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Biomedical subjects

H van Dullemen

Publications and source records attributed to H van Dullemen.

10 recordsLinked to original sources
PubMed2004

Selective approach in the treatment of esophageal perforations.

BACKGROUND: Treatment of esophageal perforation remains controversial and recommendations vary from initially non-operative to aggressive surgical management. Several factors are responsible for this life-threatening event, which has led to more individualized treatment ensuring adequate pleuromediastinal drainage with sufficient irrigation. We analyzed our data, evaluating morbidity and mortality in this selective approach. METHODS: During 1985 to 2001, 17 of the 38 patients with esophageal perforation treated in our hospital underwent primarily a thoracotomy, wide drainage and debridement of chest/ mediastinum and enteral hyperalimentation. Twenty-one patients (55%) initially were treated non-operatively (NPO, nasogastric tube, hyperalimentation, antibiotics and chest tube), but surgery was required in 9 patients (43%). RESULTS: Most perforations were iatrogenic (45%; 17/38) followed by spontaneous perforations (32%; 12/38). Cervical perforations were managed earlier (< 24 h) than thoracic tears, 8/10 (80%) and 17/28 (61%) respectively. Initial conservative treatment failed in all spontaneous ruptures and more in thoracic lesions (62%) than in cervical lesions (13%). Most patients with thoracic perforations and 'free' intrathoracic contamination underwent primary surgery. Surgery with adequate drainage (n = 23) was based on signs of sepsis, empyema and progression of pneumomediastinum/thorax. Mortality occurred in one patient (3%), initially treated conservatively. Median intensive care and duration of hospitalization were not different between the conservative (5 and 7 days, respectively) and the primary surgical approach (21 and 27 days, respectively), but were higher after secondary surgery (13 and 50 days, respectively). CONCLUSIONS: Spontaneous esophageal perforations require early surgical exploration with drainage and irrigation of mediastinum and pleural cavity, while most iatrogenic lesions can be managed conservatively. Cervical perforations can be treated adequately non-operatively, but thoracic perforations often require surgical intervention.

Adolescent↗
PubMed2001

[Acute pancreatitis--a protocol for diagnosis and treatment].

Acute pancreatitis remains a disease with high morbidity and mortality. Acute pancreatitis can be subdivided in acute interstitial pancreatitis and necrotising pancreatitis, largely compatible with clinically mild and severe pancreatitis. This diagnosis is made on the basis of patient history, physical examination, laboratory parameters, contrast CT scan and, occasionally, endoscopic retrograde cholangiopancreatography. Prognosis on admission can be established using a scoring system such as the modified Glasgow score, the Ranson score and the 'Acute physiology and chronic health evaluation'--(APACHE)-II-score. The treatment of acute pancreatitis is primarily conservative. Indications for surgical intervention are: progressive sepsis despite maximum conservative management, an established infection of (peri)pancreatic necrosis, peripancreatic abscess and perforation of stomach, small intestine or colon. The purpose of an operation is to remove necrotic tissue, achieve adequate drainage of the necrotic area or to treat a perforation. The Groningen and Utrecht University Hospitals have collaborated to develop a protocol to standardise the diagnostic approach, management, timing and choice of surgical intervention, as well as to prospectively investigate the effect of such a strategy in patients with acute pancreatitis.

Abdominal Pain↗
PubMed2001

[Reduced risk of complications associated with severe acute (necrotizing) pancreatitis by administration of antibiotics; results from a literature review].

OBJECTIVE: To determine the role of antibiotics in patients with acute pancreatitis. DESIGN: Literature review. METHOD: A Medline search for randomised clinical trials (RCTs) during the period 1990-1999 was carried out using the key words 'pancreatitis', 'acute' and 'antibiotics'. Outcome measures were pancreas-related infection, sepsis and death. RESULTS: Four RCTs were identified. Control groups were not given antibiotics. Based on the pooled data, the differences in risk in favour of the groups treated with various antibiotics were as follows: -14% (95% CI: -26(-)-1; p = 0.04) for pancreas infections, -25% (95% CI: -39(-)-12; p = 0.0002) for sepsis and -13% (95%-BI: -22(-)-3; p = 0.007) for death. CONCLUSION: Administration of antibiotics to patients with severe acute (necrotising) pancreatitis reduces the risk of serious complications.

Anti-Bacterial Agents↗
PubMed1998

Anti-inflammatory effect of interleukin-10 in rabbit immune complex-induced colitis.

BACKGROUND: Interleukin-10 (IL-10) is an anti-inflammatory cytokine that downregulates the secretion of pro-inflammatory cytokines and additionally induces the secretion of anti-inflammatory cytokines, thus possibly leading to reduction of chronic inflammation in inflammatory bowel disease. In this study we evaluated the anti-inflammatory effect of IL-10 in a model of acute colitis in rabbits. METHODS: Colitis was induced by rectal instillation of formalin, 0.65%, followed by intravenous infusion of 0.85 ml heat-aggregated rabbit immunoglobulin. Rabbits were treated with an intravenous bolus of recombinant human IL-10 (SCH52000), 100 microg/kg (n=14) or 500 microg/kg (n=14), 1 h before induction of colitis (control group, n=12). RESULTS: High-dose IL-10 improved macroscopic scores of inflammation and decreased tissue myeloperoxidase levels and leukotriene B4 levels in dialysate fluid. Thromboxane B2 and prostaglandin E2 levels remained unaffected. CONCLUSION: IL-10 ameliorates acute colitis in this model. Consequently, this anti-inflammatory cytokine may have a role in the therapy of acute inflammatory bowel disease.

Acute Disease↗
PubMed1997

Mediators of mucosal inflammation: implications for therapy.

Treatment of inflammatory bowel disease remains a challenge. The major shortcoming in the development of new therapeutic approaches is the fact that the cause of inflammatory bowel disease is still unknown. Recognition of the importance of the arachidonic acid cascade of inflammatory mediators presents the opportunity to specifically inhibit or antagonize leukotriene B4, thromboxane, platelet activating factor, or phospholipase. Interleukins and cytokines have more recently been defined as targets for specific therapy. The results of these specific immune modulating studies are not only important from a therapeutic point of view, but substantially contribute to our understanding of the pathogenic cascades in IBD. In this review, several targets for novel therapeutic intervention are discussed.

Arachidonic Acid↗
PubMed1996

Use of buffered formaldehyde in the enzymatic digestion of inflamed mucosa.

Mucosal inflammation is associated with altered expression of cell membrane molecules. Disaggregation of tissue for flow cytometry may introduce artefactual changes. In an attempt to prevent the induction of artefacts, cells were fixed prior to isolation. The addition of 0.1% buffered formaldehyde to the collagenase/dispase digestion of mucosal biopsy specimens from patients with inflammatory bowel disease enhances detection of CD3, CD11b, CD16, CD63, and CD14. No significant effect was noted for CD19, CD67 or CD45. The expression of CD3, CD11b and CD45 correlated with the degree of endoscopic inflammation. Dilute buffered formaldehyde may be a useful adjunct to the enzymatic isolation of cells from mucosal specimens, by protecting surface antigens from digestion or alterations in expression.

Adult↗