Biomedical subjects

G J Clevers

Publications and source records attributed to G J Clevers.

12 recordsLinked to original sources

PubMed2004

Preperitoneal gridiron hernia repair for inguinal hernia: single-center experience with 2 years of follow-up.

The optimal operation technique for groin hernia repair has not been established. This study evaluates the long-term recurrence rate and perioperative complications after posterior inguinal mesh hernia repair using a gridiron incision described by Frans Ugahary. A retrospective analysis was performed of the medical records of 366 patients who underwent Ugahary hernia repair. Operative results and perioperative morbidity were evaluated retrospectively. Follow-up was done by clinical examination. The main outcome measure was recurrence rate at a mean follow-up of 2 years. Of the 386 groin hernia repairs, 263 hernia repairs were examinated in the outpatient clinic. The overall recurrence rate was 6.5% with a mean follow-up of 2 years, and 10.1% of the patients had minor complications. This retrospective study demonstrates that the repair according to Ugahary is a safe technique for operating on groin hernia. However, the procedure is difficult to reproduce in nonexpert hands. This technique must be compared to other inguinal hernia operation techniques in the near future.

Adult↗

PubMed2004

The effects of remifentanil and sufentanil on the quality of recovery after day case laparoscopic cholecystectomy: a randomized blinded trial.

BACKGROUND: Duration of hospitalization after laparoscopic cholecystectomy (LC) is mainly determined by temporary side effects such as pain, nausea, and vomiting. In this study we compared remifentanil, a short acting opioid, and sufentanil, a longer acting opioid, on their ability to reduce these postoperative effects and facilitate LC in day case surgery. METHOD: Seventy patients scheduled for elective LC were randomized in two groups. Remifentanil was used in group 1 as part of the anesthetic protocol, sufentanil was used in group 2. After surgery, patients were asked to evaluate pain and nausea on a verbal rate scale (VRS). Frequency of vomiting and analgesic medication consumption was registered. Time between surgery and to the start of micturition, drinking, mobilization, dressing, and discharge was recorded. Patients registered their satisfaction on a VRS. Details of any other adverse events throughout the study were recorded. RESULTS: Twenty-two patients (63%) of group 1 were treated as day cases vs. 27 (77%) in group 2 (P = NS). All patients who were not discharged as day cases left the hospital one day postoperatively. Immediately after surgery, patients in group 2 reported significantly less pain. There were no other significant differences between groups. CONCLUSION: The majority of patients scheduled for LC can be safely discharged on the day of surgery. Reported satisfaction one week postoperatively was high for all patients. We found no major relevant differences between the two anesthetic protocols.

Adult↗

PubMed2000

Functional results after treatment of hip fracture: a multicentre, prospective study in 215 patients.

OBJECTIVE: To find out which factors influence outcome after a fractured hip, so that the optimum treatment may be chosen for each patient. DESIGN: Prospective cohort study. SETTING: 3 teaching and 2 rural hospitals, The Netherlands. SUBJECTS: 215 patients aged 55-102 years (median 82) who presented with a fractured hip during 1994. INTERVENTIONS: Interviews shortly after the injury and 4 and 12 months later, study of radiographs, and evaluation of casenotes. MAIN OUTCOME MEASURES: Mobility and functional recovery. RESULTS: 38 patients had died by the 4-month follow up, at which time 64/177 (36%) had regained the level of mobility that they had before the injury. At 12 months the figure was 58/148 (39%). The corresponding figures for functional recovery were 52/177 (29%) and 36/148 (24%). Factors that militated against recovery were increasing age, coexisting diseases, general complications and local complications. CONCLUSIONS: The chance of a patient with a hip fracture making any further recovery after 4 months is minimal. Local complications are the most important risk factor.

Aged↗

PubMed1997

Comparison of conventional anterior surgery and laparoscopic surgery for inguinal-hernia repair.

BACKGROUND: Inguinal hernias can be repaired by laparoscopic techniques, which have had better results than open surgery in several small studies. METHODS: We performed a randomized, multicenter trial in which 487 patients with inguinal hernias were treated by extraperitoneal laparoscopic repair and 507 patients were treated by conventional anterior repair. We recorded information about postoperative recovery and complications and examined the patients for recurrences one and six weeks, six months, and one and two years after surgery. RESULTS: Six patients in the open-surgery group but none in the laparoscopic-surgery group had wound abscesses (P=0.03), and the patients in the laparoscopic-surgery group had a more rapid recovery (median time to the resumption of normal daily activity, 6 vs. 10 days; time to the return to work, 14 vs. 21 days; and time to the resumption of athletic activities, 24 vs. 36 days; P<0.001 for all comparisons). With a median follow-up of 607 days, 31 patients (6 percent) in the open-surgery group had recurrences, as compared with 17 patients (3 percent) in the laparoscopic-surgery group (P=0.05). All but three of the recurrences in the latter group were within one year after surgery and were caused by surgeon-related errors. In the open-surgery group, 15 patients had recurrences during the first year, and 16 during the second year. Follow-up was complete for 97 percent of the patients. CONCLUSIONS: Patients with inguinal hernias who undergo laparoscopic repair recover more rapidly and have fewer recurrences than those who undergo open surgical repair.

Activities of Daily Living↗

PubMed1997

Bicycle-spoke injuries: a prospective study.

A prospective study of bicycle-spoke injuries was undertaken to assess the severity of soft tissue damage and the incidence of skeletal injuries. During a 12 month period, 59 children with spoke injuries were examined. Soft tissue damage was divided into three categories: bruising without laceration (four), bruising and superficial abrasions (49) and full thickness skin defects (six). Seventeen children had skeletal injuries: nine tibial fractures (five greenstick fractures and four spiral fractures) and eight epiphyseal injuries of the distal fibula. All fractures were treated non-operatively. The mean time for soft tissue healing was 16.5 days and the mean time for regaining full weight-bearing was 8.5 days. Soft tissue damage is the most important prognostic factor in the healing of a bicycle-spoke injury.

Ankle Injuries↗

PubMed1996

The learning curve for totally extraperitoneal laparoscopic inguinal hernia repair.

BACKGROUND: Several laparoscopic techniques have been introduced to re pair inguinal hernia, the newest and most promising being a totally extraperitoneal approach. Nevertheless, the surgeon may encounter several complications and technical difficulties associated with the transition from the conventional anterior operation. METHODS: In late 1993 and 1994, 120 patients were operated on for inguinal hernia using the totally extraperitoneal approach by four laparoscopic surgeons inexperienced in this new technique in a secondary referral setting. Their learning curve was assessed through operation time, perioperative and postoperative complications, and technical difficulties. RESULTS: Median operative time decreased significantly (P = 0.0003) when going through the learning curve. During the initial part of the learning curve, conversion to another technique was necessary in 10 (8%) cases, and in 6 of these cases, conversion was needed for a peritoneal tear (relative risk for conversion if peritoneal tear was present: 4.0; 95% confidence interval 1.2 to 13.1, P = 0.025). The median operative time for Nyhus type IIIb and IVb hernias was significantly longer than for other types (70 versus 55 minutes, P = 0.003). Median postoperative stay was 2 days (range 0 to 7). There were 10 recurrences within 6 months due to technical or judgement errors. CONCLUSIONS: For surgeons, the learning curve for totally extraperitoneal laparoscopic hernia repair can be overcome; however, the presence of an experienced surgeon during the procedure is vital, as this may prevent unnecessary recurrences.

Adolescent↗

PubMed1996

Evaluation of the Singh index for measuring osteoporosis.

We studied the reliability of the Singh classification of trabecular bone structure in the proximal femur as a measure of osteoporosis, using kappa statistics. Radiographs of fractures of the femoral neck or trochanteric region in 80 consecutive patients were assessed by six observers. The interobserver variation was large; only three of 72 radiographs were given the same classification by all six observers and the kappa values ranged from 0.15 to 0.54. the intraobserver variation showed substantial strength of agreement; kappa values ranged from 0.63 to 0.88. In 77 patients dual-energy X-ray absorptiometry was used to measure bone mineral density. The results were compared with those of the Singh classification: we found no correlation.

Absorptiometry, Photon↗

PubMed1993

Locked intramedullary nailing of humeral fractures.

Of 46 patients, 30 with fresh fractures of the humerus, nine with non-unions and seven with pathological fractures were treated with a new locked intramedullary nail. Of 30 patients with a fresh humeral fracture, three were lost to follow-up. All fresh fractures healed within 4 months. Functional results of the fresh fracture group were excellent in eighteen patients and satisfactory in three patients. Two patients with Neer type 6 fractures had unsatisfactory shoulder function; in the four other patients poor shoulder function resulted from a pre-existing condition. Out of nine non-unions, six united within 6 months. The three other patients with atrophic non-union required bone-grafting later, after which consolidation was obtained. The long functional recovery period of the non-union group was related to the pre-existing limited shoulder function. The seven patients with a pathological fracture died within 8 months of operation. While alive they were free from pain and could be nursed well.

Adolescent↗

PubMed1989

The natural course of postoperative ileus following abdominal surgery.

Postoperative ileus is a normal, transient condition following surgical procedures of the abdomen. The restoration of gastrointestinal motility was studied in 50 patients who had abdominal surgery. The motility was evaluated by means of physical signs and clinical symptoms. Physical signs, such as bowel sounds, passage of first flatus and defecation, occurred on relatively constant moments in the postoperative period and did not depend on the type of operation. In the patients who had rectopexy, flatus and defecation passed significantly later, probably due to existing defecation problems before the operation. The moment of resumption of a normal diet varied greatly. None of the physical signs had a predictive value with regard to postoperative nausea or vomiting. No relation could be demonstrated between the moment of removal of the nasogastric tube and the volume of gastric aspirate drained by the tube. The period of postoperative drainage of the stomach in comparable patient groups differed strongly from ward to ward. More attention for nasogastric tube management following abdominal surgery seems desirable. Early removal of the tube is possible in most patients and diminishes unnecessary discomfort.

Abdomen↗

PubMed1988

Crush accident resulting in isolated abdominal aortic injury.

The case history is presented of a patient with isolated abdominal aortic trauma due to blunt injury of the abdominal wall. Survey of the literature shows a typical clinical manifestation of this rare injury. When present, prompt recognition and proper treatment are essential in the management of this condition.

Abdominal Muscles↗

PubMed1988

Diagnostic arthroscopy of the knee joint: comparison of the accuracy of physical examination, contrast arthrography and arthroscopy.

A group of 474 patients was retrospectively studied to assess the value of physical examination, arthrography and arthroscopy in the diagnosis of knee pathology. In 54% of cases, the correct clinical diagnosis was made from the patient's history, physical examination and standard radiology. The diagnosis at arthrography, especially in chondropathy and synovitis, appeared to be unreliable (only 46% corresponded to the definitive diagnosis). Contrast-arthrography of the knee joint is an invasive technique which provides relatively little extra (reliable) information, and is therefore not suitable as a standard procedure. Diagnostic arthroscopy is a superior and safe technique. Apart from the essential clinical assessment of patients with acute or chronic knee complaints (patient history, physical examination and standard radiology), there is a wide range of indications for diagnostic arthroscopy.

Adolescent↗

PubMedDate not supplied

Myo-electrical and motor activity of the stomach in the first days after abdominal surgery: evaluation by electrogastrography and impedance gastrography.

The electrical and motor activities of the stomach were studied in the early postoperative phase after abdominal surgery by means of surface recording techniques: electrogastrography (EGG) and impedance gastrography (IGG). EGG and IGG recordings were made pre-operatively and on the first and second postoperative days. Physical signs and symptoms related to gastrointestinal motility were assessed. Two patient groups were studied; a group of patients undergoing cholecystectomy (n = 9) was compared with a group with major colonic surgery (n = 14). After colonic surgery, resumption of a normal oral diet was later and nausea and vomiting were seen more frequently than after cholecystectomy. Other physical signs concerning intestinal motility did not differ between the groups. Gastric myo-electrical activity (0.04-0.06 Hz), recorded electrogastrographically, tended to decrease in the postoperative phase in both groups, and return to pre-operative values later in the colonic surgery group. However, none of the differences reached statistical significance. Abnormal gastric activity (tachyarrhythmia) was observed in one pre-operative patient but in 6 patients (2 cholecystectomy, 4 colonic surgery) after operation. IGG variables were not significantly affected by the operation and were not significantly different between the groups. No correlation between the symptoms nausea and vomiting in the postoperative phase and the incidence of tachyarrhythmias could be demonstrated in this study. It is concluded that antral myo-electrical and motor activity, measured with non-invasive techniques (EGG and IGG), are not grossly abnormal on the first and second postoperative day after abdominal surgery. It is further concluded that abnormal gastric frequencies do not appear to play a major role in the genesis of postoperative nausea and vomiting.

Cholecystectomy↗