Torsion of a wandering spleen.
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Adolescent↗
Biomedical subjects
R Balm
Publications and source records attributed to R Balm.
The clinical and endoscopic spectrum of the watermelon stomach.
The watermelon stomach is an uncommon but treatable cause of chronic gastrointestinal bleeding. We report our experience with the clinical and endoscopic features of 45 consecutive patients treated by endoscopic Nd:YAG laser coagulation. The prototypic patient was a woman (71%) with an average age of 73 years (range of 53-89 years) who presented with occult (89%) transfusion-dependent (62%) gastrointestinal bleeding over a median period of 2 years (range of 1 month to > 20 years). Autoimmune connective tissue disorders were present in 28 patients (62%), especially Raynaud's phenomena (31%) and sclerodactyly (20%). Atrophic gastritis occurred in 19 of 19 (100%) patients, with hypergastrinemia in 25 (76%) of 33 patients tested. Antral endoscopic appearances included raised or flat stripes of ectatic vascular tissue (89%) or diffusely scattered lesions (11%). Proximal gastric involvement was present in 12 patients (27%), typically in the presence of a diaphragmatic hernia. Endoscopic laser therapy after a median of one treatment (range of 1-4) resulted in complete resolution of visible disease in four patients (13%) and resolution of > 90% in 24 patients (80%). Hemoglobin levels normalized in 87% of patients over a median follow-up period of 2 years (range of 1 month to 6 years) with no major complications. Blood transfusions were not necessary after laser therapy in 86% of 28 initially transfusion-dependent patients. The characteristic clinical, laboratory, and endoscopic features allow for a confident diagnosis that can lead to successful endoscopic treatment.
Aged↗
["Endarterectomy revisited": long-term results of aorto-iliac disobliteration with the "arterial disobliteration device" (plaque cracker). A 7-year follow-up study].
In 1973 LeVeen et al. described a new technique for extensive, retroperitoneal disobliteration of the aorto-bifemoral tract using the arterial disobliteration device (ADD). In Europe this technique was first described in 1981 by Widdershoven and Willekens. Later on more publications from Spain, Poland, Belgium and the Netherlands appeared. At the Groot Ziekengasthuis in 's-Hertogenbosch (the Netherlands) the new procedure was introduced in 1984. Until 1991, 158 patients were operated. The results were analysed. The average follow-up time was 44 months (range 3-84). In 44.5% of these patients intermittent claudication was the reason for operation. In 40.5% of the cases there was untreatable ischemic rest pain and in 15% there was also ischemic gangrene of one or both legs. Aorto-bi-iliac disobliteration was performed in 55 patients, aorto-bi-femoral disobliteration in 31 patients and unilateral disobliteration in another 48 patients. In 24 patients we performed an unilateral aorto-femoral with a contralateral aorto-iliac desobstruction. Both the operation technique and the results are described. Five patients died in the early postoperative period and in 16 patients early reintervention i.e. within 6 hours after the initial operation was necessary for hemorrhage or acute vascular occlusion. During the follow-up 15 patients died. Recurrent occlusion was seen six times while in two patients restenosis developed. In conclusion; in selected patients with aorto-femoral occlusive disease the ADD-procedure can replace the up to now usual procedures.
Arteriosclerosis↗
Does performance status influence the outcome of Nd:YAG laser therapy of proximal esophageal tumors?
The value of endoscopic palliative therapy for malignant obstruction in the proximal esophagus has been questioned. To assess the importance of pre-treatment performance status on treatment outcome, we reviewed the records of patients with tumors of the proximal esophagus undergoing endoscopic laser therapy between January 1986 and December 1988. As compared with 10 patients having a good performance status, eight patients with a poor performance status had a lower frequency of obtaining complete functional relief of dysphagia (14% versus 71%), an increased rate of complications (50% versus 0%), and a shorter median survival time (24 days versus 161 days). We conclude that performance status should be considered in determining the appropriateness of laser therapy in patients with proximal esophageal cancer.
Aged↗