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Biomedical subjects

E M Mathus-Vliegen

Publications and source records attributed to E M Mathus-Vliegen.

53 records · Page 3Linked to original sources
PubMed1986

Polyp-simulating mucosal prolapse syndrome in (pre-) diverticular disease.

Eight patients with anal blood loss were referred for endoscopic polyp removal (4) or because of problems with the differential diagnosis (4). These patients were referred because of an apparent discrepancy between the initial diagnosis (malignancy, ulcerative colitis and hemangioma) and the clinical and/or radiographic and endoscopic findings. At endoscopy a polyp-simulating lesion was found in all patients; this was not adenomatous in nature, but was made up of bright red, hyperemic prolapsing redundant mucosa. Also, polypoid excrescences were present with a clearly distinguishable transition between the intensely red congested mucosa and the normal pink adjacent epithelium at the base of the stalk. The distribution of the lesions was confined to the sigmoid area. After institution of a fibre-enriched diet, regression of the lesions was documented. However, the conspicuous hypercontractility and thickening of the mucosal layer persisted. The clinical significance of the recognition of this polyp-simulating mucosal prolapse syndrome lies in the fact that endoscopic polyp removal is not indicated and that such abnormalities may be responsible for low-grade, chronic and recurrent bleeding.

Adult↗
PubMed1986

Complications and pitfalls of laser therapy.

228 patients have been studied in retrospect, in an attempt to delineate the limits and pitfalls of laser treatment of benign (n = 104) and malignant (n = 124) tumors. Benign colorectal adenomas (n = 78) were divided into 3 groups according to the size of the lesion. The occurrence of complications, the persistence and recurrence rate paralleled the size of the tumor. No relationship as to the number of sessions, the interval between them or the mean and/or total amount of energy was found. The prolonged time span of treatment in larger lesions was related to the formation of large ulcers and edema. Poor accessibility and difficult positioning of the laser beam interfered with adequacy of laser treatment. In familial polyposis (n = 26) laser photocoagulation appeared a highly effective, safe and easy procedure. In esophageal cancer (n = 16), gastric (n = 13) and colorectal malignancies (n = 95) laser therapy was very efficaceous in the palliation of bleeding and/or obstruction. Unfavorable anatomy and difficult accessibility were the main drawbacks. Problems in the assessment of pathology and submucosal extension impeded effective treatment of early cancer. Generally speaking, the presence of a whitish appearance, fibrosis of bloody tissue pointed toward a less favorable response, but much more has to be learned about the interaction between laser light and tissue properties.

Adenocarcinoma↗
PubMed1986

Combined endoscopic and surgical treatment in Peutz-Jeghers syndrome.

A combined endoscopic and surgical treatment in Peutz-Jeghers syndrome is presented. Natural history in Peutz-Jeghers syndrome often leads to multiple and acute laparotomies, resulting in intestinal resections. This may lead to a short bowel syndrome. In order to gain control over the small intestinal polyposis, a combined approach by the gastroenterologist and surgeon is performed. At laparotomy, an endoscope is introduced orally into the small intestine which is then telescoped over it by the surgeon. The small intestine is inspected in retrograde order and existing polyposis is treated by endoscopic or surgical polypectomy, or both, or by minimal intestinal resection. Thus, a "clean small intestine" is created. Data on five patients thus treated are presented. No recurrences were seen after this procedure at a mean follow-up period of 21 months. Combined endoscopic and surgical treatment of Peutz-Jeghers syndrome, together with top and tail endoscopy, results in a "clean intestine" and is supposed to diminish the need for multiple acute laparotomies and, therefore, the risk of a short bowel syndrome. There is also supposed to be an improvement in the quality of life and life expectancy.

Adolescent↗
PubMed1985

["Capers"].

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Adolescent↗
PubMed1985

Peutz-Jeghers syndrome: clinical presentation and new therapeutic strategy.

A new treatment strategy is presented and evaluated in 5 patients with Peutz-Jeghers syndrome, in an effort to preserve bowel integrity and to eliminate the threat of a short bowel. After conventional endoscopic polypectomy of all reachable lesions, peroperative endoscopic polypectomy is scheduled. Endoscopic peroperative panpolypectomy is carried out and only in bulky, broadbased, multiple or invaginating polyps is an enterotomy or a resection - kept to a minimum thanks to the information provided by the endoscopist - performed. The procedure was well tolerated, hospitalization was remarkably short, and the subsequent follow-up period free of readmission - in contrast to previous observation periods. It is, however, a tedious and time-consuming method, and close collaboration between endoscopist and surgeon is urgently required.

Adolescent↗
PubMed1983

The role of endoscopy in the correct and rapid positioning of feeding tubes.

The recognition of the importance of the enteral route for (hyper) alimentation led us to develop three methods for enteral placement of feeding tubes using endoscopic techniques. With these three treatment modalities it was possible to carry out enteral administration of nutrients in a group of patients, in whom otherwise only total parenteral feeding or enteral feeding by needle catheter jejunostomy was considered feasible. The use of endoscopic equipment permitted correct placement of tubes beyond the stomach either in the duodenum, at the ligament of Treitz or into the jejunum. Also simultaneous distal feeding combined with proximal intestinal drainage in the case of fistula, perforation, anastomotic leakage, or gastric dysfunction was achieved using this endoscopic approach.

Adolescent↗
PubMed1983

Biological fate of the vitamin A transporting protein complex and beta-carotene after excessive dietary intake. Report of a case.

Epidemiological surveys indicate a relationship between the occurrence of cancer and vitamin A status. Potential accumulation and toxicity of vitamin A and its derivatives limit its therapeutical use. Administration of carotenoids is perhaps more promising, but information about biological and kinetic behaviour is scarce. This article deals with the prospective investigation of the kinetics of beta-carotene and vitamin A in a patient with excessive oral dietary intake. Normalization took 17 months after refraining from excessive intake of beta-carotene while consuming a vegetarian diet. Apparently high levels of beta-carotene and vitamin A were not associated with toxicity phenomena in our patient. We, therefore, wonder whether dietary supplementation of carotenoids and vitamin A should be considered in research protocols regarding prevention and/or treatment of (pre)malignant conditions. Dietary supplementation of carotenoids, without apparent toxicity in our patient, should, therefore, be considered as an alternative in the prevention and/or treatment of (pre)malignant conditions. Further study of kinetics is, however, mandatory.

Adult↗
PubMedDate not supplied

The potential and limitations of laser photoablation of colorectal adenomas.

Ablation of colorectal adenomas by Nd:YAG laser energy was investigated in 271 patients. Two hundred and forty-one patients, selected because of poor surgical and medical condition or refusal of surgery, presented with incompletely removed polyps or with lesions unsuitable for endoscopic polypectomy. Thirty patients with polyposis coli were treated for rectal stump polyps after subtotal colectomy and ileorectal anastomosis. Because of insufficient follow-up (28) or malignant degeneration (23), full evaluation was possible in 196 colon adenoma and 24 polyposis patients. Complete ablation with histologic confirmation for at least 12 weeks was achieved in 150 (82%) of the 183 colon adenomas. This declined to 141 (77%) because of later recurrences in prolonged follow-up. Treatment of large adenomas was less successful than that of intermediate and small lesions: ultimate ablation in 56, 85, and 93%, respectively. Impressive was the immediate relief in 100 symptomatic elderly patients, who were bothered by frequent diarrhea, excessive mucous discharge, and incontinence. All patients survived despite major complications (7%) that mainly consisted of stenosis and hemorrhage. Rectal stump polyps were eliminated in 20 patients with polyposis coli. The remaining four had an uneventful ileoanal anastomosis for ultimately uncontrollable growth of polyps. Malignancy was discovered in 22 adenoma patients and in 1 polyposis patient. We recommend laser ablation of colorectal adenomas for small and medium-sized polyps, that cannot be removed by endoscopic polypectomy in inoperable patients or in patients refusing operation. Laser treatment for extensive adenomas seems only appropriate for symptomatic relief.

Adenoma↗
PubMedDate not supplied

Palliation by laser photoablation: a multidisciplinary quality assessment.

To evaluate the quality of life and degree of palliation by laser photoablation for gastrointestinal cancer, a questionnaire was sent to general practitioners (GPs) and referring specialists. The response was 85%. General practitioners considered palliation by laser to be effective in 74% compared with 50% for referring specialists (p less than 0.001). Specialists felt themselves unable to answer in 17% compared with no GPs (p less than 0.001). The differences in assessment between specialists and GPs were most pronounced in colorectal cancers. There was a striking consensus of opinion about the rate of failed palliation among endoscopist, referring specialist, and GP. On the other hand, the rating of success by specialists and GPs was significantly lower than the endoscopist's evaluation. The endoscopist and GP were more at variance than the endoscopist and specialist. Above all, the GPs seemed to outweigh the burden against the benefits of treatment. Disagreement of the specialists and the GPs with the endoscopist about the outcome appeared to be related to unrealistic expectations, to a shift in presenting symptoms or to complications, misinterpreted as being laser-induced but mainly due to progression of disease.

Attitude of Health Personnel↗
PubMedDate not supplied

Feeding tubes in endoscopic and clinical practice: the longer the better?

In an attempt to combine successful distal feeding tube positioning and a more prolonged stay without interfering with tube patency and feeding regimens, commercially available 105-cm polyurethane feeding tubes were compared with experimental tubes 125 cm and 145 cm long. The technique for endoscopic positioning at the bedside of the patient was standardized. Forty-five patients who required intraduodenal or intrajejunal enteral feeding in the intensive care unit were randomly assigned to one of the three tube-length groups. Even the 105-cm short feeding tubes were able to be introduced beyond the duodenojejunal junction, although insufficient tube length remained for tube fixation at the nose. The longer variants, however, were positioned significantly (p < 0.01) deeper in the intestine, with enough spare tube length for slack formation in the stomach and fixation at the nose. Tubes were electively removed in 29% of the patients. Irrespective of tube length, premature removal by the patient (in 36%) or by the nurse (in 11%) was rather high. Tube blockage was irremediable in 9%. Feeding tubes survived on average 10.6 days in all three tube-length groups, despite the fact that many drugs were administered by tube as well. The successful, easy, and fast endoscopic positioning of feeding tubes far into the intestine and at the patient's bedside may further expand the possibility for enteral feeding. Moreover, polyurethane materials are well tolerated, and increasing the tube length does not interfere with tube patency or feeding plans.

Endoscopy, Gastrointestinal↗