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Jan Willem Haveman

Publications and source records attributed to Jan Willem Haveman.

4 recordsLinked to original sources
PubMed2006

Low incidence of nephropathy in surgical ICU patients receiving intravenous contrast: a retrospective analysis.

OBJECTIVE: Various studies have documented a markedly high incidence of contrast-induced nephropathy (CIN). Most of these studies were conducted in patients not in the ICU. In ICU patients intravenous contrast may be withheld for fear of CIN. We investigated the incidence of CIN in ICU patients. DESIGN AND SETTING: Retrospective cohort study in a 12-bed tertiary surgical ICU. PATIENTS: Were evaluated all contrast-enhanced abdominal computed tomography (CT) scans between 1995 and 2003 in patients not on renal replacement therapy (RRT) before the CT. Patients received prophylactic prehydration and, since 2000, acetylcysteine. Low-osmolarity, nonionic contrast was used. CIN was defined as an increase in serum creatinine of more than 44 micromol/l (0.5 mg/dl) within 48 h after contrast administration, with no increase in creatinine of 44 micromol/l during the preceding 2 days. RRT initiated after the CT was also recorded. MEASUREMENTS AND RESULTS: The patient was not on RRT before CT in 486 of 589 cases (16% diabetics). In these 486 cases the median (IQR) creatinine decreased significantly from 88 micromol/l (66-124) on the day of the CT-scan to 84 micromol/l (63-118) 2 days later. Only 7 of the 486 cases (1.4%) fulfilled the criteria of CIN, and in another 17 (3.5%) RRT was started after the CT. Important coexisting causes of renal failure were present in these patients, and in all survivors renal function recovered. CONCLUSIONS: CT with modern contrast is associated with a very low incidence of nephropathy in predominantly nondiabetic surgical ICU patients. Intravenous contrast should only rarely be withheld in these patients.

Adult↗
PubMed2005

Implications of mediastinal uptake of 131I with regard to surgery in patients with differentiated thyroid carcinoma.

BACKGROUND: Findings of mediastinal uptake of 131I after surgical treatment for differentiated thyroid carcinoma (DTC) are common, especially in young patients. Given the frequency of false-positive findings, a protocol for diagnostic and therapeutic strategies would be useful. With the goal of accurately selecting management strategies, the authors analyzed their data and data found elsewhere in the literature for correlations with the incidence of mediastinal 131I uptake and with treatment for patients exhibiting such 131I uptake. METHODS: All patients with DTC who were treated between 1978 and 2000 at Groningen University Hospital (Groningen, The Netherlands) and who received adjuvant 131I ablation therapy were included in the current analysis, which involved retrospective review of all relevant data. RESULTS: Five hundred four patients with DTC initially underwent total thyroidectomy, with additional 131I ablation performed for 489 of these patients. In 48 of 489 patients (9.8%), 131I uptake was seen in the mediastinum on a posttreatment scan. Analysis of those 48 patients and of cases in the literature demonstrated that serum thyroglobulin levels, risk status, and the presence of thymus on radiologic images were important in the surgical decision-making process. CONCLUSIONS: Mediastinal uptake of 131I on posttreatment scans was found in approximately 10% of patients after total thyroidectomy for DTC. Based on the current data and the data presented in the literature, the authors developed a flow chart for determining appropriate treatment strategies, which included mediastinal dissection for high-risk patients and for patients with serum thyroglobulin levels > 10 ng/mL.

Adult↗
PubMedDate not supplied

Surgical experience in children with differentiated thyroid carcinoma.

BACKGROUND: The optimal surgical treatment in children with well-differentiated thyroid carcinoma remains an important point of discussion. In this study, we evaluated our surgical experience and reviewed the literature accordingly to identify the most adequate treatment. METHODS: We retrospectively analyzed 21 children, all under the age of 18 years at the time of diagnosis, with differentiated thyroid carcinoma (17 papillary, 3 follicular, and 1 Hürthle cell carcinoma). Total thyroidectomy was performed, followed by radioiodine therapy, as a part of the initial treatment in all patients. The results were compared with data from the literature. RESULTS: Eleven children (52%) who presented with cervical lymph node metastases were treated by a modified radical neck dissection. Pulmonary metastases were seen at diagnosis in three patients. Six patients developed temporary complications. During follow-up, with a median of 11 years (range, 2-26 years), two patients (10%) developed recurrences, and no patient died during this observation period. A literature search confirmed our experience of excellent results without an increase of complications in the more aggressively treated patients. CONCLUSIONS: In children with differentiated thyroid cancer, treatment should consist of total thyroidectomy, followed by a modified radical neck dissection (when indicated) and iodine-131 ablation treatment. This aggressive approach seems to be justified because of the high incidence of nodal involvement and the low complication and recurrence rate after surgery.

Adolescent↗