PubMed Health⌕ Search

Biomedical subjects

H A Bruining

Publications and source records attributed to H A Bruining.

At least 181 records · Page 10Linked to original sources
PubMed1987

Causes of failure in operations for hyperparathyroidism.

After a mean follow-up period of 6.1 years, a series of 862 patients who had undergone surgery for suspected hyperparathyroidism were evaluated to determine the reasons treatment failed. Incorrect diagnosis was found to be the cause of failure in 27 cases (3%). In 89 patients who required reoperation to achieve euparathyroidism, the three major reasons for failure were inexperience with the surgical procedure (n = 37), abnormal localization (n = 36), and multiglandular disease (n = 39). In patients with monoglandular involvement, the disease never recurred. However, of the 41 patients with more than one enlarged parathyroid gland, 20 had persistent disease and 21 others had recurrent disease with a normocalcemic interval of 1.2 to 17 years. In general, recurrent hyperparathyroidism occurs more frequently than is usually realized and thus patients with multiglandular involvement require very long follow-up periods. Persistent monoglandular disease is largely avoidable.

Clinical Competence↗
PubMed1986

Artifacts in the assessment of metabolic gas exchange.

In mechanically ventilated patients metabolic gas exchange recordings are frequently influenced by routine patient therapy. In this study the influence of such artifacts is investigated and a method for automatic detection and suppression proposed. This method reduced the influence of artifacts on diurnal oxygen and carbon dioxide exchange from up to 10% to a maximum of 1%.

Adolescent↗
PubMed1986

A nonelemental versus an elemental diet for early postoperative enteral feeding by needle catheter jejunostomy.

In a prospective randomised study the use of an elemental versus a nonelemental diet for early postoperative enteral feeding by needle catheter jejunostomy was investigated. After extensive gastrointestinal surgery, 25 patients received an elemental and 24 patients a nonelemental diet. The incidence of diarrhoea, the effects of the feeding and the costs were evaluated. The occurrence of diarrhoea was observed more frequently in the elemental diet group (14 25 ) compared to the nonelemental diet group (7 24 ), although this difference was statistically not significant (p > 0.05). No difference was found between the two groups in postoperative restoration of total protein and serum albumin levels and the extent of the postoperative weight loss. The costs showed a clear difference: the nonelemental diet was three times cheaper than the elemental diet. For early postoperative enteral feeding by needle catheter jejunostomy we therefore recommend the use of a nonelemental diet.

Journal Article↗
PubMed1986

Calculation versus measurement of total energy expenditure.

In acutely ill patients both hypo- and hyperalimentation must be avoided by adjusting caloric intake to total energy expenditure (TEE). We determined the discrepancy between basal energy expenditure (BEE) calculated from the basic Harris-Benedict formula and TEE measured by continuous indirect calorimetry in a heterogeneous group of mechanically ventilated surgical patients. We also compared the accuracy of TEE calculated from the corrected Harris-Benedict formula or estimated by intermittent indirect calorimetry to that of TEE measured by continuous indirect calorimetry. The poor correlation between calculated BEE and measured TEE was significantly (p less than .05) improved by a correction factor based on each patient's clinical condition. The mean absolute difference between calculated TEE and measured TEE was 8.9 +/- 9.6 (SD) %. Calculations were significantly (p less than .05) improved by estimating TEE from two 5-min recording periods, which suggests that continuous indirect calorimetry may not always be necessary to guide caloric replacement.

Adolescent↗
PubMed1986

A comparison of the effects of two somatostatin analogues in a patient with an external pancreatic fistula.

In a 30-year-old man, a total external pancreatic fistula developed after enucleation of an insulinoma of the head of the gland. The output of the fistula was reduced to some extent by total parenteral nutrition. Much greater reductions of volume were noted during short-term administration of two somatostatin preparations, SMS 201-995 and Somatofalk, for 1 week consecutively. Although the former showed several advantages over the latter drug, such as absence of an escape phenomenon and of a rebound effect, neither drug caused a closure of the fistula. Spontaneous closure of the fistula occurred after 3 1/2 months.

Adult↗
PubMed1986

Secretion of adrenocorticotropin, beta-endorphin and calcitonin by cultured medullary thyroid carcinoma cells. Effects of synthetic corticotropin-releasing factor and lysine vasopressin.

The present study was performed to investigate the potential of human medullary thyroid carcinoma (MTC) cells to secrete ACTH, beta-LPH/beta-EP. In addition, these studies might shed further light on the possible synthesis of a common precursor molecule for calcitonin (CT), ACTH and beta-LPH/beta-EP. MTC tissue was obtained from 10 patients (6 familial, 4 sporadic) without clinical and biochemical signs of Cushing's syndrome. Single cell suspensions were cultured for 1 to 2 weeks. Mean basal release of beta-LPH/beta-EP was 0.76 +/- 0.29 (SE) ng/10(6) cells/4 h (n = 10). Dibutyryl cyclic AMP (3 mM) stimulated beta-EP release significantly in 3 out of 7 cultures, while Ca2+ (2 mM) had no effect at all. The effects of the physiological regulators of pituitary ACTH and beta-LPH/beta-EP secretion, synthetic corticotropin-releasing factor (CRF-41) and vasopressin (LVP) were also studied in these MTC cell cultures. LVP (100 nM) had no effect on beta-EP release from MTC cells of all 8 cultures investigated. CRF-41 (10 nM) stimulated beta-EP release from 5 cultures and was without effect on 4. Maximal stimulation was noticed with 10 nM, while the effect of 100 nM CRF-41 was lower or absent. Stimulation was most outspoken in 3 cultures of familial MTC, whereas in 2 cultures of sporadic MTC CRF-41 stimulated beta-EP release marginally only after a 24 h incubation. LVP and/or CRF-41 stimulated CT release significantly in 3 cultures from sporadic MTC, while in these cultures the effect of CRF-41 on beta-EP release was either very small or absent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenocorticotropic Hormone↗
PubMed1986

Unexpected hypopotassemia after multiple blood transfusions during an operation.

A series of 226 patients undergoing major surgery was studied to asses the influence of the volume of transfused donor blood on the postoperative serum potassium level. Patients with a low serum potassium and with impaired renal function preoperatively and patients receiving medication capable of reducing the total body potassium were excluded from the study. Laboratory studies included complete blood count, electrolyte value measurements, serum creatinine, BUN, glucose, acid-base balance as well as urinalysis. A direct relationship between the volume of transfused blood and a shift of serum potassium was not found. Hyperkalemia did not occur, however, unexpected hypokalemia occurred in 50 patients. Metabolic acidosis and hyperglycemia were found in 57% and 48% respectively and did not seem to have a distinct influence on the potassium balance. As this hypokalemia can cause complications, its presence has to be anticipated and certain drugs like calcium, insulin, bicarbonate and digitalis have to be used with great caution in this situation.

Blood Transfusion↗
PubMed1985

Design and validation of an automatic metabolic monitor.

A self-calibrating fully automatic instrument for the measurement of oxygen consumption, carbon dioxide production and the respiratory quotient of mechanically ventilated patients has been developed. The instrument is based on commercially available conventional oxygen and carbon dioxide gas analysers and a domestic natural gas volumetric flow meter. The distribution of the different gas flows, i.e. calibration gases, the inspiratory mixture sample and the expiratory mixture sample, are controlled by in inexpensive microprocessor, which also performs the necessary calculations. The accuracy of the instrument has been validated by bench tests. The present prototype has been in use for over 3000 h without major failures.

Calibration↗
PubMed1985

Elective cricothyroidotomy.

Cricothyroidotomies instead of tracheostomies were performed in 61 adult patients over a period of two years. The indications were as for tracheostomy. The majority of the patients had severe trauma, respiratory problems and sepsis. The procedure was to be found easy and fast. There were no severe complications during or directly after the operation. Of the 23 surviving patients 7 were lost for follow up, 16 patients were reexamined 6 months after decannulation. No serious complications had developed, although 2 patients had minor granulation tissue formation at the stoma site and 1 had a minimal anterior narrowing of the subglottic region without granulation tissue. None of these patients needed treatment.

Aged↗
PubMed1985

Intragastric prostaglandin E2 and the prevention of gastrointestinal hemorrhage in ICU patients.

The effects of intragastric prostaglandin E2 (PGE2) on the occurrence of acute GI hemorrhage in intensive care patients were investigated in a prospective, double-blind, placebo-controlled study. Ninety patients with two or more risk factors (major surgery, multiple trauma, respiratory insufficiency, renal insufficiency, jaundice, hypotension, peritonitis, sepsis) were randomized for treatment with either PGE2 (0.5 mg) or placebo, administered every 4 h via a nasogastric tube. Blood loss in gastric aspirates was measured by 51Cr-erythrocyte labeling and a peroxidase test (orthotolidine). Of 57 patients who could be evaluated, 29 received PGE2 and 28 received placebo. Hemorrhage occurred in nine PGE2 patients and 13 placebo-treated patients, not a significant difference. The occurrence of hemorrhage was related to the number of risk factors, and GI hemorrhage was rarely the major factor determining mortality. Results of the orthotolidine test were not positively correlated with those of erythrocyte labeling, indicating that peroxidase tests should not be relied upon to detect blood in gastric aspirates.

Adolescent↗
PubMed1985

Optimal hemotherapy in elective surgery.

The transfusion incidence and the crossmatch/transfusion ratio are expected to provide objective guidelines for hemotherapy in elective surgery. For those surgical procedures which rarely require hemotherapy an ABO Rh-D typing and an antibody screening test without a crossmatch were recommended as preoperative tests. For surgical procedures with a moderate to high transfusion incidence it is suggested that the number of units to be crossmatched preoperatively should be equal to the average number of units transfused for that procedure in the past. Under conditions of normovolemia and normal cardiopulmonary function initial blood loss up to two units can readily be replaced by colloid solutions. For medical reasons transfusion of packed red cells are preferred to whole blood. supply of whole blood is only needed when rapid replacement of large amounts of blood is imminent or expected. The use of a surgical blood order schedule (SBOS) is very useful to reduce excessive preoperative crossmatching. The establishment of appropriate guidelines and recommendations can lead to an increase in quality and safety of blood transfusion and substantial economic savings.

Blood Banks↗
PubMed1985

The influence of preoperative jaundice, biliary drainage and age on postoperative morbidity and mortality after pancreatoduodenectomy and total pancreatectomy.

Details are given of the postoperative course of 56 patients after pancreatoduodenectomy, and 11 after total pancreatectomy. The main indication was adenocarcinoma (56 cases). The most serious complication was leakage from the pancreatojejunostomy, which occurred in nine patients and was fatal in seven of these (10%). This was the only cause of death in the group. The observed mortality was appreciably higher (38%) in the 13 patients aged over 70 years. Contrary to recent reports, jaundice was not found to influence postoperative mortality adversely, nor was preoperative biliary drainage found to reduce mortality.

Adenocarcinoma↗
PubMed1984

Haemorrhage from the pancreatic duct: a rare form of upper gastrointestinal bleeding.

Recurrent upper gastrointestinal haemorrhage arising from the pancreatic duct presents diagnostic difficulties. Bleeding can be secondary to pancreatic disease (pancreatitis, pseudocysts) or vascular disorders (aneurysms of the splanchic arteries). Of the 5 cases reported here, 3 involved a ruptured aneurysm of the splenic artery and 2 chronic pancreatitis. Attacks of colicky pain in the left epigastric region associated with haematemesis and/or melaena were characteristic symptoms. Pancreatectomy controlled the bleeding in 4 and ligation of the splenic artery and the pancreatic duct in one. Fifty-five patients with similar pathology have been previously reported, suggesting that this syndrome should be borne in mind when gastrointestinal haemorrhage of obscure origin is encountered. If routine endoscopy does not reveal the site of the haemorrhage and there are no signs of cholestasis, endoscopic retrograde pancreatography (ERP) and selective coeliac arteriography should be performed to evaluate the possibility of haemorrhage from the pancreatic duct. Surgical management depends on the site of the causative lesion.

Adult↗
PubMed1984

Clinical time-course and characteristics of islet cell cytoplasmatic antibodies in childhood diabetes.

Circulating islet cell antibodies (ICA) were present in high frequency (80%) early after diagnosis and decreased in the time course of childhood diabetes mellitus. The complement fixing ability of islet cell antibodies (CF-ICA) in the course of the disease appeared to depend on the titre of ICA: the coefficient of correlation between ICA and CF-ICA titres was 0.79 and all ICA's with a titre over 16 were complement-fixing. Incubating fresh frozen human pancreatic sections thrice rather than once with the children's sera, increased the detectability of complement fixation by a factor 1.4 in all ICA-positive sera. Thus tested, the detection of complement fixation per se did not appear to have a separate pathogenic significance, as the fraction of complement fixing ICA's was almost constant throughout the clinical course. The presence of ICA-IgG subclasses also was dependent on the ICA titre: above a titre of 16 mostly all four subclasses could be detected. Incubating the pancreatic tissue thrice rather than once with ICA-positive sera resulted in enhanced detectability of ICA-IgG1. Early in the course of childhood diabetes, including two prediabetic children, most of the IgG subclasses could be detected in ICA, but after a duration of one year IgG1 alone was mainly seen. In two other children, having a family history of insulin-dependency, restriction to the IgG2 subclass was found.

Adolescent↗
PubMed1984

Effect of propranolol on surgical bleeding and hemostasis: an in vivo study in the rat.

The influence of propranolol on surgical bleeding and hemostasis was studied in two different models in the normotensive rat. Propranolol was administered for 6 days subcutaneously and for 28 days orally. In both the tail and the muscle bleeding test the blood loss after the short-term as well as the long-term administration of propranolol was diminished as compared to control values. Highly significant differences were reached in the tail bleeding test. Previous studies have described the effect of propranolol on several constituents of the highly complex hemostatic process. Some of these effects enhance, others inhibit hemostasis. It is concluded that in the normotensive rat these hemostasis-enhancing effects are of greater importance than the inhibiting ones.

Animals↗