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Biomedical subjects

R Van Hee

Publications and source records attributed to R Van Hee.

At least 19 recordsLinked to original sources

Anterior gastric wall stapling combined with posterior truncal vagotomy in the treatment of duodenal ulcer.

Anterior gastric stapling with posterior truncal vagotomy was examined as an alternative to highly selective vagotomy in the treatment of peptic ulcer disease. A clinical series of 32 patients who underwent the combined procedure is presented; gastric acid output was adequately reduced (basal output by 82 per cent, peak by 64 per cent). Motility changes were temporary and mild. Clinical follow-up, using a modified Visick grading, showed good to excellent results in 21 of 25 patients who could be classified. This procedure is suggested as an appropriate alternative to highly selective vagotomy.

Adult

Management of digestive fistulas.

BACKGROUND: The efficacy of total parenteral nutrition and somatostatin was assessed in reducing output and promoting spontaneous closure of postoperative digestive fistulas. METHODS: In a consecutive series of 23 patients, closure was achieved in 83% of patients after a mean fistula duration of 11.0 +/- 7.9 days and a mean of 13.2 +/- 7.0 days of drug treatment, and without mortality. RESULTS: A marked first-day effect (output drop > 50%) was noted in 60% of patients and had a good prognosis. Infection of the fistula markedly prolonged fistula closure time, but did not affect total outcome. CONCLUSION: Somatostatin has been shown to be very useful in the conservative treatment of digestive fistulas because of its ability to reduce output significantly and to accelerate spontaneous closure.

Adolescent

[Andreas Vesalius and surgery].

By publishing De Humani Corporis Fabrica Libri Septem in 1543, Andries van Wesel (1514-1564) gave surgical science an immense impulse. The revolutionary renovation in the knowledge of man's anatomical structure changed slowly and progressively into topographical and physiological understanding of surgical diseases. At the same time, this made better aimed and more secure operations possible. Apart from the importance of this anatomical publication, Andreas Vesalius also won his spurs as a surgeon. He taught surgery in Padua for many years. He was appointed court physician and surgeon at the Habsburg Court of Charles V and Philip II. He personally performed lots of operations known at the time as major ones. He not only quickly adopted the surgical innovations of his fellow-surgeon Ambroise Paré, but he even performed operations that had been forgotten during several centuries, among which thoracocentesis for pleural empyema. His clinical perspicacity in discovering the indication for some operations was staggering and was appreciated by all great monarchs of Europe in the 16th century. In his several consilia, numerous pieces of advice were given for the treatment of surgical patients. The surgical practice which Vesalius had in Brussels for many years, consequently became most successful. Many publications by Vesalius about surgery and blood-letting are well-known. His Chirurgia magna in septem Libros digesta still remains controversial; these books were published by Prospero Borgarruccio (1560) in 1568 by the Venetian editor Valgrisi. This book gives an excellent survey of surgical pathology as it was taught and treated in the 16th century. The scientific method that Vesalius used, not only in his anatomical studies but also in his surgical practice, deserves not only our full appraisal but should still be studied in our own time.

Anatomy

Mediastinal lipoma.

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Diagnostic Imaging

Calcitonin gene-related peptide-like immunoreactivity in the human small intestine.

Calcitonin-gene-related-peptide (CGRP)-like immunoreactivity was localized in nerve fibres, neuronal somata and in mucosal endocrine cells of the human small intestine. Immunoreactive enteric neurons were more numerous in the submucous plexuses than in the myenteric plexus. Morphologically, they predominantly had the appearance of type II neurons. The majority of the CGRP-like immunoreactive nerve fibres ran within the ganglionic nerve plexuses. Only a small proportion could be observed in the lamina propria, the lamina muscularis mucosae, or the circular and longitudinal outer smooth muscle layer. These findings suggest that within the wall of the human small intestine neuronal CGRP of either extrinsic or intrinsic origin exerts its effect chiefly on other enteric neurons, and might be indirectly involved in the regulatory functions of the human small intestine.

Adult

Gastric emptying for solids in patients with duodenal ulcer before and after highly selective vagotomy.

In a series of 31 duodenal ulcer patients (23 males and 8 females), who underwent a highly selective vagotomy, gastric emptying characteristics of a solid meal, labeled with [99mTc]stannous colloid, were assessed before, two weeks and six months after operation. The clinical diagnosis was confirmed by endoscopy and x-ray; failure of treatment with H2 antagonists or antacids during 1-18 (mean 5) years was the direct indication for operative treatment. A temporary delay in gastric emptying is noted two weeks after operation (T1/2: 124 vs 57 min). After six months, gastric emptying time has practically normalized. It appears that this is the result of the preservation of the antropyloric vagal nerve supply. In these patients, a 10% recurrence rate is noted, comparable to the results in the literature. Highly selective vagotomy proves to be a safe and effective procedure with few side effects. It does not impair gastric motility.

Adult

Gastric emptying of liquids after highly selective vagotomy for duodenal ulcer.

In a group of clinical patients with duodenal ulcer submitted to highly selective vagotomy, gastric emptying studies were performed pre-operatively and 2 weeks and 6 months after surgery. A standard liquid meal labeled with radioactive technetium was used for scanning. In this group of duodenal ulcer patients, no abnormal emptying was noted prior to surgery as compared with controls. After highly selective vagotomy, the gastric emptying time for liquids was statistically shorter as compared with preoperative values. It is concluded that highly selective vagotomy may be the operative treatment of choice for duodenal ulcer patients with respect to acid secretion, but that it alters gastric motility and emptying significantly.

Duodenal Ulcer

Pancreatic function after seromyotomy of the canine stomach.

Anterior gastric seromyotomy combined with posterior truncal vagotomy has been proposed as an acid-reducing operation for patients with duodenal ulcer. Section of the posterior vagal trunk could, however, be held responsible for reduced pancreatic function, seen in patients after bilateral truncal vagotomy. In this study the pancreatic function after anterior gastric seromyotomy and posterior truncal vagotomy has been evaluated in a series of canine experiments by means of a direct hormone stimulation test. No reduction of the basal or stimulated exocrine pancreatic secretion was noted after this type of vagotomy.

Amylases

Peliosis hepatis associated with liver and retroperitoneal abscesses.

A 33-year-old woman was admitted because of coma and severe shock. CT-scan of the abdomen showed the presence of multiple liver abscesses associated with a retroperitoneal abscess which were drained percutaneously. A liver biopsy showed diffuse peliosis. After resolution of the abscesses the patient's general condition improved and she could be discharged from hospital. Peliosis hepatis is an uncommon disorder characterized by dilated sinusoids with formation of blood lakes. Many pathogenetic mechanisms and causal agents have been proposed. Liver biopsy is necessary to establish diagnosis. By withdrawing the offending drug or treatment of the underlying disorder, regression may be observed.

Abscess

Current management of traumatic chylothorax.

The development of a traumatic chylothorax is an uncommon but serious clinical entity. Two cases of traumatic chylothorax are reported. The anatomy and physiology of the thoracic duct and the etiology, diagnosis and management of traumatic chylothorax are discussed.

Adult

Pseudotumor formation in polytetrafluoroethylene-dialysis fistulae.

We report two patients with formation of pseudotumors along a polytetrafluoroethylene (PTFE) graft used for dialysis access in chronic fistulae. We postulate a relationship with seroma formation, a known complication of PTFE vascular grafts used for dialysis purposes, possibly through lipolysis of the surrounding fat by a protein-rich exudate.

Aged

Ileal intussusception due to invagination of Meckel's diverticulum.

A middle-aged patient is reported who came to laparotomy after a six months period of abdominal complaints. Extensive investigations couldn't explain his symptoms. At laparotomy he was found to have an ileal intussusception due to an invaginated Meckel's diverticulum. These events are confronted with other collected literature reports. Symptomatology and treatment are discussed.

Humans

Organ donation in Belgium: discrepancy between offer and demand.

Belgium shows one of the highest numbers of patients with terminal renal failure, treated by means of dialysis, compared to other European countries. Transplantation accounts for only one third of the therapeutic modalities in these patients. As the number of new patients, presenting with terminal renal failure, is equally rising, an always growing discrepancy exists between offered kidneys and patients, desperately waiting for these organs. The same holds true for other organs, as heart, pancreas and liver. This study examines the multiple causes that induce this growing discrepancy and points to some solutions and suggestions that can deal with it.

Belgium

The management of bronchopleural fistulas.

Bronchopleural fistulas remain a severe complication of pulmonary surgery and pulmonary disease. Treatment often requires multiple surgical interventions. The etiology, the methods for diagnosis and the different possible therapeutic procedures are discussed.

Aged