Peritonitis following endoscopic polypectomy in a peritoneal dialysis patient: the need for antibiotic prophylaxis.
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Anti-Bacterial Agents↗
Biomedical subjects
M van Blankenstein
Publications and source records attributed to M van Blankenstein.
Percutaneous metallic self-expandable endoprostheses in malignant hilar biliary obstruction.
Forty-five patients with malignant hilar obstruction were treated with a total of 68 percutaneously inserted metallic self-expandable endoprostheses (Wallstents) for palliative biliary drainage. The stent diameter was 1 cm; the length was 3.5 to 10.5 cm. Early complications occurred in seven patients (16%), including cholangitis in four patients (9%). The 30-day mortality rate was 9%, with two procedure-related deaths (4%). Of the 45 patients, 29 died between 10 and 550 days (median, 126 days) after stent insertion. Reobstruction occurred in 13 of these patients after 26 to 184 days (median, 105 days). Sixteen patients were alive 44 to 737 days (median, 305 days) after stent insertion. Reobstruction occurred in four patients after 142 to 279 days (median, 246 days). The cause of reobstruction was proximal overgrowth in seven patients; distal overgrowth in four patients; and tumor ingrowth and proximal overgrowth, tumor ingrowth, hemobilia, and angling of the stent in one patient each. The cause of reobstruction was not established in two patients. Reintervention was performed in 14 patients (31%). Because reobstruction of Wallstent endoprostheses is primarily not stent-related but rather is caused by tumor progression, and because insertion and reintervention is easier, we consider the use of the Wallstent in malignant hilar biliary obstruction advantageous in comparison with plastic stents.
Adenoma, Bile Duct↗
Therapy of esophageal carcinoma. Results from the Joint Group on Esophageal Carcinoma in Rotterdam.
During the period 1978-1981 172 patients were referred to the Rotterdam Joint Group on Esophageal Carcinoma. Ninety-one patients were considered for combined therapy, comprising radiation therapy and surgery, and 10 patients refused surgery. The figures given in this material are actuarial survival values corrected for intercurrent death (the actuarial overall survival in parentheses). The 4-year survival in 69 patients who completed this treatment was 39 per cent (26%) (significantly better for women compared with men; significantly better for tumors less than 2 vertebrae compared with tumors greater than or equal to 2 vertebrae). The resectability rate was 85 per cent and the operation mortality rate 20 per cent. Thirty-eight patients had curative radiation therapy with a 4-year corrected survival of 5 per cent (3%). For palliative treatment, radiation therapy and endoscopic introduction of a Celestin tube were mostly used. The results of curative as well as of palliative treatment of esophageal carcinoma have shown improvement during the past decade compared with an earlier period.
Actuarial Analysis↗
Comparison of endoscopic retrograde pancreatography with functional and histologic changes in chronic pancreatitis.
The findings from endoscopic retrograde pancreatography (ERP) and secretin-CCK test data were compared in 69 patients: 36 with chronic pancreatitis, 9 with possible chronic pancreatitis, and 24 without chronic pancreatic disease. The ERP findings were also compared with the histologic changes in pancreatic tissue in 18 patients who underwent pancreatic surgery for chronic pancreatitis. ERP films were reviewed according to the criteria proposed by Kasugai et coll. with special attention paid to the side branches. Secretin-CCK test data were interpreted using the discriminant analysis. A good correlation between bicarbonate and chymotrypsin output and ductular changes at ERP was found. The results of ERP and the secretin-CCK test were compatible in 86 per cent of the patients. The relationship between ERP findings and histologic changes was not straightforward. It was concluded that ERP and the secretin-CCK test are complementary in the diagnosis of chronic pancreatitis. ERP does not necessarily represent the histology in chronic pancreatitis.
Atrophy↗