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Biomedical subjects

T Wiggers

Publications and source records attributed to T Wiggers.

At least 91 records · Page 5Linked to original sources
PubMed1994

The pedicled omentoplasty, a simple and effective surgical technique to acquire a safe pelvic radiation field; theoretical and practical aspects.

A substantial number of patients need radiotherapy after surgery for pelvic malignancy. Approximately 15% of them will experience radiation enteritis. After omentoplasty, reduction of irradiated bowel volume may be obtained. We evaluated the pedicled omentoplasty during gynaecologic surgery as a technique to improve safe irradiation of the pelvic region.

Case-Control Studies↗
PubMed1994

Impending and actual pathological fractures in patients with bone metastases of the long bones. A retrospective study of 233 surgically treated fractures.

OBJECTIVE: Analysis of short-term and long-term complications after cemented osteosynthesis for pathological fractures. DESIGN: Retrospective study. SETTING: South Municipal Hospital and the Daniël den Hoed Cancer Centre, Rotterdam, The Netherlands. SUBJECTS: 199 patients consecutive surgically treated between 1978 to 1990 for 233 fractures (161 actual and 72 impending) caused by metastatic lesions of the femur, humerus and tibia. INTERVENTIONS: Local resection of the tumour was followed by endoprostheses (n = 52) and by internal plate osteosynthesis (n = 167); 14 fractures were treated with intramedullary nails. Bone cement was added in 211 cases (91%). MAIN OUTCOME MEASURES: Pain relief, mobilisation, complications. RESULTS: Pain relief was achieved in about 90%. 145 (76%) who were treated for fractures of the lower extremity were able to walk again. There were 13 local complications: 26 (11%) implanted devices failed (cumulative probability 40%, after 60 months). In 11 cases the fixation failed after 7 weeks. The failure rate was 16% in the subtrochanteric region treated with an angled blade (probability 70% after four years). The patients' survival rate was 55% after six months and 20% at two years. CONCLUSION: Despite the poor life expectancy, our results indicate that hemiarthroplasty or osteosynthesis with bone cement for treatment of pathological (impending) fractures is a safe way to restore limb function and to improve quality of life.

Adult↗
PubMed1994

Management of extended radionecrosis in the pelvic area with repeated surgical debridement and omental transposition.

Extended radionecrosis in the pelvic area is a disaster occurring in a minority of patients treated with radiotherapy. Extensive excisional procedures, including pelvic exenteration, have been recommended, but carry high morbidity and mortality rates. Alternative treatment strategies are needed to improve survival and increase the quality of life in these patients. We retrospectively analysed the charts of eight patients treated for radionecrosis in the pelvic area between 1985 and 1991. During this period deviatory procedures, repeated but limited debridement and the early incorporation of an omental flap in the ischemic area were used in an attempt to avoid exenteration, but effectively stop further progression of infection and necrosis. The patients underwent a median of five surgical interventions (range: 2 to 21) for 10 sites of radionecrosis. The total of 61 procedures consisted of debridement (29), omental pedicle grafting (6), deviation of urinary tract (3) or intestinal tract (4) and including procedures due to complications (21). They were hospitalized for a median duration of 95 days (range 43-155) divided over several admissions (median 3, range 2-8). One patient died of sepsis during treatment. Complete recovery was achieved in all surviving patients with a median of 12 months (range: 9 to 20 months) after initial surgery. Early surgery, the limited extent of the procedures and omental transposition were the main components of our approach. We conclude that this approach has an acceptable morbidity and mortality rate, while a relatively good quality of life is achieved.

Adult↗
PubMed1993

Endocrine cells in colorectal adenocarcinomas: incidence, hormone profile and prognostic relevance.

The occurrence of endocrine cells in 350 cases of colorectal adenocarcinoma was studied by immunohistochemistry for chromogranin A (CGA). The hormone profile of endocrine tumor cells, the correlation between endocrine differentiation and presence of other colorectal epithelial-cell lineages and the prognostic relevance of endocrine differentiation in colorectal cancer were investigated. CGA-positive tumor cells were found in 30% of cases, 21% showing moderate positivity and 9.0% extensive positivity. Of CGA-positive tumors, 70% additionally produced neurohormones, mainly indigenous to normal colorectal epithelium: 55% showed immunoreactivity for glucagon-like substances, 20% for serotonin and 10% for somatostatin, PYY and HCG. No immunoreactivity was found for various neurohormones not normally produced by colorectal endocrine cells. CGA-positive tumors tended to be more aggressive than CGA-negative tumors. Especially, tumors with extensive CGA positivity showed shorter survival, which was most apparent within Dukes' stage C. In multivariate analysis, extensive CGA positivity was an independent indicator of poor prognosis. CGA immunoreactivity significantly correlated with mucin production, but not with expression of secretory component (SC), a columnar-cell marker. Mucin production significantly correlated with SC expression. Tumors positive for CGA but not for mucin and/or SC showed the worst prognosis. SC expression was a relatively favorable feature, and mucin-producing tumors showed intermediate behavior.

Adenocarcinoma↗
PubMed1993

[Endometriosis of the rectum].

Intestinal endometriosis is a diagnostic and therapeutic problem. In case the rectal wall is involved the physical signs of the endometriosis may mimic rectal carcinoma. Suspicion of the correct diagnosis can be aroused by a thorough history that will uncover the periodicity of symptoms e.g. cyclic bleeding. We present two patients with rectal endometriosis externa who were eventually treated successfully by surgery. Treatment may consist of hormonal therapy, although surgery will be necessary sooner or later in the majority of patients.

Adult↗
PubMed1993

[Thyroid metastases as cause of thyroid swelling].

In the period 1983-1991 16 patients with metastases to the thyroid gland were selected with the aim to compare the treatment results with those reported in literature and eventually arrive at a recommendation on treatment. There were 11 women and 5 men with a mean age of 62 years at diagnosis. The type of the primary tumour varied widely without clear predominance of any histology. The interval between the diagnosis of the primary tumour and the appearance of the thyroid metastasis varied from 0 to 9 years. Three patients were treated with chemotherapy, 3 with radiotherapy, 6 by surgery, 2 with a combination of surgery and postoperative radiotherapy and 2 patients were not treated at all. The median overall survival after treatment was 9 months. All patients eventually showed evidence of disease somewhere in their body. The local control until death or the last follow up visit was complete in case of surgery or a combination of surgery and radiotherapy. Chemotherapy resulted in 2 partial remissions and 1 stable disease. If there is fast systemic progression of disease with evident metastasis elsewhere or a short disease-free period an expectant policy is advocated. In case of (threatening) airway obstruction, a solitary metastasis or a long disease-free period individualised treatment is indicated with the aim of lengthening the disease-free period.

Aged↗
PubMed1993

Surgical treatment or gastric drainage only for intestinal obstruction in patients with carcinoma of the ovary or peritoneal carcinomatosis of other origin.

The records of 38 patients with advanced carcinoma of the ovary and 21 patients with peritoneal carcinomatosis of other origin who were treated for relief of intestinal obstruction were retrospectively analyzed. An explorative laparotomy was performed upon 40 instances, whereas in 25 instances, a large bore draining tube gastrostomy was done primarily. Retrospectively, the 40 explorative laparotomies were performed in two separate groups of patients. The first group consisted of 15 patients without palpable masses or ascites and five patients with intestinal obstruction as the first sign of ovarian disease. Another group of 20 patients presented with clinically manifest ascites or palpable masses, or both. The patients in group 1 survived for a median time of 154 days (range of 29 to 1,086 days) without recurrent intervention for obstruction. The patients in group 2 died after a median time of 36 days (three to 151 days). The explorative laparotomy was successful in only one patient in group 2. A third group of 25 patients was deemed inoperable and primarily received a tube gastrostomy. Twenty-three patients presented with ascites or palpable masses, or both. They died after a median time of 33 days (eight to 163 days). Surgical therapy for relief of intestinal obstruction should only be considered in patients who do not present with manifest ascites or palpable masses and in patients with carcinoma of the ovary for whom effective chemotherapy is available. Percutaneous gastrostomy should be the method of choice for other patients.

Ascites↗
PubMed1992

Hepatic resections for colorectal metastases in The Netherlands. A multiinstitutional 10-year study.

BACKGROUND AND METHODS: The records of 118 patients who had hepatic resections for colorectal liver metastases were analyzed retrospectively. RESULTS: The patient group, from 15 institutions in The Netherlands, was found to have a 5-year actuarial survival rate of 21% and a 5-year actuarial disease-free survival rate of 19%. The postoperative mortality rate was 7.6%. In the remaining group, the morbidity rate was 34.7%. A number of factors were examined that were reported to be of prospective significance in other studies. In the multivariate proportional hazard model of Cox, the number of metastases (P = 0.001) and the amount of perioperative blood loss (P = 0.002) were related significantly to disease-free survival. A factor that may be considered a contraindication to resection is the presence of extrahepatic disease (whether nodal or visceral), even if resectable. CONCLUSIONS: Although the actual benefit of resection is limited, and it is associated with considerable morbidity, surgical therapy offers some patients a chance for cure. It is a valid expectation that improvement in techniques and a proper understanding of hepatic anatomy will improve the safety and efficacy of hepatic resections in the future. Future research should focus on defining better selection criteria and on study of the value of adjuvant treatment modalities.

Adult↗
PubMed1992

Liver metastases from colorectal carcinoma: detection with continuous CT angiography.

A diagnostic approach to assess liver metastases from colorectal carcinoma was prospectively evaluated in 30 patients with and without metastases on the basis of findings at conventional computed tomography (CT). With the technique, termed continuous CT angiography (CCTA), CT data were continuously sampled for 24 seconds at the same section level after initiation of a 3-second injection of 10-20 mL of contrast medium in the common hepatic artery. The procedure was repeated for each contiguous section level of the liver. Findings at preoperative ultrasound (US), conventional CT, and CCTA were compared with those at intraoperative US and surgical exploration as the standard of reference. Forty-four liver metastases were identified in 16 patients, and 14 patients had no metastases. CCTA had a sensitivity of 98% (43 lesions identified) and higher accuracy (81% [54 of 67 diagnoses]) than US and conventional CT. The data indicate that CCTA can supplement information obtained with conventional imaging techniques in patients who must undergo hepatic surgery because of metastases from colorectal carcinoma.

Adult↗
PubMed1992

Duodenal complications of gynecological malignancies.

Isolated para-aortic lymph node metastasis leading to intestinal complications is uncommon and diagnosis may therefore be delayed. In the present report duodenal bleeding, obstruction and perforation due to isolated para-aortic lymph node metastasis from stage I uterine malignancies are described. Knowledge of these potential problems may lead to early recognition and planning of treatment.

Abdomen, Acute↗
PubMed1992

Subcutaneous tumor growth complicating the positioning of Denver shunt and intrapleural port-à-cath in mesothelioma patients.

Patients with malignant ascites and malignant pleural fluid from abdominal or pleural mesothelioma underwent the positioning of Denver type peritoneovenous shunt or intrapleural catheter. They developed tumor growth in the subcutaneous tissue surrounding the devices throughout their courses. Neoplastic seeding is a potential complication of the positioning of shunts and catheters in cavities filled with fluid rich in tumor cells.

Abdominal Neoplasms↗
PubMed1991

The pedicled omentoplasty: technical aspects in reconstructive and protective surgery.

A pedicled omentoplasty is a simple and safe method to reconstruct soft-tissue defects. A pedicled omentoplasty can also be used as an adjuvant surgical procedure in preventing anastomotic leakage and radiation damage. The way a pedicled omentoplasty should be performed is described in detail with special attention to transposing techniques.

Humans↗
PubMed1991

Complications of the pedicled omentoplasty.

A total of 74 patients, additionally treated with a pedicled omentoplasty, were studied retrospectively with regard to the complications. The pedicled omentoplasty was used extra- or intra-abdominally to reconstruct large soft-tissue defects, to treat radiation necrosis or to prevent radiation enteritis. Gastro-intestinal complaints were seen in six patients, three developed an ileus and needed a relaparotomy, one patient had herniation of the stomach through a diaphragm defect. Total necrosis of the omental flap was seen in two patients and infection in seven patients with an extra-abdominally used omentoplasty. An abscess in the pelvic cavity occurred five times in an intra-abdominally placed omentoplasty. In seven patients, an operative correction of an incisional hernia was necessary. One patient died of massive pulmonary embolism. This study indicates that the pedicled omentoplasty is a safe procedure and is associated with a moderate number of postoperative complications, which can be reduced if the right surgical technique is used.

Breast Neoplasms↗
PubMed1991

Carcinoma of the duodenum after trauma, radiotherapy and chemotherapy.

The case history is reported of a patient with a carcinoma of the duodenum 30 years after blunt abdominal trauma at the site of the 'scar' in the duodenum. Thirteen years after the trauma the patient was treated with chemotherapy and abdominal irradiation for a relapse of Hodgkin's disease. At follow-up, 25 months after the operation, he had no local recurrence of Hodgkin's disease or duodenal cancer. The possible relation between the cancer and the abdominal trauma, chemotherapy and abdominal irradiation is discussed.

Abdominal Injuries↗