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Biomedical subjects

W H Brummelkamp

Publications and source records attributed to W H Brummelkamp.

At least 37 records · Page 2Linked to original sources
PubMed1990

Early adenoid cystic carcinoma of the upper oesophagus.

A 70-year-old male patient with an early stage primary adenoid cystic carcinoma of the oesophagus is reported. The 1.5 cm protuberant tumour, located in the upper oesophagus and found during examination for heartburn, was radically resected. It was restricted to the submucosa, which strongly suggests that it originated from the oesophageal glands. Microscopically, the tumour showed sparse S100 cells. This finding is in contrast with that in adenoid cystic carcinomas of the salivary glands.

Aged↗
PubMed1990

Endoscopic balloon dilation of the pylorus after esophagogastrostomy without a drainage procedure.

The necessity to perform a drainage procedure after esophagectomy using the stomach for substitution remains controversial. Transection of the pyloric sphincter may cause severe and debilitating gastroesophagitis because of increased duodenogastric reflux. Omitting the drainage procedure may lead to gastric stasis. In the patient group we studied (n = 50), 42 had partial esophagogastrectomy and intrathoracic esophagogastrostomy, 12 with and 30 without a drainage procedure. Eight had total thoracic esophagectomy and cervical esophagastrostomy using the entire stomach without a drainage procedure. Gastric stasis was not observed in the 12 patients with a drainage procedure, but in six, duodenal reflux gastroesophagitis caused considerable morbidity. This complication was seen only once in the group (n = 38) who did not have a drainage procedure. Four of the 38 patients with an intact pylorus (one patient after partial esophagogastrectomy and three patients after total thoracic esophagectomy) showed persistent pyloric closure. However, this complication was successfully managed by endoscopic balloon dilation under fluoroscopic survey. The results suggest that, after esophagectomy, the integrity of the pyloric sphincter should be preserved, since the complication arising from this policy can be simply managed by endoscopic balloon dilation.

Anastomosis, Roux-en-Y↗
PubMed1990

Percutaneous transcatheter embolization of symptomatic renal angiomyolipomas: a report of four cases.

Successful percutaneous transcatheter embolization of renal angiomyolipoma is reported in four female patients. The angiomyolipomas measured more than 4 cm in diameter. Three patients had severe haemorrhage and one patient had a growing angiomyolipoma in a solitary kidney. This patient had percutaneous transcatheter embolization to prevent further deterioration of kidney function. Three patients had multiple renal angiomyolipomas as part of tuberous sclerosis. Two of them had selective transcatheter embolization of more than one angiomyolipoma. After embolization, one patient had partial loss of kidney function and one patient developed an abscess that could successfully be drained percutaneously under ultrasound guidance. The following conclusions can be drawn. All patients with tuberous sclerosis should be screened for renal angiomyolipomas. All symptomatic renal angiomyolipomas and all angiomyolipomas that measure more than 4 cm in diameter require treatment. Embolization should be considered as a primary therapeutic modality for multiple angiomyolipomas.

Adult↗
PubMed1989

Ileal pouch-anal anastomosis without rectal muscular cuff.

Twenty patients underwent proctocolectomy followed by an ileal pouch-anal anastomosis. The rectum was mobilized in the intersphincteric plane and transected at the level of the dentate line. As a consequence, a rectal cuff, which is considered by some to be important for the maintenance of anal continence, was not left behind. All patients were continent. Manometric data demonstrated no difference compared to a group of 21 patients with a conventional mucosectomy. Nearly half of the patients in both groups had a positive recto-anal inhibitory reflex. As a rectal cuff is not essential for maintaining continence, the receptors of the rectoanal inhibitory reflex are probably located outside the rectal wall.

Adult↗
PubMed1989

Sharp thoracic injury.

In an effort to develop effective rules for the management of penetrating thoracic injuries, all records of 515 patients treated for sharp chest injuries between 1961 and 1985 at the University Hospitals of Amsterdam (Binnengasthuis, Wilhelmina Gasthuis and Academic Medical Centre), were reviewed. The analysis reveals that of these patients 321 (62 per cent) could be treated conservatively, because of a non-penetrating injury, while 140 had a penetrating injury, of whom 77 had to be operated on. Eleven patients died (2.1 per cent). Data concerning these patients are discussed separately. Based on our analysis, and supported by recent literature, an aggressive approach towards penetrating thoracic injury in haemodynamically unstable patients is justified.

Adolescent↗
PubMed1989

Tuberous sclerosis and the relation with renal angiomyolipoma. A genetic study on the clinical aspects.

Renal angiomyolipomas were present in 23 out of a series of 38 patients with proven tuberous sclerosis (60.5%). Multiplicity and bilateral localization of combined renal angiomyolipomas were important differences between this category and the isolated, usually solitary, angiomyolipomas. One of the parents of a patient with tuberous sclerosis had small renal angiomyolipomas without signs of tuberous sclerosis. This indicates that renal angiomyolipomas might be a forme fruste of tuberous sclerosis. Two patients with suspected isolated renal angiomyolipomas proved to have tuberous sclerosis. From this study we can conclude that multiple angiomyolipomas, or a combination of a single renal hamartoma with one of the signs suggestive of tuberous sclerosis, warrant a thorough examination to exclude tuberous sclerosis.

Adolescent↗
PubMed1989

Sodium ipodate in the preparation of Graves' hyperthyroid patients for thyroidectomy.

Sodium ipodate (SI) is an oral cholecystographic agent that also affects thyroid hormone metabolism. It inhibits the peripheral T4 to T3 conversion and the thyroidal hormone release. We investigated the safety and efficacy of SI (500 mg daily during 5 days) in the preparation for subtotal thyroidectomy of 7 Graves' hyperthyroid patients in whom treatment with thionamides was unsuccessful due to allergy or noncompliance. Plasma T3 levels (mean +/- SD) decreased from 4.90 +/- 1.80 nmol/l on day 0 to 1.70 +/- 0.30 nmol/l on day 4 of treatment. Thyroidectomy performed on day 5 of treatment was uneventful. In comparison with 14 Graves' hyperthyroid patients who underwent thyroidectomy during the same period after conventional preparation with thionamides and potassium iodide, the therapeutic outcome 1 year postoperatively was similar in both groups. However, in the mildly hypothyroid patients prepared with SI, the plasma thyroid-stimulating hormone level was transiently higher 3 and 6 months postoperatively. It is concluded (1) that SI is a safe and efficacious drug in the preparation of Graves' hyperthyroid patients for thyroidectomy; (2) the therapeutic outcome 12 months postoperatively is similar in SI and in conventionally prepared Graves' hyperthyroid patients, and (3) postoperative mild or subclinical hypothyroidism is more pronounced in SI than in conventionally prepared patients.

Adult↗
PubMed1989

Intestinal endocrine cells in radiation enteritis.

In this study, the intestinal endocrine cells were investigated in 13 surgical specimens affected by radiation enteritis. Endocrine cells were studied by means of Grimelius' silver staining and immunostaining for chromogranin, a general marker of endocrine cells. Positively stained cells were quantified by counting their number per unit length of muscularis mucosa. Results in radiation enteritis were compared with matched control specimens by using Student's t test. Chromogranin immunostaining showed a statistically significant increase of endocrine cells in radiation enteritis specimens compared with controls both in small and large intestine (ileum, 67.5 +/- 23.5 cells per unit length of muscularis mucosa in radiation enteritis versus 17.0 +/- 6.1 in controls; colon, 40.9 +/- 13.7 cells per unit length of muscularis mucosa in radiation enteritis versus 9.5 +/- 4.1 in controls--p less than 0.005 in both instances). Increase of endocrine cells was demonstrated also by Grimelius' staining; however, without reaching statistical significance. It is not clear whether or not the increase of endocrine cells in radiation enteritis reported in this study is caused by a hyperplastic response or by a sparing phenomenon. We should consider that increased endocrine cells, when abnormally secreting their products, may be involved in some of the clinical features of radiation enteropathy. In addition, as intestinal endocrine cells produce trophic substances to the intestine, their increase could be responsible for the raised risk of developing carcinoma of the intestine in long standing radiation enteritis.

APUD Cells↗
PubMed1989

Long-term follow-up after colectomy and ileorectal anastomosis in familial adenomatous polyposis coli. Is there still a place for the procedure?

Forty-four patients with familial adenomatous polyposis coli treated with colectomy and ileorectal anastomosis were studied. Mean age at operation was 27 years. The mean follow-up period was 10 years (median 8 years). Three patients (7%) developed rectal cancer 1, 4, and 24 years after the initial operation, respectively. Proctectomy with ileostomy was performed in one patient, and 7 patients underwent a conversion to an ileoanal procedure for an increasing number of rectal polyps in the rectum stump. Although frequent bowel actions and episodes of diarrhea were common findings in patients after colectomy and ileorectal anastomosis, almost all patients (96%) were more or less satisfied with their quality of life after the procedure. On the basis of our results and the results reported in the literature, colectomy with ileorectal anastomosis is still the operation of choice in selected patients with familial adenomatous polyposis coli. An initial ileal pouch - anal anastomosis, or a conversion to such a procedure after colectomy and ileorectal anastomosis is indicated, depending on the number and size of rectal polyps.

Adenomatous Polyposis Coli↗
PubMed1989

Traumatic neuroma giving rise to biliary obstruction after reconstructive surgery for iatrogenic lesions of the biliary tract--a report of three cases.

A traumatic neuroma of the biliary tract, most commonly has been described as an amputation neuroma in the cystic duct stump after cholecystectomy. Traumatic neuroma has less frequently been associated with biliary obstruction, and this combination is very rare after reconstructive surgery of the biliary tract. Three patients who had undergone a reconstructive procedure following accidental injury of the biliary tract during cholecystectomy are described. After many years they presented with jaundice due to an obstructive traumatic neuroma in the common hepatic duct (one patient) and in a previous biliary-digestive anastomosis (two patients). Eighteen cases of traumatic neuroma of the biliary tract causing obstructive jaundice, were found in the literature and analysed. As far as we know, a traumatic neuroma located in a previous biliary-digestive anastomosis has not been reported before.

Aged↗
PubMed1988

Urinary tract malakoplakia with extension into the retroperitoneum with secondary gastrointestinal involvement.

A rare case of malakoplakia of the urinary tract with diffuse retroperitoneal extension is presented. Sonographically guided cytologic puncture revealed the pathologic diagnosis. The splenic flexure of the colon and the stomach appeared to be secondarily involved in the inflammatory retroperitoneal tumor. The relative role of the various imaging modalities in defining retroperitoneal extension of the disease is illustrated, with a special reference to computed tomography and endosonography. After antimicrobial treatment and left nephrectomy, partial regression of the retroperitoneal mass was documented.

Adult↗
PubMed1988

Neuroendocrine innervation of the hepatic vessels in the rat and in man.

An extensive array of nerve fibers ramify around the afferent blood vessels of the liver and the extrahepatic and intrahepatic biliary pathways, and are thought to be involved in regulation of blood flow. Although the role of sympathetic innervation is established, little is known about the location or role of regulatory peptidergic innervation in the liver. We examined the anatomic distribution of a wide variety of regulatory peptides and several neural antigens by in situ immunohistochemistry in the rat and in man. A rich peptidergic plexus of nerve fibers and ganglion cells was observed around the arterial vessels in both species, with intense immunoreactivity for neuron-specific enolase, neurofilaments, neuropeptide Y, substance P, and vasoactive intestinal polypeptide. S-100 protein immunoreactivity was seen principally in large nerve bundles, suggesting that the majority of nerves in this area were unmyelinated. In contrast, the portal vessels revealed very little peptidergic innervation. No staining was observed with antibodies directed against insulin, glucagon, gastrin, serotonin, met-enkephalin-Arg-Gly-Leu, cholecystokinin, or growth hormone. These findings indicate the presence of a rich, although selective, peptidergic plexus surrounding afferent hepatic blood vessels. This plexus may play an important role in regulation of hepatic blood flow.

Animals↗
PubMed1988

Endoscopic lesions in Crohn's disease early after ileocecal resection.

Fifty patients with Crohn's disease were studied endoscopically 6 weeks to 6 months (median 9 weeks) after ileocecal or ileocolonic resection for evidence of non-resected abnormality. Only 8 of the 50 patients were endoscopically free of abnormalities. Microscopic examination of the surgical specimen revealed inflammatory pathology at the site of resection line in 30 patients. Of the latter, 27 had endoscopic lesions at the anastomosis or in the "neoterminal" ileum. Of the 42 patients with endoscopic lesions only 8 had minor biochemical abnormalities. This study suggests that the well known reappearance of inflammatory activity after resection, especially at and proximal to the anastomosis, develops from foci of remaining inflammation and should be considered as recrudescence of the disease rather than true recurrence.

Adult↗
PubMed1988

A physical model of the intrathoracic stomach.

To determine whether duodenogastric reflux into the thoracic stomach could be caused by the transmission of negative intrapleural pressure fluctuations into the gastric lumen, a physical model is described and an equation calculated Pm + Pa - Pmb - (Sv.Pmb.Vmb/Pm) = Ppl - Sv.Vmb where Pm is intragastric pressure, Pa is atmospheric pressure, Pmb is end-expiratory gastric base pressure, Vmb is corresponding gastric volume, Sv is stiffness of gastric wall, and Ppl is intrapleural pressure. The validity of the model is demonstrated in six anesthetized mongrel dogs (18-31 kg) in which a thoracic stomach was constructed. The transmission of the intrapleural pressure fluctuations across the gastric wall proved to be greatly influenced by the gastric stiffness. The latter parameter varied from 0.05 to 1.97 cmH2O/ml, corresponding with a pressure transmission of 100 and 60%, respectively. Because high degrees of gastric stiffness are only present for large gastric volumes or when gastric peristalsis is present, it is concluded that, in general, the intrapleural pressure fluctuations are transmitted into the thoracic stomach. For this reason, respiratory efforts may play an important role in inducing duodenogastric reflux into the thoracic stomach.

Animals↗
PubMed1988

Otto Lanz, surgeon and art collector.

Otto Lanz (1865-1935) was educated in Switzerland, where he was trained in the surgical clinic of Theodore Kocher. In 1902, he was appointed as a professor of surgery in Amsterdam, remaining there until his death. He was wellknown for his surgery of the thyroid gland and for his studies on the vermiform appendix. He defined a point in acute appendicitis, to which his name has been eponymously attached (Lanz's point). His wide scope of interests is pictured, ranging from his invention of meshing a split-skin graft, to his antithyroid therapy, giving thyreotoxic patients the milk to drink of thyroidectomised goats. Apart from his professional achievements, he was a great connoisseur and passionate collector of Italian Renaissance art. Part of his collection was exhibited in the Rijksmuseum of Amsterdam, as perpetuated in the Lanz room until acquired for Hitler's proposed Führermuseum during World War II. After the capitulation, the collection was returned to The Netherlands.

Art↗