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Biomedical subjects

J Oldhoff

Publications and source records attributed to J Oldhoff.

At least 55 records · Page 3Linked to original sources
PubMed1988

Results of adjuvant surgery in patients with stage III and IV nonseminomatous testicular tumors after cisplatin-vinblastine-bleomycin chemotherapy.

From January 1978 to April 1983, 53 patients were treated with cisplatin-vinblastine-bleomycin chemotherapy because of advanced nonseminomatous testicular tumor (NSTT). After the chemotherapy, the serum tumor markers were back to normal in 41 patients, of whom 35 were eligible for surgical removal of the residual tumor. In four patients, vital tumor tissue was found in the residual tumor. Salvage chemotherapy resulted in complete remission. Residual mature teratoma was encountered after the chemotherapy in 15 of the 25 patients with a teratomatous component and in one of the ten patients without a teratomatous component in the primary tumor. On completion of the study, 38 of the 53 patients (72%) are still alive, with a median follow-up of 65 months. Subdivided by tumor volume, survival is found to amount to 92% for small-volume disease, 67% for large-volume disease, and 64% for very-large-volume disease. Six patients (11%) developed a recurrence in the course of the follow-up. Exploratory laparotomy after remission induction chemotherapy is necessary in all patients with a teratomatous component in the primary testicular tumor who have become tumor marker negative, irrespective of the roentgenographic findings of the retroperitoneum. Patients without a teratomatous component in the primary tumor should have exploratory laparotomy only in case of roentgenographic evidence of retroperitoneal residual tumor. A thoracotomy is needed only in the presence of roentgenographic evidence of pulmonary residual lesions.

Adolescent↗
PubMed1988

To perfuse or not to perfuse? A retrospective comparative study to evaluate the effect of adjuvant isolated regional perfusion in patients with stage I extremity melanoma with a thickness of 1.5 mm or greater.

The use of isolated regional perfusion in an adjuvant setting for stage I melanoma of the extremity continues to be controversial. The present retrospective study evaluates the past 20 years' experience by comparing 227 perfused patients from Groningen with 238 matched controls from five hospitals in The Netherlands and Westphalia (a region of West Germany bordering the Netherlands). All patients underwent wide local excision for a primary extremity melanoma of 1.5 mm or greater in thickness. A proportional hazards regression analysis for recurrence of disease and survival identified the significant prognostic factors, of which tumor thickness was the most important. Corrected for these factors, it was not possible to demonstrate a statistically significant effect for perfusion in terms of time to limb recurrence (P = .61), time to regional lymph node metastasis (P = .11), time to distant metastasis (P = .73), disease-free interval (P = .42), and survival (P = .90). No statistically significant differences were seen for adjuvant perfusion in any of the subgroups.

Adult↗
PubMed1987

Results of isolated regional perfusion in the treatment of malignant soft tissue tumors of the extremities.

High-grade soft tissue sarcomas of the extremities continue to pose problems of local disease control and deaths from distant metastases. Between 1969 and 1976, eight patients with primary and six with recurrent high-grade soft tissue sarcomas of the extremities were treated by isolated regional perfusion with cytostatics and local excision. None received systemic adjuvant chemotherapy or external-beam radiotherapy. During the follow-up (median, 13 years) five patients (36%) developed distant metastases. One was cured after resection of a pulmonary metastasis. In one other patient (7%) recurrent local disease was diagnosed after 48 months; he was cured after resection of the local lesion followed by postoperative external beam radiotherapy. The actuarial 5-year and 10-year survival was 69%. Treatment caused no cardiovascular complications and there was no postoperative mortality.

Adult↗
PubMed1987

Orchidectomy alone in stage I nonseminomatous testicular germ cell tumors.

Fifty-four patients with Stage I nonseminomatous testicular germ cell tumors (NSTGCT) were treated from 1982 to 1984. In 1982 and 1983, the orchidectomy was followed by an exploratory laparotomy to conclude the dissemination study. In 1984, laparotomy was performed only if indicated. The mean follow-up was 29 months. A relapse occurred in 11 patients (20%). The relapse rate in patients who underwent exploratory laparotomy was as high as that in patients who did not. All patients treated for relapse by chemotherapy and surgery entered a complete remission for at least 1 year. It proved impossible to establish criteria for prediction of a subsequent relapse. Both serum tumor marker assays and roentgenography are important aids in diagnosing a relapse. With careful follow-up of Stage I NSTGCT patients, a wait-and-see attitude can be adopted until a relapse occurs.

Humans↗
PubMed1987

History, preliminary results, complications, and future prospects of intraoperative radiotherapy.

Intraoperative electron beam radiotherapy (IORT) is a new combined modality therapy in the treatment of cancer. IORT is delivered during a surgical procedure to a tumor or tumor bed and areas of possible local regional spread, with the ability to shield or physically move normal tissues and organs out of the treatment volume. IORT is feasible for various intraabdominal, retroperitoneal, pelvic, and other malignancies. It is possible to increase the total radiation dose, thereby improving the therapeutic ratio; a better local control without an increasing morbidity. Although the optimum use of IORT is still unknown, it is believed that its greatest value is in combination with maximal surgical resection of the tumor with or without external beam radiotherapy (EBRT). IORT is still an experimental treatment modality combining surgery, EBRT, and if necessary, chemotherapy. Because IORT is an expensive treatment method, it is important to determine which method is the best and most convenient for the patient. The answer can be given only when prospective, randomized clinical IORT trials and cost-effectiveness studies are initiated.

Combined Modality Therapy↗
PubMed1987

Staging laparotomy for inoperable or borderline operable cancer of the rectum.

The authors report their experience with the staging laparotomy as a means of identifying and preparing patients for high-dose preoperative radiotherapy. Twelve patients had clinically unresectable cancers of the rectum. The goal of the staging laparotomy is to assess mobility and tumor size by means of bimanual palpation, to stage the abdominal cavity, and to fashion an end colostomy at the level of the descending colon. Eight patients ultimately underwent radical resection. Three died during follow-up due to hematogenic metastases without recurrent pelvic disease. Five patients are alive with no evidence of disease and have been followed for an average of 34 months (range, 20 to 64 months).

Adult↗
PubMed1987

Sexual function after bilateral retroperitoneal lymph node dissection for nonseminomatous testicular cancer.

This study concerns the sexual functions of 101 patients who had undergone bilateral retroperitoneal lymph node dissection for stage I or II nonseminomatous testicular cancer between 1969 and 1982. All patients were without evidence of disease after at least 4 years of follow-up. Antegrade ejaculation was present in 12 patients, while 89 patients experienced "dry ejaculation." Urine collected after intercourse or masturbation from 75 patients with dry ejaculation showed retrograde ejaculation in 55 and lack of ejaculatory emission into the urethra in 20 patients. Regarding other sexual functions, 17 patients had a diminished sexual desire (especially those patients who had received radiotherapy), 12 experienced difficulty reaching organism, and 6 complained of erectile dysfunction. The incidence of a contralateral hydrocele developing after retroperitoneal lymph node dissection seems to correlate with ligation of the contralateral spermatic vessels and their lymphatics. A review of the literature is presented comparing the types of dissection with the incidence of sexual disorders after retroperitoneal lymph node dissection. Since preserving normal ejaculation and fertility is important, a modified or unilateral retroperitoneal lymph node dissection, when required, is advocated. In patients, with stage I disease the therapy may be limited to an orchiectomy without lymph node dissection. In patients with retroperitoneal lymph node metastases combination chemotherapy with cisplatin and tumor excision gives good results. Patients with true retrograde ejaculation can be treated with alpha-sympathomimetic drugs such as imipramine HCl, and thus be offered the chance of fatherhood by coitus.

Adult↗
PubMed1986

Cryosurgical treatment of sacrococcygeal chordoma. Report of four cases.

Sacrococcygeal chordoma is a rare malignant neoplasm situated in a location adjacent to important structures. Distant metastases are usually rare and occur late. The treatment of choice usually consists of radical surgery, sometimes followed by radiotherapy. Extensive surgical resection is difficult and often causes bladder and/or bowel dysfunction, and the local recurrence rate remains high. In an attempt to diminish both risks, the authors introduced cryosurgery in situ as a new treatment modality for chordoma in the sacrococcygeal region. From 1974 to 1980, four patients (two male, two female) with sacrococcygeal chordoma were treated with cryosurgery without resection. Two patients had extensive tumors (greater than 10 cm) and could be treated only palliatively. Two other patients with smaller tumors (less than 10 cm) had radical cryosurgical treatment. Both patients are disease-free 10 and 7 years after cryosurgical treatment. One of the palliatively treated patients is alive with local recurrence 4 years after cryosurgery, the other died of tumor after 5 years. In a cryosurgical lesion, the tissue is completely devitalized; however, the architecture of the tissue in peripheral nerves, large vessels, and bone is preserved and remains as a perfect autograft. Frozen tissue is very susceptible to the hematogenous spread of infection. Therefore, infection prevention is of utmost importance. The authors believe that cryosurgery should have a place in the treatment of sacrococcygeal chordoma.

Aged↗
PubMed1986

Treatment of retroperitoneal residual tumor after PVB chemotherapy of nonseminomatous testicular tumors.

Twenty-five patients with nonseminomatous testicular tumors stages IIB and IIC were treated at the Groningen University Hospital between January 1978 and April 1983. One patient died from his extensive tumor during chemotherapy. The remaining 24, treated by combination chemotherapy with cisplatin, vinblastine, and bleomycin as well as by surgery, are all alive after a mean follow-up period of 56 months. A laparotomy was performed after chemotherapy in each of the 24 cases. In four patients no residual tumor was found. Residual tumor was resected in 20 patients, in 13 the tumor contained only necrosis and fibrosis, 7 had mature teratoma. Comparison of the histologic features of the primary testicular tumor with those of the retroperitoneal residual tumor after chemotherapy, revealed that if the primary tumor did not contain a teratoma component the residual tumor showed only necrosis and/or fibrosis. When the primary tumor contained a teratoma component, mature teratoma was found in 50% (7/14) of the residual tumors.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Comparison of two methods of treating primary malignant melanomas Clark IV and V, thickness 1.5 mm and greater, localized on the extremities. Wide surgical excision with and without adjuvant regional perfusion.

A comparative retrospective study of patients with primary malignant melanomas of the extremities, Clark level IV/V and tumor thickness greater than or equal to 1.5 mm, was performed in Sydney (Australia) and Groningen (The Netherlands). The efficacy of wide local excision combined with adjuvant regional perfusion (Groningen) was compared with that of wide surgical excision only (Sydney). Patients were classified by sex and tumor location. There were only sufficient numbers of female patients with a tumor of the lower extremity available for this comparative study. All patients were stage I and none received prophylactic lymph node dissection. Age, tumor location, tumor thickness, depth of infiltration and ulceration were taken into account and the factors studied within this group were 10-year disease-free rate, 10-year survival rate, and local and regional recurrences. Women with a melanoma of the leg (excluding the foot) who had been treated by excision and adjuvant regional perfusion, had a significantly better 10-year disease-free rate (P less than 0.0005), a significantly higher 10-year survival rate (0.010 less than P less than 0.025) and significantly fewer local/regional recurrences (P less than 0.0005) than women treated by wide local excision only. For tumors of the foot, however, no significant differences in 10-year disease-free rate, 10-year survival rate or local/regional recurrences were observed after perfusion.

Adult↗
PubMed1986

The effect of chemotherapy on osteosarcoma of the extremities as apparent from conventional roentgenograms.

The introduction of chemotherapy has greatly changed the treatment of osteosarcoma. During the preoperative phase the tumor response to chemotherapy can be assessed in various ways. This paper discusses the clinical, histological and radiological response to preoperative chemotherapy in three patients. Changes in conventional roentgenograms following chemotherapy can reflect the effect of chemotherapy on the primary tumor. This can be important in planning further chemotherapy or surgery.

Adolescent↗
PubMed1986

A cancer education study in The Netherlands based on the AACE/NCI Cancer Education Survey.

A Dutch Cancer Education Study demonstrated that the data collection instruments developed for the U.S. AACE/NCI Cancer Education Survey could also be used for the same kind of studies in foreign countries. Where needed, the data collection instruments were modified to the Dutch national situation. In this way, an impression was obtained on several aspects concerning undergraduate cancer education in the Dutch medical schools. Based on the combined findings of the U.S. Cancer Education Survey and the Dutch Cancer Education Study, a number of recommendations can be made for application to student cancer education in The Netherlands.

Education, Medical, Undergraduate↗
PubMed1986

Wait-and-see policy in clinical stage I non-seminomatous germ cell tumors of the testis.

Thirty-three patients with a non-seminomatous germ cell tumor of the testis in clinical stage I were treated only by orchidectomy. The very careful follow-up--with tumor marker assays every 3 weeks, chest X-rays every 6 weeks and CT-scans of the lungs and retroperitoneum every 3 months--revealed metastases in 7 of the patients (21%). All these relapses were diagnosed within 6 months of the orchidectomy. Para-aortic node metastases were found in 5 of the 7 patients, with additional inguinal node metastases in 1 and additional lung metastases in 1; 2 patients had only lung metastases. Six of the 7 patients with a relapse were given chemotherapy (PVB); 1 patient refused chemotherapy. In view of residual disease a surgical excision was performed; it revealed necrosis as well as mature teratoma. All 33 patients are still alive, the post-orchidectomy follow-up period being 12-38 months.

Adolescent↗