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Biomedical subjects

P P Coene

Publications and source records attributed to P P Coene.

17 recordsLinked to original sources
PubMed1999

The efficacy of serial physical examination in penetrating abdominal trauma.

Over a 10-year period we reviewed the records of 370 consecutive patients with potentially penetrating abdominal wounds (48 gunshot and 322 stab wounds). Selective non-operative management for abdominal stab wounds was introduced, guided by serial physical examination. In our study the terms therapeutic and non-therapeutic laparotomies were used, the latter comprising negative as well as insignificant findings. Initially diagnostic peritoneal lavage and local wound exploration were used, but these methods were later abandoned. Mortality was 10.2% and morbidity 25% in the group of gunshot wounds and 1.2% and 8.6% in the group of stab wounds. During this period the rate of laparotomies for stab wounds decreased from 55% to 30%, while the rate of non-therapeutic laparotomies decreased from 24% to 0% in the last year. Delayed laparotomy did not cause death or increase morbidity. Our results support the concept of selective non-operative management of abdominal stab wounds using repeated physical examination. Peritoneal perforation and haemoperitoneum should not be an indication for routine laparotomy.

Abdominal Injuries↗
PubMed1997

Outcome of palliative biliary and gastric bypass surgery for pancreatic head carcinoma in 126 patients.

BACKGROUND: Recent reports of decreased morbidity and mortality following palliative surgery for patients with irresectable pancreatic head carcinoma prompted a review of the results in 126 patients (median age 64 (range 39-90) years) who had undergone palliative biliary and gastric bypass surgery. METHODS: The indication for surgical palliation was the finding of an irresectable tumour at laparotomy (n = 44), failure of endoscopic treatment (n = 43), clinical symptoms of gastric outlet obstruction (n = 28) and miscellaneous (n = 11). Biliary and gastric bypass was performed in 118 patients, biliary bypass alone in six and gastrojejunostomy alone in two. The indication for gastrojejunostomy was symptoms in 28 patients (23 per cent) and prophylaxis in 92 patients (77 per cent). RESULTS: Postoperative local complications occurred in 17 per cent of patients, general complications in 10 per cent and delayed gastric emptying in 14 per cent of patients. The 30-day mortality rate was 1 per cent and overall hospital mortality rate 2 per cent. Median hospital stay was 17 (range 5-80) days. Median overall postoperative survival was 190 (range 14-830) days. Late obstructive gastrointestinal symptoms occurred in 14 patients (11 per cent) after a median of 141 (range 21-356) days. CONCLUSION: Roux-en-Y hepaticojejunostomy combined with gastrojejunostomy offers effective palliation for irresectable pancreatic head cancer and can be performed with low mortality and acceptable morbidity rates.

Adult↗
PubMed1994

Bile viscosity in patients with biliary drainage. Effect of co-trimoxazole and N-acetylcysteine and role in stent clogging.

BACKGROUND: The main disadvantage of endoscopic insertion of an endoprosthesis is the tendency of the stent to clog after a few months. In this study we determined the role of bile viscosity in stent clogging. METHODS: Sixty patients were stented with 10 Fr 11-cm stents. The stents were electively removed after 2 months, and a bile sample was obtained simultaneously. Bile viscosity was measured with a coaxial rotation viscometer. The influence of treatment with antibiotics and a mucolytic agent on viscosity was assessed in a randomized trial. RESULTS: Bile viscosity correlated significantly with DNA and total protein concentration. After treatment with either N-acetylcysteine or co-trimoxazole a lower mean value of the viscosity was observed, but this was not statistically significant. There was no correlation between bile viscosity and the amount of sludge adhering to the stents. CONCLUSIONS: In most patients bile viscosity plays a limited role in stent clogging. Only in patients with excessively high viscosity do mucolytic agents or treatment with antibiotics seem to have a role.

Acetylcysteine↗
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↗
PubMed1991

Colorectal carcinoma: preoperative TNM classification with endosonography.

Transcolorectal endosonography (TES) with use of both a nonoptic instrument and an echocolonoscope was performed in 91 patients with colorectal carcinomas (61 rectal and 30 colonic). Correlation of results at TES with results of histologic analysis of resected specimens according to the 1987 TNM classification demonstrated that TES allowed accurate staging of all tumors except T2 carcinomas, which were often accompanied by peritumoral inflammation or abscesses. Overall, the accuracy of staging rectal and colonic carcinomas with TES was 81% and 93%, respectively; overstaging occurred in 13% and understaging in 2%. For regional lymph nodes, the accuracy of staging with TES was 70%, the sensitivity was 94%, and the specificity was 55%. Correlations between findings at TES and the Dukes classification were as follows: for rectal carcinoma, 48% for class A, 50% for class B, and 96% for class C; for colonic carcinoma, 67% for class A, 46% for class B, and 91% for class C. Overall accuracy was 67%. With the addition of abdominal computed tomographic or ultrasonographic examinations to evaluate distant metastases, TES should become an important imaging technique for clinical TNM staging of colorectal carcinomas.

Adult↗
PubMed1990

Clogging of biliary endoprostheses: a new perspective.

Endoscopic palliation with biliary endoprostheses is now an established treatment for benign and malignant strictures of the biliary tree. These endoprostheses, however, tend to clog with time. We investigated this problem by undertaking in vitro studies on stents of different designs made of different polymer materials. The stent that performed best was then tested in an in vivo trial. There was a direct relation in vitro between the frictional coefficient of a polymer and the amount of encrusted material. Catheters perfused in bacterially contaminated bile, irrespective of material and design, accrued significantly more sludge than catheters perfused with sterilised bile. The presence of side holes significantly increased the amount of sludge in the stents, but eliminated any differences between the various materials. We therefore investigated the effect of omitting side holes in a clinical trial which consisted of two groups of 20 patients each. The group treated with conventional stents accrued significantly more sludge in the stents than the group treated with experimental stents without side holes (p less than 0.05). The absence of side holes did not cause incomplete drainage or increase morbidity. Side holes are detrimental to stent patency, which is adversely affected by other factors including bacteria and proteins.

Aged↗
PubMed1990

Preoperative TNM classification of esophageal carcinoma by endosonography.

Endosonography was performed preoperatively in 111 patients with an esophageal carcinoma. The results were correlated with the histology of resected specimens employing the new (1987) TNM classification. Endosonography was accurate in assessing the depth of tumor infiltration (overall accuracy: 89%). Early carcinomas could be distinguished from advanced cancer. Extensive stenosis preventing the passage of the instrument was a limiting factor prior to the availability of a small-caliber catheter echoprobe (25% of cases). Endosonography was helpful for diagnosing lymph node metastasis, but was less accurate in defining non-metastatic enlarged lymph nodes (accuracy: 81%, sensitivity 95% and specificity 50%). The incidence of lymph node metastasis increased with the progression of tumor infiltration. Endosonography was also less accurate for diagnosing liver metastases and peritoneal dissemination because of the low depth of penetration of ultrasound. Technical improvements such as a reduction in the diameter of the instrument will further enhance the accuracy of endosonography. Moreover, ES-guided cytology may become helpful for confirming the ES diagnosis of lymph node metastasis.

Adult↗
PubMed1989

Endosonography and computed tomography of esophageal carcinoma. Preoperative classification compared to the new (1987) TNM system.

Transesophageal endosonography and computed tomography were performed preoperatively in 74 patients with an esophageal carcinoma. The results were correlated with the histology of resected specimens according to the new (1987) TNM classification. Endosonography was superior to computed tomography in the evaluation of the depth of tumor infiltration, especially in the early stages and in nonresectable carcinoma (overall accuracy: endosonography 89%, computed tomography 59%). Endosonography was also more accurate than computed tomography in the assessment of regional lymph node metastases (overall accuracy: endosonography 80%, computed tomography 51%). The incidence of lymph node metastasis increased with the progression of the depth of tumor infiltration. The definitive exclusion factor for endosonography is severe stenosis, which cannot be passed with the instrument (26% of the cases). In these cases computed tomography was superior to endosonography in diagnosing celiac lymph node metastasis (overall accuracy: computed tomography 82%, endosonography 68%).

Adult↗
PubMed1989

Endoscopic placement of expandable metal stents for biliary strictures--a preliminary report on experience with 33 patients.

The main problem with palliative treatment of extrahepatic cholestasis with an endoscopic biliary endoprosthesis is clogging. One of the factors thought to be of importance is the diameter of the stent. In order to avoid being limited by the size of the instrumentation channel of the endoscope, expandable stents have been developed. In this article we report on our preliminary clinical experience with an endoscopically placed expandable metal stent ("Wallstent") in 33 patients with extrahepatic bile duct stenoses. When fully expanded, the stent has a diameter of 30 F and a length of 6.7 cm. It was possible to successfully place a stent in every patient. Clinical improvement was achieved in all patients except one. Two patients underwent elective surgery, while one died of renal failure. Another died of septic shock after 5 weeks, but no autopsy was performed. In conclusion, our initial experience with this stent shows that at least in the short term biliary drainage was excellent, with no complications of pancreatitis or hemorrhage. Longer follow-up than our 4 weeks is necessary to establish the position of this stent in comparison with the conventional endoprosthesis in the management of obstructive jaundice.

Aged↗
PubMed1989

Esophagogastric carcinoma: preoperative TNM classification with endosonography.

Endosonography (ES) was preoperatively performed in 91 patients with esophageal carcinoma and 80 with gastric carcinoma. Imaging findings were correlated with those from histologic analysis of resected specimens. ES was accurate in assessment of the depth of tumor infiltration. Early-stage disease could be distinguished from advanced carcinoma. Overall accuracy of ES was 90% for assessment of esophageal carcinoma and 83% for gastric carcinoma. Stenosis was a limiting factor for accurate staging (16% of cases). ES was reasonably accurate in assessment of lymph node metastasis: Overall accuracy was 82% for the esophagus and 66% for the stomach. For nonmetastatic lymph nodes, however, the accuracy was low (56% or less for both esophagus and stomach). Difficulties occurred in distinguishing inflammation from micrometastatic lymph node involvement. ES was not accurate for diagnosis of distant metastases due to limited penetration of ultrasound. Prevalence of lymph node metastasis increased with the progression of tumor infiltration. Technical improvements, such as a smaller diameter echoprobe, may further enhance diagnostic accuracy of ES.

Adolescent↗
PubMed1987

Endoscopic palliation of jaundice in gallbladder cancer.

Endoscopically placed biliary endoprostheses were used to treat obstructive jaundice in 64 patients with advanced or recurrent gallbladder carcinoma. Successful placement of an endoprosthesis was achieved in 55 patients (86%). Bilirubin declined in 52 of 55 cases (94.5%) and normalized in 37 of 44 patients (84%) who survived more than 30 days. Procedure-related mortality was 3.1%. The thirty-day mortality of 14.5% was better, and the mean overall survival of 161 days was comparable to published surgical results. Due to the lower cost, improved patient tolerance, and reasonable survival, we consider endoscopic drainage to be the procedure of choice in patients with obstructive jaundice secondary to recurrent and unresectable gallbladder cancer.

Aged↗
PubMed1986

Endoscopic palliative treatment in pancreatic cancer.

Patients with carcinoma of the head of the pancreas will develop obstructive jaundice at some point in their course in 80% to 90% of the cases. Surgical biliary digestive anastomosis carries a high 30-day mortality (20%), and hospitalization may be prolonged for several weeks owing to postoperative morbidity. We attempted endoscopic endoprosthesis placement in 221 patients with pancreatic carcinoma for palliation of obstructive jaundice. The procedure was successful in 200 of 221 (90%) with a procedure-related mortality of only 2% and a 30-day mortality of 10%. The serum bilirubin level normalized in 92% of those who survived, and the mean survival of 6 months is comparable to that achieved with biliodigestive anastomosis. Early cholangitis (8%) and late clogging of the endoprosthesis (21% at a mean of 5 months) are problem areas that need to be improved. We believe these results justify considering endoscopic biliary prosthesis as the treatment of choice in nonresectable jaundiced patients with carcinoma of the head of the pancreas.

Adolescent↗
PubMedDate not supplied

Endosonography in the clinical staging of esophagogastric carcinoma.

Endosonography (ES) was preoperatively performed in 113 patients with esophageal carcinoma (group 1) and in 84 patients with gastric carcinoma (group 2). Results of imaging and histology of resected specimens were correlated according to the new (1987) TNM classification. ES was accurate in assessing the depth of tumor infiltration. Overall accuracy of ES for group 1 was 89% and for group 2 83%. Early carcinomas could be distinguished from advanced cancers. ES was accurate in diagnosing lymph node metastases (sensitivity group 1 95% and group 2 87%) but less accurate in defining inflammatory changes of lymph nodes (specificity group 1 50% and group 2 48%). The incidence of lymph node metastases increased with progression of the depth of tumor infiltration. ES is not accurate for staging distant metastasis due to the limited penetration depth of ultrasound. Thus, additional transcutaneous ultrasound or computed tomography is necessary. Routine ES-guided cytology of lymph nodes may further enhance the diagnostic accuracy of ES.

Adolescent↗
PubMedDate not supplied

Endoscopic stenting for post-operative biliary strictures.

This study evaluates the efficacy of endoscopic stenting in 70 patients with noncomplete post-operative biliary strictures. The treatment consisted of placement of two 10 F gauge straight endoprostheses with elective exchange trimonthly, for a 1-year period. Successful endoprosthesis placement was accomplished in 66 of 70 patients (94%). In all 66 patients jaundice subsided. During the stenting period six patients had an operation and six died. In 46 patients the endoprostheses were removed. The mean period of follow-up was 42 months (range, 4 to 99 months). Excellent (asymptomatic, normal, or stable liver enzymes) and good (only one episode of cholangitis) responses were achieved in 83%; restricturing occurred after stent removal in 17%. Prolonged biliary stenting appears to be a safe and effective treatment modality for benign post-operative strictures and a valid alternative to surgery.

Adult↗