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T Wiggers

Publications and source records attributed to T Wiggers.

At least 73 records · Page 4Linked to original sources
PubMed1997

Prediction of pathological subtrochanteric fractures due to metastatic lesions.

We report a radiographic review of 54 consecutive patients with 24 impending and 30 actual pathological fractures due to metastatic bone lesions in the subtrochanteric femoral region. In an attempt to develop criteria for metastatic lesions at risk of fracturing, the following variables based on anteroposterior and lateral X-rays were considered: appearance of the lesion, width of the lesion, ratio between width of the lesion and bone width, length of the lesion, length of cortex involvement, proportion of transverse cortical bone destroyed and local pain. Nearly all (99%) of the lesions were radiographically classified as lytic. In 27 cases (50%) they were radiographically unmeasurable. Maximal longitudinal cortical destruction showed a difference between patients with an actual or impending fracture. Prophylactic internal fixation of pathological subtrochanteric fractures due to metastatic lesions has to be considered in cases of increasing pain. If the conventional X-ray can not be evaluated, a computed tomography (CT) scan has to be considered.

Adult↗
PubMed1997

Effect of radiation therapy alone or in combination with surgery and/or chemotherapy on tumor and symptom control of recurrent rectal cancer.

PURPOSE: To define the value of radiotherapy alone or in combination with other treatment modalities in salvage and/or palliation of locally recurrent rectal cancer with or without concomitant distant metastases. PATIENTS AND METHOD: A series of 280 patients, treated between 1975 and 1990 was retrospectively reviewed. The patients were divided into 2 groups: 166 patients had a local recurrence only (group 1), 114 presented with simultaneously distant metastases (group 2). In group 1, 50 patients had only radiotherapy, 20 had radiation in combination with surgery, 68 patients had radiation and chemotherapy, and 28 patients had a combination of all 3 treatment modalities. In group 2 these numbers were 41, 7, 59 and 7, respectively. The median follow-up time was 11 months (1 to 118). RESULTS: The 2- and 5-year survival of group 1 were 33% and 12%. In group 2 the 2-year survival was 9%. The 2- and 5-year symptom-free survival for both groups were 18%/12% and 4%/0%, respectively. There was no significant difference in survival and symptom-free survival between treatment including concomitant 5-FU or 5-FU once a week and treatment without chemotherapy. In the combined treatments which included surgery there was a longer survival and symptom-free survival. In both groups a subanalysis of the patients who had radiation only showed a dose-response relationship for symptom-free survival. This was not the case for survival. CONCLUSION: In local recurrence of rectal cancer without detectable distant metastases, radiotherapy and/or surgery have value toward survival and symptom-free survival. Further intense efforts in preventing the local recurrence by improving primary treatment are warranted.

Adenocarcinoma↗
PubMed1997

Association between age and local recurrence of rectal cancer: results from a retrospective study of 902 patients.

Due to the ageing of the general population, there has been a relative increase of elderly patients with rectal cancer. The relation between age and the risk of local recurrence after apparently curative surgery for cancer of rectum and rectosigmoid was studied in a retrospective study of 902 patients, diagnosed from 1984 through 1991 in the southwestern part of the Netherlands. Three age-groups were defined: 15-64 (n = 328), 65-74 (n = 327) and 75 and over (n = 247). After exclusion of postoperative deaths and controlling for unrelated causes of death, 5-year survival rates were similar in the three age-groups (70%, 71% and 75%, respectively). Local recurrence rates, however, decreased with age from 23% to 18% and 14%, respectively. In multivariate analysis, the hazard ratios were 1, 0.84 and 0.66, respectively. These results suggest that local recurrence occurs less frequently in the elderly, which needs confirmation from prospective studies and warrants consideration in decisions about the use of adjuvant treatment.

Adolescent↗
PubMed1997

A prospective randomized trial of high versus low vacuum drainage after axillary dissection for breast cancer.

BACKGROUND AND METHODS: The influence of negative pressure on fluid production and complication rates after axillary dissection for breast cancer was studied in a prospective randomized trial. Patients were randomized for either a high or a low vacuum drainage system. Drainage volumes and complication rates were recorded. RESULTS: No statistically significant differences were found between the low vacuum group (n = 68) and the high vacuum group (n = 73) in volume (728 ml versus 780 ml) and duration (9.5 days versus 10 days) of seroma production, number of wound complications (5 versus 6), or infections (3 versus 2). There was a significant positive relationship between body mass index and seroma production, independent of the drainage system (P = 0.002). The drainage volume of the separately drained breast wound after mastectomy and lumpectomy was larger for the high vacuum system (55 ml versus 100 ml, P = 0.02). Vacuum loss was more frequent in the high vacuum drain group (11 versus 2, P = 0.01), where as leakage around the drain occurred more often in the low vacuum group (18 versus 6, P = 0.004). CONCLUSION: There are no differences in axillary fluid production or wound complication rates after axillary dissection and subsequent drainage between high and low vacuum drainage systems.

Adult↗
PubMed1997

Continuity of information for breast cancer patients: the development, use and evaluation of a multidisciplinary care-protocol.

The multidisciplinary nature of much patient-care may lead to gaps in the continuity of information which they receive, as well as to different care-professionals giving them contradictory information. As a counter-measure, a protocol has been developed which integrates medical, nursing, and a variety of extramural events and activities into a comprehensive description of 15 'moments' in the care of breast cancer surgery-patients. Among innovations, the protocol includes information about psychosocial guidance following diagnosis, and about the discharge procedure and contact with fellow-sufferers. The protocol was implemented in Rotterdam in 1994, in two hospitals and in the community; and evaluated formatively on the basis of reactions from 53 patients and 81 care-professionals. Both groups found its form and content to be successful and informative.

Breast Neoplasms↗
PubMed1997

Isolated hepatic perfusion in the pig with TNF-alpha with and without melphalan.

Isolated limb perfusion with tumour necrosis factor alpha (TNF-alpha) and melphalan is well tolerated and highly effective in irresectable sarcoma and melanoma. No data are available on isolated hepatic perfusion (IHP) with these drugs for irresectable hepatic malignancies. This study was undertaken to assess the feasibility of such an approach by analysing hepatic and systemic toxicity of IHP with TNF-alpha with and without melphalan in pigs. Ten healthy pigs underwent IHP. After vascular isolation of the liver, inflow catheters were placed in the hepatic artery and portal vein, and an outflow catheter was placed in the inferior vena cava (IVC). An extracorporeal veno-venous bypass was used to shunt blood from the lower body and intestines to the heart. The liver was perfused for 60 min with (1) 50 microg kg(-1) TNF-alpha (n = 5), (2) 50 microg kg(-1) TNF-alpha plus 1 mg kg(-1) melphalan (n = 3) or (3) no drugs (n = 2). The liver was washed with macrodex before restoring vascular continuity. All but one pigs tolerated the procedure well. Stable perfusion was achieved in all animals with median perfusate TNF-alpha levels of 5.1 +/- 0.78 x 10(6) pg ml(-1) (+/- s.e.m). Systemic leakage of TNF-alpha from the perfusate was consistently < 0.02%. Following IHP, a transient elevation of systemic TNF-alpha levels was observed in groups 1 and 2 with a median peak level of 23 +/- 3 x 10(3) pg ml(-1) at 10 min after washout, which normalized within 6 h. No significant systemic toxicity was observed. Mild transient hepatotoxicity was seen to a similar extent in all animals, including controls. IHP with TNF-alpha with(out) melphalan in pigs is technically feasible, results in minimal systemic drug exposure and causes minor transient disturbances of liver biochemistry and histology.

Alanine Transaminase↗
PubMed1997

Hepatic lesions: detection with ferumoxide-enhanced T1-weighted MR imaging.

PURPOSE: To compare the use of ferumoxide-enhanced T1-weighted gradient-echo (GRE) MR imaging with that of spiral computed tomography during arterial portography (CTAP) and T2-weighted Turbo spin-echo (SE) MR imaging in detection of lesions and of segmental involvement in patients with liver metastases. MATERIALS AND METHODS: Twenty-two candidates for metastasectomy of the liver underwent spiral CTAP, ferumoxide-enhanced GRE MR imaging, and T2-weighted Turbo SE MR imaging. A total of 176 liver segments were evaluated (57 with and 119 without metastases). The reference standard was laparoscopic sonographic findings. Diagnostic performance of the imaging modalities was assessed for lesion detection and determination of segmental involvement. RESULTS: The sensitivity for lesion detection with spiral CTAP, ferumoxide-enhanced MR imaging, and T2-weighted MR imaging was 0.96, 0.83, and 0.71, respectively; for segmental analysis, the sensitivity was 0.96, 0.84, and 0.75, respectively, and the specificity was 0.80, 0.99, and 0.92, respectively. All comparisons between sensitivities and specificities were statistically significant (P < .05). CONCLUSION: Ferumoxide-enhanced T1-weighted GRE MR imaging is superior to T2-weighted SE MR imaging for preoperative detection of lesions and segmental involvement in patients with liver metastases.

Adult↗
PubMed1996

The influence of age on resection rates and postoperative mortality in 6457 patients with colorectal cancer.

Due to the ageing of the general population, the proportion of elderly patients with colorectal cancer has increased. In a registry-based study, we evaluated the influence of age and other variables on resection rates and operative risk. Resection rates and postoperative mortality rates (30-day) were analysed in 6457 patients with colorectal cancer, diagnosed from 1985 through 1992 in hospitals connected to the Rotterdam Cancer Registry. Overall, 87% of the patients underwent resection but resection rates were lower for patients older than 89 years (67%) and for patients with rectal cancer (83%). The postoperative mortality rate was 1% for patients younger than 60 years and steadily increased with age. For patients 80 years and older the operative risk was 10%. According to multivariate analysis gender, age, subsite and stage were defined as independent prognostic factors. In view of the lack of alternatives, elderly patients with colorectal cancer should not be denied surgery on account of chronological age alone. Even in patients over 90 years of age resections can be performed with acceptable risk.

Adult↗
PubMed1996

Surgery for local recurrence of rectal carcinoma.

PURPOSE: This study was designed to evaluate results, especially mortality and morbidity, of surgical resection with curative intent for patients with a local recurrence of rectal cancer, in combination with radiotherapy. METHODS: Consecutive medical records of 163 patients with local recurrence of rectal carcinoma after previous "curative" therapy for primary rectal cancer were reviewed. Although 35 patients had an exploratory laparotomy, only 27 had local recurrence amendable to resection (6 irresectable locoregional recurrences and 2 distant metastases found at laparotomy). Twenty-one patients received radiotherapy. There was no perioperative mortality. Median follow-up time was 42 (range, 22-92) months. RESULTS: Local recurrence occurred in 16 (59 percent) patients. Ten patients are alive, of whom nine have good local control. Estimated five-year survival (Kaplan-Meier) is 20 percent. Survival was significantly better in patients without a second recurrence, but radicality of the resection was not influential. Good local control could be obtained in 12 (44 percent) patients, and 1 patient is living with symptoms. CONCLUSIONS: In selected patients with local recurrence of rectal carcinoma, reoperation with irradiation may result in good palliation and possibly cure.

Aged↗
PubMed1996

Detection of liver metastases from colorectal carcinoma: is there a place for routine computed tomography arteriography?

BACKGROUND: A prospective evaluation of the liver by preoperative ultrasonography, conventional computed tomography (CT), and continuous CT angiography (CCTA) was performed in 60 patients with primary or secondary colorectal carcinoma. METHODS: The standards of reference were palpation of the liver and intraoperative ultrasonography. The imaging techniques were assessed independently of each other. RESULTS: In 37 patients 105 liver metastases were identified; 23 patients had no metastases. CCTA and a high sensitivity of 94% (99 lesions identified) in contrast to ultrasonography (48%) and conventional CT (52%). The superiority of CCTA was also manifest in lesions less than 1 cm in diameter. However, the high sensitivity was accompanied by a high false-positive rate, particularly because of variations in the perfusion of normal liver parenchyma. Overall, CCTA had the highest accuracy (74%) compared with ultrasonography and CT (both 57%). The data indicate that preoperative ultrasonography and conventional CT have low sensitivity in the detection of liver metastases. CONCLUSIONS: Although CCTA seems to be superior to other preoperative imaging techniques, the too low specificity will hamper its routine application in patients with hepatic metastases from colorectal carcinoma.

Angiography↗
PubMed1996

Treatment of pathological fractures of the humeral shaft due to bone metastases: a comparison of intramedullary locking nail and plate osteosynthesis with adjunctive bone cement.

In a retrospective study 37 patients were surgically treated for 38 fractures (27 actual and 11 impending) caused by metastatic lesions of the humerus shaft. A comparison between plate osteosynthesis with bone cement (20 cases) and intramedullary nailing (18 cases) was made. There was no mortality related to the surgical procedure. The patients' survival rate was 61% after 3 months and 44% after 6 months; six were alive after 1 year. Overall, a subjective and objective relief of pain was achieved in 92% and 79%, respectively. Restoration of arm function was improved in 95%. The operative course was complicated in six patients after plate osteosynthesis (three local and three systemic complications) and in four patients after intramedullary nailing (one local and three systemic complications). Fixation failed in four patients, instability developed twice after intramedullary fixation without bipolar static locking. No significant difference in survival rate, pain relief, restoration of function and complications were associated with methods of treatment, or with operation of actual or impending pathological fractures. Despite the poor life expectancy our results indicate that intramedullary nailing with bipolar static locking and post-operative irradiation or plate osteosynthesis with bone cement for treatment of pathological (impending) fractures of the humerus shaft are safe ways to restore arm function and improve quality of life.

Adult↗
PubMed1996

The pedicled omentoplasty and split skin graft (POSSG) for reconstruction of large chest wall defects. A validity study of 34 patients.

The aim of this study was to evaluate retrospectively the results of pedicled omentoplasty and split skin graft (POSSG) in reconstructing (full thickness) chest wall defects, and to define its role as a palliative procedure for local symptom control. Thirty-four patients with recurrent breast cancer (n = 25), radiation-induced necrosis (n = 5) or sarcoma (n = 4) of the chest wall were selected for the study. All patients underwent curative or palliative chest wall resection with reconstruction by pedicled omentoplasty and split skin graft (POSSG), between 1986 and 1994. Reconstructive outcome, complications, local tumour and symptom control following surgery was measured. The most common complication was shown to be partial necrosis of the omental flap (35%), followed by respiratory problems (26%), facial hernia (26%) and thoracic wound problems (15%), which were mostly treated in a conservative way (68%). The 3-year local tumour-free interval after POSSG in patients curatively treated for breast cancer is 16%. Seventy per cent of the patients who underwent palliative resection had longstanding relief of local pain, bleeding or foetor due to local tumour growth. It can be concluded that large (full thickness) chest wall defects after resection of local recurrence, primary malignancy or osteoradionecrosis of the chest wall can successfully be reconstructed by POSSG. Chest wall resection in patients treated with palliative intention is effective in local symptom control.

Adult↗
PubMed1995

[10-year follow-up after surgery for colon cancer: no further mortality from cancer after 7 years].

OBJECTIVE: To evaluate the 10-year follow-up of a cohort of 141 patients operated between 1979 and 1981, and to analyse the prognostic significance of traditional tumour parameters, using a univariate and a multivariate analysis. DESIGN: Prospective descriptive study. SETTING: Department of Surgery, University Hospital Maastricht, the Netherlands. METHODS: In 1979 a database was established in which 141 consecutive patients with colorectal carcinoma were included. The 5-year and 10-year survival rates were determined and the values of the clinicopathological staging (deducted from the Dukes classification), CEA expression, tumour size, localisation of the tumour and age of the patient as tumour markers were assessed. RESULTS: The 5-year and 10-year survival rates were 30.5% and 15.6% respectively. The Dukes staging system appeared to be the most important prognostic factor for survival (p = 0.0004), but tumour size and shape, and central lymph node involvement were independent prognostic factors. Furthermore, no patients died as a result of colon tumour after 7 years of follow-up. CONCLUSIONS: The Dukes staging system is the most important prognostic factor for survival. The follow-up of patients treated for colon carcinoma can be stopped after seven years. Only polyp surveillance should be continued after this time.

Aged↗
PubMed1995

[Supportive care].

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Continuity of Patient Care↗
PubMed1994

[Initial results of immediate reconstruction of the breast following mastectomy].

OBJECTIVE: Evaluation of the results of immediate reconstruction after mastectomy for breast cancer by means of a silicone implant. DESIGN: Retrospective analysis. SETTING: Department of Surgical Oncology of the Dr Daniël den Hoed Cancer Centre and Department of Surgery of the Zuiderziekenhuis, Rotterdam, the Netherlands. METHOD: From September 1990 till July 1993, 37 immediate reconstructions of the breast after mastectomy were performed in 35 patients by means of a silicone implant. Indications for the treatment, consequences for further oncological treatment, additional plastic surgery, and complications of the reconstruction were evaluated. RESULTS: The indications for mastectomy and immediate reconstruction were local recurrence after breast conservative treatment (6 operations), multifocal disease (8), extensive in situ carcinoma (8), non-radically removed tumour at lumpectomy (5), anticipated poor cosmetics after breast conservative treatment (6), prophylactic ablation of the breast (2), and patient preference (1). 5 patients received adjuvant systemic chemotherapy, which could be administered without delay, and without negative influence on the result of the breast reconstruction. Additional plastic surgical treatment consisting of reconstruction of the areolar complex and correction of the breast symmetry, was performed in 5 and 3 patients respectively. In 8 of the 37 reconstructions (22%) complications were encountered. The main complications were haematoma (2), infection (4), implant removal (3), capsular contracture (2), skin necrosis (2), and luxation of the implant (1). CONCLUSION: Immediate reconstruction after mastectomy is a valuable treatment modality in breast cancer.

Adult↗