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Biomedical subjects

E Heineman

Publications and source records attributed to E Heineman.

At least 19 recordsLinked to original sources
PubMed1995

Anal dynamic graciloplasty in the treatment of intractable fecal incontinence.

BACKGROUND: In patients with intractable fecal incontinence, conventional treatment is not always successful. Dynamic graciloplasty (transposition of the gracilis muscle to the anus with the implantation of stimulating electrodes) was developed to provide such patients with functional neosphincters. We evaluated the clinical results of this new surgical approach and the effects on quality of life. METHODS: We treated 52 patients with dynamic graciloplasty. The clinical results of treatment were evaluated in an interview, by anal manometry, and by enema testing. The degree of continence was scored. To assess quality of life, four questionnaires were administered (parts 1 and 2 of the Nottingham Health Profile, the State-Trait Anxiety Inventory, and the Self-rating Depression scale). RESULTS: Among the 52 patients, 38 (73 percent) were continent after a median follow-up of 2.1 years. At 52 weeks the patients' condition had improved with respect to the median frequency of defecation (from five to two times per 24 hours, P < 0.001), the median time defecation could be postponed (from 9 seconds to 19 minutes, P = 0.012), and the median time an enema could be retained (from 0 to 180 seconds, P = 0.005). Patients in whom the technique was successful became less anxious than those in whom it failed (P = 0.002) and improved with regard to effectiveness in their occupations, ability to perform tasks around the home, personal relationships, sexual function, and social life (P = 0.01). They also became less isolated socially (P = 0.05). CONCLUSIONS: Dynamic graciloplasty is a safe and reliable technique in patients with severe incontinence and may result in a better quality of life.

Adolescent↗
PubMed1995

Outcome of transplantation of non-heart-beating donor kidneys.

To reduce the shortage of kidneys for transplantation, we started a non-heart-beating (NHB) donor programme, and compared the short-term and long-term outcomes of kidneys from NHB donors with those of a matched group of kidneys from heart-beating (HB) donors. 57 NHB kidneys were procured at the University Hospital in Maastricht and at three regional hospitals in the Netherlands, and were transplanted in 21 transplant centres within the Eurotransplant exchange organisation. 114 matched controls from HB donors were selected from Eurotransplant files. Mean follow-up was 85 months. At 5 years, graft survival was 54% for NHB kidneys and 55% for HB kidneys; patient survival was 75% and 77%. Kidneys from NHB donors had a significantly higher rate of delayed graft function (60% vs 35%), resulting in a longer hospital stay. Primary non-function of the graft was seen as frequently in the NHB donor-kidney group as in the HB group (14% vs 8%, p = 0.3). We conclude that NHB donors are a valuable source of kidneys for transplantation.

Death↗
PubMed1995

Inhibition of CD18-dependent leukocyte adherence by mAb 6.5 E does not prevent ischemia-reperfusion injury as seen in grafted kidneys.

The present study was designed to determine whether beta-2 integrin-mediated leukocyte adherence to the endothelium is involved in renal ischemia-reperfusion damage and to evaluate the therapeutic intervention potency of monoclonal antibody (mAb) 6.5 E, directed against the leukocyte CD18 adhesion molecule. To answer these questions, we used a clinically relevant canine model for the autotransplantation of kidneys that had been subjected to 30 min of normothermic ischemia, followed by 24 h of cold storage preservation. Intravital fluorescence microscopy of capsular microvessels showed that substantial leukocyte adherence occurred after renal ischemia and reperfusion. Leukocyte adherence was observed in both arterioles and venules, but predominantly in the latter. Reperfusion of the graft resulted in a statistically significant reduction of the venular red blood cell velocity (RBCV). Moreover, the venular diameter increased. No significant changes in the arteriolar RBCV or in the arteriolar diameter were observed. Administration of mAb 6.5 E, 1 h before reperfusion, inhibited leukocyte adherence to the renal microvascular endothelium, resulting in an improved venular flow 2 h after reperfusion. However, we observed no beneficial effect of mAb 6.5 E pretreatment on post-transplant graft function and survival. We conclude that leukocyte adherence does not play a critical role in the development of renal injury following reperfusion of kidneys that have been subjected to prolonged warm and cold ischemia.

Animals↗
PubMed1995

Prospective evaluation of the absorptive capacity of the bowel after major and minor resections in the neonate.

The outcome after major bowel resection in the neonatal period depends primarily on the time needed for bowel adaptation. A prospective study was begun in neonates after small bowel resection to evaluate the absorptive capacity of the bowel and growth parameters as a result of adaptation of the bowel. Twenty-four neonates who underwent bowel resection were included. The underlying diagnoses were necrotising enterocolitis (12), jejunal atresia (3), meconium peritonitis (3), and other (6). During the study, a standardized treatment with respect to nutrition was followed. At predetermined times, enterostomy fluid or faeces were collected for analysis of carbohydrate content, fat content, and fatty acids, together with a xylose test and a hydrogen breath test. Growth parameters included weight and height. The 24 patients were divided into two groups. Group A consisted of eight patients with short bowel syndrome (defined as loss of more than 50% of the original small bowel length related to gestational age). The mean remaining small bowel length in this group was 34.0% (24% to 42%). Group B consisted of 16 patients who had only minor bowel resections. Retarded growth was observed in four group A patients. Low levels of carbohydrate absorption were found 2 and 4 weeks after the initial operation in group A, and 2 weeks after the initial operation in group B. Low levels of fat absorption were found 4 and 8 weeks after the initial operation in group A. The coefficient of absorption of the different fatty acids showed complete absorption of caprylic acid.(ABSTRACT TRUNCATED AT 250 WORDS)

Case-Control Studies↗
PubMed1995

Segmental intestinal transplantation can be an adequate therapy for short bowel syndrome in growing dogs.

This study was undertaken to investigate whether two-stage segmental small bowel allotransplantation can maintain growth and development of young dogs (16 weeks, 5 to 6 kg) with surgically created short bowel syndrome (SBS). After near-total small bowel resection (group 1; n = 3), irreversible weight loss was noted. After a sham operation (group 2; n = 3), no growth disturbances were found. Major histocompatibility matched small bowel transplantation (SBT) with cyclosporine A as immunosuppressant, was performed in two stages (group 3; n = 7). During the first stage, one meter of jejunoileum from an adult donor was placed as a Roux loop. Four weeks later, the native small bowel was removed and replaced by the graft. Only one dog survived long-term; the dogs died from infectious complications. The addition of selective decontamination of the digestive tract and early gastrostomy feeding (group 4; n = 10) resulted in long-term survival in 60%. Follow-up at 4 months showed that their growth was about 20% compromised compared with that of the sham-operated animals. Functional analysis showed that electrolytes, urea, and D-xylose were normal, but there was an increase in the lactulose:mannitol ratio, fecal fat excretion, and postheparin diamine oxidase release. These results show that under the conditions described, segmental SBT functions sufficiently to treat SBS but does not maintain normal growth.

Anastomosis, Roux-en-Y↗
PubMed1995

Dynamic myoplasty in growing dogs as a feasibility study for treatment of fecal incontinence.

The feasibility of skeletal muscle transposition and electrical stimulation (dynamic myoplasty) for treatment of fecal incontinence has been shown in adults. It might be attractive to use such a technique in pediatric patients. Therefore, the influence of growth on skeletal muscle transposition and stimulation was studied in five puppies. In each dog, two neosphincters were constructed around a Thiry-Vella loop by using a dissected sartorius muscle with the neurovascular supply intact. In each of these five puppies, one of these muscles was electrically stimulated during a mean of 19 weeks (one puppy died during the first postoperative week). Muscle biopsies showed an increase in the percentage type I, fatigue-resistant muscle fibers from 61 to 94 in electrically stimulated sartorius neosphincters, but also an increase from 57 to 67 percent in transposed nonstimulated sartorius muscles. The diameter of these type I fibers during growth increased 36% in eletrically stimulated sartorius neosphincters and 55% in nonstimulated sphincters. Function of the neosphincters was tested with the inflow of saline in the Thiry-Vella loop. It was shown that the stimulated neosphincters were capable of inhibiting flow (which corresponded to manometric pressure registrations), but the nonstimulated sphincters were unable to inhibit flow. The experiments were complicated by infection and necrosis around the implanted stimulators in four puppies (which required reimplantation). We conclude that a dynamic myoplasty for fecal incontinence is feasible in growing puppies but that the technique is unacceptable during rapid growth because of the risks of infection and dislocation of the implanted device.

Anal Canal↗
PubMed1995

Tension pneumoperitoneum as an early complication after adenotonsillectomy.

Pneumoperitoneum as a result of pneumomediastinum has been described already. Amongst the causes pneumoperitoneum due to a complication of adenotonsillectomy, has not previously been described. We describe a five-year-old girl with tension pneumoperitoneum with respiratory and circulatory insufficiency half an hour after adenotonsillectomy. Removal of the intra-abdominal air with a 14 gauge needle restored normal respiration and circulation.

Adenoidectomy↗
PubMed1995

Dynamic graciloplasty for restoration of continence after traumatic destruction of the rectum and sphincters: report of a case.

A thirteen-year-old girl was run down by a speedboat, which resulted in traumatic destruction of the rectum and anal sphincters. She was treated by using a modified Duhamel procedure for rectal reconstruction and a double gracilis muscle transposition as the sphincter replacement procedure. Eight weeks after the first operation, intramuscular electrodes were implanted in both gracilis muscles and connected with an implanted electrical stimulator. This electrically stimulated gracilis muscle neosphincter restored sphincter function while anorectal sensation was preserved as a result of an intact rectovaginal septum. After closure of the temporary colostomy, the patient has good continence.

Adolescent↗
PubMed1995

Non-heart-beating donors: methods and techniques.

In light of the shortage of kidneys from HBDs the use of NHBDs can be considered essential. Emergency in situ preservation using a DBTL catheter offers the possibility of procuring kidneys from otherwise unsuitable donors. The procedure requires perfect organization and immediate availability of trained personnel and equipment. A standardized protocol is essential. The procedure is a valuable asset in emergency and transplant surgery.

Death, Sudden, Cardiac↗
PubMed1994

[3-week traction with 3-week spica-cast immobilization is as good as 6-week traction, and much cheaper].

OBJECTIVE: To gain insight into the clinical en economic results of the treatment of femoral shaft fractures in children by means of traction for 3 weeks and spica immobilization for 3 weeks as an outpatient in comparison with traction for 6 weeks. DESIGN: Retrospective. SETTING: Sophia children's hospital in Rotterdam. METHOD: Between 1981 and 1989, 278 children were admitted because of a femoral shaft fracture. This follow-up study concerned 229 children of whom 139 were treated by means of 6 weeks' traction (group 1) and 90 received the combination treatment (group 2). The two groups were comparable with regard to age, sex, cause, type and site of the fracture. RESULTS: All fractures healed, complications were rare and equally divided between the two groups. There was no significant difference between the two groups with regard to shortening and angulation of bone fragments. The mean duration of hospital stay was almost 47 days in group 1 as against 22 days in group 2, leading to a reduction of Dfl. 19,500.--in hospitalization costs per child. CONCLUSION: The results of treatment of femoral shaft fractures by means of traction in combination with spica immobilization equal those of 6 weeks' traction. The shortened duration of hospital stay leads to a considerable reduction in costs.

Adolescent↗
PubMed1994

Small bowel transplantation: an overview.

Small bowel transplantation (SBT) would, in theory, be the treatment of choice for patients suffering from the short bowel syndrome. Although SBT has been done with a considerable degree of success in some centers [36, 145], it is by no means an established or widely applicable therapy for those with short bowel syndrome. The small bowel is unique among vascularized organ grafts because it not only elicits a vigorous rejection reaction but is also capable of inducing graft-versus-host disease (GVHD). Rejection of the graft does not only lead to loss of function but also to bacterial translocation. The risk of fatal sepsis is aggravated by the immunosuppression given to prevent rejection. Here, the history of SBT is described, and recent developments in experimental and clinical SBT, as well as future prospects for this theoretically optimal treatment modality for patients dependent on total parenteral nutrition (TPN) for life, are outlined.

Animals↗
PubMed1994

Dynamic graciloplasty for anal atresia.

The aim of this study was to assess whether an electrically stimulated graciloplasty (dynamic graciloplasty) can achieve continence in nine patients with anal atresia (median age, 28 years; range, 18 to 40). As the first procedure, a gracilis muscle was transposed. Six weeks later, intramuscular electrodes were implanted and connected to a pulse generator. Eventually, the muscle was gradually trained, by electrical stimulation, to achieve fecal continence. Continence was obtained in five patients (55%). Manometry demonstrated an increase in mean anal pressure, from 36 mm Hg (without stimulation) to 52 mm Hg (with stimulation), after 8 weeks (mean increase, 16 mm Hg, [95% confidence interval, 8, 24 mm Hg; n = 9; P < .01). Failures resulted from a noncontracting distal part of the gracilis muscle (in three patients) and a nondistending rectum (in one patient). We conclude that dynamic graciloplasty can achieve continence in a substantial number of patients with thus-far untreatable incontinence after surgical correction for anal atresia.

Adult↗
PubMed1994

Nonheart-beating donors: the Maastricht experience.

The growing gap between the number of organs available for transplantation and patients on waiting lists demands additional donor sources. Nonheart-beating (NHB)-donor programs are known to increase the number of kidneys available. The group of potential NHB donors is very diverse and therefore 4 categories have been identified. At the University Hospital Maastricht, a NHB-donor program was implemented in 1980 to harvest kidneys after an in situ perfusion technique. In order to evaluate the function of kidney grafts from NHB donors, a retrospective multicenter study on the NHB-donor kidneys transplanted until 1992 was performed, using a control group of kidneys from heart-beating (HB) donors. The short-term results showed more delayed function (DF) in the NHB-donor group accompanied by higher serum creatinine levels at one-month posttransplant. The long-term outcome, however, was equal in both groups showing similar graft and patient survival rates up to 5 years. Apart from the type of donor, HB or NHB, only the number of HLA-DR mismatches could be identified as a potential risk factor for delayed graft function. NHB donors contribute considerably to reducing the gap between offer and demand in kidney transplantation and transplant centers should include NHB donors in their procurement programs. Meanwhile, efforts should be made to improve the short-term posttransplant graft function. Together with reducing DF, searching for valuable tools in viability assessment should also be an objective. Past viability tests never found broad clinical use but might be important in the optimal and safe usage of the potential NHB donor pool.

Adolescent↗