1
|
Blikman T, Rienstra W, van Raaij TM, ten Hagen AJ, Dijkstra B, Zijlstra WP, Bulstra SK, Stevens M, van den Akker-Scheek I. Duloxetine in OsteoArthritis (DOA) study: effects of duloxetine on pain and function in end-stage hip and knee OA – a pragmatic enriched randomized controlled trial. BMC Musculoskelet Disord 2022; 23:115. [PMID: 35123461 PMCID: PMC8818142 DOI: 10.1186/s12891-022-05034-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/10/2022] [Indexed: 12/27/2022] Open
Abstract
Background Some osteoarthritis (OA) patients experience inadequate pain relief from analgesics like acetaminophen and nonsteroidal anti-inflammatory drugs. This could be the result of experienced non-nociceptive centralized pain. Placebo-controlled randomized trials (RCT) have proven the effectiveness of duloxetine for OA and several chronic pain conditions where central sensitization (CS) is one of the key underlying pain mechanisms. Objectives Assess the efficacy of an 8-week duloxetine treatment compared to usual care in end-stage knee and hip OA patients with a level of centralized pain. Design Pragmatic, enriched, open-label RCT. Methods Patients were randomized to duloxetine or to care-as-usual. Primary outcome was pain in the index joint, measured with the pain domain of the Knee injury and Osteoarthritis Outcome Score (KOOS) or the Hip disability and Osteoarthritis Outcome Score (HOOS). The intention-to-treat principle was used, with mixed-model repeated measures to analyze the effect. Results One hundred eleven patients were randomized. Nearly 44% felt much to very much better after duloxetine usage compared to 0% in the care-as-usual group (p < 0.001). The duloxetine group scored 11.3 points (95%CI: 5.8, 16.8) better on the pain domain of the KOOS/HOOS (p < 0.001). Knee patients improved significantly more than hip patients (18.7 [95%CI: 11.3, 26.1] versus 6.0 [95%CI: − 2.6, 14.5] points better). Conclusions Adding duloxetine treatment seems to be beneficial for end-stage knee OA patients with neuropathic-like symptoms (at risk of CS). End stage Hip OA patients seem to be nonresponsive to duloxetine. Trial registration Dutch Trial Registry with number NTR 4744 (15/08/2014) and in the EudraCT database with number 2013–004313-41. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05034-0.
Collapse
|
2
|
Rietbergen T, Marang-van de Mheen PJ, de Graaf J, Diercks RL, Janssen RPA, van der Linden-van der Zwaag HMJ, van den Akker-van Marle ME, Steyerberg EW, Nelissen RGHH, van Bodegom-Vos L, Hofstee DJ, van Geenen RCI, Koenraadt KLM, Onderwater JPAH, Kleinlugtenbelt YV, Gosens T, Klos TVS, Rijk PC, Dijkstra B, Zeegers AVCM, Hoogeslag RAG, Veld MHAHI, Polak AA, Pereira NRP, Vervest TMJS, van der Veen HC, Lopuhaä N. A tailored intervention does not reduce low value MRI's and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:4134-4143. [PMID: 35391552 PMCID: PMC9668785 DOI: 10.1007/s00167-022-06949-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the effectiveness of a tailored intervention to reduce low value MRIs and arthroscopies among patients ≥ 50 years with degenerative knee disease in 13 Dutch orthopaedic centers (intervention group) compared with all other Dutch orthopaedic centers (control group). METHODS All patients with degenerative knee disease ≥ 50 years admitted to Dutch orthopaedic centers from January 2016 to December 2018 were included. The tailored intervention included participation of clinical champions, education on the Dutch Choosing Wisely recommendation for MRI's and arthroscopies in degenerative knee disease, training of orthopaedic surgeons to manage patient expectations, performance feedback, and provision of a patient brochure. A difference-in-difference analysis was used to compare the time trend before (admitted January 2016-June 2017) and after introduction of the intervention (July 2017-December 2018) between intervention and control hospitals. Primary outcome was the monthly percentage of patients receiving a MRI or knee arthroscopy, weighted by type of hospital. RESULTS 136,446 patients were included, of whom 32,163 were treated in the intervention hospitals. The weighted percentage of patients receiving a MRI on average declined by 0.15% per month (β = - 0.15, P < 0.001) and by 0.19% per month for arthroscopy (β = - 0.19, P < 0.001). However, these changes over time did not differ between intervention and control hospitals, neither for MRI (β = - 0.74, P = 0.228) nor arthroscopy (β = 0.13, P = 0.688). CONCLUSIONS The extent to which patients ≥ 50 years with degenerative knee disease received a MRI or arthroscopy declined significantly over time, but could not be attributed to the tailored intervention. This secular downward time trend may reflect anoverall focus of reducing low value care in The Netherlands. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- T. Rietbergen
- grid.10419.3d0000000089452978Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - P. J. Marang-van de Mheen
- grid.10419.3d0000000089452978Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - J. de Graaf
- grid.10419.3d0000000089452978Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - R. L. Diercks
- grid.4494.d0000 0000 9558 4598Department of Orthopaedics, University Medical Center Groningen, Groningen, The Netherlands
| | - R. P. A. Janssen
- grid.414711.60000 0004 0477 4812Department of Orthopaedic Surgery and Trauma, Maxima Medical Center, Eindhoven, The Netherlands ,grid.6852.90000 0004 0398 8763Orthopaedic Biomechanics, Department Of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands ,grid.448801.10000 0001 0669 4689Chair Value-Based Health Care, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | | | - M. E. van den Akker-van Marle
- grid.10419.3d0000000089452978Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - E. W. Steyerberg
- grid.10419.3d0000000089452978Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - R. G. H. H. Nelissen
- grid.10419.3d0000000089452978Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - L. van Bodegom-Vos
- grid.10419.3d0000000089452978Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Olthof M, Stevens M, Dijkstra B, Bulstra SK, Van Den Akker-Scheek I. Actual and perceived nursing workload and the complexity of patients with total hip arthroplasty. Appl Nurs Res 2018; 39:195-199. [PMID: 29422158 DOI: 10.1016/j.apnr.2017.11.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 11/17/2017] [Accepted: 11/19/2017] [Indexed: 11/30/2022]
Affiliation(s)
- M Olthof
- University of Groningen, University Medical Center Groningen, Department of Orthopedics, The Netherlands.
| | - M Stevens
- University of Groningen, University Medical Center Groningen, Department of Orthopedics, The Netherlands.
| | - B Dijkstra
- Medical Center Leeuwarden, The Netherlands.
| | - S K Bulstra
- University of Groningen, University Medical Center Groningen, Department of Orthopedics, The Netherlands.
| | - I Van Den Akker-Scheek
- University of Groningen, University Medical Center Groningen, Department of Orthopedics, The Netherlands.
| |
Collapse
|
4
|
Robinson B, Dijkstra B, Davey V, Tomlinson S, Frampton C. Adherence to Adjuvant Endocrine Therapy in Christchurch Women with Early Breast Cancer. Clin Oncol (R Coll Radiol) 2017; 30:e9-e15. [PMID: 29103853 DOI: 10.1016/j.clon.2017.10.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/16/2017] [Accepted: 10/04/2017] [Indexed: 01/31/2023]
Abstract
AIMS To assess adherence to adjuvant endocrine therapy by a real-world cohort of women in Christchurch and to determine any associated factors. MATERIALS AND METHODS Records were retrieved of all women newly diagnosed with early breast cancer and registered on the Christchurch Breast Cancer Patient Register over 4 years from June 2009. Demographic and pathological factors, dates of starting and stopping endocrine therapies and reported side-effects were collected. The proportion remaining on endocrine therapy was analysed by Kaplan-Meier curve; Cox regression analysis was used to identify independent factors influencing adherence. RESULTS Of 1213 women, 1018 (83.9%) had oestrogen receptor-positive tumours, of whom 674 (66.2%) started adjuvant endocrine therapy, including 62 (9.2%) neoadjuvantly. Uptake was 52.4% of those with T1 tumours, 89% with T2 tumours, 93% with T3/T4 tumours, 92.7% with node-positive tumours and 49.7% with node-negative tumours. The initial endocrine therapy was an aromatase inhibitor in 254 (38%) and tamoxifen for 412 (61%). At 1 year, 90% remained adherent, at 2 years 84%, at 3 years 81%, at 4 years 76%, at 4.5 years 71% and at 5 years 50%, with a median duration of 60 months (56-64 months, 95% confidence interval) and a median follow-up of 33 months. Overall, 135 (20%) women stopped treatment for adverse events or poor tolerability. A longer persistence with endocrine therapy was associated with node-positive tumours (hazard ratio 1.38, P = 0.003), but not first hormone used; aromatase inhibitor compared with tamoxifen, P = 0.76. CONCLUSION Adjuvant endocrine therapy use fell to 50% by 5 years, limiting possible survival benefits, providing support for efforts to increase compliance.
Collapse
Affiliation(s)
- B Robinson
- University of Otago Christchurch, Christchurch, New Zealand; Oncology Service, Christchurch Hospital, Christchurch, New Zealand; Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand.
| | - B Dijkstra
- Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - V Davey
- Department of General Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - S Tomlinson
- University of Otago Christchurch, Christchurch, New Zealand
| | - C Frampton
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| |
Collapse
|
5
|
Konijn N, van Tuyl L, Dijkstra B, Bultink I, van der Schueren M, Lems W. FRI0542 Bioelectrical Impedance Analysis Is Not A Valid Method for The Assessment of Body Composition in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
6
|
Blikman T, Rienstra W, van Raaij TM, ten Hagen AJ, Dijkstra B, Zijlstra WP, Bulstra SK, van den Akker-Scheek I, Stevens M. Duloxetine in OsteoArthritis (DOA) study: study protocol of a pragmatic open-label randomised controlled trial assessing the effect of preoperative pain treatment on postoperative outcome after total hip or knee arthroplasty. BMJ Open 2016; 6:e010343. [PMID: 26932142 PMCID: PMC4785324 DOI: 10.1136/bmjopen-2015-010343] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 12/14/2015] [Accepted: 12/17/2015] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Residual pain is a major factor in patient dissatisfaction following total hip arthroplasty or total knee arthroplasty (THA/TKA). The proportion of patients with unfavourable long-term residual pain is high, ranging from 7% to 34%. There are studies indicating that a preoperative degree of central sensitisation (CS) is associated with poorer postoperative outcomes and residual pain. It is thus hypothesised that preoperative treatment of CS could enhance postoperative outcomes. Duloxetine has been shown to be effective for several chronic pain syndromes, including knee osteoarthritis (OA), in which CS is most likely one of the underlying pain mechanisms. This study aims to evaluate the postoperative effects of preoperative screening and targeted duloxetine treatment of CS on residual pain compared with care-as-usual. METHODS AND ANALYSIS This multicentre, pragmatic, prospective, open-label, randomised controlled trial includes patients with idiopathic hip/knee OA who are on a waiting list for primary THA/TKA. Patients at risk for CS will be randomly allocated to the preoperative duloxetine treatment programme group or the care-as-usual control group. The primary end point is the degree of postoperative pain 6 months after THA/TKA. Secondary end points at multiple time points up to 12 months postoperatively are: pain, neuropathic pain-like symptoms, (pain) sensitisation, pain catastrophising, joint-associated problems, physical activity, health-related quality of life, depressive and anxiety symptoms, and perceived improvement. Data will be analysed on an intention-to-treat basis. ETHICS AND DISSEMINATION The study is approved by the local Medical Ethics Committee (METc 2014/087) and will be conducted according to the principles of the Declaration of Helsinki (64th, 2013) and the Good Clinical Practice standard (GCP), and in compliance with the Medical Research Involving Human Subjects Act (WMO). TRIAL REGISTRATION NUMBER 2013-004313-41; Pre-results.
Collapse
Affiliation(s)
- T Blikman
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - W Rienstra
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T M van Raaij
- Department of Orthopaedics, Martini Hospital Groningen, Groningen, The Netherlands
| | - A J ten Hagen
- Department of Anaesthesiology, Martini Hospital Groningen, Groningen, The Netherlands
| | - B Dijkstra
- Department of Orthopaedics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - W P Zijlstra
- Department of Orthopaedics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - S K Bulstra
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - I van den Akker-Scheek
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Stevens
- Department of Orthopaedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
7
|
Abstract
Various strategies have been proposed for the management of retained calculi within the biliary tree following cholecystectomy. We present a unique case of a cystic duct remnant calculus causing Mirizzi syndrome, only the fourth such case of its kind. An open procedure was planned, however the calculus was eventually extracted endoscopically. The pathophysiology and management of Mirizzi syndrome and retained calculi within the cystic duct remnant are discussed along with the merits of a minimally invasive approach.
Collapse
Affiliation(s)
- Simon Janes
- Department of General Surgery, Christchurch Public Hospital, Christchurch, New Zealand
| | | | | |
Collapse
|
8
|
Dijkstra B, Zijlstra W, Scherder E, Kamsma Y. P2.076 Gait episodes and step detection in older adults and Parkinson patients: accuracy of an accelerometry based method and a pedometer. Parkinsonism Relat Disord 2008. [DOI: 10.1016/s1353-8020(08)70306-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
9
|
Dijkstra B, Prichard RS, Lee A, Kelly LM, Smyth PPA, Crotty T, McDermott EW, Hill ADK, O'Higgins N. Changing patterns of thyroid carcinoma. Ir J Med Sci 2007; 176:87-90. [PMID: 17486294 DOI: 10.1007/s11845-007-0041-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Accepted: 01/10/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND To assess changing trends in histological types of thyroid cancer in an Irish hospital over the past 30 years. METHODS Biographical data, tumour characteristics, treatment and outcome from 190 patients with thyroid carcinoma from 1970 to 2000 were reviewed retrospectively. RESULTS Detailed records of 190 patients with thyroid cancer were identified with a mean age at presentation of 50 years. From 1970 to 1979 the distribution of histological types was: papillary carcinoma; 9 patients (4.7%), follicular; 17 patients (8.9%), anaplastic; 9 patients (4.7%), medullary; 1 patient (0.5%) and lymphoma; 1 patient (0.5%). From 1980 to 1989 papillary carcinoma accounted for 32 patients (16.8%), follicular; 14 patients (7.3%), anaplastic; 13 patients (6.8%), medullary; 7 patients (3.7%) and lymphoma; 5 patients (2.6%). From 1990 to 1999 papillary cancer accounted for 48 patients (25.2%), follicular; 14 patients (7.3%), anaplastic; 8 patients (4.2%), medullary; 7 patients (3.7%) and lymphoma; 5 patients (2.6%). Survival rates were significantly better for those aged less than 45 years (P < 0.0001), female sex (P < 0.01) and those with papillary carcinoma (P < 0.01). CONCLUSIONS This study demonstrated a significant increase in the incidence of papillary carcinoma. This may be related to increasing dietary iodine intake and may be significant as papillary carcinoma is associated with a more favourable prognosis.
Collapse
Affiliation(s)
- B Dijkstra
- Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Scarlett A, Dijkstra B, Mercer P. BS17P UTILISATION OF CYTOLOGICAL AND HISTOLOGICAL DIAGNOSIS IN THE MANAGEMENT OF BREAST CANCER BY NEW ZEALAND SURGEONS. ANZ J Surg 2007. [DOI: 10.1111/j.1445-2197.2007.04114_17.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
Edirimanne S, Mckenzie K, Wells S, Dijkstra B. BS11 THE ROLE OF PRE-OPERATIVE MRI IN PATIENTS WITH INVASIVE LOBULAR CARCINOMA OF BREAST. ANZ J Surg 2007. [DOI: 10.1111/j.1445-2197.2007.04114_11.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
12
|
Kelly LM, Hill ADK, Kennedy S, Connolly EM, Ramanath R, Teh S, Dijkstra B, Purcell R, McDermott EW, O'Higgins N. Lack of prognostic effect of Cox-2 expression in primary breast cancer on short-term follow-up. Eur J Surg Oncol 2004; 29:707-10. [PMID: 14602487 DOI: 10.1016/j.ejso.2003.07.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AIMS Cyclo-oxygenase (Cox) catalyses the conversion of arachidonic acid into prostaglandins (PG) and other eciosanoids. The prostaglandins, especially PGE(2) are implicated in tumorigenesis via angiogenesis and suppression of immune reactivity. There are two known isoforms of the enzyme, Cox-1, which is constitutively expressed and the inducible isoform, Cox-2. Cox-2 is induced in response to inflammatory mediators, growth factors, oncogenes and mitogens. Non-selective Cox inhibitors may reduce the relative risk of colonic and breast carcinoma. METHODS We studied the expression of Cox-2 by immunohistochemistry in 106 primary breast carcinoma specimens collected over a three-year period, using a commercially available polyclonal antibody on formalin-fixed, paraffin-embedded tissue. The slides were examined independently by two pathologists. Tumours were classified according to accepted criteria and an immunohistochemical score (IHS) was calculated for each specimen. The IHS combines the percentage of immunoreactive cells (quantity score) and an estimate of staining intensity (staining intensity score). RESULTS All patients were female. The mean age was 53 years, range 28-86 years. Forty percent (n=42) of tumours were node negative and 60% (n=64) node positive. Forty-nine percent (n=52) of tumours were grade 3, a further 49% (n=52) grade 2 and 2% (n=2) grade 1. There was no statistically significant correlation between IHS and tumour size, grade, histology, nodal status, estrogen receptor or progesterone receptor positivity. A trend was observed showing an IHS of zero is associated with prolonged survival compared with an IHS of 9-12. CONCLUSION Cox-2 expression in primary breast cancer does not correlate with accepted pathological or biochemical prognostic indicators.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/metabolism
- Breast Neoplasms/enzymology
- Breast Neoplasms/metabolism
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/metabolism
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Intraductal, Noninfiltrating/metabolism
- Carcinoma, Intraductal, Noninfiltrating/mortality
- Carcinoma, Lobular/metabolism
- Carcinoma, Lobular/mortality
- Cyclooxygenase 2
- Female
- Follow-Up Studies
- Humans
- Immunohistochemistry
- Isoenzymes/metabolism
- Membrane Proteins
- Middle Aged
- Neoplasm Staging
- Predictive Value of Tests
- Prognosis
- Prostaglandin-Endoperoxide Synthases/metabolism
- Survival Analysis
Collapse
Affiliation(s)
- L M Kelly
- Surgical Professorial Unit, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
BACKGROUND Despite advances in the early detection and treatment of breast carcinoma, the mortality and morbidity rates associated with this disease remain high. Primary prevention, therefore, offers the best chance of making a major impact on outcome. METHODS The aim was to review the rationale, current stage of development and adverse effects of the strategies involved in the primary prevention of breast carcinoma. A review of the literature was undertaken by searching the MEDLINE database for the period 1966-2002 without language restrictions. RESULTS AND CONCLUSION Currently, the only agent to have general approval for chemoprevention of breast carcinoma is tamoxifen. Women who derive the greatest benefit in terms of risk reduction from tamoxifen are premenopausal with a 5-year Gail risk factor of more than 1.66 per cent, postmenopausal with a 5-year Gail risk factor of more than 3 per cent, and postmenopausal without a uterus. In these specific subgroups, tamoxifen should be considered for the chemoprevention of breast carcinoma. Raloxifene, retinoids, aromatase inhibitors and cyclo-oxygenase 2 inhibitors require further clinical investigation before adoption in this context. Surgical intervention should largely be limited to those women who have a BRCA1 or BRCA2 mutation.
Collapse
Affiliation(s)
- R S Prichard
- Surgical Professorial Unit, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | | | | | | | | |
Collapse
|
14
|
Abstract
AIMS To review the role of tyrosinase RT-PCR in the detection of clinically occult metastatic disease, both within the regional lymph nodes and peripheral blood of patients with malignant melanoma. Secondly, to assess whether the detection of such minimal disease has clinical implications for patients with melanoma. METHODS A review of the literature was undertaken by searching the MEDLINE database for the period 1966-2002 without any language restrictions. Keywords included 'Molecular staging of melanoma', 'Reverse transcription polymerase chain reaction', 'Malignant melanoma' and 'Tyrosinase'. CONCLUSIONS Detection of tyrosinase RT-PCR positive cells within the peripheral blood correlates with the clinical stage of malignant melanoma, the primary tumour thickness and other known prognostic indicators. Positive tyrosinase RT-PCR is associated with a reduction of disease-free survival and overall survival. Current studies demonstrate a higher rate of recurrence in RT-PCR positive patients with clinical stage II and III disease. Implications of a positive result within the regional lymph nodes are less well defined. A significant correlation has been demonstrated between positive results and increasing primary melanoma thickness. However, a large number of false-positive results have been demonstrated, due to benign naevi and schwann cells, which may hamper any statistically significant conclusions being reached.
Collapse
Affiliation(s)
- R S Prichard
- Department of Surgery, St. Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland
| | | | | | | | | |
Collapse
|
15
|
Dijkstra B, Healy C, Kelly LM, McDermott EW, Hill ADK, O'Higgins N. Parathyroid localisation--current practice. J R Coll Surg Edinb 2002; 47:599-607. [PMID: 12365423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
In patients with primary hyperparathyroidism, neck exploration by an experienced parathyroid surgeon is curative in excess of 95% of cases. Considerable efforts have been devoted to improving parathyroid imaging. New radionucleotide agents and scanning procedures have markedly improved the success rate of localization studies with subsequent development of minimally invasive surgical techniques. In this article we review the different localization techniques and their current role in parathyroid surgery for primary hyperparathyroidism
Collapse
Affiliation(s)
- B Dijkstra
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | | | | | | | | | | |
Collapse
|
16
|
Leonard DS, Hill ADK, Kelly L, Dijkstra B, McDermott E, O'Higgins NJ. Anti-human epidermal growth factor receptor 2 monoclonal antibody therapy for breast cancer. Br J Surg 2002; 89:262-71. [PMID: 11872048 DOI: 10.1046/j.0007-1323.2001.02022.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Advances in molecular biology and improved understanding of tumour biology have led to the development of novel treatments for cancer. Trastuzumab (Herceptin; Genentech, San Francisco, California, USA) is a monoclonal antibody directed against human epidermal growth factor receptor (HER) 2 protein, which is overexpressed in a wide variety of human cancers, including 20-30 per cent of human breast cancers. HER-2 plays an important role in oncogenic transformation, tumorigenesis and metastatic spread. Overexpression is associated with a poor prognosis and predicts a poor response to several treatment modalities. METHOD Literature relating to the monoclonal antibody was identified by a Medline literature search and by cross-referencing from the references of seminal articles on the subject. Four major clinical trials were identified and reviewed. RESULTS AND CONCLUSION In clinical trials approximately 15-20 per cent of patients with HER-2-overexpressing tumours benefited from treatment with trastuzumab. In sensitive patients the antibody appeared to have intrinsic anticancer activity when given as a single agent. In combination chemotherapy it appeared to act synergistically with other agents. Ongoing research is evaluating trastuzumab in combination with numerous standard chemotherapy regimens and with other novel chemotherapeutic agents. Clinical trials have also revealed several serious side-effects of monoclonal antibody therapy. Most notable is an unpredictable cardiotoxicity, especially when used in combination with anthracycline-based chemotherapy regimens.
Collapse
Affiliation(s)
- D S Leonard
- Department of Surgery, St Vincent's University Hospital, University College Dublin, Elm Park, Dublin 4, Ireland
| | | | | | | | | | | |
Collapse
|
17
|
Healy C, Dijkstra B, Kelly L, McDermott EW, Hill ADK, O'Higgins N. Pregnancy-associated breast cancer. Ir Med J 2002; 95:51-2, 54. [PMID: 11989949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Twelve premenopausal women diagnosed with pregnancy-associated breast cancer between May 1985 and October 1999 were reviewed. Three patients were diagnosed in the first trimester of pregnancy, five in the second trimester, and three during the third trimester. There was one patient who was five weeks postpartum. At the time of diagnosis nine patients had lymph node involvement and two of these had metastatic disease. Four patients received primary chemotherapy. The remainder had surgery. Five patients died, two had metastatic disease at time of diagnosis, median survival was 31 months. There were three fetal deaths, one termination and two during primary chemotherapy. The diagnosis of breast cancer during pregnancy is difficult. Presentation is usually at an advanced stage. Surgery can be safely performed during pregnancy and adjuvant chemotherapy should not be postponed until after delivery.
Collapse
Affiliation(s)
- C Healy
- Department of Surgery, St Vincent's University Hospital, Dublin 4, Ireland
| | | | | | | | | | | |
Collapse
|
18
|
Hooper SB, Hill ADK, Kennedy S, Dijkstra B, Kelly LM, McDermott EWM, O'Higgins N. Tamoxifen as the primary treatment in elderly patients with breast cancer. Ir J Med Sci 2002; 171:28-30. [PMID: 11993590 DOI: 10.1007/bf03168937] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND With the increasing incidence of breast cancer in patients over 70 years, there is interest in the best therapeutic approach. AIMS To review the management of breast cancer in elderly women and to identify the factors involved in the decision to treat patients with tamoxifen as first line therapy. PATIENTS AND METHODS Between 1986 and 1999, 302 female patients aged > or = 70 years presented with primary breast cancer, of whom 219 underwent surgery, 79 received tamoxifen as first line treatment and four received primary radiotherapy. A retrospective review was performed on these 79 patients and the outcome recorded. RESULTS Of these 79 patients, data was available on 68. Follow-up ranged from one to 63 months (median 17 months). Co-morbidity was the principal reason for choosing first line tamoxifen therapy in 61% and patient preference in 11%. Tumour size was less than 5cm in 51%. In 25% tumour size decreased, in 24% it remained stable and in 27% it increased in size following tamoxifen therapy. Additional treatment was prescribed for 33% of patients. CONCLUSION In the authors' experience, for those elderly patients suffering considerable co-morbidity or who refuse surgical intervention, tamoxifen is an acceptable alternative.
Collapse
Affiliation(s)
- S B Hooper
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | | | | | | | | | | | | |
Collapse
|
19
|
Manecksha R, Hill AD, Dijkstra B, Kelly L, Collins CD, McDermott E, O'Higgins NJ. Value of sentinel node biopsy in the management of breast cancer. Ir J Med Sci 2001; 170:233-5. [PMID: 11918327 DOI: 10.1007/bf03167785] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS To determine the rate of detection of the sentinel node using both blue dye and radioisotope, and the accuracy with which the sentinel node histology reflects the nodal status of the axilla in a series of patients with clinically node-negative breast cancer. PATIENTS AND METHODS During a 32-month period from May 1998 to December 2000, 73 patients with clinically node-negative breast cancer underwent sentinel node biopsy immediately followed by formal axillary lymphadenectomy. The sentinel node(s) was identified using a combination of lymphoscintigraphy, blue dye and an intraoperative hand-held gamma probe. RESULTS The mean age of the 73 patients was 58 years (range 32-83 years). Twenty-six per cent (19/73) had previous surgical/excisional biopsy. Pre-operative lymphoscintigraphy was positive in 74% (54/73) of patients. Combination of blue dye and radioisotope was better than either method in isolation for identifying the sentinel node, yielding a success rate of 96% (70/73). A total of 32 cases proved to have positive nodal disease on histological examination. In 44% (14/32) of patients, the sentinel node was the only positive node. Forty-seven per cent (15/32) of patients in whom the sentinel node was positive also had positive nodes in the axillary nodal basin. There were 3/32 false negative cases, giving a false negative rate of 9.4%. CONCLUSION Sentinel node biopsy will have a role in the management of breast cancer. However, widespread adaptation of this technique awaits the results of prospective, randomised trials.
Collapse
Affiliation(s)
- R Manecksha
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | | | | | | | | | | | | |
Collapse
|
20
|
Nugent N, Hill AD, Casey M, Kelly L, Dijkstra B, Collins CD, McDermott EW, O'Higgins N. Safety guidelines for radiolocalised sentinel node resection. Ir J Med Sci 2001; 170:236-8. [PMID: 11918328 DOI: 10.1007/bf03167786] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sentinel node radiolocalisation procedures are associated with low levels of radiation exposure. Radioactive material is present in the operating theatre and pathology laboratory. In most hospitals there are no official regulations in place for sentinel node radiation exposure. AIM To establish guidelines on the safety of sentinel node mapping with emphasis on the management of radioisotopes. METHODS The current literature regarding sentinel node procedures and radiation safety was reviewed. EU and US radiation safety regulations were scrutinised. RESULTS Personnel involved in sentinel node procedures are exposed to low levels of radiation. These levels are not high enough to require designated radiation workers in the theatre and pathology laboratory. Awareness of radiation safety and certain precautions during the procedure and processing of the specimen can further reduce levels of exposure. CONCLUSION Although low levels of radiation exposure are associated with sentinel node procedures, awareness of radiation safety and adherence to regulations, along with close interdepartmental co-operation, are recommended for further reduction in radiation exposure and safe application of this technique.
Collapse
Affiliation(s)
- N Nugent
- University Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Dijkstra B, Hill A, Kelly L, Prendegast M, McDermott E, O'Donnell M, Collins C, O'Higgins N. The value of sentinel node mapping for staging melanoma. Ir Med J 2001; 94:210-2. [PMID: 11693212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
One of the most important prognostic features of malignant melanoma is the involvement of regional lymph nodes. Sentinel lymph node biopsy (SLNB) is increasingly used to stage melanoma in order to avoid lymph node dissection in patients who clinically have no lymph node involvement. We present a prospective study of 27 patients who underwent SLNB from November 1999. Lymphoscintigraphy was done on the day of surgery, and SLNB guided by blue dye and/or gamma probe performed. A sentinel node was identified in all 27 patients, mean age 46 years. The mean Breslow thickness was 1.63mm. Excision of 1-3 sentinel nodes (mean 1.5) was performed. In 3/27 patients metastatic disease was detected in the sentinel node, 2 patients had therapeutic lymph node dissections, and one had chemotherapy. There were no major complications. SLNB is a valuable technique for staging melanoma, however impact on overall survival requires longer follow up.
Collapse
Affiliation(s)
- B Dijkstra
- Surgical Professorial Unit, Dept Plastic Surgery, St Vincent's University Hospital, Dublin
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
PURPOSE Appendectomy and cigarette smoking have been suggested to reduce the chance of developing ulcerative colitis. A case-control study was undertaken to determine the relative incidence of appendectomy in patients with ulcerative colitis. METHODS This case-control study examined the incidence of appendectomy in patients with ulcerative colitis and patients attending an orthopedic outpatient clinic. RESULTS Of 100 patients with ulcerative colitis, 75 pairs were matched for age, gender, and cigarette smoking. The ulcerative colitis group had an appendectomy rate of 8 percent (6/75), compared with 21 percent in the control group (P = 0.018). The odds ratio was 3.5 (95 percent confidence interval, 1.15-10.6). CONCLUSIONS No previous study has examined the effect of appendectomy, controlling for cigarette smoking. This study confirms that appendectomy protects against or reduces the chance of development of ulcerative colitis. A possible immunological explanation for this effect is advanced.
Collapse
Affiliation(s)
- B Dijkstra
- University Department of Surgery, Christchurch Hospital and Medical School, New Zealand
| | | | | |
Collapse
|
23
|
Abstract
BACKGROUND The experience of management of popliteal artery aneurysms (PAA) in a provincial centre is described. METHODS Patients were identified from vascular audit, and case notes were reviewed retrospectively. RESULTS There were 17 patients with 23 PAA over 12 years. All patients were male, with a mean age of 73 years. Other aneurysms were present in 77% of patients, 59% had bilateral PAA and 41% had an associated abdominal aortic aneurysm (AAA). Mean follow-up was 3 years, 3 months (range, 1 month - 7 years). There were 11 acute procedures, and 12 elective. Reconstruction with bypass and ligation of the aneurysm was performed in all elective and 9/11 acute procedures. Of the 21 bypass procedures, 17 used autologous vein, three used GoreTex, and 1 composite graft. There were two PAA that were not reconstructable. All the vein grafts remained patent during the time of follow-up, but two of the three GoreTex grafts failed. Successful reconstruction was achieved in 11/12 elective and 9/11 acute cases. All grafts in the acute group remained patent during the time of follow-up (mean, 3.5 years), in the elective group 11/12 grafts (91%) remained patent (mean follow-up, 2.5 years). CONCLUSIONS An excellent outcome was achieved in both elective and acute procedures. Autologous vein grafts appear to give better results than synthetic grafts. Due to the high incidence of multiple aneurysms, screening for other aneurysms is suggested.
Collapse
Affiliation(s)
- B Dijkstra
- Healthcare Hawke's Bay, Napier Hospital, New Zealand.
| | | | | |
Collapse
|
24
|
Dijkstra B. Evaluation of a method for trabecular meshwork perfusion of half anterior segments of the human eye. Vision Res 1995. [DOI: 10.1016/0042-6989(95)98242-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
25
|
van der Meulen P, Uitewaal PJ, Boomsma LJ, van Dijk P, Hermans AJ, van de Vijver P, Dijkstra B, van der Laan J. [Is the use of antipyretics to lower fever and prevent febrile convulsions in children advisable?]. Ned Tijdschr Geneeskd 1993; 137:213-4. [PMID: 8426675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
26
|
Ollis DL, Cheah E, Cygler M, Dijkstra B, Frolow F, Franken SM, Harel M, Remington SJ, Silman I, Schrag J. The alpha/beta hydrolase fold. Protein Eng 1992; 5:197-211. [PMID: 1409539 DOI: 10.1093/protein/5.3.197] [Citation(s) in RCA: 1553] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We have identified a new protein fold--the alpha/beta hydrolase fold--that is common to several hydrolytic enzymes of widely differing phylogenetic origin and catalytic function. The core of each enzyme is similar: an alpha/beta sheet, not barrel, of eight beta-sheets connected by alpha-helices. These enzymes have diverged from a common ancestor so as to preserve the arrangement of the catalytic residues, not the binding site. They all have a catalytic triad, the elements of which are borne on loops which are the best-conserved structural features in the fold. Only the histidine in the nucleophile-histidine-acid catalytic triad is completely conserved, with the nucleophile and acid loops accommodating more than one type of amino acid. The unique topological and sequence arrangement of the triad residues produces a catalytic triad which is, in a sense, a mirror-image of the serine protease catalytic triad. There are now four groups of enzymes which contain catalytic triads and which are related by convergent evolution towards a stable, useful active site: the eukaryotic serine proteases, the cysteine proteases, subtilisins and the alpha/beta hydrolase fold enzymes.
Collapse
Affiliation(s)
- D L Ollis
- Research School of Chemistry, Australian National University, Canberra
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Dijkstra B, Dirken MN. The effect of forced breathing on the motor chronaxie. J Physiol 1939; 96:109-17. [PMID: 16995119 PMCID: PMC1393855 DOI: 10.1113/jphysiol.1939.sp003761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|