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van der Zee JM, Fitski M, van de Sande MAJ, Buser MAD, Hiep MAJ, Terwisscha van Scheltinga CEJ, Hulsker CCC, van den Bosch CH, van de Ven CP, van der Heijden L, Bökkerink GMJ, Wijnen MHWA, Siepel FJ, van der Steeg AFW. Tracked ultrasound registration for intraoperative navigation during pediatric bone tumor resections with soft tissue components: a porcine cadaver study. Int J Comput Assist Radiol Surg 2024; 19:297-302. [PMID: 37924438 PMCID: PMC10838821 DOI: 10.1007/s11548-023-03021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/12/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Resection of pediatric osteosarcoma in the extremities with soft tissue involvement presents surgical challenges due to difficult visualization and palpation of the tumor. Therefore, an adequate image-guided surgery (IGS) system is required for more accurate tumor resection. The use of a 3D model in combination with intraoperative tracked ultrasound (iUS) may enhance surgical decision making. This study evaluates the clinical feasibility of iUS as a surgical tool using a porcine cadaver model. METHODS First, a 3D model of the porcine lower limb was created based on preoperative scans. Second, the bone surface of the tibia was automatically detected with an iUS by a sweep on the skin. The bone surface of the preoperative 3D model was then matched with the bone surface detected by the iUS. Ten artificial targets were used to calculate the target registration error (TRE). Intraoperative performance of iUS IGS was evaluated by six pediatric surgeons and two pediatric oncologic orthopedists. Finally, user experience was assessed with a post-procedural questionnaire. RESULTS Eight registration procedures were performed with a mean TRE of 6.78 ± 1.33 mm. The surgeons agreed about the willingness for clinical implementation in their current clinical practice. They mentioned the additional clinical value of iUS in combination with the 3D model for the localization of the soft tissue components of the tumor. The concept of the proposed IGS system is considered feasible by the clinical panel, but the large TRE and degree of automation need to be addressed in further work. CONCLUSION The participating pediatric surgeons and orthopedists were convinced of the clinical value of the interaction between the iUS and the 3D model. Further research is required to improve the surgical accuracy and degree of automation of iUS-based registration systems for the surgical management of pediatric osteosarcoma.
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Affiliation(s)
- J M van der Zee
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
- Technical Medicine, TechMed Centre, University of Twente, Enschede, The Netherlands.
| | - M Fitski
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - M A J van de Sande
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - M A D Buser
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - M A J Hiep
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - C C C Hulsker
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - C H van den Bosch
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - C P van de Ven
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - L van der Heijden
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - G M J Bökkerink
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - M H W A Wijnen
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - F J Siepel
- Robotics and Mechatronics, TechMed Centre, University of Twente, Enschede, The Netherlands
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van den Bosch CH, van de Ven CP, Hulsker CCC, Bökkerink GMJ, Terwisscha-van Scheltinga CEJ, van de Wetering MD, Koopman MMW, van der Pal HJH, Wijnen MWHA, van der Steeg AFW. Satisfaction of Paediatric Oncology Patients, Survivors, and Nurses with the Position of Their Totally Implantable Venous Access Port (SPACE-Study). J Pediatr Surg 2024:S0022-3468(24)00003-4. [PMID: 38212153 DOI: 10.1016/j.jpedsurg.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/12/2023] [Accepted: 12/25/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND To compare paediatric oncologic vascular access ports located on the anterior thoracic wall to ports on the lower lateral thoracic wall, in terms of perceived port-related hindrance and scar-quality. METHODS A cross-sectional survey study including paediatric oncology patients (≥8-<19 yrs), caregivers (in patients <8 yrs), survivors (>22 yrs with only anterior ports) and nurses of the Princess Máxima Center, the Netherlands, was performed. The survey consisted of questions regarding satisfaction, hindrance during daily life, and port position preference. For survivors, scar-quality was assessed using the validated Patient and Observer Scar Assessment Scale (POSAS 2.0); a high score (i.e., a displeasing scar) was defined as a score higher than the third quartile of the median for that question. RESULTS In total, 147 participants were included; 83 patients/caregivers, 31 survivors, and 33 nurses. Overall, 81 % was satisfied with the position of their port. Satisfaction, hindrance and complications did not differ between anterior and lower lateral ports. For the anterior position, minimal pressure on the port during daily life was a mentioned reason to prefer this position. For the lower lateral position, less visibility of the scar and easiest access were mentioned. Of all survivors with an anterior port scar, one in five had a displeasing scar and all scars observed were widened. Female patients preferred a lower lateral port, and scar-quality was better for left-sided port scars. CONCLUSION The port position should be chosen together with patients/caregivers based on the (dis-)advantages of each position, as identified by this study. LEVEL OF EVIDENCE II.
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Affiliation(s)
- C H van den Bosch
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands.
| | - C P van de Ven
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - C C C Hulsker
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - G M J Bökkerink
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | | | - M D van de Wetering
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - M M W Koopman
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - H J H van der Pal
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - M W H A Wijnen
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - A F W van der Steeg
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
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Lonnee PW, Ovadja ZN, Hulsker CCC, van de Sande MAJ, van de Ven CP, Paes EC. Reconstructive Strategies in Pediatric Patients after Oncological Chest Wall Resection: A Systematic Review. Eur J Pediatr Surg 2023; 33:431-440. [PMID: 36640758 DOI: 10.1055/a-2013-3074] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
An appropriate reconstruction strategy after surgical resection of chest wall tumors in children is important to optimize outcomes, but there is no consensus on the ideal approach. The aim of this study was to provide an up-to-date systematic review of the literature for different reconstruction strategies for chest wall defects in patients less than 18 years old. A systematic literature search of the complete available literature was performed and results were analyzed. A total of 22 articles were included in the analysis, which described a total of 130 chest wall reconstructions. All were retrospective analyses, including eight case reports. Reconstructive options were divided into primary closure (n = 21 [16.2%]), use of nonautologous materials (n = 83 [63.8%]), autologous tissue repair (n = 2 [1.5%]), or a combination of the latter two (n = 24 [18.5%]). Quality of evidence was poor, and the results mostly heterogeneous. Reconstruction of chest wall defects can be divided into four major categories, with each category including its own advantages and disadvantages. There is a need for higher quality evidence and guidelines, to be able to report uniformly on treatment outcomes and assess the appropriate reconstruction strategy.
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Affiliation(s)
- Pieter W Lonnee
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital and Princess Máxima Center, Utrecht, the Netherlands
| | - Zachri N Ovadja
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital and Princess Máxima Center, Utrecht, the Netherlands
| | - Caroline C C Hulsker
- Department of Pediatric Surgery, Princess Máxima Center, Utrecht, the Netherlands
| | | | | | - Emma C Paes
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital and Princess Máxima Center, Utrecht, the Netherlands
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Wens FSPL, Hulsker CCC, Fiocco M, Zsiros J, Smetsers SE, de Krijger RR, van der Steeg AFW, Zweemer RP, Baas IO, Roes EM, Looijenga LHJ, Gerestein CG, Mavinkurve-Groothuis AMC. Small Cell Carcinoma of the Ovary, Hypercalcemic Type (SCCOHT): Patient Characteristics, Treatment, and Outcome-A Systematic Review. Cancers (Basel) 2023; 15:3794. [PMID: 37568608 PMCID: PMC10417391 DOI: 10.3390/cancers15153794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/26/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Small-cell carcinoma of the ovary, hypercalcemic type (SCCOHT) is a rare aggressive ovarian malignancy mainly affecting children, adolescents, and young adults. Since the discovery of mutations in the SMARCA4 gene in 2014, SCCOHT has become the subject of extensive investigation. However, international uniform treatment guidelines for SCCOHT are lacking and the outcome remains poor. The aim of this systematic review is to generate an overview of all reported patients with SCCOHT from 1990 onwards, describing the clinical presentation, genetic characteristics, treatment, and outcome. METHODS A systematic search was performed in the databases Embase, Medline, Web of Science, and Cochrane for studies that focus on SCCOHT. Patient characteristics and treatment data were extracted from the included studies. Survival was estimated using Kaplan-Meier's methodology. To assess the difference between survival, the log-rank test was used. To quantify the effect of the FIGO stage, the Cox proportional hazard regression model was estimated. The chi-squared test was used to study the association between the FIGO stage and the surgical procedures. RESULTS Sixty-seven studies describing a total of 306 patients were included. The median patient age was 25 years (range 1-60 years). The patients mostly presented with non-specific symptoms such as abdominal pain and sometimes showed hypercalcemia and elevated CA-125. A great diversity in the diagnostic work-up and therapeutic approaches was reported. The chemotherapy regimens were very diverse, all containing a platinum-based (cisplatin or carboplatin) backbone. Survival was strongly associated with the FIGO stage at diagnosis. CONCLUSIONS SCCOHT is a rare and aggressive ovarian cancer, with a poor prognosis, and information on adequate treatment for this cancer is lacking. The testing of mutations in SMARCA4 is crucial for an accurate diagnosis and may lead to new treatment options. Harmonization and international collaboration to obtain high-quality data on diagnostic investigations, treatment, and outcome are warranted to be able to develop international treatment guidelines to improve the survival chances of young women with SCCOHT.
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Affiliation(s)
- Francis S. P. L. Wens
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (F.S.P.L.W.); (C.C.C.H.); (M.F.); (J.Z.); (S.E.S.); (R.R.d.K.); (A.F.W.v.d.S.); (L.H.J.L.)
| | - Caroline C. C. Hulsker
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (F.S.P.L.W.); (C.C.C.H.); (M.F.); (J.Z.); (S.E.S.); (R.R.d.K.); (A.F.W.v.d.S.); (L.H.J.L.)
| | - Marta Fiocco
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (F.S.P.L.W.); (C.C.C.H.); (M.F.); (J.Z.); (S.E.S.); (R.R.d.K.); (A.F.W.v.d.S.); (L.H.J.L.)
- Mathematical Institute, Leiden University, 2311 EZ Leiden, The Netherlands
- Biomedical Data Science Department, Section Medical Statistics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - József Zsiros
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (F.S.P.L.W.); (C.C.C.H.); (M.F.); (J.Z.); (S.E.S.); (R.R.d.K.); (A.F.W.v.d.S.); (L.H.J.L.)
| | - Stephanie E. Smetsers
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (F.S.P.L.W.); (C.C.C.H.); (M.F.); (J.Z.); (S.E.S.); (R.R.d.K.); (A.F.W.v.d.S.); (L.H.J.L.)
| | - Ronald R. de Krijger
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (F.S.P.L.W.); (C.C.C.H.); (M.F.); (J.Z.); (S.E.S.); (R.R.d.K.); (A.F.W.v.d.S.); (L.H.J.L.)
- Department of Pathology, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands
| | - Alida F. W. van der Steeg
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (F.S.P.L.W.); (C.C.C.H.); (M.F.); (J.Z.); (S.E.S.); (R.R.d.K.); (A.F.W.v.d.S.); (L.H.J.L.)
| | - Ronald P. Zweemer
- Department of Gynecologic Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands; (R.P.Z.); (C.G.G.)
| | - Inge O. Baas
- Department of Medical Oncology, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands;
| | - Eva Maria Roes
- Department of Gynecologic Oncology, Erasmus Medical Center Cancer Institute, 3015 GD Rotterdam, The Netherlands;
| | - Leendert H. J. Looijenga
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (F.S.P.L.W.); (C.C.C.H.); (M.F.); (J.Z.); (S.E.S.); (R.R.d.K.); (A.F.W.v.d.S.); (L.H.J.L.)
| | - Cornelis G. Gerestein
- Department of Gynecologic Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, 3584 CG Utrecht, The Netherlands; (R.P.Z.); (C.G.G.)
| | - Annelies M. C. Mavinkurve-Groothuis
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (F.S.P.L.W.); (C.C.C.H.); (M.F.); (J.Z.); (S.E.S.); (R.R.d.K.); (A.F.W.v.d.S.); (L.H.J.L.)
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5
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Hulsker CCC, Kranendonk MEG, Eleveld TF, Gillis AJM, van de Ven CP, van Eijkelenburg NKA, van der Kaaij NP, van der Steeg AFW, Looijenga LHJ. Recurrence of a Mediastinal Germ-Cell Tumor as a Somatic-Type Malignancy: A Complex Case Report. Int J Mol Sci 2021; 22:ijms22179310. [PMID: 34502216 PMCID: PMC8431270 DOI: 10.3390/ijms22179310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background and case: An adolescent male presented with a second mediastinal tumor 1.5 years after treatment of a proven malignant germ-cell tumor in that location. The differential diagnosis included a recurrent germ-cell tumor or a non-germ cell malignancy. Serum tumor markers alpha-fetoprotein (AFP) and human chorionic gonadotrophin (HCG) were negative. The first biopsy was not informative, and the second biopsy gave a broad differential diagnosis including secondary non-germ cell malignancy using histology and immunohistochemistry. DNA methylation profiling, RNA sequencing, and targeted microRNA371a-3p profiling was subsequently performed, without a supportive result. After resection of the tumor the definitive diagnosis yielded two secondary non-germ cell malignancies in the form of a leiomyosarcoma and a solitary neuro endocrine carcinoma (NEC). In spite of the differences between the molecular profiles of the initial germ-cell tumor, the leiomyosarcoma and large-cell NEC are clonally related, as determined by the presence of identical chromosomal breakpoints. The copy number profiles suggest an initial polyploidization step, followed by various independent chromosomal gains and losses. This case demonstrates that germ-cell tumors must be evaluated carefully, including molecularly, in which the non-germ cell malignancy is negative for miR-371a-3p, both in tissue as well as in serum, in contrast to the primary tumor. We conclude that the patient presented with a primary type II mediastinal GCT and, a year and a half later, followed by a leiomyosarcoma and a large-cell NEC presenting as two secondary somatic-type malignancies clonally related to the original GCT. Conclusions: Malignant germ-cell tumors are known to recur as a somatic-type malignancy in very rare cases. This case report illustrates the challenges faced in defining the nature and clonality of the secondary somatic-type malignancies.
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Affiliation(s)
- Caroline C. C. Hulsker
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.E.G.K.); (T.F.E.); (A.J.M.G.); (C.P.v.d.V.); (N.K.A.v.E.); (A.F.W.v.d.S.); (L.H.J.L.)
- Correspondence:
| | - Mariëtte E. G. Kranendonk
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.E.G.K.); (T.F.E.); (A.J.M.G.); (C.P.v.d.V.); (N.K.A.v.E.); (A.F.W.v.d.S.); (L.H.J.L.)
- Department of Pathology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Thomas F. Eleveld
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.E.G.K.); (T.F.E.); (A.J.M.G.); (C.P.v.d.V.); (N.K.A.v.E.); (A.F.W.v.d.S.); (L.H.J.L.)
| | - Ad J. M. Gillis
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.E.G.K.); (T.F.E.); (A.J.M.G.); (C.P.v.d.V.); (N.K.A.v.E.); (A.F.W.v.d.S.); (L.H.J.L.)
| | - Cornelis P. van de Ven
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.E.G.K.); (T.F.E.); (A.J.M.G.); (C.P.v.d.V.); (N.K.A.v.E.); (A.F.W.v.d.S.); (L.H.J.L.)
| | - Natasha K. A. van Eijkelenburg
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.E.G.K.); (T.F.E.); (A.J.M.G.); (C.P.v.d.V.); (N.K.A.v.E.); (A.F.W.v.d.S.); (L.H.J.L.)
| | - Niels P. van der Kaaij
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Alida F. W. van der Steeg
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.E.G.K.); (T.F.E.); (A.J.M.G.); (C.P.v.d.V.); (N.K.A.v.E.); (A.F.W.v.d.S.); (L.H.J.L.)
| | - Leendert H. J. Looijenga
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands; (M.E.G.K.); (T.F.E.); (A.J.M.G.); (C.P.v.d.V.); (N.K.A.v.E.); (A.F.W.v.d.S.); (L.H.J.L.)
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Hulsker CCC, el Mansori I, Fiocco M, Zsiros J, Wijnen MHW, Looijenga LHJ, Mavinkurve-Groothuis AMC, van der Steeg AFW. Treatment and Survival of Malignant Extracranial Germ Cell Tumours in the Paediatric Population: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13143561. [PMID: 34298776 PMCID: PMC8305293 DOI: 10.3390/cancers13143561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/29/2021] [Accepted: 07/10/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This systematic review and meta-analysis was performed to explore overall survival (OS) and event free survival (EFS) rates internationally over the past two decades and to define specific subgroups with inferior outcomes which may demand different treatment strategies. METHODS The search focused on malignant extracranial germ cell tumours (GCTs) in the paediatric population. The initial database search identified 12,556 articles; 32 articles were finally included in this review, comprising a total of 5095 patients. RESULTS The studies were heterogeneous, varying from single institution reports to large prospective trials. Older studies, describing eras where non-platinum-based chemotherapy regimens were used, showed clearly worse outcomes. Survival for stage I-II gonadal disease is excellent. On the other hand, patients with an initial alpha-fetoprotein (AFP) > 10,000 ng/mL or kU/L, age > 11 years and stage IV disease confer a survival disadvantage. For testicular disease in particular, lymphovascular invasion and certain histopathological subtypes, such as embryonal carcinoma (EC) and mixed malignant GCTs, survival is poorer. Survival data for sacrococcygeal and mediastinal GCTs show a heterogeneous distribution across studies in this review, independent of year of publication. Patients > 12 years presenting with a mediastinal GCT pose a subpopulation which fares worse than GCTs in other locations or age groups. This is independent of AFP levels, stage of disease or treatment protocol, and these patients may demand a different treatment strategy. CONCLUSIONS This review describes the heterogeneous nature of GCTs in different anatomical locations, impacting on stage at presentation, treatment modalities used and survival data. Despite this heterogeneity, in line with the current developmental biology-based classification system, subpopulations can be defined which have an inferior EFS and OS and where future research and more individualised treatment would help to improve survival.
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Affiliation(s)
- Caroline C. C. Hulsker
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584CS Utrecht, The Netherlands; (I.e.M.); (M.F.); (J.Z.); (M.H.W.W.); (L.H.J.L.); (A.M.C.M.-G.); (A.F.W.v.d.S.)
- Correspondence: ; Tel.: +31-88-9727272
| | - Issam el Mansori
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584CS Utrecht, The Netherlands; (I.e.M.); (M.F.); (J.Z.); (M.H.W.W.); (L.H.J.L.); (A.M.C.M.-G.); (A.F.W.v.d.S.)
| | - Marta Fiocco
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584CS Utrecht, The Netherlands; (I.e.M.); (M.F.); (J.Z.); (M.H.W.W.); (L.H.J.L.); (A.M.C.M.-G.); (A.F.W.v.d.S.)
- Mathematical Institute, Leiden University, 2333CA Leiden, The Netherlands
- Leiden University Medical Center, Biomedical Data Science Department, Section Medical Statistics, 2333ZC Leiden, The Netherlands
| | - József Zsiros
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584CS Utrecht, The Netherlands; (I.e.M.); (M.F.); (J.Z.); (M.H.W.W.); (L.H.J.L.); (A.M.C.M.-G.); (A.F.W.v.d.S.)
| | - Marc H. W. Wijnen
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584CS Utrecht, The Netherlands; (I.e.M.); (M.F.); (J.Z.); (M.H.W.W.); (L.H.J.L.); (A.M.C.M.-G.); (A.F.W.v.d.S.)
| | - Leendert H. J. Looijenga
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584CS Utrecht, The Netherlands; (I.e.M.); (M.F.); (J.Z.); (M.H.W.W.); (L.H.J.L.); (A.M.C.M.-G.); (A.F.W.v.d.S.)
| | - Annelies M. C. Mavinkurve-Groothuis
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584CS Utrecht, The Netherlands; (I.e.M.); (M.F.); (J.Z.); (M.H.W.W.); (L.H.J.L.); (A.M.C.M.-G.); (A.F.W.v.d.S.)
| | - Alida F. W. van der Steeg
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584CS Utrecht, The Netherlands; (I.e.M.); (M.F.); (J.Z.); (M.H.W.W.); (L.H.J.L.); (A.M.C.M.-G.); (A.F.W.v.d.S.)
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7
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Bollemeijer JF, Mavinkurve-Groothuis AMC, Kooij CD, Zsiros J, Littooij AS, van der Steeg AFW, Wijnen MHWA, Hulsker CCC. Surgical challenges of excision of retroperitoneal germ cell tumors in children: a single institutional study with literature review. Ann Pediatr Surg 2021. [DOI: 10.1186/s43159-021-00086-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Retroperitoneal germ cell tumors (GCTs) are rare, commonly large tumors, often diagnosed in infancy. Complete surgical resection may pose a serious challenge as encasement of major vessels and organ displacement can lead to perioperative complications. This study aims to illustrate the surgical challenges of excising retroperitoneal GCTs.
Results
Nine patients were included: six patients with a teratoma, two patients with a mixed GCT with a yolk sac tumor component, and one patient with a pure yolk sac tumor. Six were males and seven were younger than 1 year of age at time of presentation. In all cases, perioperative vascular or organ-related complications occurred in one patient; this resulted in short bowel syndrome. There was no recurrence or mortality during the follow-up period. Relevant literature is reviewed and described.
Conclusions
The anatomical relation of a retroperitoneal GCT to the major vessels and organs is unpredictable. Preoperative radiological evaluation can help to improve the understanding of the vascular anatomy and to plan accordingly. Anteriorly displaced veins may appear insignificant and arteries, such as the superior mesenteric artery may be encased. Preoperative imaging may prevent perioperative complications, leading to safer surgical procedures.
Level IV evidence
Therapeutic study
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8
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van Nimwegen LWE, Mavinkurve-Groothuis AMC, de Krijger RR, Hulsker CCC, Goverde AJ, Zsiros J, Littooij AS. MR imaging in discriminating between benign and malignant paediatric ovarian masses: a systematic review. Eur Radiol 2019; 30:1166-1181. [PMID: 31529256 PMCID: PMC6957553 DOI: 10.1007/s00330-019-06420-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/03/2019] [Accepted: 08/08/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The use of magnetic resonance (MR) imaging in differentiation between benign and malignant adnexal masses in children and adolescents might be of great value in the diagnostic workup of sonographically indeterminate masses, since preserving fertility is of particular importance in this population. This systematic review evaluates the diagnostic value of MR imaging in children with an ovarian mass. METHODS The review was made according to the PRISMA Statement. PubMed and EMBASE were systematically searched for studies on the use of MR imaging in differential diagnosis of ovarian masses in both adult women and children from 2008 to 2018. RESULTS Sixteen paediatric and 18 adult studies were included. In the included studies, MR imaging has shown good diagnostic performance in differentiating between benign and malignant ovarian masses. MR imaging techniques including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging seem to further improve the diagnostic performance. CONCLUSION The addition of DWI with apparent diffusion coefficient (ADC) values measured in enhancing components of solid lesions and DCE imaging may further increase the good diagnostic performance of MR imaging in the pre-operative differentiation between benign and malignant ovarian masses by increasing specificity. Prospective age-specific studies are needed to confirm the high diagnostic performance of MR imaging in children and adolescents with a sonographically indeterminate ovarian mass. KEY POINTS • MR imaging, based on several morphological features, is of good diagnostic performance in differentiating between benign and malignant ovarian masses. Sensitivity and specificity varied between 84.8 to 100% and 20.0 to 98.4%, respectively. • MR imaging techniques like diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging seem to improve the diagnostic performance. • Specific studies in children and adolescents with ovarian masses are required to confirm the suggested increased diagnostic performance of DWI and DCE in this population.
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Affiliation(s)
- Lotte W E van Nimwegen
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands
| | | | - Ronald R de Krijger
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands.,Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Caroline C C Hulsker
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands
| | - Angelique J Goverde
- Department of Reproductive Medicine and Gynaecology, University Medical Center of Utrecht, Utrecht, The Netherlands
| | - József Zsiros
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands
| | - Annemieke S Littooij
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands.,Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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9
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Zwart K, Van Ginkel DJ, Hulsker CCC, Witvliet MJ, Van Herwaarden-Lindeboom MYA. Does Mechanical Bowel Preparation Reduce the Risk of Developing Infectious Complications in Pediatric Colorectal Surgery? A Systematic Review and Meta-Analysis. J Pediatr 2018; 203:288-293.e1. [PMID: 30219553 DOI: 10.1016/j.jpeds.2018.07.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 06/24/2018] [Accepted: 07/12/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To evaluate whether the application of mechanical bowel preparation (MBP) before colorectal surgery reduces the risk of developing infectious complications in children. STUDY DESIGN In this systematic review and meta-analysis, PubMed, Embase, and the Cochrane Library were systematically searched to identify all articles comparing pediatric patients receiving MBP with pediatric patients not receiving MBP before colorectal surgery. Results are presented with weighted risk differences based on the number of events and sample size per study. RESULTS Six original studies were included comparing MBP (n = 810) and no MBP (n = 1167). The overall risk of developing infectious complications was 10.1% in patients with MBP, compared with 9.1% in patients without MBP, resulting in a nonsignificant risk difference of -0.03% (95% CI, -0.09% to 0.03%). Concerning the number of wound infections and anastomotic leaks, we found nonsignificant risk differences of -0.03% (95% CI, -0.08% to 0.02%) and 0.01% (95% CI, -0.01% to 0.02%), respectively. CONCLUSION Based on the current literature, there is insufficient evidence to indicate that the use of MBP leads to a significant difference in the risk of developing infectious complications in pediatric colorectal surgery.
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Affiliation(s)
- Koen Zwart
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Dirk-Jan Van Ginkel
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Caroline C C Hulsker
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke J Witvliet
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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10
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Abstract
Esophageal atresia is an anomaly with frequently occurring sequelae requiring lifelong management and follow-up. Because of the complex issues that can be encountered, patients with esophageal atresia preferably should be managed in centers of expertise that have the ability to deal with all types of anomalies and sequelae and can perform rigorous lifelong follow-up. Tracheomalacia is an often-occurring concurrent anomaly that may cause acute life-threatening events and may warrant immediate management. In the past, major thoracotomies were necessary to carry out the aortopexy. Nowadays, aortopexy and posterior tracheopexy can both be performed thoracoscopically with quick recovery.
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Affiliation(s)
- David C van der Zee
- Department of Pediatric Surgery, University Medical Center Utrecht, KE. 04.140.5, PO Box 85090, Utrecht 3508 AB, The Netherlands.
| | - Maud Y A van Herwaarden
- Department of Pediatric Surgery, University Medical Center Utrecht, KE. 04.140.5, PO Box 85090, Utrecht 3508 AB, The Netherlands
| | - Caroline C C Hulsker
- Department of Pediatric Surgery, University Medical Center Utrecht, KE. 04.140.5, PO Box 85090, Utrecht 3508 AB, The Netherlands
| | - Marieke J Witvliet
- Department of Pediatric Surgery, University Medical Center Utrecht, KE. 04.140.5, PO Box 85090, Utrecht 3508 AB, The Netherlands
| | - Stefaan H A Tytgat
- Department of Pediatric Surgery, University Medical Center Utrecht, KE. 04.140.5, PO Box 85090, Utrecht 3508 AB, The Netherlands
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11
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van de Bunt JA, Veldhoen ES, Nievelstein RAJ, Hulsker CCC, Schouten ANJ, van Herwaarden MYA. Effects of esketamine sedation compared to morphine analgesia on hydrostatic reduction of intussusception: A case-cohort comparison study. Paediatr Anaesth 2017; 27:1091-1097. [PMID: 28940868 DOI: 10.1111/pan.13226] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hydrostatic or pneumatic reduction of intussusception is an invasive procedure that is stressful and may be painful for a child. Resistance of the child may increase the duration of the procedure and decrease success rate of reduction. Analgesia can help to reduce pain, but not necessarily resistance. General anesthesia increases success rate of reduction. However, it requires the presence of an anesthesiologist, and may lead to anesthesia-related complications. Procedural sedation with esketamine could be a safe alternative. AIM The aim of this study was to compare hydrostatic reduction using morphine analgesia compared to procedural sedation with esketamine in terms of success rate, adverse events, and duration of reduction. METHODS A retrospective case-cohort comparison study was performed with two groups of patients who had undergone hydrostatic reduction for ileocolic intussusception and received morphine analgesia (n = 37) or esketamine sedation (n = 20). Until July 2013, reduction was performed after intravenously administered morphine. Hereafter, a new protocol for procedural sedation was implemented and reduction was performed after administration of esketamine. Cases were matched for age and duration of symptoms. RESULTS No adverse events requiring intervention other than administration of oxygen were reported for either group. Success rate of reduction using esketamine sedation was 90% vs 70% using morphine analgesia, risk ratio (RR) 1.29, 95% CI[0.93-1.77]. Recurrence rate using esketamine sedation was 10% vs 15% using morphine analgesia, RR 0.67, 95% CI[0.12-3.57]. Reduction time was shorter using esketamine sedation (Median 5 minutes, IQR 9 minutes) vs morphine analgesia (Median 8 minutes, IQR 16 minutes, P = .04, Median difference 3, 95% CI[-1.50-8.75]). Median hospital stay in the esketamine group was 1.5 days (IQR 1.8) vs 2 days (IQR 5.3) in the morphine group. CONCLUSION No serious adverse events were recorded. In comparison to morphine analgesia, with esketamine there was weak evidence for a higher success rate, lower recurrence rate, shorter duration, and shorter length of hospital stay.
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Affiliation(s)
- Jascha A van de Bunt
- Department of Pediatric Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Esther S Veldhoen
- Department of Pediatric Intensive Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Caroline C C Hulsker
- Department of Pediatric Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Antonius N J Schouten
- Department of Anesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Maud Y A van Herwaarden
- Department of Pediatric Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
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12
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Zijlstra M, Hulsker CCC, Fanoy EB, Pijnacker R, Kraaijeveld A, Koene MGJ, Wolfs TFW. [Tularaemia in a boy following participation in a mud race]. Ned Tijdschr Geneeskd 2017; 160:D1180. [PMID: 28466800] [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: 06/07/2023]
Abstract
BACKGROUND Tularaemia is a rare disease. In Europe it mostly occurs in Scandinavia. Since 2011 more cases are being reported in the Netherlands. Tularaemia may manifest itself in various ways. It is important to take strict precautions during biopsy, drainage and biopsy processing in order to prevent transmission. CASE DESCRIPTION A 10-year-old boy presented to the paediatrician with a left inguinal lymphadenitis. A week before the onset of symptoms he had participated in a children's mud race. Serology and PCR of pus from the lymph node tested positive for Francisella tularensis. Treatment with ciprofloxacin was insufficiently effective, so surgical drainage of the gland was performed under strict isolation conditions. Water from the mud race location contained genetic material from F. tularensis. CONCLUSION Given the rising incidence of tularaemia in the Netherlands, it is important to consider 'tularaemia' in the differential diagnosis in patients with lymphadenitis and epidemiological clues in their case history. Since 1 November 2016 it has been mandatory to report tularaemia in the Netherlands.
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Affiliation(s)
- M Zijlstra
- UMC Utrecht, Wilhelmina Kinderziekenhuis, Utrecht
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13
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Heidsma CM, Hulsker CCC, van der Zee D, Kramer WH. [Malrotation with or without volvulus]. Ned Tijdschr Geneeskd 2015; 159:A8859. [PMID: 26173661] [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: 06/04/2023]
Abstract
Malrotation occurs when there is a failure in the intestinal rotation leading to abnormal fixation to the abdominal wall and a mesentery with a short root. Volvulus is a life-threatening complication of malrotation. It can lead to irreversible intestinal necrosis and requires immediate attention. Early recognition of malrotation and surgical correction could prevent the onset of volvulus. We describe 3 cases of children with a malrotation. Case A involves a 2-year-old boy who suffered from repeated episodes of vomiting. Case B, a 1-month-old female, was taken to the general practitioner after acute onset of crying and flexing of the legs. Case C, a 5-year-old-boy with no medical history, had started vomiting hourly. In presenting these 3 cases, we highlight the dangers of untreated malrotation and make recommendations on how to manage a patient suspected of having this congenital abnormality.
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Franken J, Mauritz FA, Suksamanapun N, Hulsker CCC, van der Zee DC, van Herwaarden-Lindeboom MYA. Efficacy and adverse events of laparoscopic gastrostomy placement in children: results of a large cohort study. Surg Endosc 2014; 29:1545-52. [DOI: 10.1007/s00464-014-3839-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 08/19/2014] [Indexed: 11/28/2022]
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15
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Kist AL, Hulsker CCC, Verheij J, Busch ORC. [An inflammatory pseudotumor of the liver]. Ned Tijdschr Geneeskd 2013; 157:A5277. [PMID: 23406639] [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: 06/01/2023]
Abstract
BACKGROUND Inflammatory pseudotumours are rare benign tumours that can present as solid and potentially malignant tumours on diagnostic images. CASE DESCRIPTION A 59-year-old male presented at the emergency department with continuous pain in his right upper abdomen, attacks of colic and intermittent fever. CT scans of the abdomen revealed a solid lesion in the liver. Histopathological analysis of a biopsy showed an inflammatory pseudotumour. Since the pain persisted and a malignancy could not be excluded with certainty, surgical resection of the tumour was performed. The specimen showed an inflammatory pseudotumour with an increase in IgG4 positive plasma cells as well as a purulent infection around aggregates of Actinomyces. CONCLUSION It is important to realise that a pseudotumour caused by an inflammatory reaction can mimic a malignancy.
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Abstract
Fractures of the ankle are fairly common injuries. Open ankle fractures are much less common and associated with severe injuries to surrounding tissues. We have performed a systematic review of the literature concerning the clinical results and complication rates in the treatment of open ankle fractures. We conducted a search limited to the following databases: Pubmed/Medline, Cochrane Database of Systematic Reviews, Cochrane Clinical Trial Register and Embase. These were searched from 1968 to April 2010 to identify studies relating to the treatment of open ankle fractures. Fifteen articles concerning 498 patients with treatment of an open ankle fracture were identified. The number of included patients varied from 11 to 64. There were 2 prospective and 13 retrospective studies. All articles were case series and classified as Level IV evidence. In 373 cases, open ankle fractures were treated by immediate internal fixation. In 125 cases, a conservative treatment or delayed/other fixation treatment was followed. Of those patients treated by immediate internal fixation, 81% had satisfactory result. Poor results (15%) were most commonly due to non-anatomic reductions, articular surface damage or deep infection. When conservative treatment was followed, 76% had satisfactory results. The most reported complications after immediate internal fixation were deep infection (8%) and skin necrosis (14%). There is a lack of high quality literature concerning the (operative) treatment of patients with open ankle fractures. Remarkable is that most authors reported satisfactory results after performance of their treatment protocol. Based on the available literature, we formulated guidelines regarding: timing of operative treatment, wound irrigation, the role of internal fixation, wound coverage and closure, the use of antibiotics and additional therapies.
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Affiliation(s)
- Caroline C. C. Hulsker
- Department of General Surgery, Academic Medical Centre, P.O. Box 22660, Amsterdam, DD 1100 The Netherlands
| | - Sanne Kleinveld
- Department of General Surgery, Academic Medical Centre, P.O. Box 22660, Amsterdam, DD 1100 The Netherlands
| | | | - Mike Hogervorst
- Department of General Surgery, Gelre Hospitals, Apeldoorn, The Netherlands
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