654 research outputs found

    Heelkunde: De kunst van het helen

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    Rede uitgesproken bij de aanvaarding van het ambt van gewoon hoogleraar in de Algemene Heelkunde aan de Erasmus Universiteit te Rotterdam op woensdag, 3 juni 198

    The Effect of Unimodal, Non-pharmacological, Preoperative Psychological Prehabilitation Interventions on Preoperative Anxiety and Stress:A Systematic Review

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    Background: Prehabilitation is a novel clinical strategy to optimize patients’ health in the waiting period before surgery. Objectives: This article aims to gather the evidence for the effectiveness of unimodal, non-pharmacological psychological prehabilitation interventions on preoperative anxiety and stress before surgery. Design: This is a PRISMA-guided systematic review and narrative synthesis of randomized controlled trials. Methods: The online databases Medline, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, PsycINFO and Google Scholar were searched on March 20th 2023. The search strategy led to 13,667 records screened and five records of randomized controlled trials included for full-text analysis. A risk-of-bias assessment was performed using the Revised Cochrane Risk of Bias 2 tool. Results: Significant reduction in preoperative anxiety was seen in three studies comprising 337 participants. Two studies did not find that unimodal psychological prehabilitation reduces preoperative anxiety. Only one study assessed preoperative stress and reported a significant reduction. Intervention types used included guided imagery, stress management training, virtual reality experience and computer cognitive behavioral therapy. Conclusions: There is contradictory evidence whether unimodal, non-pharmacological psychological prehabilitation can reduce preoperative anxiety. There is little evidence that non-pharmacological prehabilitation can reduce preoperative stress. Suggestions to improve the research in this field are discussed.</p

    Immunological enhancement of skin allo- and heterografts

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    Since the development of transplantation of tissues, much effort has been directed towards the acceptance of transplanted grafts. Many methods have been developed to prevent or delay the rejection reaction. Some of them are used in clinical transplantation, involving immunosuppression of the host by certain drugs, hormones and by anti lymphocyte serum, which contains antibodies directed against the lymphocytes of the host. These methods, if carefully applied, may indeed prevent rejection of the grafts in a proportion of the patients. However, treatment with these drugs can be deleterious for the host, for suppression of the immune response increases the susceptibility for infection and probably also for tumors. In fact, many recipients of organ transplants still die from sepsis. Thus, any type of immunosuppression is still associated with a noxious effect on the host. A solution for these transplantation problems might be provided by the oldest principle in the achievement of graft acceptance, namely enhancement. Recently Snell defined enhancement as: the enhanced or prolonged growths of allografts, due to the presence in the graft recipient of allo-antibody directed against the allo-antigens of the donor. In other words, a graft is protected by enhancing antibodies, that are not directed against the recipient as is the case for A.L.S., but against the donor antigens

    The Effect of Unimodal, Non-pharmacological, Preoperative Psychological Prehabilitation Interventions on Preoperative Anxiety and Stress:A Systematic Review

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    Background: Prehabilitation is a novel clinical strategy to optimize patients’ health in the waiting period before surgery. Objectives: This article aims to gather the evidence for the effectiveness of unimodal, non-pharmacological psychological prehabilitation interventions on preoperative anxiety and stress before surgery. Design: This is a PRISMA-guided systematic review and narrative synthesis of randomized controlled trials. Methods: The online databases Medline, Embase, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, PsycINFO and Google Scholar were searched on March 20th 2023. The search strategy led to 13,667 records screened and five records of randomized controlled trials included for full-text analysis. A risk-of-bias assessment was performed using the Revised Cochrane Risk of Bias 2 tool. Results: Significant reduction in preoperative anxiety was seen in three studies comprising 337 participants. Two studies did not find that unimodal psychological prehabilitation reduces preoperative anxiety. Only one study assessed preoperative stress and reported a significant reduction. Intervention types used included guided imagery, stress management training, virtual reality experience and computer cognitive behavioral therapy. Conclusions: There is contradictory evidence whether unimodal, non-pharmacological psychological prehabilitation can reduce preoperative anxiety. There is little evidence that non-pharmacological prehabilitation can reduce preoperative stress. Suggestions to improve the research in this field are discussed.</p

    A Novel Foil Flip-Over System as the Final Layer in Wound Closure: Excellent Cosmetic Results and Patient Comfort

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    BACKGROUND Wound closure after excision is commonly done with sutures or staples. A new sutureless innovative wound closure system is available for sutureless skin closure. OBJECTIVE To evaluate wound healing, patient comfort, and cosmetic results of a foil flip-over system for excision of small skin lesion. MATERIALS AND METHODS Patients presenting to the department of Dermatology of Erasmus University Medical Center, Rotterdam, The Netherlands for skin surgery during a 1.5-year period were prospectively studied. Key outcome measures were wound healing, patient comfort, and cosmetic results. Three independent physicians scored photographs of the scars. Evaluation tools used were comfort and body image questionnaires and visual analogue scales. RESULTS Ninety-six patients with 103 lesions were included in our study. The surgeon scored wound healing as excellent or good in 96%. No wound infections occurred. Ninety-two percent of patients scored removal of the system as comfortable. Median patient grade of scar after 1 month was 8 out of 10 points (interquartile range [IQR] 79). Median independent physician grade of photographs of the scars was 7.7 (IQR 7.18.0). CONCLUSION Sutureless foil flip-over is promising, with excellent patient comfort characteristics and good to excellent cosmetic results

    Blood transfusions and local tumor recurrence in colorectal cancer. Evidence of a noncausal relationship

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    OBJECTIVE. The authors analyzed the effect of blood transfusions on the pattern of colorectal cancer recurrence. BACKGROUND. Retrospective studies suggest that blood transfusions are associated with a poor prognosis in patients who undergo operations for colorectal malignancies. In a previously published, randomized trial, it was investigated whether autologous blood transfusions could overcome this putative detrimental effect. However, this did not appear to be the case. METHODS. In the current study, the authors analyzed the patterns of recurrence in 420 patients who underwent curative operations for colorectal cancer. RESULTS. Patients who did not require transfusions (N = 143) had significantly better disease-free survival than those who did need transfusions (N = 277); percentages at 4 years were 73% and 59%, respectively (p = 0.001). No difference was found between both groups in comparing cumulative percentages of patients having metastases; percentages at 4 years were 25% in the group that did not undergo transfusion and 27% in the transfused group. The percentage of cases having local recurrence, however, was significantly increased (p = 0.0006) in the transfused group as compared with the group that did not undergo transfusion; percentages at 4 years were 20% and 3%, respectively. The groups of patients receiving only allogeneic, only autologous, or both types of transfusions all had a significantly higher incidence of local recurrence than the patients who did not receive transfusions, but no differences were found between these three groups. CONCLUSIONS. These findings suggest that the association between blood transfusions and prognosis in colorectal cancer is a result of the circumstances that necessitate transfusions, leading to the development of local recurrences, but not of distant metastases

    Tumour growth stimulation after partial hepatectomy can be reduced by treatment with tumour necrosis factor α

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    This study investigated whether partial hepatectomy enhances the growth of experimental liver metastases of colonic carcinoma in rats and whether treatment with recombinant human tumour necrosis factor (TNF) α can reduce this increased growth. Resection of 35 or 70 per cent of the liver was performed in inbred WAG rats, with sham-operated controls (five to eight animals per group). Immediately after surgery 5·105 CC531 colonic tumour cells were injected into the portal vein. After 28 days the animals were killed and the number of liver metastases counted. A 35 per cent hepatectomy induced a significant increase in the median number of liver metastases (28 versus 3 in controls), whereas a 70 per cent resection provoked excessive growth, consistently leading to more than 100 liver metastases and a significantly increased wet liver weight in all animals. TNF-α was given intravenously to rats following 70 per cent hepatectomy or sham operation in a dose of 160 μg/kg three times per week. This had only a marginal effect on tumour development in sham-operated rats but was very effective following partial hepatectomy (median 45 liver metastases). These observations confirm previous findings that surgical metastasectomy may act as a ‘double-edged sword’ by provoking outgrowth of dormant tumour cells and suggest that adjuvant treatment with TNF-α may be of benefit in patients undergoing resection of metastases

    Exocrine and endocrine pancreatic function in patients with pancreatico-jejunostomy or pancreatic duct occlusion after pancreaticoduodenectomy

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    Pancreatic duct occlusion (PDO) is performed in some centres to avoid complications of pancreaticojejunostomy (PJ) after pancreaticodudodenectomy. The aim of our study was to study the exo- and endocrine pancreatic function, nutritional status and quality of life in patients with a PJ or PDO after a pancreatico-duodenectomy (PD)
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