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M N van der Heyde

Publications and source records attributed to M N van der Heyde.

At least 19 recordsLinked to original sources
PubMed1994

Prognostic significance of tumor DNA content in carcinoma of the hepatic duct confluence.

BACKGROUND: In an attempt to identify prognostic factors in carcinoma of the hepatic duct confluence, the value of tumor DNA content was studied in 58 patients with this type of malignancy. METHODS: Of 58 patients (ages 26 to 74 years) surgically treated for carcinoma of the hepatic duct confluence, tumor DNA content was assessed in relationship to clinical-pathologic characteristics and patient survival. Thirty-three patients underwent additive radiotherapy. Nuclear DNA content was analyzed by flow cytometry. RESULTS: Resection was radical in only three patients with negative surgical resection margins and dissection (cleavage) margins. Twenty-eight patients (48%) had diploid tumors, and 30 patients (52%) had aneuploid tumors. No significant correlation was found between tumor DNA ploidy, degree of tumor differentiation, lymph node status, and hepatic infiltration. Aneuploid tumors were significantly associated with neural invasion. The median overall survival was 18 months. The survival period of patients with diploid tumors was significantly (p < 0.0003) longer than the survival period of those with aneuploid tumors (median survival, 26 months and 11 months, respectively). Additive radiotherapy improved survival significantly only in patients with aneuploid tumors. When tested by univariate survival analysis, DNA ploidy, additive radiotherapy, and the state of the surgical resection margins were significant prognostic factors. With multivariate survival analysis, only DNA ploidy, age, hepatic infiltration, and lymph node status were significantly related to prognosis. CONCLUSIONS: This survival analysis shows that DNA ploidy is a powerful prognostic determinant of carcinoma of the hepatic duct confluence.

Adult↗
PubMed1993

Prospective randomized comparison of teres cardiopexy and Nissen fundoplication in the surgical therapy of gastro-oesophageal reflux disease.

Teres cardiopexy was compared with Nissen fundoplication in a prospective randomized study of surgery for gastro-oesophageal reflux disease refractory to medical treatment. Follow-up at 3 months of ten patients undergoing each procedure showed good clinical results and improvement of the mean symptom score in both groups, for cardiopexy from 7.8 to 1.1 (P < 0.01) and for fundoplication from 5.7 to 0.2 (P < 0.01). After 1 year, six of the ten patients undergoing cardiopexy required a second antireflux procedure because of recurrent disease, whereas one reoperation was performed after fundoplication. The mean symptom score after 1 year was higher in patients submitted to cardiopexy than in those receiving fundoplication (3.9 versus 0.3, P < 0.01). The mean endoscopic oesophagitis score after 1 year was no different from preoperative values after cardiopexy (1.9 versus 1.9) but was significantly lower after fundoplication (1.5 versus 0.3, P = 0.01). Ambulatory 24-h pH monitoring showed a significantly higher proportion of total time at pH < 4 after cardiopexy than fundoplication (24.0 versus 3.8 per cent, P < 0.05). Cardiopexy is significantly less effective than fundoplication for the treatment of gastro-oesophageal reflux disease assessed at 1-year follow-up. This study does not support the use of cardiopexy either in conventional or laparoscopic antireflux surgery.

Adult↗
PubMed1993

An in vitro method for comparing the efficacy of two preservation solutions in one canine liver using the 5'-nucleotidase assay.

The activity and localization of the plasma membrane-bound enzyme 5'-nucleotidase (5'-NT) in liver tissue are sensitive parameters of ischemic damage. The value of 5'-NT as a marker of liver graft viability was studied in relation to liver preservation. In six mongrel dogs, the main right and left branches of the portal vein were cannulated and flushed separately in situ with cold University of Wisconsin (UW) solution and Euro-Collins (EC) solution, respectively. After hepatectomy, the right and left liver lobes were split and stored at 5 degrees C in either of the two solutions. 5'-NT activity was demonstrated in cryostat sections of liver tissue using the lead salt method. After 48 h of storage in EC solution, the 5'-NT score had decreased to 31% +/- 16% (n = 6), whereas in UW solution the 5'-NT score was 76% +/- 10% (n = 6). Significantly (P < 0.05) higher 5'-NT scores were also found after 24-h and 72-h preservation times in UW versus EC solutions. This result is in keeping with the higher preservation tolerance of liver grafts preserved in UW solution. The 5'-NT assay was studied in relation to graft function in orthotopic liver transplantation experiments in dogs. All dogs with liver grafts preserved in UW solution for 24 h (n = 4) and 48 h (n = 3) survived (> 5 days). Pretransplant 5'-NT scores ranged from 61% to 100%. The 72-h-preserved livers (n = 5) did not show life-supporting function.(ABSTRACT TRUNCATED AT 250 WORDS)

5'-Nucleotidase↗
PubMed1993

Benign biliary strictures. Surgery or endoscopy?

OBJECTIVE: This study compared the results of surgery and endoscopy for benign biliary strictures in one institution, over the same period of time and with the same outcome definitions. SUMMARY BACKGROUND DATA: Surgery is considered the treatment of choice, offering more than 80% long-term success. Endoscopic stenting has been reported to yield similar results and might be a useful alternative. METHODS: In this nonrandomized retrospective study, 101 patients with benign biliary strictures were included. Thirty-five patients were treated surgically and 66 by endoscopic stenting. Patient characteristics, initial trauma, previous repairs, and level of obstruction were comparable in both groups. Surgical therapy consisted of constructing a biliary-digestive anastomosis in normal ductal tissue. Endoscopic therapy consisted of placement of endoprostheses, with trimonthly elective exchange for a 1-year period. RESULTS: Mean length of follow-up was 50 +/- 3.8 and 42 +/- 4.2 months for surgery and endoscopy, respectively. Early complications occurred more frequently in the surgically treated group (p < 0.03). Late complications during therapy, occurred only in the endoscopically treated group. In 46 patients, the endoprostheses were eventually removed. Recurrent stricturing occurred in 17% in both surgical and endoscopic patients. CONCLUSIONS: Surgery and endoscopy for benign biliary strictures have similar long-term success rates. Indications for surgery are complete transections, failed previous repairs, and failures of endoscopic therapy. All other patients are candidates for endoscopic stenting as the initial treatment.

Adult↗
PubMed1993

Bile duct injury after laparoscopic cholecystectomy: the value of endoscopic retrograde cholangiopancreatography.

This study describes the value of endoscopic retrograde cholangiopancreatography (ERCP) in patients with bile duct injury after laparoscopic cholecystectomy. Twelve consecutive patients were studied over a one year period. In all patients the biliary tree was visualised during ERCP. Four patients had complete bile duct obstruction, seven patients had a stricture (two with concomitant leakage), and one patient had leakage from a hepatic branch. Three patients with complete obstruction, presented with a relatively prolonged symptom free, 'silent' period before diagnosis. In all four patients with complete transection, a proximal hepaticojejunostomy was performed. In one patient with a tough fibrous stricture, secondary to incorrect clip placement, passage of the guidewire was impossible, leaving surgical reconstruction as the only therapeutic option. All remaining seven patients with leakage or strictures, or both were successfully treated by endoscopic sphincterotomy only (n = 1) or sphincterotomy and subsequent stent placement (n = 6). When patients do not recover uneventfully after laparoscopic cholecystectomy even without cholestasis or jaundice, early ERCP is recommended as a safe and valuable method to detect bile duct injury and to suggest treatment. Subsequently, more than half of such patients can be treated endoscopically. Extended follow up is needed to evaluate the longterm results.

Adult↗
PubMed1993

Visualization of the uptake and processing of oxidized low-density lipoproteins in human and rat liver.

The interaction of oxidized human low-density lipoproteins with human and rat liver was analyzed by light and electron microscopy. At the light microscopic level oxidized low-density lipoprotein was visualized by the fluorescent dye 1,1' dioctadecyl 3,3,3',3' tetramethyl indocarbocyanine perchlorate, whereas at the electron microscopic level, an indirect immunolabeling procedure was used that detected the apoprotein B of the oxidized low-density lipoprotein. In rats, oxidized low-density lipoprotein was administered intravenously, and uptake by human liver was studied by perfusion of tissue blocks. Both in human and in rat liver, fluorescently labeled oxidized low-density lipoprotein was mainly found to become concentrated in Kupffer cells and, to a lesser extent, in endothelial cells. In both species the cell association of fluorescently labeled oxidized low-density lipoprotein could be inhibited by preadministration of polyinosinic acid, indicating a scavenger receptor-mediated process. At the electron microscopic level, oxidized low-density lipoprotein was found to bind mainly to areas of the plasma membrane of the Kupffer cells without clathrin coating, although binding to coated regions was also noticed. Internalization of the ligand occurred through coated vesicle formation and through membrane folding of interacting lamellipodia and wormlike structures. No indication for phagocytosis of aggregated oxidized low-density lipoprotein particles was noticed. After internalization, the immunoreactive oxidized low-density lipoprotein was detected in relatively electron-lucent endosomes and, subsequently, in lysosomes. Endothelial cells internalized oxidized low-density lipoprotein solely through coated pits, after which the particles were transferred through endosomes into lysosomes.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Tumor DNA content in gallbladder carcinoma.

An abnormal DNA content has been associated with an unfavorable prognosis in a variety of cancers. In this study, tumor DNA content was measured in patients with gallbladder carcinoma in order to determine whether DNA ploidy pattern was a prognostic indicator. Thirty-six patients who had had a gallbladder carcinoma resected with curative intent were analyzed. Aneuploid tumor (20 cases, 56 per cent) was significantly associated with poorly differentiated adenocarcinoma (p < 0.05), invasion beyond the muscularis propria (p < 0.01), and a high mitotic index (p < 0.0001). A significant advantage in terms of five-year survival was demonstrated in patients with diploid tumors as compared with those with aneuploid tumors (80 per cent versus 24 per cent, respectively, p < 0.005). Aneuploid tumors invading the subserosal layer had a significantly poorer prognosis than diploid tumors with similar depth of invasion (p < 0.05). However, when tumor invasion had extended beyond the serosa, no significant advantage in survival was found between patients with aneuploid and those with diploid tumors. It is concluded that DNA ploidy pattern is a valuable addition to a staging protocol for gallbladder carcinoma.

Adenocarcinoma↗
PubMed1992

Benign fibrosing disease at the hepatic confluence mimicking Klatskin tumors.

BACKGROUND: Hilar obstructions remain a challenge with regard to diagnosis and treatment. METHODS: In the period from 1984 to 1990, 82 patients underwent resective surgery under the presumptive diagnosis of hilar cholangiocarcinoma (Klatskin tumor). The diagnosis was based on the combined appearances on direct cholangiography and ultrasonography in all cases, with the use of various other imaging modalities in some cases. RESULTS: The perioperative findings from an experienced surgical team were usually thought to be compatible with bile duct carcinoma. However, histologic examination of the resected specimens revealed benign fibrosing or localized sclerosing lesions in 11 patients (13.4%). CONCLUSIONS: The current state of diagnostic imaging fails as yet to discriminate reliably between benign and malignant hilar lesions. Whereas the immediate therapeutic consequences may be equal (resection followed by hepaticojejunostomy), the late consequences differ in a major way because benign disease has a much better prognosis. In the presence of suspicious hilar obstruction, operable lesions should not be treated by "palliative" intubational techniques and radiation therapy without a firm diagnosis of malignancy. However, overtreatment (extended liver resection, vascular reconstruction, and liver transplantation) should be avoided as well when a benign lesion has not been ruled out.

Adenoma, Bile Duct↗
PubMed1992

Morphologic changes of extrahepatic bile ducts during obstruction and subsequent decompression by endoprosthesis.

The morphologic changes of the extrahepatic biliary tract during obstruction and the effects of biliary decompression by means of an endoprosthesis on the bile duct wall were studied by light microscopy and scanning electron microscopy. Common hepatic duct biopsy specimens and bile cultures were obtained during surgery from 30 patients with a distal common bile duct obstruction caused by a tumor. Thirteen patients had obstructed bile ducts of 3 weeks' duration (group A). Seventeen patients had had jaundice for a period of 4 weeks and had subsequently undergone preoperative endoscopic biliary stenting for a period of 4 weeks (group B). Three autopsy specimens from patients without hepatobiliary disease served as controls. The results showed that the initial dilatation and thickening of the obstructed ducts in group A were associated with a mild inflammation, a moderate degree of fibrosis, and local epithelial disintegration. The presence of an endoprosthesis, however (group B), induced severe inflammatory changes with considerable fibrosis and ulcerative lesions, resulting in markedly thickened ducts with lumina approximating the diameter of the stent. Three of 13 (24%) bile cultures in group A were positive and 14 of 17 (82%) in group B were positive.

Bile Duct Neoplasms↗
PubMed1990

Liver regeneration and restoration of liver function after partial hepatectomy in patients with liver tumors.

Liver regeneration and restoration of liver function were studied in six patients who underwent partial hepatectomy with removal of 30-70% of the liver. Liver volume and liver regeneration were studied by single-photon computed tomography (SPECT), using 99mTc-colloid as tracer. The method was assessed in 11 patients by comparing the pre- and post-operative volume measurements with the volume of the resected liver mass. The correlation coefficient between these methods was 0.899 (P less than 0.01). Liver function was determined by measuring the galactose elimination capacity and the caffeine clearance. After a postoperative follow-up period of 50 days the liver had regenerated maximally to a volume of 75 +/- 2% of the preoperative liver mass. Maximal restoration of liver function was achieved 120 days after operation and amounted to 75 +/- 10% for the caffeine clearance and to 100 +/- 25% for the galactose elimination capacity. This study shows that SPECT is a useful method for assessing liver regeneration in patients after partial hepatectomy. Our study furthermore shows that caffeine clearance correlates well with total liver volume, whereas the galactose elimination capacity overestimates total liver volume after partial hepatectomy.

Adult↗
PubMed1989

[Periampullary carcinoma as a second primary tumor following a previously treated adenocarcinoma of the colon].

Three patients are presented who developed periampullary carcinoma after colectomy for adenocarcinoma. The combination of colonic carcinoma and periampullary carcinoma is rare, although wellknown in patients with colonic polyposis or Gardner's syndrome. Perhaps genetic research might help select patients with a high risk of developing multiple carcinomas in the gastrointestinal tract. The five-year survival rate for periampullary carcinoma after subtotal colectomy is higher than for pancreatic carcinoma.

Adenocarcinoma↗
PubMed1989

Reconstruction after subtotal duodenopancreatectomy in patients with pancreatic duct, distal bile duct and ampullary carcinoma: further experience with a personal technique.

A total of 142 patients underwent pancreatic resection for malignant (128 patients) or benign (14 patients) pancreatic disease. Of these patients, 111 had subtotal duodenopancreatectomy and are discussed in this paper. Reconstruction in these patients was carried out with a special technique. In this technique, two jejunal loops are used. One for fashioning the gastric anastomosis, the other for fashioning the pancreatic and biliary anastomosis. Two patients died in the first 30 postoperative days. Twenty patients had severe complications necessitating early reoperation. The surviving patients had a good quality of postoperative life. Postoperative sequelae like diabetes, steatorrhea and motility disturbances were easily controllable. On the basis of the results obtained, the reported surgical technique of reconstruction of alimentary continuity after subtotal duodenopancreatectomy can be considered an alternative for the surgical management of some of the patients with malignant or benign pancreatic disease considered eligible for subtotal duodenopancreatectomy.

Ampulla of Vater↗
PubMed1989

Subtotal duodenopancreatectomy for pancreatic duct, distal bile duct and periampullary carcinoma: short- and long-term results.

Ninety patients with pancreatic duct, distal bile duct, and ampullary carcinoma underwent pancreatic resection. Following a standard policy of resection based on surgical findings, all the patients who had resection first underwent subtotal extended pancreatectomy (n = 68) and if they were considered not to fulfill the criteria for this operation, total pancreatectomy (n = 22). Thus, 68 of the 90 patients (72%) were managed with subtotal pancreatic resection irrespective whether they had ampullary, pancreatic duct, or distal common bile duct carcinoma. On the basis of our results, subtotal duodenopancreatectomy is regarded as the method of choice for many patients with pancreatic duct, distal bile duct, or ampullary carcinoma.

Adult↗
PubMed1988

Surgical approaches for unresectable primary carcinoma of the hepatic hilus.

Thirteen patients with proximal malignant obstruction of the biliary tract secondary to primary cholangiocarcinoma are presented. Seven of these patients had bilateral involvement of the major vessels of the porta hepatis, and 12 had bilateral involvement of the main hepatic ducts up to the level of segmental bifurcation. Resection of the tumor was carried out in all of the patients. Extensive resection of the liver with resection of the regional vascular structures was done in six. Another six underwent resection of the liver without resection of the regional vascular structures. The remaining patient underwent resection of the tumor and of the regional revascular structures alone. Vascular resection included resection and reconstruction of both the portal vein and hepatic artery in four patients or only of the portal vein in three. Biliary drainage was carried out by intrahepatic cholangiojejunostomies between segmental hepatic ducts and a Roux-en-Y loop. Two patients died and ten are alive. The quality of postoperative life is satisfactory and the patients are free of sequelae and symptoms secondary to operation or disease. This approach is recommended for the management of a number of patients with bilateral vascular or biliary involvement secondary to primary cholangiocarcinoma of the porta hepatis. For those patients, this approach offers a promising alternative.

Adenoma, Bile Duct↗