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M H Nieuwenhuis,
E M Mathus-Vliegen,
C G Baeten,
F M Nagengast, J van der Bijl,
A D van Dalsen,
J H Kleibeuker,
E Dekker,
A M Langers,
J Vecht,
F T Peters,
R van Dam,
W G van Gemert,
W N Stuifbergen,
W R Schouten,
H Gelderblom,
H F A Vasen
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ABSTRACT: The optimal treatment of desmoid tumours is controversial. We evaluated desmoid management in Dutch familial adenomatous polyposis (FAP) patients.
Seventy-eight FAP patients with desmoids were identified from the Dutch Polyposis Registry. Data on desmoid morphology, management, and outcome were analysed retrospectively. Progression-free survival (PFS) rates and final outcome were compared for surgical vs non-surgical treatment, for intra-abdominal and extra-abdominal desmoids separately. Also, pharmacological treatment was evaluated for all desmoids.
Median follow-up was 8 years. For intra-abdominal desmoids (n=62), PFS rates at 10 years of follow-up were comparable after surgical and non-surgical treatment (33% and 49%, respectively, P=0.163). None of these desmoids could be removed entirely. Eventually, one fifth died from desmoid disease. Most extra-abdominal and abdominal wall desmoids were treated surgically with a PFS rate of 63% and no deaths from desmoid disease. Comparison between NSAID and anti-estrogen treatment showed comparable outcomes. Four of the 10 patients who received chemotherapy had stabilisation of tumour growth, all after doxorubicin combination therapy.
For intra-abdominal desmoids, a conservative approach and surgery showed comparable outcomes. For extra-abdominal and abdominal wall desmoids, surgery seemed appropriate. Different pharmacological therapies showed comparable outcomes. If chemotherapy was given for progressively growing intra-abdominal desmoids, most favourable outcomes occurred after combinations including doxorubicin.
British Journal of Cancer 11/2010; 104(1):37-42. · 5.04 Impact Factor
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ABSTRACT: This literature review was carried out to examine the effects of user involvement in shared decision-making processes and the methods/tools available to psychiatric nurses to measure and encourage user involvement. A systematic literature review was then used in this study. Many studies indicate that an increased involvement of service users leads to better care, better treatment compliance, improved health outcomes and higher levels of patient satisfaction. The tools and methods described are designed to measure the ability to participate, the process of implementation and the evaluation of healthcare services. An adequate instrument to measure user involvement will be necessary to underpin the positive effects. Although care providers have a statutory duty to help shape user involvement, and the tools required are available, care providers are still insufficiently inclined to take up this duty.
Journal of Psychiatric and Mental Health Nursing 11/2008; 15(8):678-83. · 0.80 Impact Factor
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ABSTRACT: Gastric cancer in Western countries is often diagnosed in an advanced stage and prognosis is poor. We performed a randomised trial with pre-operative FAMTX vs. surgery alone in order to evaluate the effect of pre-operative chemotherapy on resectability and survival.
Patients with proven adenocarcinoma of the stomach were randomised to receive four courses of chemotherapy using 5-Fluorouracil, doxorubicin and methotrexate (FAMTX) prior to surgery or to undergo surgery alone.
Fifty-nine patients were randomised; 29 patients were allocated to the FAMTX regimen prior to surgery and 30 patients had surgery alone. Resectability rates were equal for both groups. Complete or partial response was registered in 32% of the FAMTX group. With a median follow-up of 83 months the median survival since randomisation is 18 months in the FAMTX group vs. 30 months in the surgery alone group (p=0.17).
This trial could not show a beneficial effect of pre-operative FAMTX. Until large randomised studies prove otherwise, adequate surgery without delay is the best treatment for operable gastric cancer.
European Journal of Surgical Oncology 09/2004; 30(6):643-9. · 2.50 Impact Factor
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ABSTRACT: Symptomatic solitary nonparasitic liver cysts are rare, and are treated by aspiration, deroofing or total resection. We present two recent cases of women with very large such cysts, who were successfully treated by conventional deroofing and omentoplasty, since that is in our vision the treatment of choice for this benign pathology.
Acta chirurgica Belgica 11/2002; 102(5):341-4. · 0.43 Impact Factor
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ABSTRACT: The aim of this trial was to investigate whether pre-operative chemotherapy leads to a 15% higher curative resectability rate in patients with operable gastric cancer. In this randomised trial, patients were allocated to receive either four courses of chemotherapy using 5-fluorouracil, doxorubicin and methotrexate (FAMTX) prior to surgery or to undergo surgery only. Patients younger than 75 years of age with a good physical and mental condition and a histologically proven adenocarcinoma of the stomach without clinical or radiographic (computed tomography scan) evidence of distant metastases were eligible for this trial. Early gastric cancer or cardia carcinoma were excluded. The response to chemotherapy was evaluated after two and four courses. In case of progressive disease (PD) after two courses, patients were operated upon as soon as possible. Otherwise complete response (CR) partial response (PR) or stable disease (SD), two more courses were scheduled. The standard surgical procedure was a limited lymphadenectomy (D1) with staging biopsy of the para-aortic lymph nodes. Between September 1993 and February 1996, 56 eligible and evaluable patients were entered: 27 were randomised to receive FAMTX before surgery and 29 to undergo surgery only. In the FAMTX + surgery treatment group, 15/27 (56%) had curative resections versus 18/29 (62%) in the surgery only arm. There was no difference in the frequency of TNM stages I + II in both treatment arms: 15/27 versus 15/29. Due to PD and/or toxicity, 12 patients (44%) could not complete the planned four courses of FAMTX. Response evaluation after chemotherapy was possible in 25 patients: 2 CR, 6 PR, 8 SD and 9 PD. The difference in curative resectability rate was 6.5% (95% confidence interval -32 to +19%) in favour of surgery only. Downstaging for stages I + II did not occur. PD was more often the reason for not completing the planned four courses than toxicity. More active regimens than FAMTX are required for future randomised trials.
European Journal of Cancer 05/1999; 35(4):558-62. · 5.54 Impact Factor
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ABSTRACT: This paper reports on the results of a study conducted in 1994. The aim of the study was to gain insight into nurses' perceptions of ethical dilemmas concerning informational privacy of patients with hiv/aids. The chosen research method was descriptive, from a qualitative research perspective (Grounded Theory). The purposive sample consisted of seven nurses working in a university hospital. Data were collected by means of in-depth interviews and the critical incidents method. The description of the dilemmas led to a central theme: the nurses' choice whether or not to give information revealing the diagnosis seropositivity or aids to patient's relatives or partner. The core categories were derived from analysis of the descriptions given by the nurses. They are split up into experiences of the nurses and the way nurses cope with these dilemmas. Recommendations are given for promotion of expertise and education.
Verpleegkunde 06/1997; 12(2):82-94.
