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R R Postema

Publications and source records attributed to R R Postema.

11 recordsLinked to original sources
PubMed2003

Does V-A ECMO increase the likelihood of chylothorax after congenital diaphragmatic hernia repair?

BACKGROUND: The authors noticed a relatively large number of patients with congenital diaphragmatic hernia (CDH) repair after extracorporeal membrane oxygenation (ECMO) who had a chylothorax (CT). The data are reviewed. METHODS: The charts of patients from 1990 until 2000 with CDH, treated with or without ECMO, together with the charts of patients treated with ECMO for other reasons and patients with esophageal atresia (EA) repair were reviewed. The diagnosis of CT was made if aspirated fluid appeared chylous and contained more than 90% lymphocytes or if the triglyceride level was more than 1.50 mmol/L. RESULTS: Eighty-nine patients with CDH were analyzed. Postoperatively, 10% had a CT-21% in CDH patients with ECMO treatment and 6% in CDH patients without ECMO treatment. This difference appeared to be significant (P <.05). The presence of a patch as independent variable for the development of CT also showed significance (P <.05). CONCLUSIONS: Chylothorax presented in almost all cases as a left-sided fluid accumulation, and a patch was present in the majority of patients with CDH. Therefore, CT should be considered the result of the severity of the defect rather than the consequence of ECMO as a therapeutic modality.

Artificial Organs↗
PubMed2002

Spinal epidural abscess presenting with abdominal pain.

We report a case of spinal epidural abscess presenting as abdominal pain. An 7-year-old boy presented with abdominal pain. He was operated on under suspicion of appendicitis. During operation, no abnormalities were found. Postoperatively, the abdominal pain did not subside. Subsequently, the boy developed neurological abnormalities. MRI showed a spinal epidural abscess. A laminectomy was performed and the boy was treated with antibiotics; he recovered well. This case showed that it is important to consider a spinal epidural abscess as a cause of abdominal pain with fever in children.

Abdominal Pain↗
PubMed2001

Endoscopic extraperitoneal repair of a Grynfeltt hernia.

There are three types of lumbar hernia: congenital, acquired, and incisional hernias. Acquired hernia can appear in two forms: the inferior (Petit) type and the superior type, first described by Grynfeltt in 1866. We report endoscopic extraperitoneal repair of a Grynfeltt hernia. A 46-year-old woman presented with a painful swelling in the left lumbar region that had caused her increasing discomfort. The diagnosis of Grynfeltt's hernia was made, and she underwent surgery. With the patient in a left-side decubitus position, access to the extraperitoneal space was gained by inserting a 10-mm inflatable balloon trocar just anteriorly to the midaxillary line between the 12th rib and the superior iliac crest through a muscle-splitting incision into the extraperitoneal space. After the balloon trocar had been removed a blunt-tip trocar was inserted. Using two 5-mm trocars, one above and another below the 10-mm port in the midaxillary line, the hernia could be reduced. A polypropylene mesh graft was introduced through the 10-mm trocar and tacked with spiral tackers. The patient could be discharged the next day after requiring only minimal analgesics. At this writing, 2 (1/2) years after the operation, there is no sign of recurrence. This Grynfeltt hernia could safely be treated using the extraperitoneal approach, which obviates opening and closing the peritoneum, thereby reducing operative time and possibly postoperative complications.

Endoscopy↗
PubMed1999

Choledochal cysts in children: a review of 28 years of treatment in a Dutch children's hospital.

OBJECTIVE: To analyse the results of surgical treatment of choledochal cysts. DESIGN: Retrospective study. SETTING: Children's hospital, The Netherlands. PATIENTS: 14 children presenting with choledochal cysts. INTERVENTIONS: Choledochoduodenostomy, Roux-en-Y choledochojejunostomy or Roux-en-Y hepaticojejunostomy. MAIN OUTCOME MEASURES: Morbidity and mortality RESULTS: The mean age of the patients was 20 months (2 weeks to 7 years). 10 patients had a type I choledochal cyst; three a type IV, and one a type V. Mean follow-up period was 6 years (18 months to 16 years). One patient with a type I cyst died of Klebsiella pneumoniae that was resistant to treatment. One patient with a type I cyst treated by choledochojejunostomy had two episodes of cholangitis. Another patient with a type I cyst, treated by choledochoduodenostomy, had one episode of cholangitis. Both could be treated with antibiotics. The other patients had had no complications up to 1997. CONCLUSION: This rare anomaly may lead to severe complications when left untreated or after late treatment. It is easy to manage with low associated morbidity.

Child↗
PubMed1998

[Fever in intensive care: keep medications in mind at all times].

In two patients, men aged 35 and 69 years admitted postoperatively to the intensive care unit, fever of unknown origin developed. One had been admitted because aspiration was suspected. He had been treated immediately with amoxicillin and clavulanic acid. The other had undergone oesophageal excision and gastric reconstruction because of oesophageal carcinoma and had been subjected to antibiotic decontamination (amphotericin B, norfloxacine en fungizone). No cause for the fever was detected, but it quickly subsided after discontinuation of the amoxicillin-clavulanic acid and the norfloxacine, respectively. When encountering fever of unknown origin in intensive care patients it is always important to think of drug fever.

Adult↗
PubMed1993

[Arthritis as complication of acute meningococcal infection].

The incidence of meningococcal disease appears to be increasing in the Netherlands. Numerous complications, mostly involving the central nervous system, have been reported. We focus attention on arthritis by describing the case history of a 2-year-old boy who developed oligoarthritis 8 days after a disease onset characterised by general malaise, fever, signs of meningeal irritation and positive cultures of Neisseria meningitidis in CSF, blood and nasopharynx. The arthritis was probably immune complex mediated. He recovered after antibiotic therapy. There are three forms of arthritis as a complication of meningococcal disease: primary meningococcal arthritis, purulent metastatic arthritis, and immune complex arthritis.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1993

Haemostasis after partial hepatectomy using argon beam coagulation.

The argon beam coagulator is a new device for haemostasis during and after surgery on parenchymatous organs. No data are available on its efficacy and tissue effect following hepatic resection. Blood loss, the time needed to achieve adequate haemostasis and histological findings after liver resection were assessed in 12 pigs using argon beam coagulation or suture ligation only, the mattress suture technique and tissue glue application. The treatment was randomly assigned to each of the four liver lobes in each pig. Median blood loss following argon beam coagulation was 13 (range 2-47) ml and after simple suture ligation 55 (range 2-260) ml (P < 0.02). The median time needed for adequate haemostasis following argon beam coagulation was 3 (range 2-7) min versus 14 (range 2-48) min in the control group (P < 0.005). There was no difference between argon beam coagulation and tissue glue, which were both superior to the use of mattress sutures. Argon beam coagulation resulted in less tissue damage than tissue glue or mattress suturing. The argon beam coagulator is an efficient device for achieving haemostasis following partial hepatectomy in the pig. It causes only a moderate tissue reaction.

Animals↗
PubMed1991

Prognostic implications of tumor diameter in carcinoma of the head of the pancreas.

Two hundred twenty patients with a carcinoma in the head of the pancreas were divided into three tumor diameter groups: group 1, 0.5 to 4.4 cm (n = 72); group 2, 4.5 to 6.0 cm (n = 77); and group 3, 6.1 to 15.0 cm (n = 71). For these tumor diameter groups a six-fold eliminatory curability analysis was performed. Of the patients with liver metastases in group 1 the last patient had died at 10 months and in groups 2 and 3 no patients were alive at 18 months after the start of complaints. Patients with extrahepatic metastases did not survive 12 months in group 1, 16 months in group 2, and 25 months in group 3. The 6% actuarial survival rate for inoperable patients was reached in group 1 after 17 months, in group 2 after 36 months, and in group 3 after 27 months after the start of complaints. For groups 1 through 3 in curable, but not curatively operated patients, the respective 0% actuarial survival rate was reached at 24 months, 23 months, and 14 months. The 0% actuarial survival rate in patients with irresectable vessel invasion was reached in group 1 at 33 months, in group 2 at 23 months, and in group 3 at 25 months. The 0% actuarial survival rate in patients with an irresectable tumor was reached at 33 months, 31 months, and 27 months after the start of complaints in groups 1, 2, and 3, respectively. The 0% actuarial survival rate in curatively operated patients was reached in group 3 after 26 months and in group 2 after 29 months. In group 1 25% of the patients were alive at 36 months after the start of complaints. Small tumors were associated with the greatest chance of curative operation and on average had the longest survival. However, small tumors with liver or other metastases carried a worse prognosis than large tumors with liver or other metastases. If tumors were found not to be resectable at the time of operation, the size of the tumor did not appear to affect survival.

Aged↗