Heelkunde: De kunst van het helen

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

Immunological enhancement of skin allo- and heterografts

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

Utilization of the Aerial Photogrammetric Information on the Agrigultural Modernizaton (I) : On the Radio-controlled Nearby Aerial Photogrammetric Equipmentst

Aerial photogrammetry is the information science of measurement by means of space photographs, ordinary aerial photographs and nearby aerial photographs. It has been developed to the greatest extent in the field of topographic mapping from aerial photography, but there are many other applications of this science. Research work in aerial photogrammetry at the Kagawa University and Kobe University, has been focussed on the trial production and utilization of radio-controlled nearby aerial photogrammetric equipments since 1969. This paper deals with construction and principle of operation on the radio-controlled photogrammetric equipments (No. K-1 : model airplane, No. K-2 : model airship)

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

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

Percutaneous cholecystostomy for patients with acute cholecystitis and an increased surgical risk

Purpose: To evaluate percutaneous cholecystostomy in patients with acute cholecystitis and an increased surgical risk. Methods: Thirty-three patients with acute cholecystitis (calculous, n = 22; acalculous, n = 11) underwent percutaneous cholecystostomy by means of a transhepatic (n = 21) or transperitoneal (n = 12) access route. Clinical and laboratory parameters were retrospectively studied to determine the benefit from cholecystostomy. Results: All procedures were technically successful. Twenty-two (67%) patients improved clinically within 48 hr; showing a significant decrease in body temperature (n = 13), normalization of the white blood cell count (n = 3), or both (n = 6). There were 6 (18%) minor/moderate complications (transhepatic access, n = 3; transperitoneal access, n = 3). Further treatment for patients with calculous cholecystitis was cholecystectomy (n = 9) and percutaneous and endoscopic stone removal (n = 8). Further treatment for patients with acalculous cholecystitis was cholecystectomy (n = 2) and gallbladder ablation (n = 2). There were 4 deaths (12%) either in hospital or within 30 days of drainage; none of the deaths was procedure-related. Conclusions: Percutaneous cholecystostomy is a safe and effective procedure for patients with acute cholecystitis. For most patients with acalculous cholecystitis percutaneous cholecystostomy may be considered a definitive therapy. In calculous disease this treatment is often only temporizing and a definitive surgical, endoscopic, or radiologic treatment becomes necessary

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

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

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