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Biomedical subjects

H F Hoitsma

Publications and source records attributed to H F Hoitsma.

At least 19 recordsLinked to original sources
PubMed1991

[Dieulafoy's exulceratio simplex, a life-threatening gastric hemorrhage].

The 'exulceratio simplex Dieulafoy' is an uncommon and probably underdiagnosed cause of upper gastrointestinal haemorrhage. The bleeding is intermittent and even endoscopically often missed. In this article the pathogenesis, diagnostic methods, clinical presentation and therapy are discussed. We present one case treated in our hospital.

Adult↗
PubMed1991

Longitudinal myotomy of ileum for bladder replacement in dogs.

To evaluate the application of longitudinal myotomy of ileum for bladder replacement, pressure/volume characteristics of myotomized ileal segments were studied in dogs after incorporation in the urinary tract. In five dogs a 12 cm. long myotomized ileal segment was incorporated in the left urinary system as a ureteral substitute. These ileal segments did not dilate. In another six animals total cystectomy was carried out and the bladder was replaced by a 12 cm. long myotomized ileal segment. Urodynamic and radiological studies demonstrated early dilatation of these segments, leading to a four-to-five-fold increase in volume after six weeks. During filling the intraluminar pressure remained below 20 cm. H2O up to two-thirds of the maximal volume and gradually rose when filling was continued. High pressure waves were not observed. This study demonstrates that in experimental dogs longitudinal myotomy of a short length of ileum results in a high volume/low pressure urinary reservoir. This technique is easy to perform, requires less bowel compared to current reservoir techniques and leads to satisfactory reservoir function.

Animals↗
PubMed1989

Intraoperative antegrade irrigation in complicated left-sided colonic cancer.

Emergency one-stage surgery for acute, complicated, left-sided colonic cancer can be performed because of intraoperative antegrade irrigation of the large intestine. This procedure was performed in 17 patients: 15 patients with an obstructive, left-sided cancer and two patients with a perforated carcinoma. The age distribution ranged between 57 and 92 years. There were two postoperative septic complications: a small wound abscess and a partial abdominal wall dehiscence. One patient died because of massive upper gastrointestinal bleeding. This method permits the creation of a primary anastomosis in the left colon, obviating the necessity of a coeco- or colostomy, preternatural anus, or an extensive right-sided hemicolectomy. Several surgical interventions are avoided, resulting in a decrease of mortality, morbidity, duration of hospital stay, and costs. Moreover, intraoperative irrigation could be an attractive alternative for the usual preoperative mechanical bowel preparation, which is especially burdensome in elderly patients.

Aged↗
PubMed1989

Soiling: anorectal function and results of treatment.

Forty-five patients with soiling but without faecal incontinence were evaluated by means of anorectal function investigations (anal manometry, rectal capacity and saline infusion test). The causes of soiling and the effect of treatment on both soiling and anorectal function were studied. The results were compared with a control group of 161 patients without soiling or incontinence. The diagnoses were haemorrhoids (10), mucosal prolapse (7), rectal prolapse (6), fistulae (5), proctitis (3), faecal impaction (2), rectocele with intussusception (2), scars after fistulectomy (2) and others (8). Simple inspection and proctoscopy were generally sufficient to establish a diagnosis. For two patients the diagnosis rectocele was made after defaecography. Anorectal test results did not differ between the soiling and control group, did not contribute to establish a diagnosis and did not change after treatment. Only patients with a rectal prolapse had abnormal results in anorectal function tests: a low basal sphincter pressure and a limited continence reserve. Appropriate therapy resulted in complete recovery (44%) or improvement of symptoms (29%).

Anal Canal↗
PubMed1989

Epidemiology of the Bacteroides fragilis group in the colonic flora in 10 patients with colonic cancer.

We report the relative frequencies of members of the Bacteroides fragilis group in the faeces, in colon lavage fluid obtained pre-operatively, and in colonic tissue specimens obtained at operation from 10 patients with colonic cancer. B. vulgatus was the most and B. fragilis and B. ovatus were the least frequently isolated Bacteroides spp. in the faeces of the 10 subjects. B. uniformis and B. thetaiotaomicron ranked second and third in the faeces. The relative frequencies of all species except B. fragilis were lower in the lavage fluid and in cultures of mucosa. The relative frequency of B. fragilis increased from 4% in faeces to 39% in the final lavage fluid and to 42% in the colonic mucosa culture. Our results suggest that B. fragilis has a more intimate association with the gut mucosa than other members of the B. fragilis group, which might be one explanation for the high incidence of this species in gut-associated intra-abdominal infections.

Adult↗
PubMed1987

Continent urostomy: a clinical experience in 20 patients.

Urinary diversion via a continent ileal reservoir (modified Kock's procedure) was performed in 20 patients. Primary continent urostomy construction was carried out in 6 patients. Previous urinary diversion was present in 12 patients. Two patients were referred to us because a previous attempt to construct a continent reservoir urostomy had failed. There was no operative mortality. Three early complications occurred in 3 patients. Leakage from a uretero-enteric anastomosis in one patient and necrosis of a continence-providing valve in another patient necessitated reoperation. Late complications causing malfunction of the nipple valves required revisional surgery in 2 patients. Stoma stricture developed in 1 patient after 5 months and could be corrected surgically. The functional results were excellent. Continence was achieved without reflux to the upper urinary tract. Instead of a Kock pouch, an S-pouch was used. The continence and antireflux-providing valves were stapled to the reservoir wall. Slippage of the nipple valves did not occur. All our patients had consistently positive urine cultures and were without complaints. In a few cases, stone formation was observed usually on the staples at the tip of the valve. The stones were removed by forceps during endoscopy of the reservoir.

Adult↗
PubMed1987

Treatment of complicated or infected pilonidal sinus disease by local application of phenol.

This article reports on the results of conservative treatment of 48 patients with complicated pilonidal sinus disease. The treatment consisted of an injection of phenol 80% into the sinus tract after the patients had undergone depilation and excavation while under local anesthesia. The number of phenol injections in each patient varied from one to nine (mean: two injections). Patients were considered cured if no signs of recurrent pilonidal sinus disease occurred within 1 year after treatment. The mean follow-up period after cure was 3 years (range: 1 to 6 years). The recurrence rate was 6.3% (a 95% confidence interval of 1.3% to 17.2%), which was one of the lowest reported for different methods of treatment for pilonidal sinus disease. The good results in this study justify continuation of conservative treatment of pilonidal sinus disease, especially in view of the low costs and the high degree of patient comfort. Sclerosing therapy with phenol is thus recommended as a successful treatment for complicated pilonidal sinus disease.

Abscess↗
PubMed1987

The composition of plasma lipoproteins and erythrocyte membranes in cholesterol-fed pigs with partial ileal bypass.

The composition of plasma lipoproteins and erythrocyte membranes was studied in cholesterol-fed pigs with a partial ileal bypass. Cholesterol feeding caused marked increases in the plasma concentrations of cholesterol and phospholipids. In spite of continuation of cholesterol feeding, PIB reduced plasma concentrations of cholesterol and phospholipids towards basal values. PIB completely counteracted the dietary cholesterol induced alterations in the lipid composition of the apoprotein B containing plasma lipoproteins, but not in the HDL2 fraction. It is suggested that PIB specifically influences the metabolism of the atherogenic, apoprotein B containing lipoproteins. Dietary cholesterol caused significant increases in the ratios of cholesterol:phospholipids and phosphatidylcholine: sphingomyelin in erythrocytes. The high-cholesterol diet also increased the content of linoleic acid in erythrocyte phosphatidylcholine. PIB completely nullified the cholesterol-induced increase in the cholesterol:phospholipid ratio, but not the increase in the phosphatidylcholine:sphingomyelin ratio. The percentage of linoleic acid in erythrocyte phosphatidylcholine was unaffected by PIB. Neither cholesterol feeding nor PIB had an effect on the lipid fluidity of erythrocyte membranes, as measured by fluorescence polarization, using the probe diphenylhexatriene. Possible compensatory mechanisms operating to control homeostasis of lipid fluidity of erythrocyte membranes are discussed.

Animals↗
PubMed1986

Long-term effects of partial ileal bypass on the health status of rabbits.

Partial ileal bypass (PIB) surgery is a method for the treatment of familial hypercholesterolaemia in man. Since the rabbit is frequently used as an animal model in experimental studies on PIB, we have investigated the long-term effects of this surgical procedure on the health status of rabbits. Forty-eight weeks after surgery plasma and liver cholesterol levels were decreased by about 40%. The inner diameter of the bypassed ileum was drastically reduced, unlike its length. The bypassed segment did not show clear histological abnormalities. The microflora of the caecum was similar in control and PIB rabbits. PIB did not influence liver histology. The bile of the rabbits with PIB was less lithogenic than that of control animals. Blood haemoglobin levels, haematocrit values and plasma concentrations of alkaline phosphatase, alanine aminotransferase, gamma-glutamyl transferase and lactate dehydrogenase were not changed after PIB. Plasma levels of albumin, creatinine, calcium, phosphorus, vitamin B12 and folic acid were not significantly affected by PIB. Rabbits with PIB had significantly higher plasma levels of bilirubin and zinc than control rabbits, but plasma vitamin E concentrations were significantly lower. These results may be of importance for further studies on the effects of PIB in rabbits.

Animals↗
PubMed1986

Effect of partial ileal bypass on ileum morphology in cholesterol-fed pigs.

We have studied ileum morphology in pigs 3.5 months after partial ileal bypass (PIB) surgery. PIB caused a reduction in the length of the bypassed ileum by 60%, while the circumference was decreased by about 70%. We did not find evidence for dilatation of the functional, neo-terminal ileum. These results in pigs are contrary to those found earlier in rabbits. This may be of importance concerning the choice of animal model to study the effects of PIB.

Animals↗
PubMed1986

Leiomyoblastoma of the gastric wall.

A patient with leiomyoblastoma of the gastric wall is reported. The manifestations of the tumor are described and guidelines for therapy and prognosis are provided, based on a review of literature.

Adult↗
PubMed1985

Serum lipoproteins in cholesterol-fed pigs after partial ileal bypass.

Partial ileal bypass (PIB) surgery was performed in hypercholesterolaemic mini-pigs and Yorkshire pigs fed a semipurified diet containing 1% (W/W) of cholesterol. PIB drastically reduced serum total cholesterol and phospholipid concentrations and the cholesterol: phospholipid ratio in spite of continuation of cholesterol feeding. The relative distribution of cholesterol between serum lipoproteins was affected by PIB; the surgical treatment caused an increase in the ratio of high-density lipoprotein (HDL) to low-density lipoprotein (LDL) cholesterol. Serum apo B and apo A levels were rapidly decreased by PIB. The operation induced a decrease in the cholesterol: apo B and cholesterol: apo A ratios. It is suggested that the pig is a suitable animal model to study PIB-induced changes in lipoprotein metabolism.

Animals↗