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Biomedical subjects

K Welvaart

Publications and source records attributed to K Welvaart.

At least 73 records · Page 4Linked to original sources
PubMed1986

Prognoses and surgical treatment of patients with stage I melanomas of the skin: a retrospective analysis of 211 patients.

From 1960 to 1982, a total number of 216 patients with Stage I melanoma underwent local excision as the single treatment. Life-table analysis was performed on 211 evaluable patients to investigate the prognostic value of several factors on survival as well as disease-free survival. The influence of sex, age, localization of the tumor, and margin of the excision on prognosis was not statistically significant. The Clark level and Breslow thickness were important factors to predict the prognosis. Local recurrence occurred in only one patient; in most cases tumor growth close to the original site of excision indicates early manifestation of hematogenic spread. Lymph node metastases developed in 31 patients; ten of them remained free of disease after node dissection. Six patients died from hematogenic metastases without nodal involvement. Tumors with thickness less than 1.5 mm have excellent prognosis regardless of the location of the melanoma or the margin of the excision. With increasing thickness of the tumor, prognosis is proportionally worse. By performing wide excisions the final outcome can not be improved.

Adolescent↗
PubMed1986

Palliation of patients with carcinoma of the lower esophagus and cardia: the question of quality of life.

The choice of palliative therapy in patients with carcinoma of the lower esophagus and cardia is mainly between irradiation and surgery. The present report is a retrospective analysis of 40 consecutive patients who recovered after resection of the tumor. The operation was considered to be palliative in all patients. The ability to swallow in proportion to the duration of the remaining life is used as a parameter for the quality of life. After esophago-gastrostomy, the average survival amounts to 24 months, permitting the patient to enjoy an almost normal diet. In spite of the palliative intention of the treatment, one-third of the patients exceed 3-year survival.

Cardia↗
PubMed1986

The effect of radical and conserving surgery on the quality of life of early breast cancer patients.

In a randomized trial at the Leiden University Hospital, comparing (modified) radical mastectomy with tumorectomy followed by radiotherapy, all patients have been studied with respect to the quality of their lives 11 months and 18 months after surgery. The body image of women was more severely impaired after mastectomy than it was after breast conserving treatment (P less than 0.01). This was true for both younger and older women. Fear of recurrence of cancer was not related to the type of treatment. Thus, from a psychological point of view, breast conserving treatment is to be preferred in women of all ages. The overall quality of life improved and the suffering from psychological and physical complaints decreased with time in both groups of patients. This change may, therefore, have to be attributed to getting over the experience of having had cancer, and not to the treatment schedule.

Analysis of Variance↗
PubMed1985

Quality of life after breast cancer surgery.

All patients (N = 41) who participated in a randomized clinical trial in the Leiden University Hospital comparing mastectomy to tumorectomy have been studied with respect to their quality of life 11 months (+/- 5) after surgery. The body image of patients is more severely impaired after mastectomy than after tumorectomy (P less than .01). The studied groups did not differ, as has been suggested, with respect to fear of recurrence and death. These fears, however, turned out to be inversely related to the age of the patients (r = -.34, P = .02).

Body Image↗
PubMed1985

The splenic red pulp; a histomorphometrical study in splenectomy specimens embedded in methylmethacrylate.

The anatomy and pathology of the splenic red pulp was studied in three-dimensional reconstructions of methylmethacrylate embedded blocks of tissue obtained after splenectomy, as well as by morphometrical analysis of a large number of specimens. The sinuses of the spleen form a plexus of anastomosing vessels with remarkable buds. Capillaries end as sheathed capillaries in the cord tissue, the 'filtering' area, but a large proportion of the red pulp cords appear to be 'non-filtering'. These might form part of the lymphatic compartment, which is separate from the white pulp and its extension along the capillaries. This area has not yet been described in man. The change in the volume and structure of the various components of the red pulp were studied in 60 controls and in cases of traumatic rupture, idiopathic thrombocytopenic purpura, aplastic anaemia, autoimmune haemolytic anaemia, congenital spherocytosis, splenic congestion, and Hodgkin's disease. Significant differences were found in the volume of filtering and non-filtering areas, the size of the sinus compartment, and the degree of vascularization; these differences were only partially expected, for instance in disorders with excessive erythrocyte sequestration. A decrease of the 'non-filtering' area in Hodgkin's disease might indicate an unknown aspect of this disease. In agreement with our previous paper on the amount of white pulp, spleens removed because of traumatic rupture and those incidentally removed during abdominal surgery may not be combined as a single control group, because of significant and probably functional differences in the composition also of the red pulp.

Adolescent↗
PubMed1984

Immunohistochemical analysis of malignant melanomas and nevocellular nevi with monoclonal antibodies to distinct monomorphic determinants of HLA antigens.

Using an indirect immunoperoxidase technique, 20 nevocellular nevi, 5 dysplastic nevi, 14 primary cutaneous melanomas, and 24 metastatic melanomas were tested with a panel of monoclonal antibodies to monomorphic determinants of Class I (HLA-A,B,C) and Class II (la-like) major histocompatibility complex antigens. Class I HLA and beta 2-microglobulins were not detected on the majority of nevus cells but were expressed by 3 of 5 dysplastic nevi, by the majority of tumor cells in 12 of 14 primary cutaneous melanomas, and in 13 of 24 metastases. The different expression of Class I HLA and beta 2-microglobulins in primary and metastatic lesions suggests that loss of these antigens may be associated with progression of malignancy. Class II HLA were not detected in common nevi but were locally present in 1 of 5 dysplastic nevi, 7 of 14 cases of primary cutaneous melanoma, and all 24 cases of metastatic lesions tested. These findings suggest that increase in Class II HLA expression may be associated with progression of malignancy. The staining patterns obtained with monoclonal antibodies to distinct determinants of Class I HLA and Class II HLA were superimposable within each type of antigen. Therefore, the discrepancies in the literature about the expression of histocompatibility antigens by lesions of melanocytic origin are not likely to reflect the different specificity of the antibodies used by the various investigators.

Adolescent↗
PubMed1982

The incidence of carcinoma of the gastric remnant.

Carcinoma of the gastric remnant (stump carcinoma) is defined as cancer that has developed in the remnant of the stomach when primary resection was carried out at least 5 years earlier and for benign disease. Little is known about the incidence of the disease. In several publications adequate calculation is missing and unfortunately in well-designed investigations considerable numbers of patients who are to be followed from the day of the resection until many years later are missing. Thus calculations are based on a group of selected patients. We succeeded in analyzing 97% of our patients in a period for over 26 years. Stump cancer occurred in 1.9%. In our opinion stump cancer is not an independent disease, but similar to cancer of the stomach. It seems that resection provides a decrease of the chance that eventually gastric cancer may arise.

Adolescent↗
PubMed1981

Management of the undescended testis in relation to the development of cancer.

The undescended testis carries an increased risk of cancer; however, the exact individual risk of a cryptorchist during his life to develop cancer is unknown. The risk of developing cancer can be calculated from three important figures: (a) the number of cryptorchists in the population; (b) the number of malignant testicular tumors found in undescended testicles; and (c) the number of testicular tumors per annum. In the literature, a 48 times increased chance to develop testicular cancer is accepted; it is a high risk which is contrary to the fact that a malignant cryptorchid testis is a very rare disease. Based on the estimated risk for the cryptorchist in the Netherlands to develop testicular cancer, this article criticizes the value of the figures that are generally used to calculate the individual risk; it is concluded that even today the exact risk is unknown. In giving advice concerning the management of undescended testis, one must appreciate not only the supposed cancer risk, but also take into consideration morbidity and mortality after prophylactic orchidectomy and improved cure rates after electively treated testicular tumors.

Adolescent↗
PubMed1980

Preparation of the colon by whole-gut irrigation--some practical remarks.

The importance of the mechanical cleansing of the bowel in relation to surgery of the colon is well understood. This article provides practical remarks concerning the technique of irrigation. Technical details are given on transforming a Bremshey hospital bed into a 'whole-gut irrigation bed'. The clinical procedure of the irrigation is described. We recommend irrigation by nasograstric tube with large amounts of fluids to all our patients when the bowel needs to be cleansed. Our specially designed whole-gut bed provides excellent comfort to our patients.

Beds↗