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Biomedical subjects

L M Kingma

Publications and source records attributed to L M Kingma.

At least 19 recordsLinked to original sources
PubMed2005

Troponin I in predicting cardiac or pulmonary complications and outcome in subarachnoid haemorrhage.

BACKGROUND: Patients with aneurysmal subarachnoid haemorrhage (SAH) are at risk of cardiac and pulmonary complications. Troponin I (cTnI), a reliable marker of myocardial injury, is frequently raised after SAH. AIMS: To investigate the additional value of (cTnI) in predicting cardiac or pulmonary complications and outcome in patients with SAH. METHODS: Admission cTnI was measured in a prospective series of patients admitted within 24 hours of SAH. By means of univariate and multivariate logistic regression models the additional prognostic value of raised cTnI (>0.3 microg/litre) was investigated compared with established prognosticators (clinical condition on admission, age, and amount of blood on admission computed tomography) for predicting the occurrence of pulmonary oedema, pulmonary gas exchange abnormalities, rhythm disturbances, inadequate cardiac performance, a combination of these complications, and poor outcome. Area under the operator characteristic curve (AUC-ROC) was used to assess additional prognostic value. RESULTS: Abnormal cTnI concentrations were found on admission in 35 of 68 patients. Abnormal cTnI concentrations and poor clinical condition independently predicted cardiac or pulmonary complications. After extending the model with World Federation of Neurological Surgeons scale and age in addition to abnormal cTnI, the AUC-ROC improved from 0.70 (95% confidence interval (CI), 0.57 to 0.83) to 0.83 (95% CI, 0.72 to 0.93). Abnormal cTnI also independently predicted poor outcome. The additional prognostic value of cTnI for poor outcome is limited. CONCLUSIONS: cTnI measurement is a powerful predictor for the occurrence of pulmonary and cardiac complications, but does not carry additional prognostic value for clinical outcome in patients with aneurysmal SAH.

Cerebral Angiography↗
PubMed1999

Cystic lesions accompanying extra-axial tumours.

We examined the mechanism of cyst formation in extra-axial tumours in the central nervous system (CNS). Cyst fluid, cerebrospinal fluid (CSF) and blood plasma were analysed in eight patients with nine peritumoral cysts: four with meningiomas, two with intracranial and two spinal intradural schwannomas. Measuring concentrations of various proteins [albumin, immunoglobulin G (IgG), IgA, alpha 2-macroglobulin and IgM] in cyst fluid, CSF and blood plasma provides insight into the state of the semipermeability of the blood-brain barrier (BBB) and blood-cerebrospinal fluid barrier. Peritumoral cysts accompanying intra-axial brain tumours are the end result of disruption of the BBB and oedema formation. Unlike intra-axial tumours which lie embedded within nervous tissue, extra-axial tumours tend to be separated from nervous tissue by arachnoid and pia mater. High concentrations of proteins were measured in the cyst fluid, approaching blood plasma levels, suggesting a local barrier disruption, and passage across the arachnoid, pia mater and cortical/medullary layer into the CNS parenchyma, leaving the protein concentrations of CSF practically unchanged. We confirmed that very high concentrations of protein are to be found in tumour cysts, plasma proteins forming almost 90% of the total protein in the cyst. We review current hypotheses on the pathogenesis of cysts accompanying neoplasms, particularly meningiomas and schwannomas, and conclude that the majority of proteins in cyst fluid in extra-axial, intradural meningiomas and schwannomas are plasma proteins. This provides a strong argument for pathogenesis of extra-axial intradural tumour cysts in favour of leakage of plasma proteins out of the tumour vessels into the nervous tissue.

Blood-Brain Barrier↗
PubMed1998

Analysis of fluid in cysts accompanying various primary and metastatic brain tumours: proteins, lactate and pH.

There is a growing interest in cystic lesions of the brain. By examining the cyst content of brain tumours more insight into the pathogenesis of cyst formation has been found. In this study, 39 samples of cyst fluid of 34 patients with a cyst accompanying a brain tumour were collected and studied biochemically regarding their protein content, lactate and pH. In this study we investigated the relation between the grade of malignancy and the lactate-concentration and the discrepancy between the high levels of lactate in cysts and their alkaline environment. The results of the measurements of the concentrations of albumin, immunoglobulines (IgG, IgA, IgM) and alpha 2-macroglobulin in cysts compared to those in sera suggest that cyst formation associated with tumour is based upon a disruption of the blood-brain barrier with exudation of plasma proteins into the brain parenchyma resulting in accumulation of fluid (oedema) and eventually in formation of a cyst. There appears to be a positive relation between the grade of malignancy and the concentration of lactate in the cysts with a significant 2-fold increase in lactate concentration in malignant tumour cysts compared to the more benign tumour cysts (p < 0.001) probably on account of aerobic glycolysis with production of lactate by the tumour. The measured pH values in the cysts were above normal, resulting in a discrepancy of the high levels of lactate in the cyst with the alkaline environment and this suggests efflux of H(+)-ions by a Na/H exchange mechanism to compensate for the change of pH.

Alkalies↗
PubMed1998

The pathogenesis of cysts accompanying intra-axial primary and metastatic tumors of the central nervous system.

Recent reports have suggested that cyst formation accompanying astrocytomas in the central nervous system (CNS) is due to an edematous process caused by blood-brain barrier (BBB) disruption and not a result of necrosis. This study is performed to investigate whether the hypothesis of cyst formation based on BBB disruption also applies to various pathologically different intra-axial gliomatous tumors and metastases. By chemical analysis, using immunokinetic nephelometry, isoelectric focussing, cellulose acetate electrophoresis and a biuretic method, the concentrations of albumin, immunoglobulin G (IgG), IgA, alpha2-macroglobulin, IgM and total protein were measured and proportions of concentrations of these proteins were compared in cyst fluid, blood plasma and cerebrospinal fluid (CSF). Our data, based on the chemical analysis of cyst fluid and blood plasma of 37 patients, including 2 ependymomas (one cerebral; one thoracic), 3 oligodendrogliomas, 4 hemangioblastomas, 5 cerebellar astrocytomas and 1 cervical, 1 giant astrocytoma grade one, 1 gangliocytoma, 1 neuroblastoma and 19 metastases (five lung-; two renal-; three breast-; one melanoma-; one thyroid metastasis and seven metastases of unknown origin) present high protein concentrations in the cysts with a highly similar spectrum of proteins in the tumor cyst fluid and blood plasma, suggesting a BBB disruption followed by exudation of plasma proteins into the brain parenchyma with formation of edema and transition of edematous tissue into a cyst accompanying the tumor. Although histopathologically different types of tumor tissue are involved, data suggests that the pathogenesis of cysts accompanying gliomatous tumors and metastases in the CNS is based on BBB disruption and consequent edema, as is the case in the formation of cysts in anaplastic astrocytomas.

Blood Proteins↗
PubMed1995

Radiographic evaluation of developing instability of the Mecron cementless, threaded acetabular prostheses.

PURPOSE: To evaluate radiographically the history of the Mecron acetabular prosthesis. MATERIAL AND METHODS: The pelvic radiographs of 350 consecutive patients with a smooth threaded acetabular prosthesis type Mecron were retrospectively evaluated (follow-up 1 to 6 years, mean 4 years). A demarcation zone seen at the medial side of the prosthesis was graded from 0 (absent) to 3 (severe). Prostheses with grades 0 and 1 were considered stable and those with grade 3 with or without migration were presumed to be unstable. RESULTS: At five years, 62 (62%) of the cups were unstable and only 23 (23%) were stable. The rate of migration was unacceptably high, and seen in 43 (43%) patients. Migration was only seen in prosthesis with a grade 3 demarcation. CONCLUSIONS: Demarcation visible on radiographs is an important sign of instability of the prosthesis. With the grading system it is possible to evaluate radiographically the history of the prosthesis.

Acetabulum↗
PubMed1995

Radiographic loosening of cementless threaded acetabular cups. No additional diagnostic value of arthrography in 30 patients.

We compared arthrography with plain radiographs in 30 consecutive patients having a clinical diagnosis of loosening of a smooth-threaded acetabular prosthesis (Mecron, Berlin). Leakage of contrast at the interface between the ring and the bone on the medial side of the prosthesis was seen in 21 patients. Loosening of the cup was also visible on the plane radiographs and loosening was confirmed in all these patients at revision surgery. No false positive arthrographies were seen. In one patient, the arthrography was false negative because of a technical failure. We conclude that no additional information was obtained by arthrography.

Acetabulum↗
PubMed1994

Reproducible radiographs of acetabular prostheses. A method assessed in 35 patients.

35 patients with a smooth, threaded acetabular Mecron type prosthesis were examined with the aid of a table top with wiremarkers and a fixed 30-degree wedge to allow for reproducible positioning. Under fluoroscopic control, pelvic and spot films were made. The inter- and intraobserver variability of anteversion and inclination angle measurements of the prostheses had a standard deviation of less than 1 degree. The method can be applied to other acetabular prostheses as well.

Acetabulum↗
PubMed1989

Injuries of the lateral ankle ligaments: classification with tenography and arthrography.

To assess the value of tenography of the peroneal tendon sheaths and of arthrography of the tibiotalar joint for the diagnosis and classification of recent ruptures of the lateral ankle ligaments, the authors performed a prospective study on 108 patients with inversion trauma of the ankle. All patients underwent tenography. Arthrography was performed if results of tenography were negative. All patients with positive tenographic or arthrographic results underwent surgery. Tenography proved to be reliable in the diagnosis of injuries of the calcaneofibular ligament (sensitivity, 88%; specificity, 87%-94%). The positive predictive value of tenography in combination with arthrography was 100% for the diagnosis of lateral ligament ruptures. The authors conclude that a combination of arthrography and tenography is a reliable method for diagnosing recent ruptures of the lateral ankle ligaments and for differentiating between isolated ruptures of the talofibular ligament and combined lesions of both the talofibular and the calcaneofibular ligaments.

Adolescent↗
PubMed1986

Chronic posttraumatic aneurysm of the thoracic aorta: surgically correctable occult threat.

The clinical and radiographic findings of 11 patients with a chronic traumatic aneurysm were reviewed. Each patient had been under medical care at the time of injury but acute aortic rupture was not recognized in any, although several signs of mediastinal hemorrhage were present on the immediate posttraumatic radiographs. The average time between the initial trauma and the detection of the aneurysm was 5.3 years. Seven patients showed no or minimal specific complaints. Four patients showed more or less severe complaints of dysphagia, severe thoracic pain, hoarseness, and dyspnea. In all patients the chest radiograph was abnormal: Four patients showed a mass lesion at the level of the aortic knob. The other seven patients showed contour deformities of the descending aorta, sometimes subtle, with (five) or without (two) calcification. Esophagography and CT were useful in several patients. In the light of the unpredictable course of a chronic traumatic aneurysm and the low operative mortality, early operation after detection is recommended. Preoperative angiography is usually desirable.

Adolescent↗
PubMed1986

Management of oesophageal perforations; a tailored approach.

The results of treatment of 20 oesophageal perforations were retrospectively studied in 19 consecutive patients. Most complications occurred after endoscopic procedures, after a delay in treatment of more than 12 hours, in patients with intrinsic oesophageal disease and in cases where only drainage procedures were possible. Because of the many factors that influence the outcome of the treatment of oesophageal perforation it is stressed that the therapeutic approach should not be dogmatic, but tailored to the individual patient. Although morbidity is still high, mortality has markedly decreased by this differentiated approach, the only death not being directly related to the perforation. Early recognition remains the most important factor in the prognosis of patients with oesophageal perforation.

Adolescent↗
PubMed1985

Choledochocholedochostomy, a relatively safe procedure in orthotopic liver transplantation.

The biliary anastomosis has been considered the Achilles heel of liver transplantation, and especially the choledochocholedochostomy has been reported to be ill-fated. However, based on previous experimental experiences we decided to use the choledochocholedochostomy as the biliary anastomosis of preference in orthotopic liver transplantation. A choledochocholedochostomy has been performed in 29 of the 31 patients who have undergone transplantation since 1979. Five complications (17%) were diagnosed, of which one proved to be fatal. Two complications were related to the handling of the T-tube and required simple laparotomy to solve the intraperitoneal bile leakage. The other three complications were major: in one patient the choledochocholedochostomy was stenosed, requiring a conversion into a hepaticojejunostomy, while in two patients the donor common bile duct became necrotic. One of these patients underwent successful retransplantation, while the other died of sepsis. In both patients the hepatic artery anastomosis proved to be thrombosed, while in all patients without biliary complications the hepatic artery anastomosis was patent angiographically or at autopsy. The total incidence of sepsis was 26%, but in only four patients (13%) was sepsis related to the choledochocholedochostomy. The relationship between the necrosis of the donor bile duct and the patency of the hepatic artery anastomosis emphasizes an impeccable surgical technique. The low incidence of biliary complications in our 31 patients characterizes the choledochocholedochostomy as a relatively safe biliary procedure in clinical liver transplantation.

Common Bile Duct↗
PubMed1984

The abnormal proximal tibiofibular joint.

Abnormalities of the proximal tibiofibular joint are infrequently encountered. Mostly instability occurs as a result of trauma. Four types of instability are distinguished: subluxation, anterolateral, posteromedial and superior dislocation. Four radiological methods designed to visualize abnormalities of the proximal tibiofibular joint are discussed. Special notice is given to the clinical relevance of a new method. Instability was demonstrated in 19 patients; 16 of these were treated by an operation. History, data obtained by physical examination and ways of treatment are discussed.

Female↗
PubMed1984

Choledochocholedochostomy is successful in orthotopic liver transplantation.

The viability of the extrahepatic bile ducts of liver grafts depends on their arterial blood supply, and consequently, on the patency of the arterial anastomosis. Thrombosis of the hepatic artery leads almost inevitably to necrosis of the extrahepatic bile ducts of the liver graft. An impeccable technique of arterial anastomosis is essential to avoid biliary complications resulting from ischemia. The low incidence of biliary complications (17%) in our 31 patients indicates that choledocho-choledochostomy is a relatively safe biliary procedure in clinical liver transplantation, especially when compared with other commonly used biliary anastomoses.

Adult↗
PubMed1984

Long-term effects of cholecystostomy on gallbladder function.

In eight patients without a history of gallbladder disease, cholecystostomy was performed for acute pancreatitis (four patients) and blunt abdominal trauma (four patients). In one case only, acute cholecystitis developed after discontinuation of the cholecystostomy. Six patients were followed for a mean period of 3.9 years, after which the gallbladder function was evaluated. Cholecystography and ultrasonography demonstrated good visualisation of the gallbladder without signs of gallstones. The contraction of the gallbladder produced by cholecystokinin varied. This could be due to adhesions impairing the motility of the gallbladder. After cholecystostomy in a previously normal gallbladder, its function will become normal in most patients. If no signs of gallbladder disease develop within the first year after cholecystostomy, the risk of late complications is minimal.

Adult↗