Gallstone disease is an important clinical problem: approximately 10% of all adults in the wester... more Gallstone disease is an important clinical problem: approximately 10% of all adults in the western population have gallstones. Most gallstones, however, remain asymptomatic and from various disciplines there is consensus that only symptomatic gallstones require therapy. Since the fIrst gallbladder extirpation in 1882, cholecystectomy has been considered the gold standard. Nowadays, this operation is performed laparoscopically in most hospitals. Despite relatively low morbidity and mortality rates, a number of alternative therapies have been developed in the past few years. These alternative treatment modalities are especially indicated in high risk patients and in patients rejecting surgery. In this review article the currently available treatment modalities are discussed. Extracorporea1 Shock Wave Lithotripsy (ESWL) was introduced as a nonsurgical treatment for uncomplicated, symptomatic gallstone disease. Due to its limited results and the possibility of stone recurrence, ESWL is mainly indicated for patients who reject or cannot tolerate cholecystectomy. For budgetary and planning purposes, it is essential to know what percentage of patients is eligible for this form of therapy. In the literature suitability is either reported variably (ranging from 10 to 53%) or not mentioned. We retrospectively assessed eligibility for ESWL for different entry criteria, based on the histories of 694 consecutive patients, who were referred for gallstone therapy from I April, 1988 to I October, 1991. Only 10.3-46.9% of symptomatic patients were found eligible for ESWL, depending on the entry criteria used. When the overall results are compared with eligibility, there is no inverse relationship. This suggests that patient selection is not the only factor determining the results of therapy. It is concluded, therefore, that also other factors, such as treatment schemes, the lithotriptors used and experience of the treating physicians, are importants factors for the outcome of ESWL therapy.
Background: Curatively treated bronchial carcinoid tumors have a relatively low metastatic potent... more Background: Curatively treated bronchial carcinoid tumors have a relatively low metastatic potential. Gradation into typical (TC) and atypical carcinoid (AC) is limited in terms of prognostic value, resulting in yearly follow-up of all patients. We examined the additional prognostic value of novel immunohistochemical (IHC) markers to current gradation of carcinoids. Methods: A retrospective single-institution cohort study was performed on 171 patients with pathologically diagnosed bronchial carcinoid (median follow-up: 66 months). The risk of developing distant metastases based on histopathological characteristics (Ki-67, p16, Rb, OTP, CD44, and tumor diameter) was evaluated using multivariate regression analysis and the Kaplan–Meier method. Results: Of 171 patients, seven (4%) had disseminated disease at presentation, and 164 (96%) received curative-intent treatment with either endobronchial treatment (EBT) (n = 61, 36%) or surgery (n = 103, 60%). Among the 164 patients, 13 develop...
We present the case of a 44-year-old man who presented with nausea, vomiting and acute pain in th... more We present the case of a 44-year-old man who presented with nausea, vomiting and acute pain in the right groin. On physical examination an irreducible mass was palpated in the right inguinal region. Ultrasound suggested an inguinal hernia sac with bowel contents. Subsequent right inguinal exploration revealed only unspecified necrotizing tissue, but no hernia sac or bowel contents were identified. Two days later laparotomy was required since the inguinal wound produced faecal discharge. The sigmoid appeared to be necrotic and perforated, and was subsequently resected. Histology revealed a perforated adenocarcinoma without lymph node involvement. Incarcerated inguinal hernias containing an adenocarcinoma of the colon are rare, but should be considered in patients presenting with an irreducible palpable mass in the inguinal region. Moreover, a carcinoma of the sigmoid may invade the right inguinal region. An intestinal perforation to skin-level in this population is even rarer and is associated with high morbidity and mortality rates.
Urachus fistulas are rare, especially in adulthood. In grown-ups urachus fistulas are usually a r... more Urachus fistulas are rare, especially in adulthood. In grown-ups urachus fistulas are usually a reflection of Crohn's disease. We present a patient in whom an urachus fistula was the first presentation of diverticulitis of the sigmoid colon. The need for proper preoperative diagnostic imaging is discussed.
Nederlands tijdschrift voor geneeskunde, Jan 24, 2004
Three patients with cholelithiasis were found to possess a duplicate gallbladder. A 48-year-old w... more Three patients with cholelithiasis were found to possess a duplicate gallbladder. A 48-year-old woman continued to have symptoms one year after cholecystectomy, a 69-year-old woman had symptoms even though her gallbladder had been removed 40 years before, and in a 29-year-old woman a second gallbladder was found during cholecystectomy. In all three patients, the second gallbladder was removed as well, after which they recovered. The differential diagnosis of persistent symptoms following cholecystectomy should also consider the possible presence of an accessory gallbladder.
Cervical mediastinoscopy (CM) has been considered the gold standard for the evaluation of mediast... more Cervical mediastinoscopy (CM) has been considered the gold standard for the evaluation of mediastinal lymph nodes in the staging of non-small cell lung cancer (NSCLC) for many years. Recent publications on the value of PET scanning might reduce the use of CM in the near future. The aim of this study was to analyse the data of our CM procedures for their reliability and contribution in the assessment of mediastinal lymph nodes. In the period 1995-1999, 219 patients underwent CM. Data were available on 218 procedures and were analysed retrospectively. CM was performed in 162 men and 56 women with a median age of 56 years [range 29 to 80 years]. Median hospitalisation time was three days. There was no mortality and morbidity was 6%. In 96% of procedures representative lymphoid tissue was obtained. In 24%, biopsies contained malignancy. CM is a relatively safe procedure with a high diagnostic yield. As long as PET scanning remains available at a limited level, CM remains the gold standa...
Patients who had a biliary-enteric anastomosis often have elevated liver function tests. The aim ... more Patients who had a biliary-enteric anastomosis often have elevated liver function tests. The aim of this study was to investigate whether elevated liver function tests are associated with recurrent episodes of cholangitis. Thirty-two patients, who received a biliary-enteric anatomosis for benign biliary disease were evaluated. Follow-up consisted of the patient's history, physical examination, determination of liver function tests, ultrasonography and hepatobiliary scintigraphy using 99mTc-HIDA. Median duration of follow-up was 45 months (range: 1-192) and liver function tests were elevated in 22 patients (69%) at some time during follow-up. Dilated intrahepatic ducts were found in 3 of 30 patients (10%), all of whom had elevated liver function tests at follow-up. Delayed passage from the liver was observed using scintigraphy in 10 (31%) of the patients. Seven patients (22%) experienced one episode of cholangitis and none experienced more than one episode. Multivariate analysis ...
The European journal of surgery = Acta chirurgica, 1997
To investigate the role of upper gastrointestinal (GI) endoscopy in a surgical intensive care uni... more To investigate the role of upper gastrointestinal (GI) endoscopy in a surgical intensive care unit [ICU]. Retrospective analysis. University hospital, The Netherlands. 87 Male and 42 female patients, mean age 62.0 years (range 14-86). 198 Upper GI endoscopies. Incidence of, indication for, and abnormalities noted at upper GI endoscopy. 52 (40%) and 18 (14%) patients underwent 82 and 27 upper GI endoscopies, respectively, for evaluation of upper GI haemorrhage and surgical anastomoses. 59 Patients (46%) underwent 89 endoscopies for placement of nasoduodenal feeding tubes (n = 86, 97%), biliary stents (n = 2, 2%) and gastrostomy cathether (n = 1, 1%). The causes of haemorrhage were: oesophagitis (n = 13, 25%), duodenal ulcer (n = 13, 25%), gastric ulcer (n = 7, 13%) and others (n = 14, 28%). In 6 cases (11%), no bleeding site was detected. As a coincidental finding, a third of all patients had oesophagitis. The incidence of haemorrhage in patients treated and not treated by mechanical...
The European journal of surgery = Acta chirurgica, 1994
To evaluate our diagnosis and treatment of proximal cholangiocarcinoma. Retrospective clinical st... more To evaluate our diagnosis and treatment of proximal cholangiocarcinoma. Retrospective clinical study. Department of Surgery, University Hospital. 66 patients with proximal cholangiocarcinoma [median age (range): 64 years (28-87)]. Ultrasonography (n = 65), computed tomography (n = 55), endoscopic retrograde cholangio-pancreaticography [ERCP] (n = 54), percutaneous transhepatic cholangiography [PTC] (n = 32), angiography (n = 19) and cytology (n = 13) were used in diagnosis. Treatment consisted of: insertion of a stent (n = 37), resection of the tumour (n = 16), and biliary-enteric anastomosis (n = 9). Twenty-eight patients received radiotherapy, 3 patients received no active treatment. Usefulness of diagnostic methods, survival. Ultrasonography, ERCP and PTC were helpful whereas computed tomography, angiography, and cytology added little additional information. Mean (SEM) survival after resection was 35.8 months (7.4) and after conservative treatment 10.4 months (1.5) (p < 0.001)...
Background Fixation of the mesh in Lichtenstein's inguinal hernioplasty is traditionally performe... more Background Fixation of the mesh in Lichtenstein's inguinal hernioplasty is traditionally performed with polypropylene sutures. A modiWcation of this technique uses staples for securing of the mesh. Method A retrospective comparative study of 149 elective repairs of a primary inguinal hernia was performed: a control group of 67 patients undergoing mesh Wxation using sutures and a study group of 82 patients undergoing staple Wxation. Operating time, recurrence, postoperative pain, complications and costs were studied. Results Seven recurrences (11%) occurred in the polypropylene group as compared to one recurrence (1%) in the staple group (P < 0.01). There was a trend of fewer complications in the staple group. Operative time and long-term postoperative pain did not diVer signiWcantly between the two groups. The costs per surgery for mesh Wxation and skin closure were D 11.13 for the suture group and D 24.35 for the staple group. Conclusion Staple Wxation of the mesh in Lichtenstein's inguinal hernioplasty can be considered equal to traditional Wxation with sutures with regard to operating time and postoperative pain. However, staple Wxation seems to show fewer recurrences and fewer complications.
Objective: One key aspect of cancer survivorship is return-to-work. Unfortunately, many cancer su... more Objective: One key aspect of cancer survivorship is return-to-work. Unfortunately, many cancer survivors face problems upon their return-to-work. For that reason, we developed a hospital-based work support intervention aimed at enhancing return-to-work. We studied effectiveness of the intervention compared to usual care for female cancer patients in a multicentre randomised controlled trial. Methods: Breast and gynaecological cancer patients who were treated with curative intent and had paid work were randomised to the intervention group (n = 65) or control group (n = 68). The intervention involved patient education and support at the hospital and improvement of communication between treating and occupational physicians. In addition, we asked patient's occupational physician to organise a meeting with the patient and the supervisor to make a concrete gradual return-to-work plan. Outcomes at 12 months of follow-up included rate and time until return-to-work (full or partial), quality of life, work ability, work functioning, and lost productivity costs. Time until return-to-work was analyzed with Kaplan-Meier survival analysis. Results: Return-to-work rates were 86% and 83% (p = 0.6) for the intervention group and control group when excluding 8 patients who died or with a life expectancy of months at follow-up. Median time from initial sick leave to partial return-towork was 194 days (range 14-435) versus 192 days (range 82-465) (p = 0.90) with a hazard ratio of 1.03 (95% CI 0.64-1.6). Quality of life and work ability improved statistically over time but did not differ statistically between groups. Work functioning and costs did not differ statistically between groups. Conclusion: The intervention was easily implemented into usual psycho-oncological care and showed high return-to-work rates. We failed to show any differences between groups on return-to-work outcomes and quality of life scores. Further research is needed to study which aspects of the intervention are useful and which elements need improvement.
Shortly after extracorporeal shock wave lithotripsy (ESWL) was introduced as a promising new trea... more Shortly after extracorporeal shock wave lithotripsy (ESWL) was introduced as a promising new treatment modality for gallstone disease, a randomized controlled study was performed to assess the cost-effectiveness of ESWL compared to open cholecystectomy, the gold standard. During the performance of this study it was found that during a 3-year intake period only 8.3% (37 of 448) of the patients could be entered into the trial. Three factors were identified that hampered patient accrual: (1) restricted eligibility for ESWL (and thus for the study), which could not have been predicted on the data provided in the literature; (2) the introduction of laparoscopic cholecystectomy; and (3) strong patient preference, inhibiting randomization. All three mechanisms could not have been predicted during the design phase of the study. It is concluded that it is not always feasible to conduct a randomized study in surgery due to unforeseen circumstances. Entering patients into surgical trials is difficult in quickly evolving fields of surgery, such as the management of gallstone disease. Acquiring informed consent is also difficult when treatment characteristics are divergent. A randomized controlled study on the effects of laparoscopic cholecystectomy will therefore probably never be performed.
The case of a 47-year-old premenopausal woman is presented in whom axillary lymph node metastases... more The case of a 47-year-old premenopausal woman is presented in whom axillary lymph node metastases occurred on both sides 3 years apart although no primary tumor was detectable in either breast is presented. An overview of the literature on this rare entity is given. Patients with occult breast carcinoma with axillary lymph node metastases should have a complete physical examination, radiologic analysis (mammography, ultrasonography, and MRI of both breasts) and screening for disseminated disease. If there is no evidence of a primary tumor and metastases other than in the axilla, an axillary dissection should be carried out. In addition, the patient should be offered the choice of irradiation of the breast or mastectomy. Postoperatively, patients should receive appropriate systemic therapy tailored to their age, menopausal status, and receptor status.
Background: Inguinal hernias are a common entity with nearly 31,000 repairs annually in the Nethe... more Background: Inguinal hernias are a common entity with nearly 31,000 repairs annually in the Netherlands and over 800,000 in the USA. The aim of the present study is to determine whether a laparoscopically diagnosed patent processus vaginalis (PPV) is a risk factor for the development of groin hernia. Methods: The study population was originally composed of 599 consecutive cases (189 male, 32%) of laparoscopic transperitoneal surgery for different indications performed in 4 teaching hospitals in the Netherlands between November 1998 and February 2002. During laparoscopy, the deep inguinal ring was inspected bilaterally. The PPV group was compared with the obliterative processus vaginalis (OPV) group. Results: After a mean follow-up of 5.5 years, the studied population consisted of 337 cases (94 male, 28%). In this study 12% of the studied population appeared to have PPV in adult life. The percentage PPV of our study group is much higher than the percentage of hernia repairs performed in the Dutch population. A greater proportion (12%) of hernia repairs in the PPV group was found as compared with the OPV group (3%). The chance of developing an inguinal hernia within 5.3 years is four times higher in the group with PPV. No significant correlation between age and the prevalence of PPV was observed. Conclusion: This study demonstrates that PPV is an etiologic factor and a risk factor for acquiring an indirect inguinal hernia in adults.
... Preoperative biliru-bin, alkaline phosphatase and amylase levels as predictors of common duct... more ... Preoperative biliru-bin, alkaline phosphatase and amylase levels as predictors of common duct stones. Surg Gynecol Obstet 1982;154:381-84. 10. ... 53. Lillemoe KD, Yeo CJ, Talamini MA, Wang BH, Pitt HA, Gadacz TR. ... 73. Taylor TV. Torrance B, Rimmer S, Hillier V. Lucas SB. ...
To establish the value of ultrasound (US) in the follow-up of patients treated with extracorporea... more To establish the value of ultrasound (US) in the follow-up of patients treated with extracorporeal shockwave lithotripsy (ESWL), the results of 484 US examinations of 87 patients were analyzed and related to the results of ESWL. Reliability of US in assessing efficacy was investigated by comparing consecutive US examinations. Unreliable US results were found in 36 patients (41%); in 7 patients US failed to demonstrate fragments. In nine patients (10%) unreliable US findings contributed to delayed retreatment with ESWL. To prevent errors in treatment regimen, verification of US findings is advised in case no fragments or fragments &lt; 5 mm are found. In 22 patients (25%) US findings appeared indicative of hampered stone migration. Only 2 of these 22 patients (9.1%) became free of stones, compared with 32 of the remaining 65 patients (49.3%) (p &lt; 0.01), even though both groups had similar initial stone characteristics and similar time of follow-up. US findings such as a contracted gallbladder or a common bile duct &gt; 7 mm therefore indicate poor efficacy of ESWL.
To perform a process evaluation of a hospital-based work support intervention for cancer patients... more To perform a process evaluation of a hospital-based work support intervention for cancer patients aimed at enhancing return to work and quality of life. The intervention involves the delivery of patient education and support at the hospital and involves the improvement of the communication between the treating physician and the occupational physician. In addition, the research team asked patient's occupational physician to organise a meeting with the patient and the supervisor to make a concrete gradual return-to-work plan. Methods Eligible were cancer patients treated with curative intent and who have paid work. Data were collected from patients assigned to the intervention group (N = 65) and from nurses who delivered the patient education and support at the hospital (N = 4) by means of questionnaires, nurses' reports, and checklists. Data were quantitatively and qualitatively analysed. Results A total of 47 % of all eligible patients participated. Nurses delivered the patient education and support in 85 % of the cases according to the protocol. In 100 % of the cases at least one letter was sent to the occupational physician. In 10 % of the cases the meeting with the patient, the occupational physician and the supervisor took place. Patients found the intervention in general very useful and nurses found the intervention feasible to deliver. Conclusions We found that a hospital-based work support intervention was easily accepted in usual psycho-oncological care but that it proved difficult to involve the occupational physician. Patients were highly satisfied and nurses found the intervention feasible.
Gallstone disease is an important clinical problem: approximately 10% of all adults in the wester... more Gallstone disease is an important clinical problem: approximately 10% of all adults in the western population have gallstones. Most gallstones, however, remain asymptomatic and from various disciplines there is consensus that only symptomatic gallstones require therapy. Since the fIrst gallbladder extirpation in 1882, cholecystectomy has been considered the gold standard. Nowadays, this operation is performed laparoscopically in most hospitals. Despite relatively low morbidity and mortality rates, a number of alternative therapies have been developed in the past few years. These alternative treatment modalities are especially indicated in high risk patients and in patients rejecting surgery. In this review article the currently available treatment modalities are discussed. Extracorporea1 Shock Wave Lithotripsy (ESWL) was introduced as a nonsurgical treatment for uncomplicated, symptomatic gallstone disease. Due to its limited results and the possibility of stone recurrence, ESWL is mainly indicated for patients who reject or cannot tolerate cholecystectomy. For budgetary and planning purposes, it is essential to know what percentage of patients is eligible for this form of therapy. In the literature suitability is either reported variably (ranging from 10 to 53%) or not mentioned. We retrospectively assessed eligibility for ESWL for different entry criteria, based on the histories of 694 consecutive patients, who were referred for gallstone therapy from I April, 1988 to I October, 1991. Only 10.3-46.9% of symptomatic patients were found eligible for ESWL, depending on the entry criteria used. When the overall results are compared with eligibility, there is no inverse relationship. This suggests that patient selection is not the only factor determining the results of therapy. It is concluded, therefore, that also other factors, such as treatment schemes, the lithotriptors used and experience of the treating physicians, are importants factors for the outcome of ESWL therapy.
Background: Curatively treated bronchial carcinoid tumors have a relatively low metastatic potent... more Background: Curatively treated bronchial carcinoid tumors have a relatively low metastatic potential. Gradation into typical (TC) and atypical carcinoid (AC) is limited in terms of prognostic value, resulting in yearly follow-up of all patients. We examined the additional prognostic value of novel immunohistochemical (IHC) markers to current gradation of carcinoids. Methods: A retrospective single-institution cohort study was performed on 171 patients with pathologically diagnosed bronchial carcinoid (median follow-up: 66 months). The risk of developing distant metastases based on histopathological characteristics (Ki-67, p16, Rb, OTP, CD44, and tumor diameter) was evaluated using multivariate regression analysis and the Kaplan–Meier method. Results: Of 171 patients, seven (4%) had disseminated disease at presentation, and 164 (96%) received curative-intent treatment with either endobronchial treatment (EBT) (n = 61, 36%) or surgery (n = 103, 60%). Among the 164 patients, 13 develop...
We present the case of a 44-year-old man who presented with nausea, vomiting and acute pain in th... more We present the case of a 44-year-old man who presented with nausea, vomiting and acute pain in the right groin. On physical examination an irreducible mass was palpated in the right inguinal region. Ultrasound suggested an inguinal hernia sac with bowel contents. Subsequent right inguinal exploration revealed only unspecified necrotizing tissue, but no hernia sac or bowel contents were identified. Two days later laparotomy was required since the inguinal wound produced faecal discharge. The sigmoid appeared to be necrotic and perforated, and was subsequently resected. Histology revealed a perforated adenocarcinoma without lymph node involvement. Incarcerated inguinal hernias containing an adenocarcinoma of the colon are rare, but should be considered in patients presenting with an irreducible palpable mass in the inguinal region. Moreover, a carcinoma of the sigmoid may invade the right inguinal region. An intestinal perforation to skin-level in this population is even rarer and is associated with high morbidity and mortality rates.
Urachus fistulas are rare, especially in adulthood. In grown-ups urachus fistulas are usually a r... more Urachus fistulas are rare, especially in adulthood. In grown-ups urachus fistulas are usually a reflection of Crohn's disease. We present a patient in whom an urachus fistula was the first presentation of diverticulitis of the sigmoid colon. The need for proper preoperative diagnostic imaging is discussed.
Nederlands tijdschrift voor geneeskunde, Jan 24, 2004
Three patients with cholelithiasis were found to possess a duplicate gallbladder. A 48-year-old w... more Three patients with cholelithiasis were found to possess a duplicate gallbladder. A 48-year-old woman continued to have symptoms one year after cholecystectomy, a 69-year-old woman had symptoms even though her gallbladder had been removed 40 years before, and in a 29-year-old woman a second gallbladder was found during cholecystectomy. In all three patients, the second gallbladder was removed as well, after which they recovered. The differential diagnosis of persistent symptoms following cholecystectomy should also consider the possible presence of an accessory gallbladder.
Cervical mediastinoscopy (CM) has been considered the gold standard for the evaluation of mediast... more Cervical mediastinoscopy (CM) has been considered the gold standard for the evaluation of mediastinal lymph nodes in the staging of non-small cell lung cancer (NSCLC) for many years. Recent publications on the value of PET scanning might reduce the use of CM in the near future. The aim of this study was to analyse the data of our CM procedures for their reliability and contribution in the assessment of mediastinal lymph nodes. In the period 1995-1999, 219 patients underwent CM. Data were available on 218 procedures and were analysed retrospectively. CM was performed in 162 men and 56 women with a median age of 56 years [range 29 to 80 years]. Median hospitalisation time was three days. There was no mortality and morbidity was 6%. In 96% of procedures representative lymphoid tissue was obtained. In 24%, biopsies contained malignancy. CM is a relatively safe procedure with a high diagnostic yield. As long as PET scanning remains available at a limited level, CM remains the gold standa...
Patients who had a biliary-enteric anastomosis often have elevated liver function tests. The aim ... more Patients who had a biliary-enteric anastomosis often have elevated liver function tests. The aim of this study was to investigate whether elevated liver function tests are associated with recurrent episodes of cholangitis. Thirty-two patients, who received a biliary-enteric anatomosis for benign biliary disease were evaluated. Follow-up consisted of the patient's history, physical examination, determination of liver function tests, ultrasonography and hepatobiliary scintigraphy using 99mTc-HIDA. Median duration of follow-up was 45 months (range: 1-192) and liver function tests were elevated in 22 patients (69%) at some time during follow-up. Dilated intrahepatic ducts were found in 3 of 30 patients (10%), all of whom had elevated liver function tests at follow-up. Delayed passage from the liver was observed using scintigraphy in 10 (31%) of the patients. Seven patients (22%) experienced one episode of cholangitis and none experienced more than one episode. Multivariate analysis ...
The European journal of surgery = Acta chirurgica, 1997
To investigate the role of upper gastrointestinal (GI) endoscopy in a surgical intensive care uni... more To investigate the role of upper gastrointestinal (GI) endoscopy in a surgical intensive care unit [ICU]. Retrospective analysis. University hospital, The Netherlands. 87 Male and 42 female patients, mean age 62.0 years (range 14-86). 198 Upper GI endoscopies. Incidence of, indication for, and abnormalities noted at upper GI endoscopy. 52 (40%) and 18 (14%) patients underwent 82 and 27 upper GI endoscopies, respectively, for evaluation of upper GI haemorrhage and surgical anastomoses. 59 Patients (46%) underwent 89 endoscopies for placement of nasoduodenal feeding tubes (n = 86, 97%), biliary stents (n = 2, 2%) and gastrostomy cathether (n = 1, 1%). The causes of haemorrhage were: oesophagitis (n = 13, 25%), duodenal ulcer (n = 13, 25%), gastric ulcer (n = 7, 13%) and others (n = 14, 28%). In 6 cases (11%), no bleeding site was detected. As a coincidental finding, a third of all patients had oesophagitis. The incidence of haemorrhage in patients treated and not treated by mechanical...
The European journal of surgery = Acta chirurgica, 1994
To evaluate our diagnosis and treatment of proximal cholangiocarcinoma. Retrospective clinical st... more To evaluate our diagnosis and treatment of proximal cholangiocarcinoma. Retrospective clinical study. Department of Surgery, University Hospital. 66 patients with proximal cholangiocarcinoma [median age (range): 64 years (28-87)]. Ultrasonography (n = 65), computed tomography (n = 55), endoscopic retrograde cholangio-pancreaticography [ERCP] (n = 54), percutaneous transhepatic cholangiography [PTC] (n = 32), angiography (n = 19) and cytology (n = 13) were used in diagnosis. Treatment consisted of: insertion of a stent (n = 37), resection of the tumour (n = 16), and biliary-enteric anastomosis (n = 9). Twenty-eight patients received radiotherapy, 3 patients received no active treatment. Usefulness of diagnostic methods, survival. Ultrasonography, ERCP and PTC were helpful whereas computed tomography, angiography, and cytology added little additional information. Mean (SEM) survival after resection was 35.8 months (7.4) and after conservative treatment 10.4 months (1.5) (p < 0.001)...
Background Fixation of the mesh in Lichtenstein's inguinal hernioplasty is traditionally performe... more Background Fixation of the mesh in Lichtenstein's inguinal hernioplasty is traditionally performed with polypropylene sutures. A modiWcation of this technique uses staples for securing of the mesh. Method A retrospective comparative study of 149 elective repairs of a primary inguinal hernia was performed: a control group of 67 patients undergoing mesh Wxation using sutures and a study group of 82 patients undergoing staple Wxation. Operating time, recurrence, postoperative pain, complications and costs were studied. Results Seven recurrences (11%) occurred in the polypropylene group as compared to one recurrence (1%) in the staple group (P < 0.01). There was a trend of fewer complications in the staple group. Operative time and long-term postoperative pain did not diVer signiWcantly between the two groups. The costs per surgery for mesh Wxation and skin closure were D 11.13 for the suture group and D 24.35 for the staple group. Conclusion Staple Wxation of the mesh in Lichtenstein's inguinal hernioplasty can be considered equal to traditional Wxation with sutures with regard to operating time and postoperative pain. However, staple Wxation seems to show fewer recurrences and fewer complications.
Objective: One key aspect of cancer survivorship is return-to-work. Unfortunately, many cancer su... more Objective: One key aspect of cancer survivorship is return-to-work. Unfortunately, many cancer survivors face problems upon their return-to-work. For that reason, we developed a hospital-based work support intervention aimed at enhancing return-to-work. We studied effectiveness of the intervention compared to usual care for female cancer patients in a multicentre randomised controlled trial. Methods: Breast and gynaecological cancer patients who were treated with curative intent and had paid work were randomised to the intervention group (n = 65) or control group (n = 68). The intervention involved patient education and support at the hospital and improvement of communication between treating and occupational physicians. In addition, we asked patient's occupational physician to organise a meeting with the patient and the supervisor to make a concrete gradual return-to-work plan. Outcomes at 12 months of follow-up included rate and time until return-to-work (full or partial), quality of life, work ability, work functioning, and lost productivity costs. Time until return-to-work was analyzed with Kaplan-Meier survival analysis. Results: Return-to-work rates were 86% and 83% (p = 0.6) for the intervention group and control group when excluding 8 patients who died or with a life expectancy of months at follow-up. Median time from initial sick leave to partial return-towork was 194 days (range 14-435) versus 192 days (range 82-465) (p = 0.90) with a hazard ratio of 1.03 (95% CI 0.64-1.6). Quality of life and work ability improved statistically over time but did not differ statistically between groups. Work functioning and costs did not differ statistically between groups. Conclusion: The intervention was easily implemented into usual psycho-oncological care and showed high return-to-work rates. We failed to show any differences between groups on return-to-work outcomes and quality of life scores. Further research is needed to study which aspects of the intervention are useful and which elements need improvement.
Shortly after extracorporeal shock wave lithotripsy (ESWL) was introduced as a promising new trea... more Shortly after extracorporeal shock wave lithotripsy (ESWL) was introduced as a promising new treatment modality for gallstone disease, a randomized controlled study was performed to assess the cost-effectiveness of ESWL compared to open cholecystectomy, the gold standard. During the performance of this study it was found that during a 3-year intake period only 8.3% (37 of 448) of the patients could be entered into the trial. Three factors were identified that hampered patient accrual: (1) restricted eligibility for ESWL (and thus for the study), which could not have been predicted on the data provided in the literature; (2) the introduction of laparoscopic cholecystectomy; and (3) strong patient preference, inhibiting randomization. All three mechanisms could not have been predicted during the design phase of the study. It is concluded that it is not always feasible to conduct a randomized study in surgery due to unforeseen circumstances. Entering patients into surgical trials is difficult in quickly evolving fields of surgery, such as the management of gallstone disease. Acquiring informed consent is also difficult when treatment characteristics are divergent. A randomized controlled study on the effects of laparoscopic cholecystectomy will therefore probably never be performed.
The case of a 47-year-old premenopausal woman is presented in whom axillary lymph node metastases... more The case of a 47-year-old premenopausal woman is presented in whom axillary lymph node metastases occurred on both sides 3 years apart although no primary tumor was detectable in either breast is presented. An overview of the literature on this rare entity is given. Patients with occult breast carcinoma with axillary lymph node metastases should have a complete physical examination, radiologic analysis (mammography, ultrasonography, and MRI of both breasts) and screening for disseminated disease. If there is no evidence of a primary tumor and metastases other than in the axilla, an axillary dissection should be carried out. In addition, the patient should be offered the choice of irradiation of the breast or mastectomy. Postoperatively, patients should receive appropriate systemic therapy tailored to their age, menopausal status, and receptor status.
Background: Inguinal hernias are a common entity with nearly 31,000 repairs annually in the Nethe... more Background: Inguinal hernias are a common entity with nearly 31,000 repairs annually in the Netherlands and over 800,000 in the USA. The aim of the present study is to determine whether a laparoscopically diagnosed patent processus vaginalis (PPV) is a risk factor for the development of groin hernia. Methods: The study population was originally composed of 599 consecutive cases (189 male, 32%) of laparoscopic transperitoneal surgery for different indications performed in 4 teaching hospitals in the Netherlands between November 1998 and February 2002. During laparoscopy, the deep inguinal ring was inspected bilaterally. The PPV group was compared with the obliterative processus vaginalis (OPV) group. Results: After a mean follow-up of 5.5 years, the studied population consisted of 337 cases (94 male, 28%). In this study 12% of the studied population appeared to have PPV in adult life. The percentage PPV of our study group is much higher than the percentage of hernia repairs performed in the Dutch population. A greater proportion (12%) of hernia repairs in the PPV group was found as compared with the OPV group (3%). The chance of developing an inguinal hernia within 5.3 years is four times higher in the group with PPV. No significant correlation between age and the prevalence of PPV was observed. Conclusion: This study demonstrates that PPV is an etiologic factor and a risk factor for acquiring an indirect inguinal hernia in adults.
... Preoperative biliru-bin, alkaline phosphatase and amylase levels as predictors of common duct... more ... Preoperative biliru-bin, alkaline phosphatase and amylase levels as predictors of common duct stones. Surg Gynecol Obstet 1982;154:381-84. 10. ... 53. Lillemoe KD, Yeo CJ, Talamini MA, Wang BH, Pitt HA, Gadacz TR. ... 73. Taylor TV. Torrance B, Rimmer S, Hillier V. Lucas SB. ...
To establish the value of ultrasound (US) in the follow-up of patients treated with extracorporea... more To establish the value of ultrasound (US) in the follow-up of patients treated with extracorporeal shockwave lithotripsy (ESWL), the results of 484 US examinations of 87 patients were analyzed and related to the results of ESWL. Reliability of US in assessing efficacy was investigated by comparing consecutive US examinations. Unreliable US results were found in 36 patients (41%); in 7 patients US failed to demonstrate fragments. In nine patients (10%) unreliable US findings contributed to delayed retreatment with ESWL. To prevent errors in treatment regimen, verification of US findings is advised in case no fragments or fragments &lt; 5 mm are found. In 22 patients (25%) US findings appeared indicative of hampered stone migration. Only 2 of these 22 patients (9.1%) became free of stones, compared with 32 of the remaining 65 patients (49.3%) (p &lt; 0.01), even though both groups had similar initial stone characteristics and similar time of follow-up. US findings such as a contracted gallbladder or a common bile duct &gt; 7 mm therefore indicate poor efficacy of ESWL.
To perform a process evaluation of a hospital-based work support intervention for cancer patients... more To perform a process evaluation of a hospital-based work support intervention for cancer patients aimed at enhancing return to work and quality of life. The intervention involves the delivery of patient education and support at the hospital and involves the improvement of the communication between the treating physician and the occupational physician. In addition, the research team asked patient's occupational physician to organise a meeting with the patient and the supervisor to make a concrete gradual return-to-work plan. Methods Eligible were cancer patients treated with curative intent and who have paid work. Data were collected from patients assigned to the intervention group (N = 65) and from nurses who delivered the patient education and support at the hospital (N = 4) by means of questionnaires, nurses' reports, and checklists. Data were quantitatively and qualitatively analysed. Results A total of 47 % of all eligible patients participated. Nurses delivered the patient education and support in 85 % of the cases according to the protocol. In 100 % of the cases at least one letter was sent to the occupational physician. In 10 % of the cases the meeting with the patient, the occupational physician and the supervisor took place. Patients found the intervention in general very useful and nurses found the intervention feasible to deliver. Conclusions We found that a hospital-based work support intervention was easily accepted in usual psycho-oncological care but that it proved difficult to involve the occupational physician. Patients were highly satisfied and nurses found the intervention feasible.
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Papers by Peter Plaisier