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R H Kruyt

Publications and source records attributed to R H Kruyt.

17 recordsLinked to original sources
PubMed1996

Biopsy of nonpalpable cervical lymph nodes: selection criteria for ultrasound-guided biopsy in patients with head and neck squamous cell carcinoma.

This article is designed to find an appropriate policy to select nonpalpable cervical lymph nodes in head and neck squamous cell carcinoma patients for ultrasound-guided aspiration biopsy (USB). According to the literature, generally used selection criteria are width of nodes > 10 mm, length-to-width ratio > 2 and absent echo-rich hilum. In 562 nonpalpable nodes of 355 patients (mean age 60 y, range 20-92 y) with head and neck squamous cell carcinoma, a USB procedure was carried out. Nodes were classified according to dimensions and to echo pattern. Representative cytology was obtained in 489 nodes; 112 were classified as malignant. Of the 412 nodes with a width < or = 10 mm, 79 were malignant. Width is the strongest predictor for malignancy and, if corrected for width, the length-to-width ratio is of no influence. Of the 142 nodes with an echo-poor centre, or an inhomogeneous pattern, 46% were malignant, compared to 13% of 342 nodes with an echo-rich centre. It is concluded that selection of lymph nodes of the neck of patients with squamous cell carcinoma of the head and neck should be based on width and echo pattern. We advise subjecting nodes with an echo-rich centre or homogeneous pattern and a width > or = 4 mm to USB, and also subjecting nodes with an echo-poor centre or inhomogeneous pattern with a width > or = 3 mm to USB.

Adult↗
PubMed1996

Regional metastasis in head and neck squamous cell carcinoma: revised value of US with US-guided FNAB.

PURPOSE: To verify the acclaimed accuracy of ultrasound (US) combined with US-guided fine-needle aspiration biopsy (FNAB) in the detection of lymph node metastasis in the neck and to evaluate the interobserver variability. MATERIALS AND METHODS: In a prospective, multicenter study of 185 patients with head and neck squamous cell carcinoma, US (n=238 neck sides) with US-guided FNAB (n=178 neck sides) was used for evaluation of the lymph node status of the neck. Findings were correlated with those of histopathologic examination in 238 neck sides. RESULTS: US with US-guided FNAB had a sensitivity of 77% and a specificity of 100%. Nineteen of 178 aspirations were nondiagnostic. There were no significant differences between the four participating hospitals or the individual sonologists (P>.05). CONCLUSION: Sensitivity of US with US-guided FNAB was slightly lower compared with previous reports. Specificity was similar to previous reports. Interobserver variability appeared to be low. The validity of US with US-guided FNAB is high and warrants widespread use of the procedure for evaluation of the neck.

Adult↗
PubMed1994

Anterior rectocele: assessment with radiographic defecography, dynamic magnetic resonance imaging, and physical examination.

PURPOSE: The aim of this study was to devise a measuring method for an anterior rectocele on standardized defecographies and magnetic resonance images (MRI) to quantify anterior rectocele and to test whether this could substantiate clinical decision making for operative treatment for anterior rectocele. METHODS: Quantitative analysis by the measuring method as proposed was compared with qualitative scores on defecographies and MRI from the same patients. Thirty-eight patients with symptoms compatible with an anterior rectocele were subjected to physical examination in the left decubitis position and supine position and to defecography. Findings on defecography were compared with findings on physical examination. Thirteen patients were examined before and after surgical correction of the anterior rectocele for a total of 51 qualitative and quantitative examinations. The group of operated patients was analyzed for treatment results. Nineteen controls were included. RESULTS: Sixty-six radiographs of 33 defecographies were qualified in three grading classes and quantified with the proposed method by two observers. The mean measured value of the anterior rectocele in the three subjective grading classes is significantly different (P < 0.001). Anterior rectoceles qualified as severe had a measured value of 20 mm or more in 96 percent of the radiographs. Lower gradings were never > 20 mm. On MRI severe anterior rectoceles were not scored and measured values did not correlate with qualitative scores. When findings on physical examination were compared with defecographic measurement, the coefficient of correlation (r) between the radiologic assessment and clinical examination in the left decubitis position is r = 0.87, for the examination in the supine position, r = 0.77. All 15 cases scored as severe anterior rectocele in the left decubitis position had a measured anterior rectocele of > or = 20 mm. In the 13 cases that received surgery, there was a significant reduction of the anterior rectocele (P < 0.001) and clinical improvement. Patients with small or moderate anterior rectocele on physical examination with a size > or = 20 mm on defecography were cured by surgical correction. None of the controls had an anterior rectocele on physical examination or an anterior rectocele > or = 20 mm on defecography. CONCLUSIONS: An anterior rectocele with a size of 20 mm or more corresponds with a qualitative score of "severe" on radiographic defecography. Physical examination for anterior rectocele in the left decubitis position corresponds best with quantitative radiographic assessment and anterior rectocele with a size > or = 20 mm on defecography is pathologic. Patients with complaints compatible with anterior rectocele can be assessed in objective and quantitative terms by radiography and can be successfully surgically treated, even if at physical examination the anterior rectocele is not classified as large, provided that dynamic defecography shows an anterior rectocele of > or = 20 mm. The potential of dynamic MRI with regard to anterior rectoceles presently seems absent.

Adult↗
PubMed1994

Solid breast neoplasms: differential diagnosis with pulsed Doppler ultrasound.

In this prospective study, duplex Doppler ultrasound was used in 95 consecutive patients with solid breast masses to evaluate the presence of neovascular flow. A positive Doppler signal, i.e., a Doppler shift frequency of more than 1 kHz using a 5 MHz insonating frequency, was found in 34 of 57 patients with a carcinoma, and also in three patients with a benign condition. These results indicate that negative findings with pulsed Doppler ultrasound cannot be used to exclude malignancy. However, a frequency shift of more than 1 kHz indicates a high probability for malignancy. In our study a high frequency shift was not related to tumor size. We also evaluated the correlation between a high frequency shift and axillary nodal metastasis. According to our results there is a very low chance of axillary metastasis when no high frequency shifts are found.

Adult↗
PubMed1994

Renal masses: value of duplex Doppler ultrasound in the differential diagnosis.

In a prospective study, 84 nonanechoic renal masses were examined with duplex Doppler ultrasound with a 3.5 mHz. transducer. This study included malignant lesions in 49 cases (30 renal carcinomas, 9 metastases, 8 lymphomas and 2 sarcomas) and benign lesions in 35 (18 complicated cysts, 6 inflammatory processes, 5 columns of Bertin, 3 angiomyolipomas and 3 hematomas). We analyzed whether duplex Doppler ultrasound can have a role in the differential diagnoses of these solid renal masses. Renal carcinomas demonstrated Doppler shifts of 2.5 kHz. or more in 23 cases (77%). These masses had significantly higher Doppler shifts than all of the other malignant masses (p < 0.001). Among the benign lesions the Doppler shifts were less than 2.5 kHz. in 33 cases (84%). The 2 masses with a Doppler shift of more than 2.5 kHz. in this group were inflammatory lesions. Detection of a Doppler shift of 2.5 or greater in a renal mass supports suspicion of a renal cell carcinoma, although an inflammatory process may also produce such a high Doppler shift. Doppler shifts of less than 2.5 kHz. in solid renal masses support the diagnoses of a benign lesion and a malignant lesion other than renal cell carcinoma.

Adult↗
PubMed1993

Pelvic prolapse.

Explore the source record for details and available documents.

Defecation↗
PubMed1992

Vascularization of left kidney by single vessel originating from splenic artery.

According to the literature, sole renal arteries always originate from the aorta. In multiple renal arteries, the origin of an accessory renal artery may be expected from the splenic artery on theoretical basis. This origin, however, never is described. A patient is presented with a sole left renal artery, originating from the splenic artery. The diagnosis is made by angiography and confirmed by computed tomography and surgery.

Aged↗
PubMed1992

Defecography and anorectal manometry.

In a prospective study anorectal manometry was performed in 160 consecutive patients who were referred for defecography. Leakage of contrast material of standardized viscosity, the anorectal angle (ARA), anal resting pressure (Pr) and squeeze pressure (Ps) were measured and analyzed. This was done to investigate the role of ARA on rectal continence during defecography and to investigate whether relevant findings of manometry can be predicted from findings at defecography as part of the diagnostic work-up in selected patients in order to avoid manometry in these patients. The ARA was of significance in maintaining rectal continence for the contrast medium (P = 0.008). With increasing leakage, Pr and Ps decreased significantly (P less than 0.001). In all fully incontinent patients (n = 36) Ps was distinctly below normal values. Manometry can be avoided in these patients if the level of Pr is not important for therapeutic strategy.

Adult↗
PubMed1991

The effect of posterior rectopexy on fecal continence. A prospective study.

Twenty-three patients with rectal prolapse or intussusception were studied to specifically focus on the effect of posterior rectopexy on fecal continence, anal pressure, and rectal capacity. Before operation, five patients were fully continent (A), 10 were continent for solid stools (B) and eight patients were fully incontinent (C). Group A remained fully continent; continence was regained nine times in group B and in group C, three patients regained full continence, two became continent for solid stools, three patients remained incontinent. Other symptoms such as constipation, false urgency, and a feeling of incomplete evacuation were not beneficially influenced by rectopexy. The patients' continence status was correlated to anorectal manometry and rectal capacity measurement. In group B, incremental pressure (P = squeeze - basal P) increased significantly (P less than 0.02) as well as incremental volume (V = maximum tolerated volume - volume of first sensation) (P less than 0.05). We conclude that, by an increase of incremental anal pressure and incremental rectal volume, posterior rectopexy offers an 83 percent chance of regaining full continence, or a major improvement, and a 17 percent chance of stabilization of fecal incontinence.

Adult↗
PubMed1991

Normal anorectum: dynamic MR imaging anatomy.

In this study, the anatomy of the anorectum in relation to the surrounding structures and the anorectal angle were analyzed with magnetic resonance (MR) imaging at rest, during perineal contraction, and during straining in 10 asymptomatic subjects. The intra- and inter-observer and intra- and interpatient variations in the measurements of the anorectal angle, position of the anorectal junction, and position of the plica of Kohlrausch in the rectum were established at rest, during perineal contraction, and during straining. The values for the anorectal angle and position of the anorectal junction obtained with MR imaging were compared with standard radiography defecography findings. It was shown that MR imaging has the potential for measuring these parameters in a more precise and more patient-friendly way than defecography. Unlike dynamic defecography, MR imaging is able to depict the mobility of the posterior rectal wall. A descent of over 20 mm from rest to straining should be considered pathologic. This finding might play a role in patient selection for operation.

Adult↗
PubMed1988

Kock pouch urinary diversion: follow-up by ultrasound.

In the post-operative follow-up of 24 patients who received a continent Kock pouch for urinary diversion, several complications were encountered, including hydronephrosis, stone formation and valve dysfunction, resulting in reflux and/or urinary incontinence. After comparing findings on ultrasound with those obtained by Koch pouch cystography, intravenous urography, plain abdominal radiography, Kock pouch endoscopy and operation, we consider ultrasound to be an important technique in the follow-up, especially in non-symptomatic patients. All cases of hydronephrosis and pouch calculi were detected by ultrasound and no false positive findings were encountered in either group. A good correlation is demonstrated between nipple length, as measured by ultrasound, and valve dysfunction, clinically important only for the afferent nipple.

Adult↗
PubMed1986

Renovascular hypertension and digital subtraction analysis.

Intravenous digital subtraction angiography (DSA) is a good imaging modality for the renal arteries and their main branches. Using an anterior-posterior beam direction, a considerable reduction in X-ray exposition is achieved, and by taking 3 runs with the patient in prone position, the renal arteries are adequately visualized in a high percentage. Nevertheless we advocate arterial DSA as a screening procedure for renovascular hypertension, especially in younger patients, because of the higher diagnostic output and the possibility of taking therapeutic action in the same session in about 1 out of 3 patients.

Adolescent↗