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Biomedical subjects

J Jeekel

Publications and source records attributed to J Jeekel.

258 records · Page 15Linked to original sources
PubMedDate not supplied

Is there a place for gastroenterostomy in patients with advanced cancer of the head of the pancreas?

There remains doubt about the need for gastroenterostomy in patients with advanced cancer of the pancreatic head, performed either prophylactically or when passage of food becomes impossible. The records of 142 patients admitted for advanced pancreatic cancer to the Erasmus University Hospital over a period of 11 years were reviewed. We concentrated especially on the pre- and postoperative intake of food in cases involving gastroenterostomy and the morbidity and mortality associated with abdominal surgery in these patients. Of 129 patients without symptoms of gastric outlet obstruction at the time of diagnosis, 31 underwent prophylactic gastroenterostomy. The procedure did not prevent gastric outlet obstruction in 4 patients. Of the remaining 98 patients, 15 developed gastric outlet obstruction. Cox proportional hazards analysis showed no significant difference in the interval to the occurrence of a symptomatic obstruction between these two groups, taking into account other covariables. Postoperative complications and mortality regarding a gastroenterostomy were high, ranging from 9% to 41% and 11% to 33%, respectively. Our results do not indicate that prophylactic gastroenterostomy may significantly prevent future gastric outlet obstruction; therefore, as it also increases morbidity, it should not be performed. A gastroenterostomy to relieve symptoms should be considered carefully, as the success rate is low and is accompanied by a considerable incidence of morbidity and mortality.

Adult↗
PubMedDate not supplied

Percutaneous cholecystectomy for patients with acute cholecystitis and an increased surgical risk.

PURPOSE: To evaluate percutaneous cholecystostomy in patients with acute cholecystitis and an increased surgical risk. METHODS: Thirty-three patients with acute cholecystitis (calculous, n = 22; acalculous, n = 11) underwent percutaneous cholecystostomy by means of a transhepatic (n = 21) or transperitoneal (n = 12) access route. Clinical and laboratory parameters were retrospectively studied to determine the benefit from cholecystostomy. RESULTS: All procedures were technically successful. Twenty-two (67%) patients improved clinically within 48 hr; showing a significant decrease in body temperature (n = 13), normalization of the white blood cell count (n = 3), or both (n = 6). There were 6 (18%) minor-moderate complications (transhepatic access, n = 3; transperitoneal access, n = 3). Further treatment for patients with calculous cholecystitis was cholecystectomy (n = 9) and percutaneous and endoscopic stone removal (n = 3). Further treatment for patients with acalculous cholecystitis was cholecystectomy (n = 2) and gallbladder ablation (n = 2). There were 4 deaths (12%) either in hospital or within 30 days of drainage; none of the deaths was procedure-related. CONCLUSIONS: Percutaneous cholecystostomy is a safe and effective procedure for patients with acute cholecystitis. For most patients with acalculous cholecystitis percutaneous cholecystostomy may be considered a definitive therapy. In calculous disease this treatment is often only temporizing and a definitive surgical, endoscopic, or radiologic treatment becomes necessary.

Acute Disease↗
PubMedDate not supplied

The effect of blood transfusions on survival after surgery for colorectal cancer.

The immunosuppressive effect of allogeneic blood transfusions can be associated with a poor prognosis for cancer patients. Predeposit autologous blood transfusions could be a solution to overcome this putative deleterious effect. We performed a randomised clinical study to compare the effects of autologous with allogeneic blood transfusions in colorectal cancer patients. There was no significant difference in disease-free survival between both randomisation arms. However, the transfused patients had a significantly shorter disease-free interval as compared with the non-transfused patients. This association of transfusions with recurrent disease was only the case for local recurrences, whereas the incidence of distant metastases was unaffected. We conclude that the use of a predeposit autologous blood transfusion programme does not improve the prognosis in colorectal cancer patients. The negative association between blood transfusions and cancer recurrence is only true for local recurrences, which suggests that not the blood transfusions themselves but rather the circumstances necessitating them are the real predictors of prognosis.

Adult↗
PubMedDate not supplied

Developments in colorectal cancer surgery.

The developments in colorectal cancer since the 19th century are reviewed. Local recurrence of colorectal cancer after curative surgery is a major problem and may occur because of inadequate removal of the primary tumour and lymph node metastases, or intra-operative spill of tumour cells. Colorectal surgeons differ with regard to postoperative mortality. The best surgical technique has not yet been determined; there have been only two prospective randomised trials on surgical technique. However, it is predicted that laparoscopic surgery will have an important place in colorectal surgery.

Blood Transfusion↗
PubMedDate not supplied

Serum CA19-9 determination in the management of pancreatic cancer.

BACKGROUND/AIM: CA19-9 is a tumor marker present in the serum of 70-90% of patients with pancreatic carcinoma. In order to investigate the value of CA19-9 determination in the clinical management of patients with pancreatic cancer, we performed a retrospective study. MATERIAL AND METHODS: We reviewed the records of 122 patients who were admitted to the Surgical Department of the Dijkzigt University Hospital in Rotterdam, the Netherlands, with a diagnosis of pancreatic cancer. RESULTS: Patients with distant metastases at the time of diagnosis show a significantly higher serum CA19-9 level than patients without distant metastases. Unfortunately there is much overlap between the levels in both groups. There was no statistically significant difference in CA19-9 level between patients with a resectable tumor and a tumor that was unresectable due to local conditions. In the postoperative follow-up, there was a statistical relationship between the postoperative CA19-9 level and the development of distant metastases. However, since there is no known therapy for metastases of pancreatic carcinoma, it is not useful to detect these in an early stage. CONCLUSIONS: No useful information can be obtained from postoperative CA19-9 determinations. In the preoperative workup of a patient with a pancreatic tumor CA19-9 determination is at least helpful in estimating the probability of metastatic disease.

Biomarkers, Tumor↗