18FDG SUV in the primary tumor and lymph node metastases is not predictive for development of distant metastases in high risk head and neck cancer patients.

Background: Pretreatment screening on distant metastases is particularly useful in head and neck squamous cell carcinoma (HNSCC) patients with high risk factors.

Methods: In a retrospective study of 88 patients with previously identified clinical high risk factors the predictive value of standardized uptake value (SUV) of 18F-fluorodeoxyglucose (FDG) in the primary tumor and in the lymph node metastases for the development of distant metastases was examined. Different SUVs corrected for plasma glucose levels and body mass index were calculated and analysed in different patient groups: all patients (n=88), patients with a follow up >6months (n=73), not previously treated patients (n=51) and not previously treated patients with a follow up >6months (n=40).

Evaluation of trauma care by comparing mortality risks and admission policy in a Dutch trauma region.

Objective: To evaluate the effectiveness of trauma care in the Netherlands compared to UK norms and in terms of mortality risks in three groups of patients. The hypothesis was that there is no difference in risk of hospital death between major trauma patients transferred from another hospital to the trauma centre and patients directly admitted to the trauma centre.

Methods: Trauma admissions (n=17,023) during the period 2000-2006 in 12 emergency departments were selected from a regional trauma registry database.

Base deficit-based predictive modeling of outcome in trauma patients admitted to intensive care units in Dutch trauma centers.

Background: Worldwide, the base deficit is available as an objective indicator of acid base status. We used the base deficit as a measure of physiologic derangement in a Trauma and Injury Severity Score (TRISS)-like model as a predictor for outcome in trauma patients.

Methods: We prospectively recorded data of 349 consecutive trauma patients admitted to the intensive care unit and calculated Revised Trauma Score, Injury Severity Score and Abbreviated Injury Scale, and TRISS and correlated them with the simultaneously determined base deficit value.

Prevalence and determinants of disabilities and return to work after major trauma.

Objective: The purpose of this study was to assess the prevalence and determinants of disabilities and return to work after severe injury in a Dutch, Level I trauma center.

Methods: We prospectively included 295 patients with an Injury Severity Score > or = 16 treated between January 1996 and January 1999. All survivors received a mailed questionnaire in 2000, at least 1 year after their initial hospital admission.

Clinical impact of advanced trauma life support.

The Advanced Trauma Life Support (ATLS) course sponsored by the American College of Surgeons Committee On Trauma (ACSCOT) presents a standardized method of initial trauma care. This study attempted to measure any changes in morbidity and mortality in trauma patients after the introduction of ATLS training. Over a 3-year period (May 1996 to September 1997-pre-ATLS period; December 1997 to April 1999-post-ATLS period), 63 trauma patients with an Injury Severity Scale (ISS) > or =16 (n = 31, pre-ATLS and n = 32, post-ATLS) were prospectively studied in two community teaching hospitals.

Advanced trauma life support study: quality of diagnostic and therapeutic procedures.

Background: The introduction of the ATLS course in The Netherlands in 1995 provided for an opportunity to compare data of trauma patients between a pre-ATLS and a post-ATLS period.

Materials And Methods: Over a 3-year period (May 1996 - September 1997 pre ATLS; December 1997-April 1999 post ATLS) 63 trauma patients with an AIS-ISS > or = 16 (n = 31, pre-ATLS and n = 32, post-ATLS) were prospectively studied in two community residency training (ACS Level III) hospitals. All diagnostic and therapeutic procedures were recorded by a video-camera and evaluated by a neutral faculty of six experienced ATLS trained specialists.

Pre-hospital trauma care: a proposal for more efficient evaluation.

Although mortality is an important outcome parameter for pre-hospital trauma care, it is influenced by many factors other than pre-hospital trauma care alone. We therefore studied an alternative method to evaluate pre-hospital trauma care by calculating the change in probability of survival (Ps) according to the TRISS methodology, before and directly after the pre-hospital trauma care. Correlations between patient characteristics and a change in Ps were assessed.

Consequences of delayed diagnoses in trauma patients: a prospective study.

Background: The approach to trauma care has improved in recent decades but delayed diagnoses still occur. This study aimed to analyze the prevalence and consequences of delayed diagnoses in a single European trauma center. The effect of a systematic reexamination of the patient (tertiary survey) and reevaluation of x-rays and CT scans was evaluated.

[Traumatic atlanto-occipital dislocation with minimal neurologic deficits].

A 21-year-old woman presented with mild neck pain following a scooter accident. Conventional cervical radiographs showed a lateralisation of the dens axis to the left in relation to the foramen magnum. A subsequent CT with a multiplanar reconstruction revealed an atlanto-occipital dislocation that was repositioned under fluoroscopic control.

Totally extraperitoneal endoscopic repair of recurrent inguinal hernia.

Background: Conventional repair of recurrent inguinal hernia is associated with a re-recurrence rate as high as 35 per cent. Endoscopic mesh repair has promising results regarding both recurrence and complication rates.

Methods: In a retrospective review, the results of endoscopic totally extraperitoneal repair were evaluated in 104 patients with 108 recurrent hernias.

[Multitrauma patients: principles of 'damage control surgery'].

The principles of damage control surgery were applied in the cases of three severely injured multitrauma patients, men aged 47 and 33 years who had a motorcycle accident and a 66-year-old man who had a car crash. Victims of major trauma suffer from a worsening physiologic derangement manifested by the triad of acidosis, hypothermia and coagulopathy. This often leads to a vicious cycle that heralds imminent death or organ failure.

Induction in vivo of cartilage grafts for craniofacial reconstruction.

In the craniofacial region, defects of cartilage structures are preferably reconstructed with autologous cartilage. Donor-site morbidity related to the creation of a new defect elsewhere, and a lack of growth potential of the graft--mandatory in children--have stimulated investigators to find other ways to generate new "extra" cartilage. Several biomaterials have been tested as a matrix for the ingrowth of (peri)chondroblasts in experimental animals.

Postoperative treatment of internally fixed ankle fractures: a prospective randomised study.

In a prospective, randomised trial of 81 patients with fractures of the ankle of AO types A, B and C we compared two regimes of postoperative management after internal fixation. The patients were mobilised either non-weight-bearing with crutches or weight-bearing in a below-knee walking plaster. We found a temporary benefit in subjective evaluation only (65 v 50 points, Mann-Whitney test, cft, p=0.

Effect of intranasal fluticasone proprionate on the immediate and late allergic reaction and nasal hyperreactivity in patients with a house dust mite allergy.

Background: Patients with perennial allergic rhinitis develop nasal symptoms not only after allergen exposure, but generally also after non-specific stimuli.

Objective: To evaluate the effect of 2 week's treatment with fluticasone propionate aqueous nasal spray (FPANS) on the nasal clinical response, inflammatory mediators and nasal hyperreactivity.

Methods: Twenty-four rhinitis patients allergic to house dust mite (HDM), participated in a double-blind, placebo-controlled crossover study.

Anterior exposure for open reduction of supracondylar humeral fractures in children: a forgotten approach?

Objective: To describe the anterior approach for open reduction of supracondylar fractures in children and to assess the morbidity and functional outcome.

Design: Retrospective analysis.

Setting: University Hospital.

Normal and abnormal nasal growth after partial submucous resection of the cartilaginous septum.

Using the nose of growing rabbits as an experimental model, the effects on nasal growth of various Killian-type partial resections of the cartilaginous septum were studied. Larger resections in young animals caused decreased height and length of the nose in the adult stage. Partial resection of the basal rim of the cartilaginous nasal septum demonstrated no effects on the postnatal growth of the nasal dorsum.

K-wire fixation of supracondylar humeral fractures in children: results of open reduction via a ventral approach in comparison with closed treatment.

The morbidity and functional outcome of K-wire fixation of dislocated supracondylar humeral fractures in children after open reduction through a ventral approach were studied, using the results after closed reduction as a golden standard. A series of 49 children were evaluated retrospectively. Of these, 46 children could be included in the study, of whom 35 were treated with closed reduction (group A) and 11 were treated with open reduction via a ventral approach (group B).

Reconstruction of the growing cricoid with a composite graft of demineralized bovine bone and autogenous perichondrium; a comparative study in rabbits.

In growing rabbits, the feasibility of a new type of composite graft for the reconstruction of defects in the cricoid ring is studied. This graft consists of Demineralized Bovine Bone matrix (DBBM) enfolded in a perichondrial flap. The cartilage formed in the DBBM by cells, derived from the perichondrium, is demonstrated to provide a valuable substitute for resected parts of the cricoid.

The simple fix: external fixation of displaced isolated tibial fractures.

Eleven patients with an isolated and displaced tibial fracture were treated by external fixation with a simple device to provide mobile traction. Anatomical results were good and all fractures healed uneventfully with minimal morbidity.

[Favorable results of the surgical treatment of intra-articular crush fractures of the distal femur].

Severely comminuted intra-articular femoral fractures are usually associated with major soft-tissue damage as a part of serious multiple injuries. Surgical treatment should aim at exact anatomical restoration of the articular surface. Internal fixation should be stable so that functional after-treatment is possible, a condition of achieving an optimal result.

Subglottic hemangiomas in infants: treatment with intralesional corticosteroid injection and intubation.

Six children with a subglottic hemangioma were treated in the Sophia Children's Hospital in the period 1982-1987 by means of intralesional corticosteroid injection, followed by intubation. After treatment all children were symptomfree. In 3 patients this result was attained after 1 injection, in 2 after 3 injections.

Conservative versus operative treatment of displaced noncomminuted tibial shaft fractures. A retrospective comparative study.

The results of conservative (mainly, functional bracing) and operative treatment (mainly, plate fixation) have been compared in a retrospective study of 170 displaced noncomminutive tibial shaft fractures. The characteristics of the fractures in both treatment groups showed no significant differences. The follow-up analysis revealed no statistical differences in outcome between the two methods.

Anatomical and functional results after treatment of dislocated supracondylar fractures of the humerus in children.

From 1972 to 1983 105 patients were admitted with a dislocated supracondylar fracture of the humerus. The average follow-up was five years. In general the functional results of treatment were good.

Effective reconstruction after pharyngolaryngo-oesophagectomy with an ileal autograft.

Total pharyngolaryngo-oesophagectomy is performed for carcinoma of the cervical oesophagus, the piriform sinuses and the postcricoid region. A safe effective way of reconstructing the cervical oesophagus is of the utmost importance in these patients. Use of a revascularized intestinal segment for this purpose is described.