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Biomedical subjects

J N Keeman

Publications and source records attributed to J N Keeman.

At least 19 recordsLinked to original sources
PubMed2006

[Bladder stones and lithotomy: a vanished ailment as the basis of urology].

Urinary bladder stones have played a role in medicine for ages. Many examples of this disease can be found in Dutch history. The need to cure this ailment led to the development of extremely painful interventions, for which self-appointed specialists very soon came forward and were then employed in this capacity in the cities. The various interventions were: perineal lithotomy using either the 'apparatus minor' or the 'apparatus major', lateral lithotomy, cutting for stone 'in two trips', suprapubic cystotomy, and ultimately lithotripsy. Bladder stones have largely disappeared from contemporary medicine and now represent only 5% of all urinary-tract stones, the main groups at risk being men with prostate hypertrophy, whether or not surgically treated, and women previously operated on for incontinence. Bladder stones are now seen mainly in developing countries. The dangerous operations via an extravesicular route have now been replaced by transurethral procedures in which the stone is disintegrated with the aid of an electric charge, shock waves or ultrasound. In an early stage, this ailment was the incentive for the development of a separate medical specialty: urology.

Cystostomy↗
PubMed2004

[Treatment of open fractures before Lister and the management of the fatal leg fracture of Admiral Michiel Adriaensz de Ruyter, 1676].

On 22 April 1676, Admiral De Ruyter suffered a fatal open fracture of the right lower leg during the naval battle near the Etna. The fleet doctor, Jan Mannart, and the two ship's surgeons treated the wound with brandy and prescribed rest, but fatal gangrene developed a few days later. Before Lister first reported his technique of antiseptic treatment in 1876, the possibilities for the treatment of open wounds were limited to cauterisation and application of hot oil. Until the middle of the 19th century, amputation of the wounded limb was the most obvious solution. Why amputation was not performed in the case of De Ruyter is unknown. Actually, however, amputation would probably have increased his chances of survival only to a limited extent.

Amputation, Surgical↗
PubMed2003

[Cosmetic surgery, certificates and the 'head-baker' of Eeclo].

The legend of the head-baker of Eeclo, an imaginary cosmetic surgeon, clearly illustrates that the improvement of the human physionomy was of great interest to people as long ago as the mid-16th century. In order to display their credentials the surgeons of that time and in the succeeding centuries would display certificates that testified in glowing terms to their knowledge and expertise. One only has to open a modern newspaper to see that this phenomenon has not died out.

Advertising↗
PubMed2002

[One hundred years of the Netherlands Association of Surgeons. II. The evolution of the Association].

The Association of Surgeons in the Netherlands was founded 100 years ago with the objective to further surgery in general; from 1948 onward a separate objective was to further the interests of surgeons. The Association has developed into an active scientific society that ensures that quality of Dutch surgical practice, that stimulates the development of surgery and that organizes the training of surgeons. The number of operations has more than doubled in the past 25 years, despite the limited increase in the number of surgeons owing to a great leap in efficiency. This has led to a differentiation in the surgical discipline, with a number of sub-associations. The currents quality policy emphasizes certification of clinics, the development of guidelines, mandatory attendance to ongoing training programmes, a registry of complications, adequate patient information, visitation of clinics and a compulsory specialization course for all surgical residents.

Education, Medical↗
PubMed2002

[One hundred years of the Netherlands Association of Surgeons. I. Introduction].

On 9 February 1902, the Association of Surgeons in the Netherlands was founded--a remarkable fact. The surgeons, who formerly worked in guilds, were by no means the first to found such a society. Some specialist disciplines had already preceded them by forming an association. During the course of these 100 years, surgery has undergone vast development and progress. This has consequences for the deployment of the surgical profession. Subspecialties have arisen, increasing the quality of surgical care. Technical possibilities enhance small access surgery. This means a very different approach in the training of young surgeons in their profession, for instance through the use of virtual reality techniques.

History, 20th Century↗
PubMed2002

[The retained surgical sponge, an ongoing surgical problem].

The retained surgical sponge seems to be an ongoing problem. Despite the fact that reports of retained surgical sponges are comparatively rare, this problem seems to be more prevalent than is generally appreciated. Even though counting sponges is a tedious task, it should nonetheless be performed with the utmost attention. Although the presence of radiopaque wires in the sponges is helpful in locating these, it does not prevent surgical sponges from being forgotten. These retained sponges can result in serious conditions such as septic complications or pseudo-tumour formation, which in turn might lead to extensive diagnostic and secondary surgical procedures.

Foreign Bodies↗
PubMed2001

[Physical diagnostics--duplex scanning is necessary only for selected patients with varicose veins].

With the advent of non-invasive duplex scanning, the imaging of the lower limb venous system has been greatly improved. Some authors routinely use duplex on their patients with varicose veins. However, this policy is associated with increased costs and demands a lot of logistics as well as the radiologists' time in clinics treating many of these patients. In view of the small difference in diagnostic accuracy compared to venography, duplex scanning is the gold standard for diagnosing patients with varicose veins in current practice. Recently the cheaper and simpler Doppler testing was compared with duplex scanning. In patients with primary varicose veins who have not previously been operated on, physical examination combined with Doppler can indicate more than 90% of V. saphena magna insufficiencies. However, Doppler misses approximately one-third of insufficient V. saphena parva (VSPs) and it is unable to localize the variable saphenopopliteal junction accurately. Since the incidence of VSP insufficiency in patients with primary varicose veins is only 15-33%, physical examination combined with Doppler investigation is sufficient to establish the correct diagnosis in the majority of patients. For recurrent varices, the sensitivity, specificity and negative predictive value of a Doppler investigation is marginal. In practice, duplex scanning is only indicated as follows; when VSP insufficiency is suspected, for recurrent varices, when signs of chronic venous insufficiency are present and when the findings from a physical examination combined with Doppler tests are inconclusive, e.g. in patients with adipose legs.

Clinical Trials as Topic↗
PubMed2000

[Physical examination--tourniquet tests for varicose veins].

Physical examination of patients with varicose veins is time-consuming and subjective. Nowadays, it is frequently replaced by hand-held Doppler examination and duplex scanning. Adequate studies investigating the value of physical examination for varicose veins are lacking. It is unclear whether the tourniquet tests of Trendelenburg and Perthes are more accurate than other physical tests, such as the cough test or tap test. In selected patients, who are not obese, have clearly visible varicose veins and have not been treated before, physical examination seems accurate, especially for assessment of the long saphenous vein. When physical examination is inconclusive, as often is the case with recurrent varicose veins, suspected short saphenous vein or perforator incompetence, or adipose legs, additional Doppler or duplex testing is required for an accurate diagnosis.

Diagnosis, Differential↗
PubMed1999

[New diagnostic imaging technology often offers no advantage in the differential diagnosis of acute abdomen].

Imaging techniques may lead to better insight in the diagnosis of the acute abdomen, and in specific cases to a more rapid diagnosis, especially in the upper abdomen. However, frequently the only result of the accessory diagnostic methods is delay of the necessary treatment. The yield of CT scanning in acute abdomen is too small to justify routine use. Ultrasonography is useful in selected cases, but not for routine application. Laparoscopic examination in acute abdomen in certain conditions facilitates making the correct diagnosis, but it constitutes an aggressive method for patients found free of abnormalities. Skillful history-taking and adequate performance of physical examination still constitute the basis of correct diagnosing. Technical aids may be of value. Good systematical studies of the clinical results and the cost effectiveness of physical examination and of the technological aids are still largely lacking.

Abdomen, Acute↗
PubMed1999

[Trauma during pregnancy].

Mortality due to trauma in pregnancy is not very common in the Netherlands. More often a pregnant woman presents herself for examination after trauma. Blunt trauma is more common in the third trimester. Minor trauma also needs good care, with special attention for solutio placentae. Maternal mortality after penetrating trauma is low because of the protection of vital organs by the uterus. With good treatment the mortality in pregnant trauma patients will not be higher than in nonpregnant patients. A rapid and effective resuscitation of the mother will give the foetus the best chance of survival.

Adult↗
PubMed1999

[Clinical thinking and decision-making in the practice. A young man in shock].

A previously healthy male aged 32 years with noticeably long extremities went into shock whilst straining to defaecate. He did not lose consciousness and reported pain high in the back and in the abdomen. Transoesophageal echocardiography revealed no abnormalities. Ultrasonography of the abdomen showed blood in the abdominal cavity, following which laparotomy was performed. An aneurysm of the splenic artery was found to have ruptured. The aneurysm and the spleen were removed. Morbid-anatomical examination showed no vascular abnormalities. The postoperative course was uneventful.

Abdomen↗
PubMed1999

Three-dimensional dynamic external fixation of distal radial fractures. A prospective study.

This prospective study describes the experience with a new dynamic external fixator which provides three degrees of freedom, while the centre of rotation of all these movements is located in the wrist. 44 patients with unstable fractures of the distal radius were included. During the period of dynamisation, with a median flexion of 30 degrees, extension of 18 degrees, radial deviation of 0 degree and ulnar deviation of 20 degrees the range of motion needed to perform activities of daily living was approached. In spite of early mobilisation reduction was maintained. The radiological result was excellent or good in 82% of the patients and the functional result was excellent or good in 92% of the cases. Pin track infections were noted rather frequently, possibly related to the interaction between the soft tissues and the fixator pins. Based on the experiences of the study the device needs further improvement.

Adult↗