Mechanical factors influencing the incidence of burst abdomen.

Objective: To compare laparotomy closure with interrupted polyglactin 910 (Vicryl) and continuous polydioxanone (PDS II), and assess the mechanical and other factors that influenced the incidence of burst abdomen.

Design: Retrospective study.

Setting: University hospital, The Netherlands.

Prediction of postoperative pain and duration of hospitalization using two anxiety measures.

This study examined the extent to which measures of anxiety could predict pain and the length of hospitalization following surgery in 111 patients with gallstones over and above what could be predicted on the basis of biographical and medical status variables. Self-reported pain on the third day postoperative could hardly be explained by the variables measured. Preoperative anxiety did not increase the value of the prediction.

Psychological variables as predictors of the length of post-operative hospitalization.

The extent to which measures of anxiety and personality characteristics, which had been assessed preoperatively, could predict the length of hospital stay following surgery, above and beyond what could be predicted on the basis of biographical, medical-status and post-operative anxiety variables, was examined in 58 patients with gall-bladder disease. Hierarchical multiple regression analysis revealed that gender, previous operations, complications and State Anxiety (A-State) measured on the third day post-operatively, jointly explained a significant proportion of the variance in the length of hospitalization. Neither preoperative anxiety measures nor personality characteristics had any significant incremental value in the prediction.

[Relationship between perioperative anxiety and postoperative recovery].

One day before surgery and three days postoperatively, 118 cholecystectomy patients were investigated by means of several self-report anxiety-question(naire)s. On the basis of these, the patients were assigned to either the category more anxious postoperatively (A+) or the category less anxious postoperatively (A-). A+ patients rated preoperatively lower and postoperatively higher on the anxiety-question(naire)s than A- patients, and they stayed longer in hospital postoperatively.

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.

Prognosis and morbidity after total thyroidectomy for papillary, follicular and medullary thyroid cancer.

The prognosis and the morbidity results after total thyroidectomy are reported for 148 patients with differentiated thyroid cancer. Ninety-two patients (62%) had papillary cancer, 27 (18%) had follicular cancer and 29 (20%) had medullary cancer. In the latter group, 16 patients had no clinical signs of a tumour and underwent total thyroidectomy after elevated calcitonin levels were found in a family screening programme.

Adenocarcinoma of the colon and rectum: a report on 624 cases.

A total of 624 patients with adenocarcinoma of the large bowel and operated between 1958 and 1978 were retrospectively studied. According to the period of operation, patients were divided into group A (1958 to 1968, n = 259) and group B (1969 to 1978, n = 365). Symptoms were closely related to tumour location.

Effects of sounds presented during general anaesthesia on postoperative course.

In a double-blind, randomized study, patients undergoing cholecystectomy were administered one of four different sounds during general anaesthesia: positive suggestions, nonsense suggestions, seaside sounds or sounds from the operating theatre. The effect of these sounds on the postoperative course was examined to assess intraoperative auditory registration. No differences were found between the four groups in postoperative variables.

In vivo isolated liver perfusion technique in a rat hepatic metastasis model: 5-fluorouracil concentrations in tumor tissue.

An in vivo method of isolated rat liver perfusion was developed with true vascular isolation and recirculating perfusate. This new surgical technique to temporarily isolate the liver vascularly, and the perfusion procedure are described in depth. Twelve inbred WAG/RIJ rats were subjected to 25 min of normothermic liver perfusion without chemotherapy, and all rats survived the procedure.

An evaluation of routine follow-up for detection of breast cancer recurrences.

Four hundred patients who were radically treated for breast carcinoma during the period May 1974 to December 1980 were followed for a minimum of 4 years. The outcomes of the 128 patients with recurrences were studied. A differentiation into two groups was made: those in whom recurrences were detected as a real result of follow-up (27%) and those in whom this was not the case (73%).

Perioperative blood transfusion and cancer prognosis. Different effects of blood transfusion on prognosis of colon and breast cancer patients.

A detailed retrospective analysis was undertaken of the effect of perioperative blood transfusion on long-term survival of 113 patients with Dukes' Stages A, B and C1 cancer of the colon and 383 patients with invasive cancer of the breast who were treated in our institution between 1973 and 1978 and followed for 5 to 10 years. In the patients with colon cancer, a significant adverse effect of transfusion on long-term survival was seen. In this group there was a cumulative 5-year overall survival of 48% for the transfused and 74% for the nontransfused patients (P = 0.

Diagnostic evaluation and survival analysis of colorectal cancer patients with liver metastases.

Clinical features and their prognostic value were evaluated in 83 colorectal cancer patients with liver metastasis. The clinical features analysed included presenting symptoms and signs, liver function tests, extent of liver involvement, associated extrahepatic tumor growth, and physical condition of the patients. Overall median survival time after diagnosis of liver metastases was 8.

A successful technique of in vivo isolated liver perfusion in pigs.

A technique was developed to isolate the hepatic circulation from the general circulation using a double lumen intracaval shunt. Low flow normothermic perfusion of the liver was performed for 1 hr 25 min in pigs. All pigs survived the procedure.

Clinical study of so-called unconscious perception during general anaesthesia.

Ninety-one patients undergoing biliary tract surgery were randomly assigned to one of three treatment groups in which different sounds were administered, by means of earphones, in a double-blind design. The effects of the administration of positive suggestions, noise or operating theatre sounds on the postoperative course were studied. Results showed that exposure to positive suggestions during general anaesthesia, as compared with noise or operating theatre sounds, protected patients older than 55 yr against prolonged postoperative stay in hospital.

Breast scintigraphy with 99mTc-diethylene triamine penta-acetic acid for the detection of malignant disease.

A single-blind prospective study of 99mTc-diethylene triamine penta-acetic acid (DTPA) breast scintigraphy was performed on 160 women who presented at the outpatient clinic with suspected breast tumour. The sensitivity of scintigraphy in establishing the diagnosis of breast cancer was 75 per cent. The specificity of scintigraphy in excluding the presence of breast cancer was 91 per cent.

Prognoses and surgical treatment of patients with stage I melanomas of the skin: a retrospective analysis of 211 patients.

From 1960 to 1982, a total number of 216 patients with Stage I melanoma underwent local excision as the single treatment. Life-table analysis was performed on 211 evaluable patients to investigate the prognostic value of several factors on survival as well as disease-free survival. The influence of sex, age, localization of the tumor, and margin of the excision on prognosis was not statistically significant.

Scintigraphy of the female breast with Tc-99m-DTPA: a prospective blind evaluation.

Following a report on the use of Tc-99m-diethylenetriamine pentaacetic acid (Tc-99m-DTPA) for detection of malignant breast tumors we compared this method with other diagnostic aids such as mammography and cytology. Among 160 women referred to our department for diagnosis, 166 examinations were performed (six patients had bilateral lesions); the final diagnosis of the breast lesion was established as malignant in 62 cases and benign in 104 cases. The scintigraphic image was reported malignant if an area of focal uptake observed on the scan 30 minutes after injection of the tracer persisted or became more intense on the 2-hour scintigram.

Testicular tumors in the Netherlands.

The data of 764 patients, registered with the Netherlands Committee for Testicular Tumors during the 1971-1978 period, were analyzed. To a large degree the results were in agreement with those in the literature. Chest x-rays and bipedal lymphangiograms were the most useful investigations for detection of metastases, with supplementation by lung planigraphy where indicated.