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Biomedical subjects

W H Brummelkamp

Publications and source records attributed to W H Brummelkamp.

At least 55 records · Page 3Linked to original sources
PubMed1987

Increased populations of endocrine cells in Crohn's ileitis.

Hyperplasia of nerves has been described previously in Crohn's disease. To determine whether similar alteration of the enteric endocrine system occurs, endocrine cells of the ileal epithelium were quantified in typical cases of the disease. In the ileum from patients with Crohn's disease, there was an increase in the endocrine cell population, as visualised by immunostaining of chromogranin. Quantification of endocrine cell numbers showed significant increases in both macroscopically uninvolved (i.e. histologically normal) (35.0 +/- 3.8, cells per unit length of muscularis mucosae mean +/- SEM, P less than 0.05) and involved (44.5 +/- 5.5, P less than 0.01) Crohn's disease samples, compared with normal controls (23.7 +/- 3.4). Although individual types of endocrine cell showed slight increases in Crohn's samples, only the enterochromaffin cells in abnormal bowel showed a significantly greater population (normal controls 10.5 +/- 2.3; involved Crohn's 21.3 +/- 4.4, P less than 0.05).

Antigens↗
PubMed1987

Different response to preliminary biliary drainage in proximal versus distal malignant biliary obstruction.

This study assessed prospectively the results of endoscopic biliary drainage preoperatively in 40 patients with extrahepatic malignant biliary obstruction. The patients were divided into two groups depending upon the location of the obstruction. Those in group 1, n = 20, were patients with proximal malignant obstruction and those in group 2, n = 20, had distal malignant biliary obstruction. Preliminary endoscopic biliary drainage succeeded in lowering the biliary pressure and the incidence of bacteremia in patients in group 2. In contrast, for those in group 1, it failed to reduce the intrabiliary pressure and, thus, in the presence of bile infection led to an increased incidence of bacteremia. From the results of the present study, preliminary endoscopic biliary drainage is recommended for patients with distal malignant biliary obstruction. For those with proximal malignant biliary obstruction, surgical drainage appears to be the method of choice.

Adolescent↗
PubMed1986

Ileal pouches.

Explore the source record for details and available documents.

Anal Canal↗
PubMed1986

A new surgical approach for the management of carcinoma of the junction of the main hepatic ducts.

In the present study we discuss our early results and some technical aspects of a new surgical approach in dealing with high-lying malignant biliary obstruction. After transection of the common bile duct we proceed through a cephalad reflection of its proximal end in a meticulous dissection of the intrahepatic biliary tree. During dissection we follow the intrahepatic course of the right and left portal vein, which leads us to follow the respective course of the main right and left hepatic ducts and to reach the levels of their subsequent consecutive segmental bifurcations. By transecting at high levels, we excise completely or partially the tumor with the confluence of common hepatic duct. We reconstruct the biliary tree by multiple intrahepatic cholangiojejunostomies by use of a Roux-Y jejunal loop and a varied number of segmental hepatic ducts. Transanastomotic tubes were used only temporarily. Fifteen patients underwent operations by the described surgical approach without mortality. All were relieved of their jaundice completely and in all the tumor was either completely (5) or partially (10) removed. All patients had a good quality of postoperative life without being obliged to carry transanastomotic tubes and the complications and problems associated with them.

Adenoma, Bile Duct↗
PubMed1986

Combined endoscopic and surgical treatment in Peutz-Jeghers syndrome.

A combined endoscopic and surgical treatment in Peutz-Jeghers syndrome is presented. Natural history in Peutz-Jeghers syndrome often leads to multiple and acute laparotomies, resulting in intestinal resections. This may lead to a short bowel syndrome. In order to gain control over the small intestinal polyposis, a combined approach by the gastroenterologist and surgeon is performed. At laparotomy, an endoscope is introduced orally into the small intestine which is then telescoped over it by the surgeon. The small intestine is inspected in retrograde order and existing polyposis is treated by endoscopic or surgical polypectomy, or both, or by minimal intestinal resection. Thus, a "clean small intestine" is created. Data on five patients thus treated are presented. No recurrences were seen after this procedure at a mean follow-up period of 21 months. Combined endoscopic and surgical treatment of Peutz-Jeghers syndrome, together with top and tail endoscopy, results in a "clean intestine" and is supposed to diminish the need for multiple acute laparotomies and, therefore, the risk of a short bowel syndrome. There is also supposed to be an improvement in the quality of life and life expectancy.

Adolescent↗
PubMed1986

[Benign strictures of the bile ducts. Significance of adequate bile duct drainage for the prognosis and course of this disease].

Ninety-five patients with benign biliary strictures are presented in this study. All underwent reconstructive biliary surgery, either for proximal biliary strictures (Group A; 38 patients) or for distal biliary strictures (Group B; 57 patients). The type of bypass was individualized according to each patient's mechanical and anatomical characteristics as were assessed in our cholangiographic findings. For group A we used either a proximal to the stricture intrahepatic cholangiojejunostomy between Roux-en-Y jejunal loop and the main right or left hepatic ducts or multiple intrahepatic cholangiojejunostomies between segmental hepatic ducts and a Roux-en-Y jejunal loop. For Group B we chose between a choledocho- or hepaticoduodenostomy and a choledocho- or hepaticojejunostomy. There were three deaths due to sepsis, one in patients of group A and two among those of group B. Long-term results were satisfactory. None of our patients during a mean six year follow-up underwent further surgery for reasons related with either his/her operation or disease.

Adult↗
PubMed1986

Bacteremia in relation to intrabiliary pressure in proximal v. distal malignant biliary obstruction.

Ten patients with proximal malignant biliary obstruction (group A) and ten with distal malignant biliary obstruction (group B) who underwent surgery in 1983-1984 were prospectively studied as regards incidence of bacteremia and its relationship with intrabiliary pressure. The patients with proximal obstruction had higher intrabiliary pressure, associated with higher incidence of bacteremia. The intergroup differences were statistically significant in these respects, which influenced the clinical presentation. In general, the clinical manifestations were more severe in the group A patients. The study indicated that lowering of the intrabiliary pressure is essential for a good outcome in acute cholangitis. This applies particularly to proximal malignant obstruction, in which the intrabiliary pressure tends to be high and rapidly to provoke a dramatic increase in the incidence of bacteremia.

Adult↗
PubMed1986

Surgical management of proximal benign biliary strictures.

In 38 patients with high benign biliary stricture, who had previously undergone on average two unsuccessful operations for the condition, reoperation was performed. Direct mucosa-to mucosa anastomosis proximal to the stricture was done between a Roux-en-Y jejunal loop and a number of hepatic ducts in 20 patients (group A) or between a Roux-en-Y jejunal loop and the right and left hepatic ducts in 18 (group B). There was one death (group B). Complications resolved under conservative treatment. The long-term results were satisfactory. During follow-up averaging 6 years, no patient required further surgery for any reason related to the disease or its surgical treatment. Selective use of intrahepatic cholangiojejunostomy permits adequate biliary drainage of both liver lobes. Such drainage is essential for elimination of biliary stasis and to prevent postoperative cholangitis and recurrence of stricture.

Cholestasis↗
PubMed1986

Periampullary and pancreatic head carcinoma: facts and factors influencing mortality, survival, and quality of postoperative life.

From September 1983 to December 1985 40 patients from a total of 55 with periampullary and pancreatic head carcinoma underwent resectional surgery in our department. Following a policy of precise evaluation of each patient's operative findings, six patients underwent a Whipple duodenopancreatectomy, 29 patients underwent regional subtotal pancreatectomy, and five underwent regional total pancreatectomy. Five patients underwent vascular reconstruction of their regional vascular structures after transection of the invaded segments of their vessels and eight had positive lymph nodes. Lymph node involvement was confined to the regional area. Patients with distant lymph node involvement (paraaortic) were not considered eligible to resection. Three patients died and 10 required reoperation. Thirty-one had radical resection, one palliative and eight equivocal resection. From the survived patients (n = 37) 33 are alive and doing well at the time of this report (overall mean survival 18 months). The results of this study demonstrate that a radical approach based on a precise evaluation of operative findings of the individual patient might well offer a higher resectability rate and is probably the only chance for radical resection and for a longer survival in patients with periampullary and pancreatic head carcinoma.

Adult↗
PubMed1986

Adequate anamnesis for the evaluation of hip function in elderly patients.

A study for the evaluation of hip function was carried out in a series of 102 patients who, together with an escort, visited the Outpatients Department for other than hip complaints. Questions derived from a number of known systems for hip assessment formed the basis of the interview and, if present, the degree of senile dementia was approximated. Auto-anamnesis proved to be sufficient for adequate hip assessment in 40 patients, in six of whom there was a mild senile dementia, and insufficient in 62 patients, in 53 of whom there was senile dementia. From the 102 patients, adequate anamnestic information was presented for proper hip assessment in only 57 percent of cases (n = 58). The results of this study show that the practical value of the current systems for hip assessment in elderly patients is rather limited.

Activities of Daily Living↗
PubMed1986

The Hartmann procedure: its role in acute complicated diverticulitis.

A retrospective study of 38 patients with Hartmann procedure for acute complicated diverticulitis. Two patients died. Continuity was restored in 30 patients (30/36). With the present mortality (2/38) and a rather low morbidity, the Hartmann procedure can be recommended in acute complicated diverticulitis.

Acute Disease↗
PubMed1985

Gracilis muscle transposition in the treatment of fecal incontinence. Long-term follow-up and evaluation of anal pressure recordings.

The results after gracilis muscle transposition were studied in ten patients with a follow-up of six months to 17 years. Nine patients were continent for formed feces and the condition of one patient worsened after operation. Anorectal manometry was performed in eight of the ten patients. Evaluation of pressure recordings showed a normal image, both at rest and at maximal squeeze, in five patients. Low-pressure recordings at rest and at maximal squeeze were seen in two continent patients, in whom the tissue scarring resulted in narrowing of the anal canal. One patient with low-pressure recordings was completely incontinent. An attempt was made to explain the continence and low-pressure recordings. The results suggest gracilis muscle transposition to be a method of choice in patients with total incontinence who have no functional and sphincter.

Adolescent↗
PubMed1985

The significance of intrabiliary pressure in acute cholangitis.

To assess the relation of intrabiliary pressure to the incidence of bacteremia in instances of acute cholangitis, 20 patients were prospectively studied herein. They were divided into two groups: patients (n equals ten) with an intrabiliary pressure of more than 25 cubic centimeters of H2O were in group 1, and patients (n equals ten) with an intrabiliary pressure of less than 25 cubic centimeters of H2O were in group 2. All patients underwent operation. Bacteremia occurred in a proportion of 60 per cent during admission and increased to 90 per cent after a short interval of time in patients in group 1. In group 2, bacteremia was 20 per cent at admission and increased to 40 per cent after the same interval of time. Mortality was 30 per cent in patients in group 1 and 10 per cent for those in group 2. Data of this study suggest that the urgent release of obstruction of the biliary tract, either endoscopically or surgically, is important in order to minimize biliary pressure and subsequently reduce the incidence of bacteremia and improve survival time for patients undergoing treatment due to acute cholangitis.

Acute Disease↗
PubMed1985

A new approach for the reconstruction of continuity of the alimentary tract after pancreaticoduodenotomy.

To assess the value of a new method of reconstruction after PD, 14 patients are presented who underwent this operation. We used two jejunal segments for the reconstruction after PD, one for the biliary tract and pancreatic anastomosis and one for the gastrojejunal anastomosis. Additionally truncal vagotomy was carried out in all 14 patients. Pancreatic anastomotic leakage developed in two patients who responded favorably to conservative treatment and two patients died. Long term results revealed a satisfactory nutritional status, satisfactory quality of postoperative life and absence of dumping, steatorrhea and marginal ulceration. The results are attributed to the aforementioned reconstruction after PD. The encouraging results with the present series of patients prompted us to recommend this type of reconstruction. From the results of the present study, we recommend this type of reconstruction after PD as a single, safe and effective approach in reconstructing continuity of the alimentary tract after the aforementioned operation.

Adult↗
PubMed1984

Relaxation biofeedback conditioning as treatment of a disturbed defecation reflex. Report of a case.

The case history is presented of a patient with a disturbed defecation reflex by viral encephalopolyradiculoneuritis. The inability to defecate was thought to be due to hyper-reflexibility and, hence to increased spasm of the external anal sphincter. Normal defecation was eventually brought about by an operant learning technique, as described originally by Haskell and Rovner. The patient was conditioned to relax his external anal sphincter once he felt rectal fullness and the urge to defecate. Defecation was initiated by a Dulcolax suppository.

Adult↗
PubMed1982

Pre-operative whole-gut irrigation with mannitol.

Whole-gut irrigation preceded by oral mannitol administration as a method of preoperative bowel preparation was studied in 58 patients. Our results did not confirm the advantages described in the literature. Irrigation time, irrigation fluid volume, patient acceptability and the quality of bowel preparation were not improved, compared to our earlier studies with saline alone. Fluid retention was considerably diminished after mannitol preparation. A significant increase in postoperative septic complications was observed. Disadvantages and possible hazards of mannitol administration are discussed. Mannitol cannot be recommended as a safe and useful adjunct in whole-gut irrigation.

Abdomen↗