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Biomedical subjects

T Wobbes

Publications and source records attributed to T Wobbes.

At least 127 records · Page 7Linked to original sources
PubMed1990

Risk of postoperative septic complications after abdominal surgical treatment in relation to perioperative blood transfusion.

A group of 548 patients was analyzed retrospectively to determine risk factors, particularly the perioperative administration of blood, for postoperative septic complications after intra-abdominal operations. Of the entire group, 198 (36.1 per cent) had at least one complication. The postoperative mortality rate was 0.9 per cent. Using univariate analysis, blood transfusion, serum protein concentration, gastric malignant disease, total gastrectomy, anastomotic dehiscence, diabetes mellitus, the surgeon and perioperative antibiotics were significant factors influencing the rate of postoperative septic complications. After adjustment for all these factors, logistic regression analysis was used to study the effect of perioperative blood transfusion. Age, serum protein concentration, antibiotics, extended malignant disease of the colon, gastric operation, total colectomy, operation performed by staff members and anastomotic dehiscence were significant independent factors. Blood transfusion per se was not significant (p = 0.07). In patients who received more than 3 units of blood, the postoperative septic complication rate was significantly elevated (p = 0.003). We conclude that the perioperative administration of blood may negatively influence the risk of developing postoperative septic complications after intra-abdominal operations.

Abdomen↗
PubMed1989

[The central venous catheter in the treatment of patients with malignancies].

This review describes the role of central venous catheters (CVC's) in the treatment of cancer. Indications and contra-indications for CVC-insertion, CVC-care, their complications, prevention and management are discussed. Totally implantable CVC's have been compared with Hickman-Broviac catheters to facilitate an adequate choice for an individual patient. Both CVC-types showed a similar and low number of complications, provided staff and patients are well instructed and given good care. In such cases infection and thrombosis occur in less than 3-5% of nowadays CVC's. The CVC proved to be useful and safe in cancer treatment and should not be withheld when the patient lacks, or will probably lack within a short time an adequate venous access.

Antineoplastic Agents↗
PubMed1989

Small-bowel perforation complicating the open treatment of generalized peritonitis.

Fourteen patients were found to have developed 53 small-bowel perforations in the absence of pathogenic factors during "open abdominal treatment" for generalized peritonitis. They occurred after three to 17 laparotomies, on average at the eighth postoperative day (one to 120 days). Forty-nine lesions were located superficially. A relation with organ system failure, routine blood tests, type of nutrition, or microorganisms could not be demonstrated. The etiology of the lesions remains uncertain, but the open abdominal treatment must play some important role in its pathophysiology. Five patients survived. The therapy of choice appears to be mobilization of the bowel with resection of the affected part and primary anastomosis.

Adult↗
PubMed1989

Residual tumour after biopsy for non-palpable ductal carcinoma in situ of the breast.

In a group of 40 patients with non-palpable ductal carcinoma in situ (DCIS) of the breast, 41 breast specimens were available for studying residual tumour after biopsy. In one group of ten patients seen before 1977, simple histological examination revealed a 9 per cent incidence of residual tumour. However, after thorough examination residual foci of DCIS were found in 77 per cent of a subsequent group of 30 patients. This means that the majority of patients would have had to undergo reoperation if a breast-saving procedure had been performed. This fact must be taken into account when planning treatment of patients with non-palpable DCIS.

Adult↗
PubMed1989

Role of gastroenterostomy in the palliative surgical treatment of pancreatic cancer.

The records of 72 consecutive patients with unresectable pancreatic cancer treated between 1974 and 1986 were evaluated to determine whether gastroenterostomy should be performed on a routine basis at initial intervention or on a therapeutic basis. Fourteen patients underwent an explorative laparotomy, 41 patients underwent biliary bypass, and 17 patients required biliary bypass and therapeutic gastroenterostomy at initial laparotomy. The mortality and morbidity rates in this last group were 18 and 59%, respectively. The most common complication was delayed gastric emptying (29%). Of the 37% of patients who required gastroenterostomy after initial biliary bypass, the mortality rate was 50% and delayed gastric emptying occurred in 57%. The mean survival after biliary bypass was 9.4 months while survival after therapeutic gastroenterostomy averaged 4.2 months. These findings suggest that gastroenterostomy should be performed on a prophylactic basis at initial intervention, unless a limited survival is expected.

Adolescent↗
PubMed1989

Phase II trial of 5-fluorouracil, adriamycin and cisplatin (FAP) followed by radiation and 5-fluorouracil in locally advanced pancreatic cancer.

A total of 19 patients (7 men, 12 women) with locally advanced pancreatic adenocarcinoma were treated with six cycles of FAP (5-fluorouracil, 300 mg/m2 i.v. on days 1-5; Adriamycin, 50 mg/m2 i.v. on day 1; cisplatin, 20 mg/m2 i.v. on days 1-5). Each course was repeated every 28 days. After six cycles, the treatment was followed by irradiation amounting to 4,000 cGy (split course) in combination with 5-FU (500 mg/m2) on days 1-3 of the two irradiation periods. The median age of our patients was 55 years (range, 40-64 years). The median WHO performance status was 1, with a range of 0-2. Three (16%) complete (CR) and six (31%) partial responses (PR) were observed, as were six cases of stable disease (SD) and four of progressive disease (PD). The median duration of response was 11 months, with a range of 4-24 months, and the median survival was 14 months (range, 5-27 + months). FAP toxicity was tolerated fairly poorly. The dose-limiting toxic effect was myelosuppression, with a mean WBC nadir of WHO grade 1.6 (range, 0-3) and a mean platelet count of WHO grade 1.1 (range, 0-4). Nausea and vomiting were not dose-limiting. Complete alopecia was seen in 14/19 patients. Neuropathy was mild (WHO grade 1) in seven and moderate (grade 2) in four. Irradiation in combination with 5-FU was generally well tolerated. Due to several reasons, only ten patients could be treated with all six cycles of FAP. We conclude that in future combined modality studies, irradiation should be given after three cycles of chemotherapy, and that combined modality treatment for locally advanced pancreatic cancer is feasible and warrants further testing.

Adult↗
PubMed1989

The effect of packed cells and whole blood transfusions on survival after curative resection for colorectal carcinoma.

The effect of perioperative blood transfusions on survival after curative resection for colorectal carcinoma was studied retrospectively on 270 patients with special emphasis on whole blood transfusion. Eighty-six (32 percent) patients did not receive blood transfusions, whereas the remaining 110 (41 percent) received packed cells and 74 (27 percent) received at least 2 units of whole blood. The recurrence-free and overall 5-year survival rates for the transfused group were 58 and 57 percent, respectively, and for the non-transfused group, 78 and 72 percent, respectively. These differences were highly significant (log rank test, P less than 0.001). The recurrence-free and overall 5-year survival rates for patients who received only whole blood or a combination of whole blood and packed cells was 51 percent, and of those who received only packed cells was 63 percent. The difference was not statistically significant (log rank test, P = 0.08, P = 0.35). Administration of more than 6 units of blood is attended with a significantly worse 5-year disease-free survival rate than administration of a smaller volume. The survival was not decreased if 6 or more units of whole blood were given. The authors conclude that perioperative blood transfusions have a significant detrimental effect on survival after curative resection for colorectal carcinoma. This effect is not enhanced by whole blood transfusions.

Age Factors↗
PubMed1989

Glutathione S-transferases in normal and cancerous human colon tissue.

In order to evaluate the role of the placental form of glutathione S-transferase (GST-Pi) as a tumour marker, activity and composition of GSTs from human colon were investigated. GSTs were purified from normal colon mucosa and from colonic tumours by affinity chromatography on glutathione-agarose. After SDS-PAGE or isoelectric focusing these purified preparations revealed only one band that comigrated with GST-Pi from human placenta. A monoclonal antibody (mAb) very specific for GST-Pi was developed and characterized. On immunoblot this mAb stains purified GST from normal and diseased colon tissue. GST activity was significantly higher in most cancerous (247 +/- 38 nmol/min/mg protein; n = 7), compared with the corresponding normal tissues (171 +/- 18 nmol/min/mg protein; n = 7). In colon from patients without large bowel malignancies GST-Pi is also by far the most prominent isoform detectable. In conclusion, both normal and tumorous colon tissue predominantly express GST-Pi and therefore GST-Pi is not suitable as a tumour marker for colonic carcinomas. However, the increased GST-Pi levels in colonic tumours could possibly contribute to the relatively high resistance to anti-cancer drugs.

Biomarkers, Tumor↗
PubMed1989

Treatment and survival of female patients with nonpalpable breast carcinoma.

Since 1971, 151 nonpalpable breast cancers (100 invasive carcinomas, 39 in situ ductal carcinomas, and twelve lobular carcinomas in situ) have been diagnosed and treated at the St. Radboud University Hospital. Of the 100 clinically occult invasive carcinomas, 53 had pathologic diameters of more than 10 mm, 29 were of sizes between 6 and 10 mm, and 18 were tumors of 5 mm or less. Residual tumor outside the "excisional" biopsy cavity was encountered in 76 of the 118 mastectomy specimens (64.4%) fully capable of evaluation. Invasive residual tumor would have been left behind in 34 of 86 mastectomy specimens (39.5%). Of 27 axillas studied, no patient with in situ carcinoma had evidence of axillary lymph node metastases. Invasive carcinoma, however, showed axillary lymph node involvement in 7.7% of mastectomy specimens when the size of the primary tumor was not more than 5 mm, in 12.5% when the size was between 6 and 10 mm, and in 29.5% when the primary tumor was more than 10 mm in diameter. The 10-year recurrence-free survival (RFS) of patients with clinically occult invasive carcinomas greater than 10 mm in size was 71.9% and differed significantly from the 90.9% for patients with the invasive tumors less than or equal to 5 mm, as well as from the 100% RFS of patients with invasive tumors of between 6 and 10 mm and noninvasive tumors. Although the 10-year RFS was 92.6% for the patients with negative axillary nodes and 80.0% for the patients with positive axillary nodes, this difference did not reach statistical significance. However, the disease-specific overall survival after 10 years was significantly different between node-negative patients (96.4%) and node-positive patients (78.8%). Multivariate analysis disclosed that the relationship between size of the primary tumor and RFS was independent of the presence of axillary lymph node metastases. In conclusion, the validity of the concept of minimal breast cancer has been re-enforced. However, the results of this study suggest that the upper limit of the original definition of minimal breast cancer is too narrow and should be extended, so that, apart from the noninvasive tumors--regardless of their size--all invasive tumors having a maximum diameter less than or equal to 10 mm should be regarded as minimal breast cancers.

Actuarial Analysis↗
PubMed1989

Epidural administration of morphine for control of cancer pain: long-term efficacy and complications.

The long-term analgesic effects and the complications of epidural narcotic analgesia (ENA) were investigated in 40 cancer patients in whom systemic narcotic therapy failed to relieve pain or caused unacceptable side effects. In 32 patients, an externally fixated polyamide epidural catheter was used ("external group"), and in 8 patients, a polyurethane epidural catheter was tunneled and connected to a subcutaneous access port ("internal group"). The average duration of catheter treatment was 80.9 days (range 9-533 days). Twenty-five patients were treated as outpatients, and 15 remained hospitalized. Initially, all patients had significant or complete pain relief from 10 mg morphine/day, but the daily epidural morphine requirement showed a threefold increase during the first 3 weeks. During ENA, other methods of pain relief (radiotherapy, chemotherapy, surgery, epidural administration of local anesthetics, and nerve blocks) were necessary in 14 patients. Pharmacological side effects were of minor importance, with transient pruritus being the main subjective complaint. In the "external" group, 31 catheter replacements were necessary, mostly due to backflow of injected morphine outside the catheter. In two patients of the internal group, neurological complications occurred, but these disappeared spontaneously after removal of the system. They were presumably due to epidural fibrosis with compression of the spinal cord. Further technical improvements are necessary for the easier use and higher safety of the catheter technique.

Adult↗
PubMed1988

Collagen in colorectal cancer in relation to clinicopathologic stage and histologic grade.

Interstitial collagen is a major constituent of the tumor matrix. The quantity of this protein may influence the prognosis. The collagen content of 54 colorectal tumors, measured as the hydroxyproline concentration in relation to clinicopathologic stage and histologic grade, was investigated and no support for either a negative or positive influence on the prognosis.

Adenocarcinoma↗