PubMed Health⌕ Search

Biomedical subjects

H A Bruining

Publications and source records attributed to H A Bruining.

At least 199 records · Page 11Linked to original sources
PubMed1984

Different sensitivity to adrenocorticotropin of dispersed adrenocortical cells from patients with Cushing's disease with macronodular and diffuse adrenal hyperplasia.

A patient with Cushing's syndrome and low plasma ACTH levels had a unilateral adrenal mass (diameter, 3 cm), which proved to consist of adenomatous hyperplasia. Dispersed adrenocortical cells prepared from this mass responded to ACTH with a maximal increment in cortisol release of more than 400%. Five months after operation Cushing's syndrome recurred. Computed tomography scanning showed an enlarged macronodular adrenal gland on the other side. The cells prepared from this adrenal gland were stimulated by ACTH by more than 600%. In adrenal glands from eight other patients with Cushing's disease cells from macroscopic nodules in hyperplastic adrenocortical tissue had increased responsiveness to ACTH in vitro, in comparison to cells from macroscopically diffuse hyperplastic adrenal tissue. The stimulability of the pituitary-adrenal axis (by metyrapone) and its suppressibility (by high dose dexamethasone) did not differ between the two groups of patients. These observations suggest that in the presence of adenomatous or macronodular adrenal hyperplasia lower circulating ACTH levels may sustain hypercortisolism than in diffuse adrenal hyperplasia. The presence of a unilateral adrenal mass and low normal plasma ACTH levels in patients with Cushing's syndrome, therefore, does not unequivocally indicate the presence of an autonomous adrenal adenoma. Tests with metyrapone and dexamethasone should still be carried out in order to make a secure differential diagnosis.

Adrenal Cortex↗
PubMed1984

Clinical judgment versus delayed hypersensitivity skin testing for the prediction of postoperative sepsis and mortality.

In 59 patients operated upon for malignant disease of the gastrointestinal tract, skin testing with recall antigens was compared with assessments based upon clinical judgment alone for prediction of risk of postoperative septic complications. Clinical judgment alone could identify patients with a significantly increased risk for postoperative sepsis and mortality. Prediction based upon clinical judgment is superior to prediction based upon delayed hypersensitivity skin testing.

Adult↗
PubMed1984

Treatment of pancreatic injuries.

Between 1972 and 1983 14 patients with pancreatic injuries have been treated. The diagnosis was often difficult and only made at laparotomy in most patients. Peritoneal lavage and serum amylase levels were of little help in diagnosis. Even at laparotomy, the diagnosis was initially missed in one patient. Six patients had injuries of the pancreatic head and were treated either by Whipple pancreatoduodenectomy (one patient), drainage with gastric and jejunal decompression (two patients) or simple drainage (three patients). Six patients had injuries of the pancreatic body, necessitating distal pancreatectomy and splenectomy in four cases. Two patients with contusion of the pancreatic tail were treated by drainage, followed by development of an infected pancreatic pseudocyst in one case. Six patients died (43%). It is concluded that complete inspection of the pancreas and peripancreatic hematoma is mandatory in the diagnosis and treatment of pancreatic injuries.

Accidents, Traffic↗
PubMed1984

The role of early surgery in the treatment of acute hemorrhagic necrotizing pancreatitis (AHNP).

A retrospective study of the effect of surgical treatment and the value of different biochemical criteria in the early identification of AHNP in 33 patients with this condition, as proven by laparotomy, is presented. Biochemical criteria were not specific for AHNP and could only infrequently be used for assessment of the severity of acute pancreatitis. Surgical treatment consisted of pancreatic resection in 22 patients and drainage in 11 patients. Twenty-six of the 33 patients died regardless of the type of surgery. Mortality was due to multiple organ failure, either shortly after operation (eight patients) or after a protracted septic clinical course (18 patients). In total AHNP early subtotal pancreatectomy is probably not the treatment of choice since it did not improve the outcome.

Acute Disease↗
PubMed1984

Results of adrenalectomy with various surgical approaches in the treatment of different diseases of the adrenal glands.

In a retrospective study, the impact of the various possible approaches for adrenalectomy were analyzed in 90 patients undergoing 120 adrenalectomies in one or two operations. The posterior approach proved to be the best tolerated procedure as expressed by the shortest operation time (less than 60 minutes) and the lowest blood loss (less than 100 milliliter). The number of opiate injections required was the lowest with this operation and the ambulation earliest (on the first postoperative day). Only two instances of wound infection, both from dorsal incision, occurred in operations for hypercortisolism in 46 patients (4 per cent). Splenectomy was necessary in four of 32 laparotomies (12 per cent), mostly for pheochromocytoma. There was no operative related mortality. The preoperative measures to reduce preoperative and postoperative complications are given.

Adrenal Gland Diseases↗
PubMed1984

Primary hyperparathyroidism and pancreatitis.

Frequently a causal relationship between hyperparathyroidism (HPT) and pancreatitis has been defended. Bess et al. queried the existence of any causality. A series of 686 patients with surgically confirmed primary hyperparathyroidism (PHPT) was analysed with a coincidence of pancreatitis of 1.5% (n = 10). Three patients had an attack immediately after exploration of the neck, which is more than one would expect after a non-related operation. Although these data are not conclusive, a causal relationship cannot be excluded. It is uncertain whether a parathyrotoxic crisis due to surgical manipulation plays a part. In 27 patients a partial or total thyroidectomy was performed at the time of the parathyroidectomy. None of these patients had a postoperative pancreatitis, which means that in this series the recently postulated protective role of calcitonin cannot be confirmed.

Adolescent↗
PubMed1983

Acute abdominal pain due to early postoperative elemental feeding by needle jejunostomy.

Early postlaparotomy needle jejunostomy feeding with an elemental diet resulted in a typical clinical entity in six of 160 patients (4 per cent). In all, an acute condition of the abdomen developed with a grossly distended intestine, filled with fluid and gas, and an empty stomach as confirmed roentgenographically or at a second laparotomy. This complication is presumably caused by carbohydrate hyperosmolarity of the elemental diet and carbon dioxide production by fermentation. The complication was seen predominantly in patients with a Roux-en-Y reconstructed pancreatectomy. In two patients, a negative second laparotomy was performed. In two others, a pancreaticojejunostomy suture line blowout followed, resulting in death. One patient died after aspiration of the gastric contents.

Abdomen↗
PubMed1983

Needle catheter jejunostomy (NCJ) for early postoperative feeding: experience in 210 patients.

Enteral feeding has many advantages over total parenteral nutrition (TPN) in the early postoperative period. The risk of sepsis is small, the nutrients are cheap and metabolic problems are rare. In the period April 1980 to January 1983, needle catheter jejunostomy (NCJ) was applied in 210 patients after surgery of the oesophagus, stomach, duodenum, liver or pancreas. All but 14 of these patients were fed by NCJ for a certain period postoperatively, NCJ feeding being initiated within 48 hours after the operation in 63% of the cases. In 14 patients, it was decided not to use NCJ feeding because of counter-indications observed postoperatively. The mean duration of the feeding by NCJ was 17 days (range two to 84 days). The complications observed were intraperitoneal leakage in four patients (1.9%), ileus in seven patients (3.3%) and diarrhoea in 54 patients (25.7%). The total number of feeding days was 2,906. This form of feeding resulted in savings of Dfl. 115,00 per patient per day compared with TPN, for a 12,600 Joule intake. NCJ feeding is a relatively safe, economical procedure that can be applied as a matter of routine after abdominal surgery.

Adolescent↗
PubMed1983

Surgical treatment of chronic pancreatitis by distal pancreatectomy.

No consensus exists on the best surgical treatment for chronic pancreatitis. In a retrospective study on 29 patients it was found that pain caused by chronic pancreatitis can be treated effectively by a 95% DP or a 40-80% DP. However, after a 40-80% DP the incidence of endocrine and exocrine pancreatic insufficiency is less frequent than after a 95% DP. Therefore, distal pancreatectomy can be advised as a treatment of pain, caused by chronic pancreatitis. In order to minimize the chance of pancreatic insufficiency resection should be done as conservatively as possible.

Chronic Disease↗
PubMed1983

Ultrasound-guided percutaneous drainage of 25 abscesses.

Twenty-four confirmed well-defined abdominal abscesses and one abscess in the thorax were percutaneously drained in 21 patients. In all, 28 puncture and drainage procedures were performed. Nineteen abscesses were drained without further surgery (76%). The high success rate, combined with minimal complications and low overall mortality (9.5%), indicates that ultrasound-guided percutaneous drainage is probably the method of choice in the treatment of well-defined, unilocular abscesses, avoiding the risk of major surgery.

Abdomen↗
PubMed1982

Operative approach to cancer of the head of the pancreas and the peri-ampullary region.

A retrospective study was made of 75 consecutive patients treated for a tumour of the head of the pancreas and the peri-ampullary region from January 1978 to August 1981. These patients underwent either pancreatic resection--pancreatoduodenectomy (n = 24) and total pancreatectomy (n = 10)--palliative procedures (n = 29) or exploratory laparotomy (n = 12). Clinical signs and diagnostic procedures, such as ultrasonography and coeliac arteriography, were studied for their value in preoperative assessment of operability. Vaso-invasion, as revealed by arteriography and, to a lesser extent, ultrasonographic signs of a tumour and the absence of jaundice were poor prognostic signs. The operative mortality was 8 per cent for the group as a whole, but somewhat higher (13 per cent) for the group that underwent pancreatoduodenectomy. No patient died after total pancreatectomy. The operative mortality was 27 per cent in all patients aged 70 years or older, but only 3 per cent in patients under 70 years. One-year patient survival was 94 per cent after pancreatoduodenectomy for peri-ampullary cancer and 57 per cent after resection for cancer of the head of the pancreas. The results of this study point to pancreatic resection as the treatment of choice for resectable tumours of the peri-ampullary region and the head of the pancreas in patients under 70 years of age. Coeliac arteriography and ultrasonography have been found to be useful for preoperative classification of tumour stage.

Adenocarcinoma↗
PubMed1982

Haemodynamics and renal function in patients undergoing surgery for abdominal aortic aneurysm.

Haemodynamics and renal function were studied in patients undergoing surgery for abdominal aortic aneurysm, before, during and after infrarenal aortic clamping, in order to establish base-line criteria. The mean arterial pressure (MAP) remained practically unchanged during aortic clamping. A significant decrease in cardiac index (CI) was found. The significant decrease in pulmonary artery wedge pressure (PAWP), despite a significant rise in the systemic vascular resistance (SVRI), probably reflects relative preoperative dehydration and venous pooling in the lower part of the body. Brief suggestions are made concerning the management of this condition. No irreversible loss of renal function was seen.

Aged↗