Reliability and validity of the Dutch-translated Body Image Scale.

PURPOSE: Lacking a comprehensible and widely applicable Dutch test to assess body image changes in cancer patients, we validated Hopwood's Body Image Scale (BIS) for the Dutch language. METHODS: The BIS consists of 10 items scored 0-3. Total scores range from 0 (minimum body image-related distress) to 30 (maximum distress). After forward and backward translation of the BIS, we evaluated its psychometric characteristics in breast cancer patients. We assessed feasibility by missing answer rates and positive response prevalence (score ≥ 1) per item (criterion ≥ 30 %), test-retest reliability with a 2-week interval, internal consistence using Cronbach's α and discriminant ability by comparing body image after breast-conserving therapy (BCT) versus mastectomy. RESULTS: Psychometric evaluation of 108 BCT and 101 mastectomy patients showed high feasibility (0.2 % missing answers), high positive response prevalence of ≥ 30 % in 9/10 items and high internal consistency (α > 0.90). Test-retest reliability and correlation were high with 5.78 (test) versus 5.75 (retest; P = 0.86) and Spearman's ρ = 0.92 (P < 0.01). Discriminant ability was good with BIS scores of 4.56 after BCT versus 7.19 after mastectomy (P < 0.01). All results were comparable to the results of the original BIS. CONCLUSION: The Dutch-translated BIS showed excellent psychometric results very similar to the original BIS. Its concise and simple design further supports wide application in clinical practice.

Measurement of health-related quality of life with the Dutch translated Aberdeen Varicose Vein Questionnaire before and after treatment.

OBJECTIVE: This clinical trial evaluated the use of the Dutch translated Aberdeen Varicose Vein Questionnaire (AVVQ) and SF-36 before and after treatment in patients with clinical-severity classes 1-6 venous disease of the lower limb. METHODS: A total of 145 patients with symptomatic venous disease of the leg were included. Numbers of patients were evenly distributed among the six clinical-severity classes 1-6 (clinical, aetiology, anatomy and pathophysiology; CEAP). Patients completed two preoperative AVVQ questionnaires and one short-form health survey with 36 items (SF-36) questionnaire to evaluate test-re-test reliability of the AVVQ. Patients completed one postoperative AVVQ and SF-36 to evaluate the effect of treatment. RESULTS: The test (99%) and re-test responses (97%) of the AVVQ were sufficient. Internal consistency of the Dutch translated AVVQ showed a Cronbach's alpha of 0.76. Correlation of test and re-test of the AVVQ was high (rho=0.86, P<0.001). A significant negative association, by Spearman's correlation coefficient, was found between the preoperative baseline Dutch translated AVVQ score and all eight domains of the preoperative SF-36 (P<0.001). These significant associations were also found in the postoperative scores. The mean preoperative AVVQ score of 19.5 (SD 11.8) and mean postoperative AVVQ score of 16.1 (SD 12.0) differed significantly (P<0.01). Analysis of three subgroups of clinical-severity classes (C1-2, C3-4 and C5-6) showed significant score changes before and after surgery (P<0.01). Preoperative and postoperative SF-36 scores were not significantly different. CONCLUSIONS: This study established the use of the Dutch translated AVVQ as a valid, health-related quality of life (QOL) questionnaire for measuring QOL before and after treatment in patients with clinical-severity classes 1-6 venous disease of the leg.

Reliability and validity of the Dutch translated Aberdeen Varicose Vein Questionnaire.

OBJECTIVE: To evaluate reliability and validity of the Dutch translated Aberdeen Varicose Vein Questionnaire (AVVQ) for measuring health related quality of life (HR-QOL) in patients with venous disease in the lower limb. METHODS: The AVVQ consists of 13 questions related varicose veins. This study assessed feasibility, reliability and validity of the Dutch translated AVVQ in a sample of 145 patients with venous disease of the leg. Test and retest of the Dutch translated AVVQ were performed within a 2 week interval. RESULTS: There was a high test (99%) and retest (97%) response. Feasibility; AVVQ showed few missing answers (0.6%) and non-unique answers (0.2%). Regarding internal consistency; Cronbach's alpha exceeded 0.7 indicating a high level of concordance between the AVVQ questions (alpha=0.76). Test-retest reliability; Spearman's rho showed a significant strong association between test and retest scores (rho=0.87). Discriminative validity; AVVQ score was able to differentiate between subgroups of patients with different severity of venous disease according to the CEAP classification (Mann-Whitney U test, p<0.01). CONCLUSIONS: This study supports applications of the Dutch AVVQ in HR-QOL measurement in patients with venous disease in the Netherlands and the Flemish speaking part of Belgium.

Factors affecting the rate of surgical site infection in patients after hemiarthroplasty of the hip following a fracture of the neck of the femur.

AIMS: Surgical site infection can be a devastating complication of hemiarthroplasty of the hip, when performed in elderly patients with a displaced fracture of the femoral neck. It results in a prolonged stay in hospital, a poor outcome and increased costs. Many studies have identified risk and prognostic factors for deep infection. However, most have combined the rates of infection following total hip arthroplasty and internal fixation as well as hemiarthroplasty, despite the fact that they are different entities. The aim of this study was to clarify the risk and prognostic factors causing deep infection after hemiarthroplasty alone. PATIENTS AND METHODS: Data were extracted from a prospective hip fracture database and completed by retrospective review of the hospital records. A total of 916 patients undergoing a hemiarthroplasty in two level II trauma teaching hospitals between 01 January 2011 and 01 May 2016 were included. We analysed the potential peri-operative risk factors with univariable and multivariable logistic regression analysis. RESULTS: A total of 92 patients (10%) had a surgical site infection, and 44 (4.9%) developed a deep infection. After univariable analyses, the multivariable model showed that the level of experience of the surgeon measured by the number of hemiarthroplasties performed per year was a significant prognostic factor (odds ratio (OR) 0.93, p = 0.042) for the development of an infection. Secondly, the development of a haematoma (OR 9.6, p < 0.001), a re-operation (OR 4.7, p = 0.004) and an operating time of < 45 mins (OR 5.1, p = 0.002) or > 90 mins (OR 2.7, p = 0.034) were also significant factors. CONCLUSION: There was a significant association between the experience of the surgeon and the rate of deep infection. Secondly, a haematoma, a re-operation and both shorter and longer operating times were associated with an increased risk of deep infection after hemiarthroplasty. No association was found between deep infection and the anatomical approach, the time when surgery was undertaken and the use of a drain. Cite this article: Bone Joint J 2017;99-B:1088-94.

[Preventive contralateral mastectomy despite absence of gene mutation; management and treatment of women with no medical indication]. / Geen aangetoonde genmutatie, maar toch preventieve contralaterale mastectomie.

Recently, there has been an increase in the rate of contralateral prophylactic mastectomies (CPM) as a therapy for breast cancer. The CPM is performed to achieve a reduction in the risk of developing asecond breast cancer. However, evidence is lacking for beneficial survival outcomes after a CPM in patients without a gene mutation, and complications of surgery are inevitable. Currently there are no evidence-based clinical practice guidelines available for clinicians to decide upon the right treatment for patients without a gene mutation. Our hospitals have therefore implemented their own clinical pathway to achieve a comprehensive treatment for this group of patients. In this article we will provide an overview of the existing literature and illustrate our clinical pathway by presenting three patients treated in our hospitals in the last two years.

Treatment outcome in breast cancer patients with ipsilateral supraclavicular lymph node metastasis at time of diagnosis: a review of the literature.

INTRODUCTION: In the revised 6th edition of the AJCC-TNM staging system for breast cancer, metastasis in ipsilateral supraclavicular lymph node(s) is considered as a locoregional disease and classified as N3c rather than M1 distant disease. The aim of this review was to search the recent literature in order to investigate whether the reported treatment outcome of patients with ipsilateral supraclavicular metastases in breast cancer patients justifies this revision. METHODS: A review of the recent English-language literature (January 2001-June 2012) concerning breast cancer with supraclavicular involvement was performed. RESULTS: A total number of six studies were included in the current review. All reported comparable data with regard to treatment outcome after multimodality treatment, despite considerable heterogeneity in study populations. Patients with ipsilateral supraclavicular lymph node involvement showed outcomes more similar to locally advanced breast cancer patients rather than patients with distant tumor spread. CONCLUSION: It seems that the 2002 revision of the AJCC-TNM staging system for breast cancer has appropriately reclassified patients with supraclavicular disease to a new category (N3c).

Radiofrequency ablation for early-stage breast cancer: treatment outcomes and practical considerations.

BACKGROUND: Radiofrequency ablation (RFA) for early-stage breast cancer has the potential advantage of being a less invasive treatment associated with improved cosmetic outcome. The aim of this review was to summarise the reported treatment outcomes of ultrasound-guided RFA for early-stage breast cancer and to highlight practical considerations with regard to this treatment. METHODS: A search of the English-language literature concerning RFA for breast cancer treatment was performed. RESULTS: RFA is a technique that can be safely applied in patients with early-stage breast cancer, which is restricted to cT1-T2N0 ductal carcinoma with radiologically defined borders without any signs of multifocality or multicentricity. However, before RFA can be adopted as local therapy for early-stage breast cancer, more research is needed to assess the post-treatment pathological complete response and margin status, the long-term oncologic outcome in comparison to current standard breast conserving therapy and the potential cosmetic superiority of percutaneous RFA. CONCLUSION: RFA appeared to be a feasible technique for the treatment of early-stage breast cancer, but considerable practical considerations form an obstacle to introduce RFA as a standard of care.

Benzopyrene serum concentration after endovenous laser ablation of the great saphenous vein.

BACKGROUND: During endovenous laser ablation (EVLA) of the great saphenous vein, patients often involuntarily mention an uncomfortable "burnt" smell and taste. When applying intense heat to proteins and carbohydrates, it is inevitable that polycyclic aromatic hydrocarbons (PAHs) are formed. This group of PAH includes the human carcinogen benzo[a]pyrene (B[a]P). This study determined the serum concentration of B[a]P just before and after EVLA. METHODS: A total of 20 patients were included. The B[a]P serum concentration was determined just before and directly after EVLA. RESULTS: In 18 patients, B[a]P was determined before and after EVLA. In 2 patients, EVLA was not possible. In this study, no elevated serum concentration of B[a]P was found before and after EVLA. CONCLUSION: It remains to be established which heat products cause the burnt smell and taste sensation in patients during EVLA. Further research is needed to determine whether EVLA can be considered as a safe procedure.

Hand assisted laparoscopic surgery of aortoiliac occlusive disease: initial results.

OBJECTIVES: Open aortobifemoral bypass grafting has been the procedure of choice for many years in patients with symptomatic aortoiliac occlusive disease (AIOD). Hand assisted laparoscopic surgery (HALS) for AIOD could have advantages like faster recovery, faster oral intake and shorter hospital stay compared to the conventional technique. We documented the results of patients who underwent HALS for AIOD in our hospitals. MATERIALS AND METHODS: from January 1999 to December 2002, 33 consecutive patients underwent HALS for AIOD. Peri- and postoperative results were prospectively registered. Three different laparoscopic approaches were applied: transperitoneal, retroperitoneal and apron approach. RESULTS: There were 23 males and 10 females, with a mean age of 59 years (range 39-85). The surgical technique applied was: transperitoneal: 22 patients, retroperitoneal: 7 patients, apron: 4 patients. Per-operative results (median) of the transperitoneal, retroperitoneal and apron approach are: operating time 240, 420 and 263 minutes, cross clamp time 32.5, 40 and 33.5 minutes, blood loss 1150, 2100 and 950 ml, respectively. Postoperatively oral intake was fully resumed in 3, 4.5 and 2 days after performing the transperitoneal, retroperitoneal and apron technique. During the ICU stay patients received artificial respiration for 0, 1 and 0 days, admission to the ICU was 0.5, 1 and 0.75 days for the transperitoneal, retroperitoneal and apron approach. Finally, hospital stay was 8, 12.5 and 7 days after the transperitoneal, retroperitoneal and apron approach. Four patients (12%) had a minor complication, 4 patients (12%) had a major complication; pneumonia with ARDS, sepsis, bypass occlusion and chylo-abdomen. No patients died. CONCLUSIONS: HALS for AIOD is a technically demanding operation with a long learning curve. All three approaches are feasible. In this series of patients, we feel the transperitoneal and apron approach have the most advantages because of the larger working space. Finally, randomized trials will determine if laparoscopic assisted or total laparoscopic aortoiliac surgery has the potential to reduce morbidity for the patient compared to the conventional technique.