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Biomedical subjects

C van der Werken

Publications and source records attributed to C van der Werken.

At least 19 recordsLinked to original sources
PubMed1995

Percutaneous endoscopic gastrostomy (PEG): comparison of push and pull methods and evaluation of antibiotic prophylaxis.

BACKGROUND AND STUDY AIMS: Infection of the gastrostomy opening after placement of a percutaneous endoscopic gastrostomy (PEG) catheter has been reported to occur quite often, especially when the pull method is used. We therefore compared complications occurring with the pull and push methods, and evaluated the role of antibiotic prophylaxis. PATIENTS AND METHODS: In a prospective study, 100 consecutive patients were randomly assigned to group A (pull plus antibiotic prophylaxis: amoxycillin-clavulanic acid 3 x 1.2 g i.v. over 24 hours; 37 patients), group B (pull without antibiotic prophylaxis; 34 patients) and group C (push without antibiotic prophylaxis; 29 patients). The indications for PEG placement were dysphagia due to oropharyngeal tumors (56%), neurological disease (32%), or other (12%). Patients were evaluated twice weekly for one month after the PEG placement. RESULTS: PEG catheters were successfully placed in 96% of the patients. The total procedure-related complication rate was significantly lower in group A than in groups B and C (28%, 58%, and 70%, respectively; p < 0.01). Major complications occurred in one patient in group A (seeding metastasis of a hypopharyngeal carcinoma in the gastrostomy tract), and in four patients in group B (three cases of peritonitis and one aspiration, resulting in two deaths), but in none of the group C patients. Group A patients experienced fewer peristomal infections than the other two groups (14%, 30%, and 41%, respectively: p = 0.05). The risk of peristomal pain was similar (11%, 15%, and 11%, respectively; p = n.s.). In three patients in group C, the PEG catheter had to be replaced by the pull method, due to repeated dislocation of the balloon catheter. CONCLUSIONS: The complication rate with PEG placement is high with both the push and pull methods. The complication rate with the pull method is significantly reduced when antibiotic prophylaxis is used.

Aged↗
PubMed1992

[Favorable results of the surgical treatment of intra-articular crush fractures of the distal femur].

Severely comminuted intra-articular femoral fractures are usually associated with major soft-tissue damage as a part of serious multiple injuries. Surgical treatment should aim at exact anatomical restoration of the articular surface. Internal fixation should be stable so that functional after-treatment is possible, a condition of achieving an optimal result. In a period of over 7 years, 24 patients with 26 intra-articular comminuted fractures were operated on. Twenty patients had multiple injuries (ISS > 18), 11 fractures were complicated. Postoperatively, impaired wound healing occurred in three elderly patients; in two of these amputation was necessary. Considering the severity of the injury, the long-term results were good: ten of the 16 patients examined with 18 fractures recovered completely, in the other cases the functional result wa adequate to good. Surgical treatment of comminuted intra-articular fractures of the distal femur is to be adapted to the individual case; depending on the fracture type and the associated damage a selection is to be made from various implants and techniques. With consistent, individually adapted application of the current AO techniques good results can be obtained.

Adult↗
PubMed1992

The posterior antiglide plate for fixation of fractures of the lateral malleolus.

Anatomical reduction and internal fixation of displaced lateral malleolar fractures are the cornerstone of the operative treatment of ankle fractures. The classical method of fixation is the application of one-third tubular plates laterally to the distal fibula, a technique, however, that has several disadvantages. In exceptional cases and under special circumstances we prefer a dorsal approach with the use of an antiglide plate. Indications, technique and experiences are discussed.

Adolescent↗
PubMed1992

Fracture-dislocations of the tarsometatarsal joint, a combined anatomical and computed tomographic study.

Based on anatomical and computed tomographic data as well as experience with the treatment of 30 patients with fracture-dislocation of the tarsometatarsal (Lisfranc) joint, a pathophysiological model is described in which the shape of the foot and ligamentous configuration in combination with applied forces are of pivotal importance. CT imaging helps to elucidate the extent of the lesions, easily overlooked in straight radiographs. In the transverse plane we discern three grades of dislocation. Grade 1, virtually no displacement; grade 2, dislocation of half of the shaft; grade 3, total displacement. Treatment is generally dictated by the severity of the lesion and ranges from plaster application to open reduction and internal fixation. Quality of reduction is easily visualized with CT imaging.

Adult↗
PubMed1992

External fixation for diaphyseal femoral fractures: a benefit to the young child?

External fixation for the treatment of diaphyseal femoral fractures in children seems an attractive alternative, which explains why its application gets more and more advocates. Between 1984 and 1989 15 children aged from 4 to 10 years were treated for a diaphyseal femoral fracture with an external fixation using a small Hofmann system. Fracture healing was without complications. Four children were able to walk on crutches non-weight-bearing after a short period. Six cases had complications, such as pin tract infection, inexplicable pain, or secondary displacement. One patient sustained a supracondylar fracture through one of the distal pin tracts. Hospital stay was longer than expected. In conclusion external fixation for femoral fractures in children is simple and elegant, but has considerable complications, while presumed advantages are not always obtained. In selected cases it is an attractive alternative, but the indications must be restricted.

Child↗
PubMed1992

Intrapelvic intrusion of the lumbosacral spine.

A 34-year-old female fell 7 meters onto her lower back and side, and sustained a nondislocated fracture of the 7th thoracic vertebra, a complex pelvic fracture with symphysiolysis and a left acetabular fracture in combination with a bilateral comminuted sacral fracture and downward intrusion of the lumbosacral spine. There was also a cauda equina-syndrome. Laparotomy with exploration of the lumbosacral area was terminated early because of hemorrhage. Later internal fixation of the fractures was performed by an anterior approach with complete reduction of the bilateral sacral fracture and the lumbosacral spine intrusion. We conclude that an anterior approach to this area gives good visualization, but is hazardous owing to the close proximity of the fractures to the central vessels and retroperitoneal muscles. A posterior approach gives less good visualization but may cause less hemorrhage.

Acetabulum↗
PubMed1991

[Surgical treatment of toxic megacolon].

From 1978 to 1989, 11 patients suffering from toxic megacolon were treated. In eight patients it was based on ulcerative colitis, while Crohns' disease, infectious colitis and pseudomembranous colitis were seen once each. Patients were initially treated with intravenous fluids and corticosteroids. They were closely followed both clinically and radiologically. The plain abdominal X-ray was of great help. Conservative regimen was successful in 3 patients, the remaining had to be operated on in due course. Three patients proved to have a perforation of the bowel at the time of operation. The initial operations performed were one proctocolectomy, four times a subtotal colectomy, twice a partial colectomy and in one instance a diverting colostomy. Two patients had to undergo an additional colon resection. Postoperative complications consisted mainly of intra-abdominal abscesses. Two of the operated patients died. Follow-up is between 2 and 9 years. None of the patients had a recurrence of the toxic megacolon. Four patients had a recurrence of their underlying disease, which however could be resolved in most cases by medical means. In one patient total colectomy is being considered.

Adolescent↗
PubMed1991

The AO-plate for external fixation in 12 cases.

The AO-plate was used for external fixation in 12 patients. The main indications were severe open fractures of the forearm and infected pseudarthroses at several locations. In 10 cases, the fixation provided enough stability to allow bone healing. The technique is simple, is convenient for the patient, and is always available without additional special equipment.

Adult↗
PubMed1991

External fixation of Smith's fracture. 16 patients followed for 2 years.

External fixation of 16 Smith's fractures was evaluated after 22 (6-42) months. In 15 patients, the radiographic results were satisfactory. There was a definite correlation between the radiographic and clinical end results. However, 6 patients had residual signs of an upper limb dystrophy. Although external fixation of Smith's fractures results in good function, this method should be used with caution because it cannot prevent reflex dystrophy; indeed, it may even initiate it.

Adult↗
PubMed1991

Aorto-caval fistula after lumbo-sacral disk surgery.

A patient with an aorta-caval fistula after intervertebral disk surgery is presented. Deterioration of the condition of the patient, mainly due to a progressive congestive heart failure, was caused by a large aorto-caval fistula; emergency repair of the lesion led to complete recovery. Because of delay in diagnosis, this insidious complication generally causes serious cardiopulmonary disturbances with a high morbidity and a significant mortality. The surgical treatment consists of the reconstruction of the greater veins and arteries involved.

Aorta, Abdominal↗
PubMed1991

Surgical arthrolysis for posttraumatic stiffening of elbow and knee joints.

Arthrolysis can be performed for posttraumatic stiffening of elbow and knee joints if all conservative treatment has failed. The mobility gained during the operative procedure is partly lost during the first two to three postoperative weeks. Intensive physical therapy is essential to maintain the mobility. In a follow-up study all 19 patients, who underwent arthrolysis from 1983 up to 1989, were re-examined. Considering the relative increase of motion the result was good in nine patients, moderate in six and poor in four patients. Arthrolysis is not an innocent procedure. However, if strict pre-operative conditions are considered, good results can be obtained.

Adult↗
PubMed1991

The femoro-femoral cross-over bypass.

From 1984 to 1990 64 patients (56 men and 8 women) with a mean age of 67.1 years (36-88 yrs.) were treated with a femoro-femoral cross-over bypass (45 primary and 19 secondary procedures). All patients had an occlusion of one iliac artery. In 26 patients there were factors that made a central reconstruction unattractive. These disorders were congestive heart failure, COPD, CVA, an age over 80 years, etc. In 19 patients an occlusion of one leg of a former aortobifemoral bypass determined the choice for cross-over bypass. Three patients died (5 per cent), two patients of the so-called redo-group (septicaemia, one patient and arteriojejunal fistula one patient), the third patient died after a primary femoro-femoral bypass (myocardial infarction). The overall patency rate after three years was 78 per cent. Especially primary cross-over bypasses showed a good outcome with a primary patency of 80 per cent and a secondary patency of 85 per cent after three years. Considering that 23 of the 45 (51 per cent) primary procedures were for treatment of critical ischaemia (stage III and IV of Fontaine), a favourable limb-salvage of 21 out of 23 (91 per cent) was obtained. The cross-over bypass can be recommended as first choice therapy for patients with a unilateral iliac artery occlusion.

Adult↗
PubMed1991

[Tension band osteosynthesis of resorbable material].

Tension-band osteosynthesis is a simple and well-known procedure applied in the surgical treatment of fractures. This type of osteosynthesis does nonetheless have some disadvantages, e.g., irritation of the skin and fistulization at the point where the metal cerclage bends, that can make removal necessary mostly under full anaesthesia. Since 1987 we have replaced the metal cerclage in 36 tension-band osteosyntheses (21 fractures of the medial malleolus, 6 lateral malleolar fractures, 4 patella, 4 olecranon and 1 distal clavicular fracture) with the resorbable suture material Vicryl No 2. Our results were good: there have been no skin problems at all and there are several advantages.

Bone Wires↗