30 research outputs found
Archeologisch veldonderzoek (IVO), d.m.v proefsleuvenGat van Bolmers, Schiedam, Gemeente Schiedam
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Inventariserend Veldonderzoek (IVO), d.m.v. proefsleuven
No full textTussen 14 en 17 april 2008 heeft Becker & Van de Graaf bv in opdracht van de gemeente Schiedam een Inventariserend Veldonderzoek (IVO) door middel van proefsleuven uitgevoerd op de locatie “Gat van Bolmers” te Schiedam, gemeente Schiedam. Het plangebied is gelegen in het zuidwesten van de middeleeuwse stad Schiedam, tussen het Broersveld en de Broersvest.
Uit het vooronderzoek is gebleken dat voor het plangebied een kans bestond op de aanwezigheid van archeologische resten uit de IJzertijd en Romeinse tijd en de Late Middeleeuwen en de Nieuwe tijd. Met name de kans op resten uit de Late Middeleeuwen en Nieuwe tijd was groot. Schiedam is ontstaan aan het begin van de 13e eeuw aan weerszijden van een dam in de Schie. In 1442 of 1443 vestigden de Kruisbroeders zich in Schiedam en stichtten een convent. Volgens de oudste stadsplattegrond van Schiedam, uit ca. 1560, maakte het plangebied deel uit van het kloosterterrein. Het was niet bekend in hoeverre de Beeldenstorm en latere sloopwerkzaamheden de resten van het klooster in de bodem hadden verstoord.
Uit informatie van de Historische Verenging Schiedam blijkt dat het Gat van Bolmers is ontstaan door sloopwerkzaamheden in de jaren zeventig van de 20e eeuw en in 1999. Tot die tijd stond aan weerszijden van het plangebied aaneengesloten bebouwing. Het klooster zou volgens de historische vereniging ten zuiden van het Herenpad gelegen moeten hebben.
Voor het proefsleuvenonderzoek waren drie proefsleuven gepland: één van oost naar west en twee van noord naar zuid. Uiteindelijk is slechts één proefsleuf aangelegd. De sleuf is laagsgewijs en trapsgewijs aangelegd tot een maximale diepte van 1,5 m –mv. Het onderzoek heeft in totaal dertig sporen opgeleverd, waarvan elf lagen. De overige sporen bestaan uit delen van muren, vloeren en een tongewelf. De funderingen kunnen op basis van de grootte van de bakstenen gedateerd worden in de eerste helft van de 17e eeuw en de latere aanpassingen als vloeren op basis van de grootte van de plavuizen in de 18e eeuw. De sporen zijn alle sterk verstoord, waarschijnlijk ten gevolge van de sloopwerkzaamheden, en er zijn in de vloeren en muren geen structuren te herkennen.
Het vondstmateriaal is waarschijnlijk huisafval afkomstig uit verwijderde kuilen en bestaat voornamelijk uit aardewerk. In zeer geringe hoeveelheden is er ook bot en glas aangetroffen. Metaal was niet aanwezig. Het aardewerk is te dateren vanaf het einde van de Late Middeleeuwen of begin van de Nieuwe tijd A tot in de 19e eeuw.
De sloopwerkzaamheden hebben een dusdanige invloed op het plangebied gehad dat er niet gesproken kan worden van een intacte vindplaats. Op basis van de resultaten van het onderzoek wordt door Becker & Van de Graaf geen vervolgonderzoek geadviseerd
Prospective nationwide outcome audit of surgery for suspected acute appendicitis
No full textStudies comparing laparoscopic and open appendicectomy are difficult to interpret owing to several types of bias, and the results often seem of limited clinical importance. National audits can be valuable to provide insight into outcomes following appendicectomy at a population level. A prospective, observational, resident-led, nationwide audit was carried out over a period of 2 months, including all consecutive adult patients who had surgery for suspected acute appendicitis. Complications after laparoscopic and open appendicectomy were compared by means of logistic regression analysis; subgroup analyses were performed for patients with complicated appendicitis. A total of 1975 patients were included from 62 participating Dutch hospitals. A normal appendix was seen in 3·3 per cent of patients. Appendicectomy was performed for acute appendicitis in 1378 patients, who were analysed. All but three patients underwent preoperative imaging. Laparoscopy was used in 79·5 per cent of patients; the conversion rate was 3·4 per cent. A histologically normal appendix was found in 2·2 per cent. Superficial surgical-site infection was less common in the laparoscopic group (odds ratio 0·25, 95 per cent c.i. 0·14 to 0·44; P < 0·001). The rate of intra-abdominal abscess formation was not significantly different following laparoscopic or open surgery (odds ratio 1·71, 0·80 to 3·63; P = 0·166). Similar findings were observed in patients with complicated appendicitis. Management of acute appendicitis in the Netherlands is preferably performed laparoscopically, characterized by a low conversion rate. Fewer superficial surgical-site infections occurred with laparoscopy, although the rate of abscess formation was no different from that following open surgery. A low normal appendix rate is the presumed effect of a mandatory preoperative imaging strateg
Appendicular neoplasms and consequences in patients undergoing surgery for suspected acute appendicitis
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229842.pdf (Publisher’s version ) (Open Access)INTRODUCTION: In patients treated with an appendectomy for acute appendicitis, the specimen is generally sent for histological evaluation. In an era of increasing non-operative treatment for acute appendicitis, it is important to know the incidence, the diagnostic accuracy, and treatment consequences of appendicular neoplasms that are found in acute appendicitis. We hypothesize that pre- and intra-operative parameters might predict an appendicular neoplasm. METHODS: Data was used from our previous prospective observational cohort study. All patients undergoing surgery for suspected acute appendicitis were included. The primary outcome was the incidence of appendicular neoplasms in patients operated for acute appendicitis. Secondary outcomes were pre-operative diagnostics and imaging outcomes, intra-operative surgical judgment, and postoperative management and outcome. Possible predictors of an appendicular neoplasm were identified and used in multivariable logistic regression. Patients with an appendicular neoplasm were followed for 3 years after initial appendectomy. RESULTS: A total of 1975 patients underwent surgery for suspected acute appendicitis and in 98.3% (1941/1975) the appendix was removed. In 1.5% (30/1941) of these patients, an appendicular neoplasm was found. Among the malignant neoplasms, the majority were grade 1 neuroendocrine tumors (NET) in 65% (13/20). On pre-operative imaging, there was no suspicion of malignancy. In three cases, there was an intra-operative suspicion of malignancy. Multivariable analysis showed only age as an independent predictor for appendicular neoplasms. No recurrent or new malignancy was found during follow-up. DISCUSSION: The incidence of appendicular neoplasm in patients undergoing an acute appendectomy is very low and clinical risk factors could not be identified
A comparison of the long-term outcome of partial articular (AO Type B) and complete articular (AO Type C) distal radius fractures
No full textA short-term comparison of AO type B (shearing) and type C (compression) articular fractures of the distal radius found no significant differences in functional outcome, but long-term studies would provide important information. We tested the null hypothesis that there is no difference in arm-specific disability between patients with type B and C fractures in long-term follow-up. We evaluated 46 patients (17 with type B fractures and 29 patients with 31 type C fractures of the distal radius) with a mean age of 39 years at the time of injury at a mean of 20 years after operative treatment. We used the Disabilities of the Arm, Shoulder, and Hand questionnaire and 2 physician-based rating systems, the modified Mayo wrist score and the modified Gartland and Werley score. We performed bivariate and multivariable analyses to identify the factors that contributed most to the variation in these scores. There were no significant differences between patients with type B and C fractures on the Disabilities of the Arm, Shoulder, and Hand, modified Mayo wrist, or Gartland and Werley scores, or with respect to range of motion, grip strength, and arthrosis. The only statistical difference was in volar tilt of the articular surface on lateral radiographs. On average, patients undergoing operative treatment of type B and type C articular fractures of the distal radius have similar impairment, symptoms, and disability in the long-term. Therapeutic II
Diagnosing acute appendicitis:surgery or imaging?
No full textAIM: Investigation of suspected appendicitis varies widely across different countries, which creates variation in outcome for patients. Use of imaging drives much of this variation, with concerns over delay of imaging and radiation exposure of computed tomography being balanced against the risks of unnecessary surgery.METHOD: Two national, prospective snapshot audits (UK n = 3326 and Netherlands n = 1934) reported investigation, management and outcome of appendicectomy and can be compared to generate treatment recommendations.RESULTS: Preoperative imaging was conducted in 32.8% of UK patients in contrast to 99.5% of patients in the Netherlands. A large difference in the normal appendicectomy rate was observed (20.6% in the UK vs 3.2% in the Netherlands) and the connection between these two outcome differences cannot be neglected.CONCLUSION: This article discusses the role of imaging in the diagnostic work-up of patients who are suspected of acute appendicitis, comparing national snapshot studies as a model to do so.</p
Discriminating complicated from uncomplicated appendicitis by ultrasound imaging, computed tomography or magnetic resonance imaging: systematic review and meta-analysis of diagnostic accuracy
No full textBACKGROUND: Discriminating complicated from uncomplicated appendicitis is crucial. Patients with suspected complicated appendicitis are best treated by emergency surgery, whereas those with uncomplicated appendicitis may be treated with antibiotics alone. This study aimed to obtain summary estimates of the accuracy of ultrasound imaging, CT and MRI in discriminating complicated from uncomplicated appendicitis. METHODS: A systematic literature review was conducted by an electronic search in PubMed, Embase and the Cochrane Library for studies describing the diagnostic accuracy of complicated versus uncomplicated appendicitis. Studies were included if the population comprised adults, and surgery or pathology was used as a reference standard. Risk of bias and applicability were assessed with QUADAS-2. Bivariable logitnormal random-effect models were used to estimate mean sensitivity and specificity. RESULTS: Two studies reporting on ultrasound imaging, 11 studies on CT, one on MRI, and one on ultrasonography with conditional CT were included. Summary estimates for sensitivity and specificity in detecting complicated appendicitis could be calculated only for CT, because of lack of data for the other imaging modalities. For CT, mean sensitivity was 78 (95 per cent c.i. 64 to 88) per cent, and mean specificity was 91 (85 to 99) per cent. At a median prevalence of 25 per cent, the positive predictive value of CT for complicated appendicitis would be 74 per cent and its negative predictive value 93 per cent. CONCLUSION: Ultrasound imaging, CT and MRI have limitations in discriminating between complicated and uncomplicated appendicitis. Although CT has far from perfect sensitivity, its negative predictive value for complicated appendicitis is high
Predictors for interval appendectomy in non-operatively treated complicated appendicitis
No full textPurpose: To determine the incidence rate and identify predictive factors for interval appendectomy after non-operatively treated complicated appendicitis. Methods: Single-center retrospective cohort study conducted between January 2008 and June 2017. Adult patients with acute appendicitis were identified. Patients with complicated appendicitis initially treated non-operatively were included. Outcomes included abscess rate on imaging, results of additional imaging during follow-up, incidence rate of and surgical indications for interval appendectomy, and outcomes of histological reports. Results: Of all adult patients with acute appendicitis (n = 1839), 9% (170/1839) was initially treated non-operatively. Median age of these patients was 55 years (IQR 42–65) and 48.8% (83/170) were men. In 36.4% (62/170) of the patients, an appendicular abscess was diagnosed. 62.4% (106/170) did not require subsequent surgery (no interval appendectomy group) and in 37.6% (64/170), an interval appendectomy was performed (interval appendectomy group). Median follow-up was 80 weeks (17–192) and 113 weeks (34–246), respectively. Most frequent reason to perform subsequent surgery was recurrent appendicitis (45% (29/64)). Increasing age was significantly associated with a lower risk of undergoing interval appendectomy (OR 0.7; CI 0.6–0.89); p = 0.002). In the interval appendectomy group, appendicular neoplasm was found in 11% (7/64) of the patients, in contrast to 1.5% (25/1669) of the patients that had acute surgery (p < 0.001). Conclusions: One out of three patients non-operatively treated for complicated appendicitis required an interval appendectomy. The incidence of appendicular neoplasms was high in these patients compared with those that had acute surgery. Therefore, additional radiological imaging following non-operatively treated complicated appendicitis is recommended
