractions over a period of 1 yr. The combined patient response was 75% and the overall dentist response 90%. In the urban and the rural areas respectively 137 and 237 cases of full mouth extraction were recorded. When comparing the dentists' diagnoses with the conditions of the dentitions there appeared to be a fair degree of agreement in most of the cases, although some striking deviations were also found. In the relationship between the patient's opinion and the condition of the dentition some unexplained discrepancies were found: 37% of the dentitions in which the teeth and attachment were in a healthy condition were perceived as bad by the patients. Dentists and patients agreed in their perceptions of the dental conditions in 60% of the cases. In 27% there was a strong disagreement. In most of the discrepancies found plausible explanations could be given. In some cases this was not possible. As this involves a substantial minority of cases, dentists should be aware of reasons other than the clinical condition in the disabling treatment of full clearance.

Attitude↗
PubMed1987

Decision processes preceding full mouth extractions.

Full mouth extraction is the final step in a continuous process in which not only dental but also social processes play a role. In a research project concerning the reasons for full mouth extractions in The Netherlands, it was found that over one-third of the patients had considered full mouth extractions at least once before, and 16% considered it frequently over a period of many years. Anxiety was the most important reason for not visiting a dentist. In the patients' view in 86% of the cases they were the initiator of the decision to have all their teeth extracted. According to the dentist the patients initiated full mouth extraction in 70% of the cases. Dentists and patients agreed that irregular attenders more often took the initiative than regular attenders. Most patients (87%) had discussed the decision to have all teeth extracted with one or more persons; different contacts were reported by 14% percent of the patients. According to Freidson's lay referral theory two groups could be identified: a group with a severely truncated lay referral structure and a group characterized by a more extended lay referral structure. The first group was older (46 versus 36 yr) and had a more positive attitude towards full dentures. In order to avoid problems dentists are recommended to involve (a representative of) the patient's social network when important decisions have to be taken.

Adult↗
PubMed1987

Pathways to full mouth extraction.

The process of not attending the dentist is a vicious cycle in which anxiety plays a crucial role. A research project concerning the disease and non-disease reasons for full mouth extraction provided an opportunity to describe the dental histories in terms of dental attendance pattern and related factors which resulted in full dentures. Three profiles of dental histories could be outlined: 1) The regular attenders (19%). Because of their age (means = 47 yr), their positive attitude towards dentistry together with their positive attitude towards full dentures, it is suggested that the possibilities of keeping the natural dentition were exhausted so that full mouth extraction was an acceptable solution. 2) The symptomatic attenders (38%). Because anxiety, which was widespread in this group, was not based on negative experiences, it is suggested that anxiety is caused by social learning. Together with their positive attitude towards full dentures, the high prevalence of full dentures in their social environment and their low socioeconomic status, the conclusion is drawn that these patients lived in a culture which supports behavior that leads to total tooth loss. 3) Once regular attenders (43%). In this group anxiety leads to a negative perception of dental visits and to a negative attitude towards dentists. As a consequence dental visits are deferred, which results in deterioration of the dentition. Experiences with dentists are distorted in a negative way, which increases dental anxiety. Facilitated by a positive attitude towards full dentures, their bad dental condition finally urges them to take full dentures at early age.

Adult↗
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

Anthracycline antitumour agents. A review of physicochemical, analytical and stability properties.

A review of physicochemical and analytical properties of anthracycline antitumour agents is presented. The following subjects are discussed: protolytic equilibria, partition and partition coefficients, self-association, adsorptive properties, metal complexation, spectroscopy and chromatography. Furthermore, the stability of anthracyclines in solutions, in pharmaceutical preparations and in biological media is discussed.

Adsorption↗
PubMed1986

Caries status at the moment of total tooth extraction in a rural and an urban area in the Netherlands.

Edentulousness varies with the availability and accessibility of dental care. Comparing the dental status of groups of patients getting full dentures might give insight into the effect of different levels of supply of dental care on the dental condition. Therefore a research project has been started in the Netherlands in an urban and a rural area, having dentist-patient ratios of 1:2,500 and 1:5,700 respectively. In the urban and rural area an equal proportion had partial dentures prior to losing the last of their teeth. However, in the urban area 33% of the patients wearing partial dentures had full maxillary or mandibular dentures; in the rural area this figure was 73%. In the rural area a larger proportion had lost 21 or more teeth at the moment of total extraction. Therefore, it was concluded that in the urban area more effort was spent in maintaining the natural dentition. Looking at DMF-T figures and separate components of DMF-T, no differences could be established between people living in areas with a high and a low dentist-patient ratio.

Adult↗
PubMed1986

Differences in total tooth extraction between an urban and a rural area in the Netherlands.

Differences in total tooth loss between an urban and a rural area (dentist-patient ratio 1:2500 and 1:5700 respectively) have been studied. Patients who participated in this study were those who received total tooth extraction during the calendar yr 1982 (urban area) and 1983 (rural area). The overall dentist response was 90%, the combined patient response was 75%. During the year, in the urban area 137 cases of total tooth extraction were recorded; in the rural area this was 237. This frequency is equivalent to 109 and 226 total tooth extractions per 100,000 inhabitants, respectively. The age and sex distribution of the urban and rural population could not account for this difference. The rural population had a lower educational level and more people insured in a State Health Scheme, which is related to income. The frequency of symptomatic attenders was highest in the rural area among those who were insured in a State Health Scheme. It is concluded that differences in numbers of total extractions between the rural and urban areas cannot be explained entirely by differences in population characteristics.

Adult↗
PubMed1985

Caries and total extraction in a medium-sized city in the Netherlands.

In 1982 a combined sociodental research project was started in the city of Groningen in order to gain insight into the dental and social reasons for total extraction. 91% of the dentists in the city participated in this study by collecting the extracted teeth, filling out a questionnaire and asking their patients to fill out another questionnaire concerning the behavioral aspects of total tooth loss. 78% of the 134 patients returned the questionnaire. In this article the caries status in relation to the social background and dental attendance pattern has been described. The mean age at the time of extraction was 44.2 yr. The patients were a good cross-section of the Dutch population as regards education level, type of health insurance and sex. The average number of teeth was 14.2. The average DEMFT value was 22.8. Although regular attenders had less D-teeth than irregular attenders they had an average of 3.5 teeth with active caries. Regular attenders had more F-teeth but less sound teeth than irregular attenders. The contribution of the dental health care system to the dental health of the population is discussed.

Adolescent↗