Biomedical subjects
T Wobbes
Publications and source records attributed to T Wobbes.
[Breast carcinoma in women over 70].
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[Ductectomy as diagnosis and treatment of galactorrhea without palpable lesions].
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Phase II trial of 5-fluorouracil, adriamycin and cisplatin (FAP) in advanced gastric cancer.
Twenty patients (15 male, 5 female) with nonresectable gastric adenocarcinoma were treated with FAP (5-fluorouracil 300 mg/m2 IV on days 1-5, adriamycin 50 mg/m2 IV on day 1, cisplatin 20 mg/m2 IV on days 1-5). Each course was repeated every 21 days. Eighteen patients were evaluable for response. The median age was 51 years, the range extending from 34 to 68. None had undergone chemotherapy. The median Karnofsky performance score was 80%. Nine (50%) partial responses (PR) and eight (44%) cases of stable disease (SD) were observed. One patient showed progression of the disease and died after 6 months. The median duration of response was 6+ months for PR and 6 months for SD. The median survival was 12 months. FAP toxicity was moderate, with the median WBC nadir 3.2 X 10(9)/l (range 0.7-4.2). One patient in PR died of septicemia. Nausea and vomiting were not dose-limiting. Neuropathy was mild in four and moderate in two patients. This FAP combination appears to be as effective with respect to response rate and duration as reported for 5-fluorouracil, adriamycin and mitomycin C (FAM).
[Percutaneous gastrostomy in the rabbit].
Gastrostomy is performed in patients with obstructive carcinoma of the esophagus. As in this operation the peritoneal cavity has to be opened we tried to find in experiments with 11 rabbits whether the percutaneous gastrostomy is a possible alternative.
Carcinoma of the colon and rectum in geriatric patients.
In the period 1967-1981, 102 patients older than 70 years were treated for a colorectal carcinoma. The mean age was 76 years. The average delay was 7.6 months. Obstruction as initial symptom was seen in only 8% of the cases. The resection rate was 85%. The postoperative mortality rate was 6% for patients patients who underwent a resection. For all patients the postoperative mortality rate was 8%. The five-year survival rate for stage A (Astler-Coller) was 37%, for stage B 27%, for stage C 8%, for stage D 0%. Of the whole group, the actuarial five-year survival rate was 27%, the ten-year survival rate 10%. Surgery for colorectal carcinoma in the elderly is well tolerated, and a resection should be pursued as long as the general condition permits.
The spleen in Hodgkin disease: diagnostic value of CT.
Findings of CT of the spleen were compared with those of histologic examination in 35 patients who had Hodgkin disease. CT provides a simple way to calculate splenic size. This index is also of value in the assessment of the histologic state of the spleen. An accuracy rate of 91%, specificity of 94%, and a sensitivity of 89% in diagnosing splenic localization of lymphoma was found in this study.
Total thyroidectomy: the treatment of choice in differentiated thyroid carcinoma?
A review of 46 patients with differentiated thyroid cancer, diagnosed and treated in the St. Radboud Hospital from 1977 till 1984, is presented. The age of the patients ranged from 16 to 80 years. There were 39 women and 7 men. Thirty of 31 patients with papillary carcinoma and 13 of 15 patients with follicular carcinoma underwent total thyroidectomy. If less than total thyroidectomy had been performed, 13 (43%) patients with papillary cancer and 2 (15%) with follicular cancer would have had cancer left in the residual lobe. The complication rate was acceptable, two cases of permanent hypoparathyroidism, one recurrent nerve palsy. During a short follow-up period of 7 years maximum already 6 patients older than 60 years with papillary carcinoma had died, 5 of widespread cancer (16.6%) and one of an unrelated disease. Three patients developed local recurrences, on in the trachea and 2 outside the thyroid bed. One patient with follicular carcinoma, who had undergone a lobectomy, developed recurrent disease. These figures plus the increased risk of complications in a second neck exploration suggest that total thyroidectomy is the treatment of choice for patients with differentiated thyroid cancer. Total thyroidectomy can be done without mortality and without significant morbidity.
Chemotherapy (5-fluorouracil, adriamycin and cisplatin) preceding irradiation in locally advanced unresectable carcinoma of the pancreas: a phase II study.
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Results and complications of staging laparotomy in Hodgkin's disease.
Between 1969 and 1983, 123 patients with Hodgkin's disease underwent a staging laparotomy. The stages of 34 (27%) patients were changed by laparatomy. Twenty-nine patients (23%) were upstaged , five (4%) downstaged . The most considerable change was found in stage III. The accuracy of preoperative lymphangiography was 85%. The postoperative complication rate was 15%. There were no operative deaths. The staging laparotomy for Hodgkin's disease is a reliable procedure, and allows less aggressive therapy in selective groups.
Estrogen and progestin receptors in colonic cancer?
Adenocarcinomas of the large bowel in 28 consecutive patients were examined for the presence of estrogen and progestin receptor proteins. None of the specimens showed specific high affinity receptor binding. Our findings suggest that adenocarcinoma of the large bowel does not contain cytoplasmic receptor sites for estrogen and progestin.
Surgical aspects of radiation enteritis of the small bowel.
Injury to the small bowel is one of the tragic complications of radiotherapy. We performed a retrospective analysis of patients operated upon for stenosis, perforation, fistulization, and chronic blood loss of the small bowel after radiotherapy for multiple malignant diseases. In the period 1970 to 1982 in the Department of General Surgery of the St. Radboud University Hospital, Nijmegen, and the Department of Surgical Oncology of the State University, Groningen, 27 patients were treated surgically. Twenty patients presented with obstruction. In 17 patients a side-to-side ileotransversostomy was performed; in three the injured bowel was resected. Of the five patients with fistulization, three underwent a bypass procedure; in two cases the affected bowel was resected. In one patient with perforation, a resection was performed, as in a patient with chronic blood loss. Two of the 20 patients (10 per cent) in whom the diseased bowel was bypassed died postoperatively. Of the seven patients whose affected bowel was resected four (57 per cent) died of intra-abdominal sepsis. Management of the patient with chronic radiation enteritis is discussed. We conclude, on the basis of our experience, that in patients with obstruction and fistulization, a bypass procedure of the affected bowel is a safe method of treatment. In case of resection, the anastomosis should be performed during a second operation.
Removal of the massive spleen: a surgical risk?
The results of splenectomy for hematologic disorders have been reviewed with special attention to problems possibly associated with massive spleens (1,500 g or more). The mortality rate in the group of patients with massive spleens did not differ from that in the group of patients with smaller spleens (2 percent and 3 percent, respectively). The complication rate, however, in the group of patients with massive spleens (43 percent) was twice that in the patients with smaller spleens (43 percent and 22 percent, respectively). The most frequent complication was postoperative hemorrhage in the splenic bed, usually caused by thrombocytopenia, perisplenitis , or both. Postoperative morbidity is seen as a function of the underlying disorder and of the general condition of the patient and not of the weight of the spleen per se.
Tumores rari et inusitati. Adenoid cystic carcinoma of the oesophagus: report of a case not responding to combination chemotherapy.
A case of a 62-year-old man with an adenoid cystic carcinoma of the oesophagus with liver metastases is described. The patient was treated with adriamycin, cisplatin and bleomycin. This combination chemotherapy failed to induce a remission.
Five years' experience in access surgery for polychemotherapy. An analysis of results in 100 consecutive patients.
In 100 consecutive patients with various malignancies, 142 operations were performed to establish an arteriovenous fistula giving vascular access for chemotherapy. The fistula of choice was always an end-to-side fistula between the cephalic vein and the radial artery (radiocephalic fistula). A fistula of this type was established in 88 operations on 76 patients and functioned well in 64% of this group. In 29 patients in whom this fistula failed or was not feasible, an elbow fistula was performed in 32 operations and functioning well in 59%. In 13 patients whose arms offered no alternative possibility, 15 long saphenous vein (LSV) autografts were implanted in the inguinal region. A radiocephalic fistula was successfully performed in 77% of the patients who had received preoperative chemotherapy during less than 4 weeks, versus 26% of those who had received preoperative chemotherapy during a longer period. The radiocephalic fistula is the fistula of choice to gain vascular access for chemotherapy. It has proved necessary to perform this operation before chemotherapy is started. When this type of fistula is not feasible, alternatives are an elbow fistula or an (LSV) autograft in the inguinal region.
[Chronic radiation injuries of the small intestines].
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Results of retroperitoneal lymph node dissection and postoperative adjuvant chemotherapy with dactinomycin in the treatment of retroperitoneal metastases of nonseminomatous testicular germ cell tumors.
This article discusses 103 patients with a nonseminomatous testicular germ cell tumor. Treatment of 87 patients in clinical Stages I, II-A, and II-B consisted of bilateral retroperitoneal lymph node dissection. In Stage I (54 patients), no further treatment was given. The three-year survival was 96%, while recurrence-free survival was 98%. Of 33 patients in Stages II-A and II-B, 26 received adjuvant chemotherapy with dactinomycin, and ten of these were given radiotherapy (peritoneum/mediastinum) as well. The three-year survival was 88% and recurrence-free survival was 85%. Seven patients in Stages II-A and II-B received no adjuvant chemotherapy; four of them died. Treatment of 14 patients in Stage II-C primarily consisted of dactinomycin therapy, subsequently combined with surgery and radiotherapy. The three-year survival was 28.5%. These findings raise the question whether adjuvant single-agent chemotherapy with dactinomycin for patients with a nonseminomatous testicular germ cell tumor should not be re-evaluated.
The radiocephalic fistula as vascular access for chemotherapy.
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