Biomedical subjects
Publications and source records attributed to F Vermassen.
The authors report a 7-year old boy suffering from a renal carcinoma with a tumoral thrombus invading the vena cava. The kidney and the tumoral thrombus were removed with the help of a Biomedicus pump. This paper shows how to avoid a cardiopulmonary bypass procedure in order to perform safely a tumoral thrombectomy with this relatively new technique.
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From 1976 to 1990, 140 patients (mean age, 66 years; 91% male) underwent repeat mediastinoscopy as a routine staging procedure. The mean interval between first and second mediastinoscopy was 56 months. Owing to adhesions, 26 repeat mediastinoscopies (18%) were considered incomplete. There was no mortality, and 10 complications did not require interventional therapy. The results were positive in 20 patients, thus avoiding an unnecessary thoracotomy. In 7 patients with negative findings, positive lymph nodes were found at thoracotomy or by transcarinal puncture biopsy. The sensitivity of repeat mediastinoscopy in this series is 74%, and the accuracy 94%. We consider repeat mediastinoscopy a safe and reliable preoperative staging procedure in new or recurrent lung cancer.
In order to evaluate whether temporary immunosuppressive therapy is able to improve the results obtained with viable venous allografts and achieve better results than with synthetic grafts, 142 arterial reconstructions were performed in mongrel dogs bypassing their ligated femoral arteries. Histological as well as immunological studies were performed and patency determined by weekly palpation and regular angiography. The 6-month cumulative patency rates were: Group I: synthetic grafts (a) Dacron: 48%, (b) plasma-TFE: 53%. Group II: fresh grafts (a) autografts: 100%, (b) allografts: 37%, (c) allografts treated with cyclosporin 4 mg kg-1 daily for 1 month: 74% (100% after 1 month). Group III: grafts preserved in Hanks' solution with 15% DMSO at -160 degrees C for 1 month (a) autografts: 77%, (b) allografts: 35%, (c) allografts treated with methylprednisolone 1 mg kg-1 daily: 38%, (e) allografts treated with cyclosporin and methylprednisolone: 83%. Group IV: human saphenous veins implanted as xenografts and treated with cyclosporin and methylprednisolone: 18%. Immunosuppressive therapy with cyclosporin seems to be able to prevent early thromboses due to rejection seen after implantation of viable fresh or cryopreserved venous allografts, and the results are significantly better than those obtained with synthetic grafts. Tissue matching might further improve these results. This study suggests that cryopreserved venous allografts could be used for the creation of a vein-bank and their use, in combination with tissue typing and temporary immunosuppressive therapy may be warranted for arterial reconstructions when autologous saphenous vein is not available.
Patients with one internal carotid artery occlusion and a contralateral stenosis run a significantly higher risk of stroke. We performed endarterectomy of the stenotic carotid in 44 such patients and followed them for mean 54 months (range 1-172 months). Early mortality was 2%. Life-table analysis shows that the incidence of a new stroke was 0.6% per year, the survival rate was 78% after three years, and 70% after five years. We conclude that carotid endarterectomy can be safely performed in patients with contralateral internal carotid artery occlusion and can significantly improve the long-term prognosis of these patients.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
AIM: We retrospectively assessed the effectiveness of ultrasound-guided percutaneous thrombin injection in the treatment of iatrogenic femoral pseudoaneurysms and registered the occurrence of complications in the systemic circulation. METHODS: We performed ultrasound-guided thrombin injection in 26 iatrogenic femoral pseudoaneurysms: 24 were classified as single en 2 as complex. We registered the volume and the pseudoaneurysm neck measurements, as well as the complication rate. RESULTS: Ultrasound-guided percutaneous thrombin injection led to a successful obliteration of pseudoaneurysm in 25 out of 26 cases (96.2%). The thrombin amount varied between 250 and 1000 IU. A thrombosis of the common femoral artery after the thrombin injection occurred only in one patient. CONCLUSION: Ultrasound-guided percutaneous thrombin injection is effective and safe in the treatment of iatrogenic femoral pseudoaneurysms provided the exclusion criteria are respected. Complications are rare.
In order to evaluate various protocols for the preservation of venous allografts 162 arterial reconstructions were performed in mongrel dogs bypassing their ligated femoral arteries. The cumulative 6-month patency-rates as determined by weekly palpation and regular angiography were. Group I = Synthetic grafts: (a) Dacron 48%, (b) PTFE 53%. Group II = Fresh venous grafts: (a) autografts 100%, (b) allografts 37%. Group III = Veins preserved in saline at 4 degrees C for 1 month: (a) autografts 44%, (b) allografts 34%. Group IV = Veins preserved in saline at -70 degrees C: (a) autografts 58%, (b) allografts 47%. Group V = Veins preserved in glutaraldehyde solution: (a) autografts 26%, (b) allografts 22%. Group VI = Veins preserved in Hanks-solution with 15% DMSO at -160 degrees C: (a) autografts 77%, (b) allografts 35%. Histological as well as immunological studies suggest that these results are determined by the preservation protocol in Groups III, IV and V and by the presence of rejection in Groups I and VI. As the results with the allografts are not superior to those obtained with synthetic grafts, their use should be confined to those cases where the use of synthetic materials should be avoided at any price. Further experiments with immunosuppression and antigenic matching are indicated to see whether this would improve the results obtained with viable venous allografts.
A patient is presented with repeated sub-obstructive symptoms due to a documented intermittent hiatal herniation of the transverse colon, accompanied by a volvulated and complete thoracic herniated stomach. The symptoms, the complications, and affirmative investigations, and the treatment are discussed. Surgical reduction, hernia repair and antireflux operation are always recommended in case of a massive hiatal hernia, since a conservative treatment stands for serious and frequent complications.
Data about the number and treatment of trauma-patients are, certainly in our country, very rare. In this study we showed that such a registration with grading of the severity of the injuries following the ISS-Score is feasible and useful. Further and more extensive registration seems necessary in order to obtain a better insight in epidemiology and treatment of trauma patients in our country.
The mortality of generalised intra-abdominal sepsis and severe necrotising pancreatitis remains very high. The persistence of intra-abdominal septic foci leads to recurrent abscess formation, persistence of sepsis and development of multiple organ failure, ultimately leading to the death of the patient. Therefore we believe that a repeated and total elimination of all septic and necrotic material is the cornerstone of an adequate surgical therapy in these patients. We performed "staged lavage" with the aid of a Zipper in 24 patients (10 with intra-abdominal sepsis and 14 with severe necrotising pancreatitis). Via the Zipper 98 relaparotomies were performed (mean 4.1 per patient). The high Apache II-scores (12 to 45, mean 24) illustrate the severity of disease in most of these patients. The expected in-hospital mortality-rate was 59% while in our series 7 patients died on a total of 24 (28%).
Kaunitz-procedure for gastro-oesophageal reflux. Between May '74 and May '86 we performed 121 Kaunitz-procedures for gastro-oesophageal reflux, mostly with oesofagitis. Follow-up was obtained in 120 of these 121 patients. The mean follow-up is 55 months and the mean age 49.5 years at the time of operation. Of these patients 103 were completely free of reflux-symptoms after the operation while 6 patients had apparent amelioration of their symptoms. In 7 patients we obtained no subjective improvement but in 4 of them the oesofagitis, which they had preoperatively, has disappeared. 4 patients were reoperated because of anatomical recurrence. The results can be considered as good or excellent in 94% of the patients. The Kaunitz procedure is a simple and efficient operative technique in patients with hiatus hernia and reflux.
The use of a perisplenic prosthesis in Polyglactin (Vicryl) is a recent technique for spleen conservation after trauma. We present our experience in eight severely traumatised patients with hemoperitoneum on the basis of a ruptured spleen. In all cases we were able to save the spleen. No complications occurred and the splenic function was intact after the operation. An overview of the techniques for conservation of the spleen after trauma is given.
In order to evaluate under what conditions the use of venous homografts could yield the best results. 230 arterial reconstructions were performed in mongrel dogs bypassing their ligated femoral arteries. Cumulative 6-month patency-rates were: Group 1: Prosthetic materials: a) Dacron grafts: 48%, b) PTFE grafts: 53%. Group 2: Fresh veins: a) autografts: 100%, b) allografts: 37%, c) allografts treated with cyclosporin 4 mg/kg.day for one month: 74% (100% after one month). Group 3: Veins preserved in saline at 4 degrees C. for one month: a) autografts: 44%, b) allografts: 34%. Group 4: Frozen veins preserved in saline at -70 degrees C. for one month: a) autografts: 58%, b) allografts: 47%. Group 5: Veins preserved in glutaraldehyde 0.25% for one month: a) autografts: 26%, b) allografts: 22%. Group 6: Veins preserved in 15% DMSO in Hanks solution at -160 degrees C for one month: a) autografts: 77%, b) allografts: 35%, c) allografts treated with cyclosporin 4 mg/kg.day for one month: 72%, d) allografts treated with methylprednisolone 1 mg/kg.day for one month: 38%, e) allografts treated with cyclosporin 4 mg/kg and methylprednisolone 1 mg/kg daily for one month: 83%. Fresh veins and veins preserved in 15% DMSO at -160 degrees C. are viable but immunologically active grafts. In allografts rejection phenomena cause a relatively high occlusion rate which, however, can be prevented with low dose cyclosporin. The optimal duration of immunosuppressive therapy remains to be determined. Veins stored at 4 degrees C or at -70 degrees C are not viable and only weakly antigenic. Their results are not better than those obtained with prosthetic material.(ABSTRACT TRUNCATED AT 250 WORDS)
The authors report about a recurrence in a uremic patient who underwent a subtotal parathyroidectomy with autotransplantation in the sternocleidomastoid muscle for hyperparathyroidism. Reexploration revealed an enlarged parathyroid graft. This paper illustrates the potential complication of parathyroid autografts in patients with chronic renal failure.
Preterm infants undergoing surgical closure of patent ductus arteriosus are usually critically ill and are suffering from many concomitant diseases. The high risk of increased morbidity in transferring them from the neonatal intensive care unit (NICU) to a distant operating room is generally recognized. For this reason we report our experience in 33 premature infants with patent ductus arteriosus who have been operated in the NICU over a six-year period. There were no operative or immediate postoperative deaths and the 30 days hospital mortality was 6%. Based upon these findings we can confirm that operative closure of PDA can be performed safely in the NICU.