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Biomedical subjects

F Derom

Publications and source records attributed to F Derom.

At least 19 recordsLinked to original sources

Surgery for arteriovenous fistulas and dilated vessels in the right lung after the Glenn procedure.

A superior vena cava-right pulmonary artery (SVC-RPA) anastomosis was constructed in a 2-year-old boy with tetralogy of Fallot. Ten years later and 5 years after "corrective" surgery without removal of the shunt, cyanosis and heart failure developed. Stereocineangiography and lung scanning revealed arteriovenous fistulas and dilated vessels in the right lung. The SVC-RPA anastomosis was taken down, the SVC being reimplanted in the right atrium and the RPA end being closed with a few stitches. Neither lobectomy nor pneumonectomy was performed. Immediately after the operation and during a follow-up period of almost 2 years, the boy has remained asymptomatic. Whenever a correction is planned in a patient with SVC-RPA anastomosis, the vessels of the right lung should be examined by scanning and angiography. If important arteriovenous fistulas do exist, the affected lung should be excluded from the pulmonary artery circulation.

Arteriovenous Fistula

[Bronchussuture (author's transl)].

We describe the method of manual bronchussuture, used from 1968 until new, which gave us complete satisfaction. Many of the important factors are discussed. The results are analysed and concluding we expose the reasons why we found manual bronchussuture better than any automatic stapling device.

Bronchi

[Ureteral obstruction secondary to aortic femoral by-pass (author's transl)].

We have presented 3 cases of ureteral obstruction secondary to aortic femoral by-pass grafting. This complication has not been frequently reported and we feel that it may be more common than recognised. In all the other published cases the ureter was passing behind the prosthesis but the authors present a surgically proved case where the ureter lies in its normal position. They also prefer the aseptic vascular procedures for reconstruction.

Aorta, Abdominal

[Indications, method and results of autotransfusion in trauma and vascular surgery (author's transl)].

The authors have used the Bentley Ats 100 system, a disposable autotransfusion unit, in 31 cases of trauma and major vascular surgery. An original method of anticoagulation consisting in heparine (1 mg/kg bodyweight) and priming and flushing of the succion unit with ACD is described. The effect of the autotransfusion on the coagulation and the recent problems and advances are discussed.

Abdominal Injuries

[Surgical repair of a congenital cervical lung hernia in a baby (author's transl)].

Case report of a congenital cervical lung hernia causing serious feeding and respiratory problems in a 5 1/2 months old baby. Surgical repair of the endothoracic fascia defect with a MARLEX mesh. As far as we know the first report of a surgical repair of a congenital cervical hernia in an infant. Review of frequency, signs and therapy of lung hernia in literature. Analysis of the anatomic situation of a lung hernia in the cervical region.

Fascia

Anastomotic aneurysms of the femoral anastomosis after aortic bifurcation graft.

A 17 year experience (1958-1975 with anastomotic aneurysms of the femoral anastomosis after aortic bifurcation graft is presented. An anastomotic aneurysm is a progressive dilatation of an anastomosis between an artery and a prosthesis, caused either by a defective suture line or by a wall dilatation. One thousand one hundred and eighty-four femoral anastomoses with a decent follow-up were reviewed and 89 aneurysms were encountered, a per site incidence of 7.5%. Aetiological agents were arterial hypertension, non-infective bad wound healing, type of suture material, defect of the graft and trauma. The therapeutical approach with only 12% recurrences is a segmental interposition. The rate of satisfactory results was 78%. By reducing our bad wound healing from 15 to 10% of the anastomoses over the last five years, we reduced considerably our percentage of anastomotic aneurysms. The use of ultraleight weight prostheses seems to have also reduced the incidence and, in our study that we closed in December 1975, we encountered no aneurysm on Cooley or Milliknit, even with a follow-up of four years. Since the end of the study, however, we encountered one case of bilateral anastomotic aneurysm with Milliknit, one year after the primary operation but with a definite trauma in the anamnesis.

Adult

The management of abdominal wall stomata: skin protection, peristomal wound healing and support for the collecting bag. A multi-center study.

The specific properties of Stomahesive tested in 116 stomal and 20 fistulous patients render it really useful in stomatherapy where it increases the comfort of the patients: 1. it offers an excellent peristomal skin protection whatever the nature of the stoma or origin of the fistula; 2. it promotes rapid healing of skin lesions, even in ileostomy, transverse colostomy, ureterostomy and fistula patients; 3. it ensures an effective degree of impermeability; 4. it provides a large base for adhesion of the collecting bag; 5. it can be kept on for about 6 days in most cases; 6. The local tolerance is excellent (Acta chir. belg., 1977, 76, 533-537).

Abdominal Muscles

[Therapeutic strategy in the cold nodule of the thyroid (author's transl)].

The benign or malignant nature of a cold nodule in the thyroid can never be definitely assessed before surgery. All cold nodules that show no tendency to regress must be resected. The nodule is resected with surrounding healthy tissue and immediately examined in freezen sections. Out of 108 cases of simple resection of the nodule only one diagnosis of carcinoma was missed at the operation. That patient was reoperated two weeks later with curative intention.

Biopsy

Variations in the capacity of the steroid binding beta globulin (SBbetaG) in plasma from normal young twins.

The capacity of human plasma to bind specifically dihydrotestosterone (DHTBC) has been determined in normal monozygotic and dizygotic twins less than 20 years old. The total variation in DHTBC was analysed by stepwise multiple regression, combined with variance analysis, applied to the pair sums in DHTBC, body height and body weight, as well as to age. A significant part of the variation in DHTBC was explained. Due to the strong interwining between body weight, body height and age in growing children it was impossible to make out which one of the latter variable contributed most to the negative correlation which was observed. Previous studies in adults did, however, show that only body weight and not body height or age correlated negatively with DHTBC. By doing the same calculations for the within-pair differences in DHTBC, body height and body weight it was hoped to delineate the within-family part of the environmental variation in DHTBC. Body weight and body height did, however, not offer any significant explanation as to this part of the variation in DHTBC. The upper limit of heritability (h2) for DHTBC was estimated by comparing intraclass-correlation coefficients in monozygotic and dizygotic twins. According to the method used to calculate the latter intraclass-correlation coefficients h2 estimates for DHTBC of 0.774 and 0.960 were arrived at. However, due to the rather small number of dizygotic twins available the confidence limits of these estimates were rather large.

Adolescent

Aorto-enteric fistula as clinical entity.

A 19 year experience (1958-1977) with aortoenteric fistulas is presented. An aorto-enteric fistula is a direct communication between the aortic lumen and the gastro-intestinal tract producing a gastro-intestinal bleeding. The commonest cause of a primary or spontaneous aorto-enteric fistula is aneurysm formation. If there has been an operation on the aorta then the aorto-enteric fistula is called secondary. No primary aorto-enteric fistulas were encountered but thirteen secondary aorto-enteric fistulas are reported on a total of 841 aorto-femoral by-pass operations reviewed. Six hundred and sixty-one of these had an acceptable follow-up: this gives a 2% incidence. Our survival rate is 40%. Four different possible mechanisms are proposed for the formation of the secondary aorto-enteric fistula: anastomotic aneurysm formation, fibrous reaction, intra- or postoperative contamination or a combination of these possibilities. Some etiological factors as type of anastomosis, suture material, prosthesis material, hypertension, end-arterectomy and preoperative aneurysmatic tendency are analysed. A study is made of the different available diagnostic tools and the different possible therapies are discussed.

Aortic Diseases

Transthoracic vagotomy for recurrent peptic ulcer after gastrectomy. An appraisal of fifteen years experience.

The case records of 38 patients operated for recurrent ulcer following partial gastrectomy were examined. They all underwent a transthoracic vagotomy. Two patients died during follow-up, one because of a gastro-intestinal bleeding 14 days after operation and one following a psychiatric disorder (vital depression) three months after his second intervention. According to Visick's grading overall results are very good in 89%, moderate in 5.5% and disappointing in 5.5%. These figures indicate that transthoracic vagotomy is the treatment of choice for recurrent ulceration after partial gastrectomy.

Adult

[Intraoperative identification of parathyroid glands with methylene blue (author's transl)].

Identification of parathyroid glands during surgery for treatment of hyperparathyroidism remains difficult. The staining with methylene blue was first described by Dudley. Twenty-one patients were explored. Thirty to sixty minutes before surgical incision, an intravenous perfusion of methylene blue was started. The dose varied between 5 to 10 mg per kg. Thirty-seven enlarged glands were found of which 33 were obviously stained; 13 showed some color that could not be attributed with certainty to the dye; 1 adenome was not stained at all. In 89.2% of the cases the staining had the favorable effect of shortening the operation. Only 4 normal glands showed the blue stain. The affinity for methylene blue is thus mainly found in pathological parathyroid glands.

Adenoma