Biomedical subjects
Publications and source records attributed to L Heytens.
A general review of the physical principles and the applications of transcranial Doppler (TCD) sonography is given. This new non-invasive technique is presented as an important diagnostic tool in neurology, neurosurgery and intensive care medicine. The applications are documented using our own patient material.
Ten patients presenting a subarachnoid hemorrhage (SAH) due to rupture of a middle cerebral or an anterior communicating aneurysm are presented. Transcranial Doppler (TCD) values are obtained at different time intervals after SAH. The correlation of TCD values, vasospasm and clinical course is discussed.
A major problem in the surgical treatment of diffuse peritonitis is to obtain a complete clearance of septic foci in the peritoneal cavity which may lead to persistence of sepsis and multiple organ failure. We describe our experience with staged abdominal re-explorations using a Zipper system in 23 patients with a mean APACHE II score of 20.3 (s.e.m: 1.5). A total of 91 lavages were done in these patients. Overall mortality was 39%. None of the patients having an APACHE II score between 10 and 20 died whereas the predicted mortality was 15%-45%. After successful treatment, primary closure was possible in 8 of the 14 surviving patients. Large incisional hernias developed in 6 patients. One patient eviscerated two years after complete granulation of his laparostoma. Staged abdominal re-explorations using a Zipper system is an useful tool in the treatment of diffuse peritonitis.
We report a family that was referred to our laboratory after a fatal malignant hyperthermia (MH) accident during general anesthesia. Postmortem study of different muscles of the proband pointed retrospectively to the presence of central core disease (CCD). Of the 8 family members investigated by histology and in vitro contracture testing (IVCT) 5 were found to be MH-susceptible. Neurological examination was completely normal. Histologically, these 5 patients showed a highly variable proportion (6-89%) of cores in type 1 fibers on light microscopy. In 3 patients definite central cores were found, in 1 patient multicore disease was diagnosed, and 1 patients presented with a mixed central/paracentral form. Electron microscopy could detect cores in only 4 out of 5 patients. These results demonstrate the difficulty to diagnose central or multicore disease and suggest that mixed forms within the same family may occur. The one histologically dubious patient in this family shows that the most sensitive test for the diagnosis of this myopathy might be the IVCT.
We studied the correlation between the in vitro contracture test (IVCT) performed in malignant hyperthermia (MH) and the muscle fiber type composition in 29 human vastus lateralis (VL) biopsy samples (from 12 women and 17 men) using a semiautomated image analyzer. Relative number, lesser diameter, global area, and spatial distribution of the muscle fibers were measured. In these and in 26 additional VL muscle biopsy samples of patients with other myopathies, we compared our morphometric data with the observations made by the pathologist. Among the MH group, type 1 fibers were larger in both malignant hyperthermia susceptible (MHS) men and women reaching statistical significance only in the latter. The relative number and global area were unchanged. In MHS patients relative number and global area of type 2A fibers were smaller. No changes in the parameters of type 2B fibers were found. In a minority of sections (14%) clustering was observed. Sex-related alterations in type 2 fiber characteristics were found between MHS patients. However, our findings do not clearly point towards a syndrome-induced alteration of size, number, global area, or distribution of type 1, 2A, and 2B muscle fibers in VL of MH patients. By morphometric analysis, we found several additional biopsy samples that met the interpretation of "abnormal" size and number of muscle fibers in human malignant hyperthermia than were reported by the pathologist.