PubMed Health⌕ Search

Biomedical subjects

L P Leenen

Publications and source records attributed to L P Leenen.

18 recordsLinked to original sources
PubMed2003

[Endovascular treatment of 4 patients with a traumatic rupture of the thoracic aorta].

OBJECTIVE: To present our initial results with the endovascular treatment of traumatic rupture of the thoracic aorta. DESIGN: Retrospective. METHOD: Between April and October, 2002, 4 men between the ages of 22 and 46 were treated endovascularly for a traumatic rupture of the thoracic aorta. The diagnosis 'rupture of the thoracic aorta' was made on the basis of CT-angiography in all cases. In the first case, a thoracic Gore TAG-endoprosthesis (Gore & Associates; Den Bosch) was used, and in 3 cases a Talent-endoprosthesis (Medtronic AVG; Heerlen). RESULTS: There was an average of 2.5 days (limits: 0-5 days) between admission and the placement of the endoprosthesis. There was one intra-operative complication in the form of a dissection of the right femoral artery when the endoprosthesis was inserted. In 3 cases, the left subclavian artery was occluded by the prosthesis. This had no negative consequences for the patients during the follow-up period (limits: 4-12 months). The CT-angiogram taken 3 months after the operation consistently showed a good position of the endoprosthesis with no signs of leakage. CONCLUSION: For a limited follow-up period, the endovascular treatment of a traumatic rupture of the thoracic aorta has been shown to be safe and effective. The long term results must be awaited.

Adult↗
PubMed2000

[Multitrauma patients: principles of 'damage control surgery'].

The principles of damage control surgery were applied in the cases of three severely injured multitrauma patients, men aged 47 and 33 years who had a motorcycle accident and a 66-year-old man who had a car crash. Victims of major trauma suffer from a worsening physiologic derangement manifested by the triad of acidosis, hypothermia and coagulopathy. This often leads to a vicious cycle that heralds imminent death or organ failure. Damage control surgery involves three distinct stages. The first consists of rapid temporary measures to control bleeding and contamination, followed by rapid closure of the abdomen. The second involves aggressive correction of the lethal triad in the intensive care unit. The third is the planned re-operation for the definitive repair of the injuries. As shown in these three patients, the appropriate use of this strategy can lead to a decrease in the morbidity and mortality in complex trauma patients.

Accidents, Traffic↗
PubMed2000

[Luxatio cordis in blunt-trauma thoraco-abdominal injuries].

A 56-year old woman was admitted to the emergency ward after suffering a blunt thoraco-abdominal high-velocity trauma as she hit the wheel when her car drove into a tree. A laparotomy was performed because of haemodynamic instability and radiographic suspicion of a diaphragmatic rupture. Besides haemorrhage from liver and spleen injuries, an abdominal herniation of the heart through a ruptured pericardium and diaphragm was found. Haemostasis of liver, splenectomy and suturing of defects in pericardium and diaphragm resulted in a haemodynamically stable situation. A high index of suspicion of rupture of pericardium and diaphragm with luxation of the heart in the trauma patient is important to reduce morbidity and mortality due to delay of surgical intervention.

Accidents, Traffic↗
PubMed1996

[Registration of postoperative complications to improve the results of surgery].

OBJECTIVE: To analyse the consequences of postoperative complications in 1418 surgical patients. DESIGN: Prospective descriptive study. SETTING: St. Elisabeth Hospital in Tilburg, The Netherlands. METHOD: In the period 1986-1992 all postoperative complications and their consequences occurring during or after the clinical treatment of surgical patients were registered. RESULTS: In 5% of the 28,485 surgical procedures (= 1418 patients) postoperative complications were found. To treat these complications, 577 patients had to be reoperated on, 233 patients several times, and generally because of postoperative infections. Readmission after discharge was necessary in 310 patients for treatment of their complications. Mean hospital stay for all patients was 10 days, as against 21 days in patients with postoperative complications. On the basis of the figures recorded, quality enhancing measures were taken, e.g. regarding antibiotic prophylaxis and wound treatment. CONCLUSION: The consequences of postoperative complications are considerable. With respect to quality control in health care it is important to develop national registration and documentation of surgical complications.

Female↗
PubMed1993

Internal fixation of open unstable pelvic fractures.

From 1980 through 1990 14 patients with severely complicated unstable fractures of the pelvis were treated. There were 13 men and one women (mean age, 28 years). Eight fractures also involved the acetabulum. The injuries were accompanied by anorectal (nine), urogenital (eight), vascular (three), and nerve (three) injuries. After resuscitation, fractures were stabilized immediately, preferably using internal fixation, notwithstanding fecal contamination in certain cases. Anorectal ruptures were treated with lavage of the distal colon and a divergent stoma. The urogenital lesions also were treated primarily. Two patients died early after treatment of accompanying injuries. Infectious complications were seen seven times. In one patient internal fixation broke down. All fractures healed with good functional results. At last follow-up examination all patients were continent for feces. It is concluded that early internal stabilization of these complex injuries achieves a low mortality rate and good functional results. Immediate repair of urogenital and sphincter lesions, with concomitant divergent stoma and lavage of the distal colon, gives good results notwithstanding the risk of infectious complications.

Adolescent↗
PubMed1992

Fracture-dislocations of the tarsometatarsal joint, a combined anatomical and computed tomographic study.

Based on anatomical and computed tomographic data as well as experience with the treatment of 30 patients with fracture-dislocation of the tarsometatarsal (Lisfranc) joint, a pathophysiological model is described in which the shape of the foot and ligamentous configuration in combination with applied forces are of pivotal importance. CT imaging helps to elucidate the extent of the lesions, easily overlooked in straight radiographs. In the transverse plane we discern three grades of dislocation. Grade 1, virtually no displacement; grade 2, dislocation of half of the shaft; grade 3, total displacement. Treatment is generally dictated by the severity of the lesion and ranges from plaster application to open reduction and internal fixation. Quality of reduction is easily visualized with CT imaging.

Adult↗
PubMed1991

[Surgical treatment of toxic megacolon].

From 1978 to 1989, 11 patients suffering from toxic megacolon were treated. In eight patients it was based on ulcerative colitis, while Crohns' disease, infectious colitis and pseudomembranous colitis were seen once each. Patients were initially treated with intravenous fluids and corticosteroids. They were closely followed both clinically and radiologically. The plain abdominal X-ray was of great help. Conservative regimen was successful in 3 patients, the remaining had to be operated on in due course. Three patients proved to have a perforation of the bowel at the time of operation. The initial operations performed were one proctocolectomy, four times a subtotal colectomy, twice a partial colectomy and in one instance a diverting colostomy. Two patients had to undergo an additional colon resection. Postoperative complications consisted mainly of intra-abdominal abscesses. Two of the operated patients died. Follow-up is between 2 and 9 years. None of the patients had a recurrence of the toxic megacolon. Four patients had a recurrence of their underlying disease, which however could be resolved in most cases by medical means. In one patient total colectomy is being considered.

Adolescent↗
PubMed1991

Angiosarcoma of the irradiated breast: a new problem after breast conserving therapy?

Post-irradiation angiosarcoma of the breast is an uncommon neoplasm. The first patient with this disease after breast conserving therapy was reported in 1987 and only a few more patients can be traced in the literature since that time. Two more cases are presented in this paper: both women in the seventh decade of life. The tumour became apparent five and seven years after the primary treatment of breast cancer. The possible influence of irradiation and lymphoedema in inducing this malignancy is discussed.

Aged↗
PubMed1990

[The pneumoportogram, a rare finding in septicemia due to an intra-abdominal abscess].

A man aged 73 is described with radiologically revealed air in the portal vein, a peumoportogram, on the basis of intra-abdominal sepsis. Characteristic of this finding are the air shadows extending far into the periphery of the liver in contrast to an air cholangiogram. It is an ominous sign, mostly secondary to severe intra-abdominal pathology such as ischaemic bowel necrosis, peritonitis or abscesses. Treatment should be aimed at these causes. Prognosis depends on the underlying pathology.

Abscess↗
PubMed1990

Cecal carcinoma: a different colon malignancy?

Cecal carcinoma has been associated with a poorer prognosis than other colon carcinomas because of the presumed longstanding obscure symptoms. In a combined study of three Dutch hospitals, a total of 166 patients with cecal carcinoma were evaluated after right hemicolectomy. Special emphasis was placed on clinical symptoms related to advanced tumor growth, e.g., pain, anemia, and palpable mass. These factors and clinicopathological staging were evaluated with aid of the Cox regression model. Ninety percent of the resected specimens contained a Dukes' B or C carcinoma. Only 5% were found to have widespread metastatic disease. Overall 5 year survival rate was found to be 0.57. No statistically significant relation to pain or palpable mass was found. Anemia, however, was related to a better survival, especially in patients with a Dukes' B carcinoma. Clinicopathological staging according to Dukes' is closely related to survival. It is concluded that carcinoma of the cecum behaves similarly to other colon malignancies.

Adenocarcinoma↗
PubMed1990

Bilateral primary breast carcinoma in a man.

The case history is presented of a 56-year-old man, who had a second primary carcinoma in the contralateral breast after 13 years. Both times, he underwent a modified radical mastectomy. The axillary lymph nodes were free from tumour. The incidence in men is about 1 per cent being bilateral in 14 out of 1,000 of these cases. The therapy for men is the same as for women. Because of the smaller breast volume, tumours in men are earlier discovered and show infiltration. If metastases cannot be detected, the first choice of treatment is surgical. Radiotherapy is indicated in case surgical intervention has not been radical.

Breast Neoplasms↗
PubMed1990

Traumatic posterior luxation of the hip.

The long-term outcome of treatment of posterior hip dislocations was studied in 60 patients. Thirty-two patients had concomitant fractures of the acetabular rim and seven had also femoral head fractures. Treatment consisted of immediate reduction, followed by gentle traction during one week and progressive weight-bearing over six weeks. Thirteen patients needed internal fixation of the acetabular fracture. Fourty-six patients could be followed for a median of 6.5 years. Fifteen patients, all with associated fractures, had late complications: peri-articular ossifications (5), avascular necrosis of the femoral head (1), mild osteo-arthrosis (5) and pain of unknown origin (4). No complications were noted in patients with simple posterior dislocation of the hip. Simple traumatic posterior hip dislocation has an excellent prognosis. Poor results only occur in case of associated fractures.

Accidents, Traffic↗
PubMed1989

Some factors influencing the outcome of stoma surgery.

In a retrospective study, the procedure and follow-up of 266 patients with 345 stomas on the small and large bowel were reviewed to reveal possible etiologic factors for stomal complications. The overall complication rate for creating a stoma was 36 percent. No differences in overall complication rate were encountered when comparing acute and elective management; however, high output stomas and necrosis were encountered more often in the acutely managed group. Preoperative contamination was followed more often by stomal retraction. Septic events, however, occurred less frequently than in the noncontaminated procedures. Adequate supply with antibiotics might account for the lack of difference in these complications between the two groups. Antibiotics might not have prevented low-grade infections giving rise to retractive reaction. The influence of body weight was evaluated by the Quetelait index. It was demonstrated that moderate obesity had no significant influence on the outcome of the procedure. Adipose patients had a statistically significant larger number of necroses. This may be due to the relatively short and fatty mesenterium causing a compromised circulation. The outcome of stoma surgery was greatly influenced by bowel quality. Crohn's disease and bowel ischemia were encountered in 50 percent of stoma complications. In ischemic disease, significantly more necrosis was found. Retraction of the stoma occurred more often in Crohn's disease. Chronic ulcerative colitis did not have a higher complication rate.

Adolescent↗
PubMed1989

Differences in the fiber composition of the pyramidal tract in two- and 14-month-old rats.

The present study is aimed at an electron-microscopic morphometrical analysis of the pyramidal tract of 14-month-old rats at the level of the pyramis medullae and the second cervical segment, and a comparison with data obtained for rats of two months of age. Between 2 and 14 months of age there is, at the level of the pyramis medullae of the left pyramidal tract, a statistically significant increase of the number of myelinated fibers, from 91,000 to 118,000, whereas the total number of unmyelinated fibers decreases from 133,000 to 101,000. On the right side at the same level there is no statistically significant change in the number of myelinated fibers, whereas there is a significant decrease of unmyelinated fibers at this side, from 148,000 to 89,000. At the second cervical level, a statistically significant increase in the number of myelinated fibers has been noted at both sides (from 43,000 to 60,000) between 2 and 14 months, whereas the mean total number of unmyelinated fibers at this level decreases somewhat (from 35,000 to 28,000), but is not statistically significant. Several processes which might be involved in the age-related changes observed are discussed, including the possibility of a shift from unmyelinated fibers to myelinated ones, withdrawal of corticobulbar fibers and ongoing outgrowth of myelinated corticofugal fibers after two months of age, and a summarizing scheme is presented. We conclude that the pyramidal tract of the rat changes in composition after the age of two months and that continuing outgrowth of myelinated corticospinal fibers is an important aspect of this continuing development.

Aging↗
PubMed1989

Treatment of complete rectal prolapse with foreign material.

The results of treatment of complete rectal prolapse with Teflon mesh repair are described in 64 patients. Adequate fixation by posterior rectopexy was reached in all patients. In 23 per cent of the patients postoperative constipation was noticed that could adequately be managed with laxatives in most instances. After a mean follow-up of 30 months, none of the patients had complete recurrences. Four patients had new complaints of prolapse. These complaints were two times based on haemorrhoids, two other patients had a small mucosal prolapse. Modified Teflon mesh repair is recommended as a safe method to manage rectal prolapse with a high rate of success.

Adolescent↗
PubMed1985

A detailed morphometrical analysis of the pyramidal tract of the rat.

The present study is aimed at a quantitative analysis and comparison of the fibers of the pyramidal tract of the rat at two levels: the pyramis medullae and the second cervical segment. For this purpose both levels of the pyramidal tracts of 5 rats have been studied morphometrically at the ultrastructural level. Fiber numbers as well as fiber diameter distributions are presented for both myelinated and unmyelinated axons. At the level of the pyramis medullae the number of unmyelinated fibers (140,000 +/- 7000) exceeds the number of myelinated axons (103,000 +/- 6000). In contrast at the level of the second cervical segment the numbers of fibers of the axon populations studied are not significantly different, viz. 43,000 +/- 2000 myelinated and 35,000 +/- 8000 unmyelinated fibers. However, these numbers mean a significant decrease of myelinated axons (48%) compared with the pyramis medullae level and an even much larger decrease (75%) in the numbers of unmyelinated fibers. Diameter distributions, obtained from the minimal fiber diameter, show a similar, monomodal shape for all axon and myelin profiles. For unmyelinated axons the minimal diameter ranges from 0.05 to 1.21 micron with a mean of 0.18 +/- 0.03 micron. For myelinated axons a mean minimal diameter of 0.72 +/- 0.12 micron has been found (range 0.13-4.92 micron), whereas their diameter measured with myelin sheath measure 1.08 +/- 0.13 micron (range 0.25-6.03 micron). The average thickness of the myelin sheath is 0.2 micron and is strongly correlated to axon diameter. Furthermore, g-ratio has been computed at a mean of 0.65 and is fairly constant throughout the diameter spectrum. Several possibilities concerning the functional and anatomical qualities of the numerically important unmyelinated axon population in the pyramidal tract of the rat are discussed.

Animals↗
PubMedDate not supplied

[Fournier's gangrene].

Two patients with a necrotizing soft tissue infection of the scrotum and perineum are described. The etiology was found to be a gram negative synergistic gangrene. Patients were managed with extensive necrotectomy with a planned second look operation and supportive antibiotics (aminoglycosides, amoxicillin, metronidazole). Despite this aggressive approach one of the patients died of ongoing necrosis. The therapeutic management for necrotizing soft tissue infection comprises early surgical intervention with supportive antibiotic treatment. Nevertheless the disease is associated with a high mortality rate.

Adult↗