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Biomedical subjects

H A Bruining

Publications and source records attributed to H A Bruining.

At least 217 records · Page 12Linked to original sources
PubMed1981

Creation of an anal sphincter mechanism by bilateral proximally based gluteal muscle transposition.

A case report is given of a girl who, at the age of 17 years, lost her total posterior part of her perineum in a traffic accident. She was left with out an anal sphincter mechanism and a diverting sigmoidostomy was performed. Two years after the accident a new anal sphincter was constructed using bilateral transposition flaps of the gluteus maximus muscles. After 6 months of active training of this new "reanastomosed". The patient thereafter regained complete fecal continence by the natural route.

Accidents, Traffic↗
PubMed1980

Clinical experience with the medical anti-shock trousers (MAST) treatment of hemorrhage, especially from compound pelvic fracture.

The experience and results of treatment with external counterpressure for uncontrollable bleeding in 11 patients with compound pelvic fractures and 7 other patients with various subdiaphragmatic bleeding sites are reported. In 11 cases (61%) the bleeding could be arrested with medical anti-shock trousers (MAST). 9 patients died: 5 due to hemorrhagic shock and 4 of related disorders. Treatment with MAST was unsuccessful in 7 cases of major arterial tears. In patients with compound pelvic fractures the acute blood loss may necessitate further treatment by either arterial embolization, an operation for concomitant traumata, or both. Complications of the use of MAST were minor. The (clinical) use of this garment can therefore be strongly advised in patients with otherwise intractable bleeding.

Adolescent↗
PubMed1979

Gastro-intestinal bleeding and malignancy of the testis.

Three cases of gastro-intestinal bleeding caused by metastasis of a testicular tumour to the duodenum are described. The report illustrates that, particularly in young patients, the possibility of a primary tumour in the testis should be considered when a tumour mass is found in the upper abdomen, even if other symptoms suggestive of primary gastro-intestinal disorders, such as melaena and haematemesis, are also present. As primary malignancies of the small intestine are rare, a presumptive diagnosis of anaplastic duodenal carcinoma should always arouse the suspicion of metastatic rather than primary growth.

Adolescent↗
PubMedDate not supplied

Unexpected difficulties in randomizing patients in a surgical trial: a prospective study comparing extracorporeal shock wave lithotripsy with open cholecystectomy.

Shortly after extracorporeal shock wave lithotripsy (ESWL) was introduced as a promising new treatment modality for gallstone disease, a randomized controlled study was performed to assess the cost-effectiveness of ESWL compared to open cholecystectomy, the gold standard. During the performance of this study it was found that during a 3-year intake period only 8.3% (37 of 448) of the patients could be entered into the trial. Three factors were identified that hampered patient accrual: (1) restricted eligibility for ESWL (and thus for the study), which could not have been predicted on the data provided in the literature; (2) the introduction of laparoscopic cholecystectomy; and (3) strong patient preference, inhibiting randomization. All three mechanisms could not have been predicted during the design phase of the study. It is concluded that it is not always feasible to conduct a randomized study in surgery due to unforeseen circumstances. Entering patients into surgical trials is difficult in quickly evolving fields of surgery, such as the management of gallstone disease. Acquiring informed consent is also difficult when treatment characteristics are divergent. A randomized controlled study on the effects of laparoscopic cholecystectomy will therefore probably never be performed.

Cholecystectomy↗
PubMedDate not supplied

Infections after auxiliary partial liver transplantation. Experiences in the first ten patients.

In ten auxiliary partial liver transplant recipients selective bowel decontamination (SBD) was used to reduce infections due to gram-negative microorganisms and fungi. During SBD no gram-negative infections occurred. Candida peritonitis was observed in one patient. After discontinuation of SBD serious infections of gram-negative origin did occur and three fungal infections were seen. SBD seems to have a favourable effect in reducing infections by gram-negative microorganisms and fungi. Most striking was the number of enterococcal infections that occurred. Five out of ten patients developed enterococcal infections which in two cases contributed to a fatal outcome. These infections occurred after increase of the number of enterococci in faeces and concomitant positive cultures of bile, ascites or wound drains. This increase could be due to the use of SBD. Also, the kind of biliary anastomosis may play an important role in the relatively high incidence of enterococcal infections. In the postoperative period, recurrence of hepatitis B infection in the liver graft was observed in all patients with cirrhosis due to this virus. Problems caused by other viral infections or protozoal infections remained limited in these ten patients.

Adolescent↗
PubMedDate not supplied

Use of isotope-labeled somatostatin analogs for visualization of islet cell tumors.

The results of visualization of the islet cell tumors of 25 patients after intravenous administration of two isotope-labeled somatostatin analogs (123I-Tyr3-octreotide and 111In-octreotide) are described. The primary tumors, as well as previously often unrecognized distant metastases were visualized in 20 of the 25 patients (80%). Parallel in vitro detection of somatostatin receptors on those tumors that had also been visualized in vivo indicates that the ligand binding to the tumor in vivo indeed represents binding to specific somatostatin receptors. The detection of somatostatin receptors on these tumors in vivo predicted a good suppressive effect of octreotide on hormonal hypersecretion by these tumors. It is an easy, quick, harmless procedure that is valuable for localization of primary endocrine pancreatic tumors and their often radiologically and clinically not yet recognized metastases.

Adenoma, Islet Cell↗
PubMedDate not supplied

Role of extracorporeal shock wave lithotripsy in hepato-biliary-pancreatic surgery.

Since the early 1980s extracorporeal shock wave lithotripsy (ESWL) has partially replaced major operative procedures in various fields of surgery. In the interest of the patient, it is important to determine the exact role of ESWL in surgery. Comparing our own prospectively followed patients with other patient series, we have tried to assess this role. We treated 133 patients with cholecystolithiasis, 80 patients with choledocholithiasis, and 17 patients with pancreatic stones using a second-generation lithotriptor, the Siemens Lithostar (Siemens, Erlangen, Germany). The results suggest a limited role of ESWL for cholecystolithiasis, in which it is reserved for patients with high operative risk and patients who reject an operation. For choledocholithiasis ESWL seems to become an integral part of the treatment in the elderly patient in whom endoscopic stone removal proved impossible. Finally, ESWL could become a first option for the treatment of intractable pain in patients with chronic calcifying pancreatitis.

Adult↗
PubMedDate not supplied

Single and multigland disease in primary hyperparathyroidism: clinical follow-up, histopathology, and flow cytometric DNA analysis.

Two-hundred seventy-four patients with primary hyperparathyroidism had selective removal of enlarged parathyroid glands. Biopsies were taken from all parathyroid glands. Normal-size glands were not resected irrespective of their histological appearance. After a mean follow-up of 13.5 years the rates of persistent and recurrent hyperparathyroidism were, respectively, 3.6% and 0.7%. Transient and permanent hypoparathyroidism occurred in 24% and 2.5% of the patients. The microscopic appearance of enlarged glands and of biopsies taken from normal-size glands were reviewed by two pathologists. Normal parathyroid glands were distinguished from abnormal glands fairly accurately (sensitivity 93%, specificity 80%). Microscopic classification of abnormal parathyroid glands as adenomas or hyperplastic glands correlated poorly with the gross classification as single or multigland disease. Flow cytometric DNA analysis of paraffin embedded parathyroid tissue showed significant differences for DNA index, % S-phase and % G2M (p less than 0.001). Differentiating single from multigland disease by means of DNA analysis was not possible. In conclusion, removal of only enlarged parathyroid glands results in acceptable rates of persistent and recurrent hyperparathyroidism. Biopsies should only be taken sparingly to prevent transient and permanent hypoparathyroidism. Microscopic examination and flow cytometric DNA analysis can differentiate normal from abnormal parathyroid glands but are unable to differentiate abnormal glands into single or multigland disease.

Adolescent↗