Biomedical subjects
Publications and source records attributed to F Derom.
Over a 20 year period 390 adults underwent 454 operations for inguinal hernia using the technique of McVay. The recurrence rate after primary repair was 7.61% and 18.33% for secondary hernias. This was usually early in the postoperative period. These results must be interpreted taking into a ccount that the operations were performed at a teaching institution.
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.
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.
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.
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.
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.
The surgical indications of a benign multinodular euthyroid struma are: compression of trachea and oesophagus or a possible malignity of the lesion. The operation of choice is a bilateral subtotal lobectomy. To avoid postoperative vocal cord paralysis or hypocalcemia due to damage of the parathyroid glands, it is important to demonstrate systematically the recurrent nerve and spare the inferior thyroid artery.
The surgical treatment of twenty patients operated for postoperative alkaline reflux gastritis is discussed together with the pathogenesis of this syndrome as a late postoperative surgery syndrome. Diagnostic procedures and results of investigations and treatment were compared with data of the literature. Surgical treatment is of great benefit. The different surgical technics should be used according their own indication.