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Biomedical subjects

J N Homan van der Heide

Publications and source records attributed to J N Homan van der Heide.

At least 19 recordsLinked to original sources
PubMed1998

[Giant urinoma of the thigh].

A man aged 70 during a hospital stay over a period of a few weeks developed increasing pain and swelling of the left thigh. Despite extensive diagnostic imaging and surgical drainage, initially no diagnosis could be established. After more than 3 months the tumour proved to be caused by leakage of urine from the pelvis to the soft tissues of the leg. Unfamiliarity of the clinicians with such an extension of an urinoma contributed to the considerable diagnostic delay. Introduction of a bladder catheter stopped the flow of urine to the leg and reduced the leg circumference.

Aged↗
PubMed1991

Permanent cardiac pacing in children: morbidity and efficacy of follow-up.

The data from 50 permanently paced children [mean standard deviation follow-up 5.3 +/- 3.7 years] were reviewed, with special attention being paid to the cause of complications and the efficacy of follow-up. The 5-year survival (SD) of the patients was 78 +/- 6%; mortality was mainly due to the underlying cardiac disease. The 5-year survival (SD) of the pacing systems was 48 +/- 8%. Surgical interventions were necessary every 4.9 patient years. Of these interventions, 58% were caused by lead-related problems. Epicardial leads showed significantly more exit blocks and high thresholds than endocardial leads. Endocardial leads, therefore, should be used at a younger age than is now the current practice, from 5 years of age onwards, for example. If epicardial leads are used, the pacemaker must have a high output facility. Since exit block occurred only within the first 3 months after implantation, we suggest frequent transtelephonic monitoring during the first 3 months. Holter monitoring appeared to be the most effective and sensitive method of detecting malsensing and should be performed regularly.

Adolescent↗
PubMed1990

Patency of arm vein grafts used in aorto-coronary bypass surgery.

Arm veins have been used in myocardial revascularisation procedures as a last resort bypass conduit because of their associated low patency. Nevertheless, leg veins and mammary arteries, which are the most commonly used, are sometimes not sufficient, leaving little choice as to the bypass conduit. To assess the properties of arm veins in bypass surgery, we compared a group of 28 patients that underwent an arm vein graft coronary bypass procedure with a matched group of patients in which leg veins were used. In 28 patients, 40 arm vein grafts with 77 distal anastomoses were used (mean 1.9 +/- 0.9; range 1-5). A cerebrovascular accident was the cause of the sole death (2%) during the study period. The mean follow-up was 4.6 years (Standard deviation, SD: 1.5 years). More antianginal medication was used in the arm vein group (P = 0.017). Additionally, the percentage of the expected maximal frequency during exercise testing was lower in the arm vein group as compared to the leg vein group. Digital subtraction angiography showed that the patency of the arm vein bypass grafts was 47% (70% confidence limits, CL: 32%-62%) while the patency of the leg vein grafts was 77% (CL: 64%-87%), which was statistically significant (P = 0.051). Comparison of these figures with the few published reports on arm veins used as coronary bypass grafts reveals similar results. We conclude that the arm vein as a coronary bypass graft is only to be used when mammary arteries and leg veins are not available.

Arm↗
PubMed1989

Rates of thromboembolism with three different mechanical heart valve prostheses: randomised study.

In 434 operations for valvular heart disease, patients were randomised to receive Björk-Shiley, Edwards-Duromedics, or Medtronic-Hall mechanical prostheses. At a median follow-up time of 37.5 months there were no differences in hazard of death or non-embolic events. In the first six postoperative months the incidence of thromboembolism was about the same for the three valves. Subsequently, however, the incidence of thromboembolism for the Edwards-Duromedics valve was 3.9 times higher than for the Björk-Shiley valve, and for the Medtronic-Hall valve 2.6 times higher than for the Björk-Shiley valve.

Adult↗
PubMed1989

Treatment of post pneumonectomy pleural empyema by open window thoracostomy.

In 13 patients an open window thoracostomy (OWT) was performed for post pneumonectomy pleural empyema. The operation, and life with an OWT cavity, were tolerated well. Early closure of an OWT is not advisable because of a high chance of recurrence of the infection and, in lung cancer patients also the risk of tumour relapse within two years after tumour surgery.

Adult↗
PubMed1986

Clinical comparison between four modern membrane oxygenators: Bentley CM 40/50, COBE CML, Sci Med 3500-2A and Travenol LPM 50.

The devices with flat polypropylene membranes can be primed simpler and faster, than devices with the capillary membranes or with silicone rubber membranes. These two devices also offer more protection against venous air admixture and leaking of bubbles across the membrane. From hematologic standpoint there was no clear advantage of one particular device over another.

Carbon Dioxide↗
PubMed1984

Left ventricle descending aorta valved conduit to relieve congenital aortic stenosis in children.

A valved conduit was inserted between the apex of the left ventricle and the descending aorta in 2 patients, 4 months and 10 years of age, respectively, who had valvular aortic stenosis. The development of both patients has been excellent since operation. At control catheterization (1 and 2 years postoperatively) no pressure gradient was found between the left ventricle and the aorta. In both patients the aortic valve area showed growth to near normal size on echocardiographic study 3 years postoperatively.

Aorta, Thoracic↗
PubMed1982

Experiences with the Fontan operation.

Up to December 1980 we performed 21 Fontan operations: 8 for tricuspid atresia and 13 for a functional monoventricle. Although palliative, the operation is currently a good method of treating tricuspid atresia. In our experience, the use of a sufficiently large atriopulmonary valved conduit assures a more satisfactory immediate postoperative hemodynamic result than the atriobulbar non-valved connection (RA-infund. tunnel). Good results can be obtained by a modified Fontan operation in patients with a monoventricle. However, with this malformation, very careful preoperative selection of patients is necessary with special regard to pulmonary vascular resistance. The connection between the right atrium and pulmonary artery was established by a valved conduit in 15 patients; no valve was incorporated in the other 6 patients. The largest prostheses gave the best immediate postoperative hemodynamic results. Two patients with monoventricle were successfully reoperated for persistent right-left shunt. The 13 patients so far followed up for at least a year show definite improvement as compared with their preoperative condition. Late complications from the valved prostheses have not been observed so far.

Adolescent↗
PubMed1982

Is prevention of hypertension after open heart surgery possible by blocking 5HT2-receptors with ketanserin?

Eleven patients undergoing coronary or aortic valve surgery received ketanserin (3 X 10 mg i.v.). When surgery was finished hemodynamic measurements were performed prior to and after cessation of nitrous oxide. The results were compared with those of a control group (n = 30), reported in a previous study. At the end of operation the ketanserin treated patients had significantly lower heart rate (84 +/- 16 vs. 96 +/- 14 min-1; Mean +/- S.D.), lower mean arterial pressure (75 +/- 12 vs. 84 +/- 10 mmHg) and higher skin temperature (31.9 +/- 1.3 vs. 27.7 +/- 2.3 degrees C). However, postoperative hypertension after the withdrawal of nitrous oxide was not prevented: similarly as in the control group blood pressure rose and systemic vascular resistance increased. As the last dose of ketanserin was given 60 minutes before the end of anesthesia it is likely that the effect of ketanserin had already worn off.

Adult↗
PubMed1982

Clinical study of blood trauma during perfusion with membrane and bubble oxygenators.

This clinical study was designed to show differences in hemostasis after perfusion with membrane (MO) or bubble (BO) oxygenators in cardiopulmonary bypass. These differences, however, may be obscured by other damaging factors, such as cardiotomy suction, various perfusion durations, or different types of operations. Therefore, only patients undergoing coronary artery bypass grafting were studied. During such operations, rather equal perfusion durations can be expected and mainly apex vent suction is used. Data on postoperative blood loss and transfusions were collected from two groups: one comprising 49 patients perfused with the Travenol TMO membrane oxygenator (MO group) and the other composed of 25 patients with the Polystan VT 5000 bubble oxygenator (BO group). In 10 patients of each group, blood samples were taken at frequent intervals for blood cell counts, for the determination of platelet function, hematocrit, hemoglobin, and plasma hemoglobin, for several coagulation tests, and for the assessment of kidney and liver function. Significant differences between the two groups were found for postoperative blood loss and transfusions, both higher in the BO group. Platelet function was better maintained in the MO group until the moment of releasing the aortic cross-clamp, after which it decreased concurrently with a doubling of the amount of suction. After protamine administration, an additional drop of platelet function occurred and there was virtually no platelet function left in either groups; however, it recovered 90 minutes after bypass, mainly in the MO group. This study shows that hemostasis is better preserved with MO perfusion. Still further improvements may be achieved by preventing the damage of suction and by a correct protamine dose.

Blood Cell Count↗
PubMed1981

Hemodynamic side effects of prostaglandin E1 in patients before and during cardiopulmonary bypass.

Animal experiments have shown that the administration of prostaglandin E1 (PGE1) during cardiopulmonary bypass (CPB) reduces platelet damage and the tendency to bleeding disorders. Because PGE1 also has a strong vasodilating action, a clinical trial was started to evaluate its hemodynamic side-effects. PGE1 was studied during 3 different periods: 1. a 10-minute period before bypass, 2. a hemodynamically stable period during CPB, 3. during the whole period of CPB. 1. Before CPB, a consistent fall of mean arterial pressure (MAP) was observed (26 mmHg). 2. During the stable period of CPB, the blood pressure fall was dependent on the pre-existing systemic vascular resistance. 3. PGE1 infusion during the whole CPB period was, in general, badly tolerated. Increased perfusion flow was not sufficient to compensate for the resulting blood pressure drop. In most of the 13 cases vasopressors had to be given continuously. In 7 patients PGE1 had to be reduced, and in 4 patients the infusion had to be stopped altogether. Because of the marked vasodilator effects of PGE1 it appears impossible to give patients doses adequate to achieve platelet preservation during clinical CPB with safety.

Adult↗