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Biomedical subjects

H W Ooms

Publications and source records attributed to H W Ooms.

5 recordsLinked to original sources

[Epiploic appendicitis].

A 50-year-old woman presented with sudden onset of localised pain in the right and later the left lower abdomen, without other complaints. Only tenderness in the left lower abdomen was noted at physical examination. The ESR (25 mm/1st hr) and C-reactive protein (25 mg/l) were slightly elevated. The ultrasound (US) revealed a solid ovoid non-compressible hyperechoic mass (diameter 26 mm) at the point of maximum tenderness. The CT scan confirmed the presence of this lesion which appeared to be an infarction of an epiploic appendix with subsequent inflammation, called primary epiploic appendagitis. On conservative therapy the pain resolved in four weeks. The follow-up US and CT showed disappearance of the lesion after 35 days. When epiploic appendagitis is suspected, an US followed by CT is helpful to confirm the diagnosis and to avoid unnecessary treatment with antibiotics or operation.

Abdominal Pain↗

Parathyroid hormone-related protein (PTH-rP)-associated hypercalcemia in a patient with an atypical chronic lymphocytic leukemia.

We describe a patient with an atypical chronic lymphocytic leukemia (CLL) of the mixed cell type with a hypercalcemia due to parathyroid hormone-related protein production by the malignant B cells. On regard of the elevated serum calcium level without overt lytic bone lesions we found elevated serum levels of PTH-rP and demonstrated the presence of PTH-rP on the malignant lymphocytes. PTH-rP-related hypercalcemia in CLL is very rare. The role in PTH-rP in humoral hypercalcemia of malignancy is discussed.

Aged↗

Percutaneous gallbladder drainage in emphysematous cholecystitis.

Emphysematous cholecystitis is a serious disorder with a high mortality and morbidity. We report successful drainage of the gallbladder in a male diabetic patient with emphysematous cholecystitis in whom surgery was considered contraindicated because of his poor cardiac status.

Aged↗

Ultrasonography in the diagnosis of acute appendicitis.

Ultrasonography with graded compression was performed in 525 patients with clinical signs of acute appendicitis. Of 207 patients with surgically proven appendicitis the inflamed appendix (diameter greater than or equal to 6 mm) had been visualized sonographically in 177 (86 per cent). The score for non-perforated appendicitis (91 per cent) was higher than for perforated appendicitis (55 per cent). Twenty-four patients in whom an inflamed appendix was seen on ultrasonography did not undergo surgery because of rapidly subsiding symptoms ('abortive appendicitis'). Four of these 24 developed recurrent appendicitis warranting surgery. Two underwent elective appendectomy and 18 have remained symptom-free. Of 155 patients with a subsequently confirmed alternative condition, ultrasonography made the correct diagnosis in 140: bacterial ileocaecitis (69), mesenteric lymphadenitis (eight), gynaecological conditions (34), urological conditions (eight), caecal diverticulitis (six), perforated peptic ulcer (six), Crohn's disease (two) and miscellaneous conditions (seven). Of 139 patients in whom no definite diagnosis was made ultrasonography showed no abnormalities in 138. In four patients a false positive sonographic diagnosis of appendicitis was made and in two patients with appendicitis an alternative condition was incorrectly diagnosed. During the last 3 years of the study the negative appendicectomy rate was 7 per cent and delay beyond 6 h after admission occurred in only 2 per cent of patients with surgically proven appendicitis. When used to complement the clinical diagnosis ultrasonography improves the diagnostic accuracy and patient management in those suspected of having acute appendicitis.

Acute Disease↗