64 research outputs found
Management of early neoplasms and surgical complications of the rectum
No full textColorectal cancer (CRC) is one of the most common cancers in the world and is expected to rise from 1.4 million annually diagnosed patients worldwide in 2012 to 2.4 million patients by 2035. In the Netherlands, currently 13,000 new patients are diagnosed with CRC each year, of which approximately one third have rectal cancer. The prognosis of patients with rectal cancer has improved significantly during the last two decades in the Netherlands. The cornerstone of locoregional treatment is still surgery, and improved quality of resection as well as locally advanced rectal cancer by specialised surgical teams contributed substantially to these improvements. Rectal cancer surgery is complex and requires specific expertise. But despite specialisation and centralisation, there is still a relatively high risk of postoperative complications. In contrast to literature on treatment of rectal cancer, prevention and treatment of short and long-term surgical complications has less extensively been explored. At the time prognosis improves, quality of life and management of treatment related morbidity becomes more and more important. Treatment of rectal cancer requires a multidisciplinary evidenced based approach, in which the treatment related morbidity has to be weighed against the expected health benefit. This thesis starts with a chapter on endoscopic treatment of the precursor lesions of rectal cancer. In the subsequent chapters, several complications after rectal surgery are discussed, focussing on predictive factors, prevention, and evaluation of treatment modalities
Calibration approaches in Multi-Node Antenna Characterization Setups
No full textIn this work we present calibration approaches aimed at mitigating the measurement error in testbenches featuring multiple sensor-nodes and operating over-the-air. Such errors can arise from fluctuations in component responses and mechanical tolerances of the setup. The calibration approaches are detailed for the case of the Antenna Dome measurement setup previously presented by the authors.In the current implementation, the Antenna Dome employs multiple dual linearly-polarized scalar sensing nodes, to enable real-time 2D (theta and phi) radiation pattern acquisition. The variation of the electrical response among the different sensing elements as well as their position, with respect to the nominal one, due to the mechanical tolerances, introduce systematic error in the generated radiation patterns.Over-the-air procedures to linearize the power conversion asymmetry within the dually polarized nodes as well as the linearity response across them are described. Proposed approach provides a reduction of the angular dependent error within ±0.5 dB across the various nodes. Moreover, to minimize the impact of mechanical deviations an over-the-air method is described to transfer the sensor coordinates from the mechanical reference system to the antenna under test one.Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Electronic
Perineal Wound Healing After Abdominoperineal Resection for Rectal Cancer: A Systematic Review and Meta-Analysis Reply
No full textPerineal wound healing after abdominoperineal resection for rectal cancer: a systematic review and meta-analysis
No full textImpaired perineal wound healing has become a significant clinical problem after abdominoperineal resection for rectal cancer. The increased use of neoadjuvant radiotherapy and wider excisions might have contributed to this problem. The primary aim of this systematic review with meta-analysis was to determine the impact of radiotherapy and an extralevator approach on perineal wound healing after abdominoperineal resection for rectal cancer. In March 2014, electronic databases were searched. Studies describing any outcome measure on perineal wound healing after abdominoperineal resection for rectal cancer were included. The primary end point was overall perineal wound problems within 30 days after conventional or extralevator abdominoperineal resection with or without neoadjuvant radiotherapy. Secondary end points were primary wound healing, perineal hernia rate, and the effect of biological mesh closure on perineal wound problems. A total of 32 studies were included. The pooled percentage of perineal wound problems after primary perineal wound closure in patients who did not undergo neoadjuvant radiotherapy was 15.3% (95% CI, 12.1-19.2) after conventional abdominoperineal resection and 14.8% (95% CI, 9.5-22.4) after extralevator abdominoperineal resection. After neoadjuvant radiotherapy, perineal wound problems occurred in 30.2% (95% CI, 19.2-44.0) after conventional abdominoperineal resection and in 37.6% (95% CI, 18.6-61.4) after extralevator abdominoperineal resection. Radiotherapy significantly increased perineal wound problems after abdominoperineal resection (OR, 2.22; 95% CI, 1.45-3.40; p < 0.001). After biological mesh closure of the pelvic floor following extralevator abdominoperineal resection with neoadjuvant radiotherapy, the percentage of perineal wound problems was 7.3% (95% CI, 1.5-29.3). Heterogeneity was high for some analyses. Neoadjuvant radiotherapy significantly increases perineal wound problems after abdominoperineal resection for rectal cancer, whereas the extralevator approach seems not to be of significant importanc
Iatrogenic injury of the urinary tract during salvage procedures for pelvic sepsis: Experience of a national referral centre
No full textAim: This study aimed to determine the incidence, consequences and outcomes of iatrogenic urinary tract injury (IUI) during salvage surgery for pelvic sepsis. Method: Patients who underwent salvage surgery for pelvic sepsis after prior low anterior resection or Hartmann's procedure for rectal cancer were prospectively maintained in a database between 2010 and 2020 and reviewed retrospectively. The primary endpoint was the incidence of IUI. Secondary endpoints were timing of diagnosis (intra- vs. postoperative), reinterventions related to the IUI and healing of IUI. Results: In total 126 consecutive patients were included, and IUI occurred in 13 patients (10%). A ureteric injury occurred in eight patients, bladder injury in four patients and a urethral injury in one patient. All patients with an IUI had radiotherapy as neoadjuvant treatment. The IUI was diagnosed postoperatively in 63% (n = 8/13) with a median duration between surgery and diagnosis of the IUI of 10 days (IQR: 6–15). The median number of reinterventions was five (range 1–31) in the group with a postoperative diagnosis and one (range 0–1) in the group with an intraoperative diagnosis. Four patients required a surgical reintervention, all concerning injuries diagnosed postoperatively. At the end of follow-up, 85% of patients (n = 11/13) had a healed IUI. Conclusion: Iatrogenic urinary tract injury is not uncommon in salvage procedures for pelvic sepsis, even in an experienced tertiary referral centre. Most injuries were diagnosed postoperatively which affects the severity of these complications, emphasising the need to improve intraoperative diagnostic modalities
Quality of life in patients with a perineal hernia
No full textIntroduction: Patients who develop a perineal hernia after abdominoperineal resection may experience discomfort during daily activities and urogenital dysfunction, but the impact on quality of life has never been formally assessed. Materials and methods: Patients who underwent abdominoperineal resection for rectal cancer between 2014 and 2022 in two prospective multicenter trials were included. Primary outcome was defined as median overall scores or scores on functional and symptom scales of the following quality of life questionnaires: 5-level version of the 5-dimensional EuroQol, Short Form-36, and European Organization for Research and Treatment of Cancer QoL Questionnaire Colorectal cancer 29 and 30, Urogenital Distress Inventory-6, Incontinence Impact Questionnaire-7. Results: Questionnaires were available in 27 patients with a perineal hernia and 62 patients without a perineal hernia. The 5-dimensional EuroQol score was significantly lower in patients with a perineal hernia (83 vs 87, p = 0.048), which implies a reduced level of functioning. The median scores of pain-specific domains were significantly worse in patients with a perineal hernia as measured by the SF-36 (78 vs. 90, p = 0.006), the EORTC-CR29 (17 vs. 11, p=<0.001) and EORTC-C30 (17 vs. 0, p = 0.019). Also, significantly worse physical (73 vs. 100, p = 0.049) and emotional (83 vs. 100, p = 0.048) functioning based on EORTC-C30 was observed among those patients. Minimally important differences were found for role, physical and social functioning of the SF-36 and EORTC-C30. The urological function did not differ between the groups. Conclusion: A symptomatic perineal hernia can significantly worsen quality of life on several domains, indicating the severity of this complication.</p
The Media Commons
No full textToday's global media sustains a potent new environmental consciousness. Paradoxically, it also serves as a far-reaching platform that promotes the unsustainable consumption ravaging our planet. Patrick Murphy musters theory, institutional analysis, fieldwork, and empirical research to map how the media communicates today's many distinct, competing, and even antagonistic environmental discourses, demonstrating how the media pushes us to save the whales even as we are encouraged to devour all the fish. By examining this paradox through case studies of the “greening” of cable TV, online corporate branding campaigns, indigenous media, and the globalization of commercial media, he shows how today's complex, integrated media networks draws the cultural boundaries of our environmental imagination—and influences just who benefits. Analysis emphasizes social context, institutional alignments, and commercial media's ways of rendering discussion. Murphy identifies and examines key terms, phrases, and metaphors as well as the ways consumers are presented with ideas like agency and the place of nature. What emerges is the link between pervasive messaging and an "environment" conjured by our media-saturated social imagination. As the author shows, today's complex, integrated media networks shape, frame, and deliver many of our underlying ideas about the environment. Increasingly—and ominously—individuals and communities experience these ideas not only in the developed world but in the increasingly consumption-oriented Global South.</p
Perineal wound healing after abdominoperineal resection for rectal cancer: a two-centre experience in the era of intensified oncological treatment
No full textIntensified treatment for distal rectal cancer has improved oncological outcome, but at the expense of more perineal wound complications in patients undergoing an abdominoperineal resection (APR). The aim of this study was to analyse perineal wound healing after APR with primary perineal wound closure over time. All patients undergoing APR for primary rectal cancer with primary wound closure between 2000 and 2013 were included and analysed in three consecutive time periods. Both early ( <30 days postoperatively) and late perineal wound complications were determined. Independent risk factors of early perineal wound complications were identified using multivariable analysis. A total of 136 patients were identified, of whom 129 patients underwent primary perineal wound closure. The use of neo-adjuvant (chemo)radiotherapy increased from 72 to 91%, and the use of an extralevator approach increased from 9 to 19%. The rate of early perineal wound complications increased from 18 to 31% and was independently associated with an extralevator approach [odds ratio (OR) 3.17; 95% confidence interval (CI) 1.16-8.66] and intra-operative perforation (OR 3.35; 95% CI 1.06-10.57). Perineal wound complications had no impact on local recurrence or 3-year overall survival rate. During a median follow-up of 28 months [interquartile range (IQR) 14-56], a persistent presacral sinus was diagnosed in 10%, and a perineal hernia occurred in 8% of the patients. The increased use of an extralevator APR for rectal cancer significantly increased the risk of perineal wound complications over time. Intra-operative perforation was also independently associated with impaired perineal wound healin
Adhesive small bowel obstruction following abdominal surgery in young children (≤ 3 years): A retrospective analysis of incidence and risk factors using multivariate cox regression
No full textBackground: Adhesions following abdominal surgery can cause small bowel obstruction (SBO) necessitating surgery. Whilst some studies have addressed SBO in children, the incidence of SBO, the diseases that are of increased risk as well as risk factors in young children remain unclear. Therefore, this study aims to determine; (1) the general incidence of SBO in young children, (2) which diseases entail highest incidence of SBO and (3) risk factors for SBO in young children. Study design: Young children (≤ 3 years of age) who underwent abdominal surgery in our tertiary referral centre between 1998–2018 were retrospectively included. Both general incidence and incidence per disease of SBO were determined. Independent risk factors for SBO were identified using cox-regression. Results: The incidence of SBO was 5% (N = 88/1931) in our cohort. Five of the SBOs developed following laparoscopic treatment. Patients treated for gastroschisis (17%,N = 9/53), necrotizing enterocolitis (8%,N = 15/188) and intestinal atresia (7%,N = 13/177) were at high risk of experiencing SBO. Diaphragmatic hernia (28%,N = 7/25) and meconium ileus (28%,N = 7/25) also showed high SBO proportions. Having a history of stoma (HR:3.2, 95%-CI:2.0–5.2), undergoing emergency surgery (HR:2.2, 95%-CI:1.3–3.7) and postoperative infections (HR:1.9, 95%-CI:1.2–3.1) were general risk factors for the development of SBO. Conclusion: The incidence of SBO in young children seems higher than what has previously been reported in older children, which is why they should be studied separately. The incidence of SBO differs between diseases. Having a history of a stoma, emergency surgery and postoperative infections were independent risk factors for SBO development. Although less at risk, SBOs do develop after laparoscopies, which is why they should be included in more long-term follow-up studies. Level of evidence: I
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