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Biomedical subjects

W J Mastboom

Publications and source records attributed to W J Mastboom.

At least 19 recordsLinked to original sources
PubMed2001

[Tumor of the omentum in 2 patients with a large, mobile mass in the upper abdomen].

A mobile mass in the right upper abdomen was felt in an 81-year-old woman with nausea and a 45-year-old man with exertional dyspnoea. Radiological investigations did not reveal sufficient information, whereupon laparotomies were carried out. In both cases, a tumour was found at the exit of the greater omentum. Following resection, the tumour recurred in the woman five months later, and she died as a result; the man made a rapid recovery and remained tumour-free two years later. Tumours originating in the omentum majus are rare. The presentation of these tumours is late, due to late presentation of complaints. These tumours are usually only detected once they reach a diameter of more than 10 centimetres. In general, it is difficult to establish whether the tumour is benign or malignant either pre- or peri-operatively. Surgery is the only curative option. A wide resection is preferable, with resection of any (parts of) organs which may be involved.

Aged↗
PubMed1999

[Two patients with osteochondroma of the cervical spine].

In two patients, both women of 32 years old, who had a local tumour in the neck firmly attached to the spine, radiologic imaging and biopsy led to the diagnosis of osteochondroma. Both patients recovered, but one had an episode of atrophy of the M. trapezius and the M. rhomboideus. If a solid mass is palpated in the neck a malignant process and cervical exostosis should be considered in the differential diagnosis. Exostoses usually are benign symptomless tumours, diagnosed in the second or third decade of life. They may compress spinal nerves and in rare cases cause severe complications by compression of vital structures such as myelum and arteries. An exostosis should be resected only if it is symptomatic or if a malignant process is suspected. In case of doubt surgical intervention is indicated with special attention to surrounding structures such as nerves and blood vessels.

Adult↗
PubMed1998

[Pilomatrixoma often not identified as such].

OBJECTIVE: To inventory incidence, diagnosis and treatment of pilomatrixoma. DESIGN: Retrospective. METHOD: Patients treated in the period 1984-1996 in the department of Surgery of the Medical Spectrum Twente, Enschede for a pilomatrixoma were traced via the Dutch Automatic Morbid-Anatomical Records Office (PALGA). Data were collected by status study. Also, the patients or their parents were interviewed by telephone about recurrences. RESULTS: Forty-eight patients with 54 pilomatrixomas had been treated. The ages varied from 2 to 77 years, 14 patients were younger than 14 years. The correct diagnosis had been made preoperatively in 11 patients (20%) in four of whom (7%) the manifestation was not the first one. In many cases (69%), the condition was mistaken for an atheromatous cyst, in children as well (in 47% of the cases). The pilomatrixoma was localized in the head and neck area 25 times, in eight of these in the parotid region. Owing to incorrect interpretation of the abnormality, three children with a pilomatrixoma in the head and neck area underwent a more radical operation than necessary. CONCLUSION: The clinical diagnosis was frequently missed. In cutaneous tumours occurring in children or localized in the head and neck area the diagnosis of pilomatrixoma should be considered.

Adolescent↗
PubMed1998

[Inguinal pain caused by iliopsoas bursitis].

Four patients, three men aged 69, 55 and 45 years and one woman aged 72 years, complained of pain in and around the inguinal region without clear cause. The crippling symptoms were of a few days' to 8 years' standing. Passive hip movements were not restricted. Presence of pain after pressure on or stretching of the bursal wall during provocation tests and absence of other disorders resulted in a probability diagnosis of iliopectineal bursitis. This diagnosis was confirmed by marked abatement of the pain after an injection of lidocaine into the bursa. Inflammation of the iliopectineal bursa may occur after injury or overstrain and cause various kinds of complaints. The diagnosis injection of lidocaine as a rule constitutes an adequate treatment as well.

Aged↗
PubMed1998

[Phyllodes tumor in the breast].

In three women aged 51, 37 and 58 years, with a palpable tumour in the breast, excision and pathological examination led to the diagnosis of 'phyllodes tumour'. During 3-5 years after radical excision, in one patient followed by radiotherapy, no recurrences were seen. This rare breast tumour with a variable clinical course usually affects women between the ages of 30 and 50. There is often a large tumour and (or) rapid growth. Mammography and ultrasound are unhelpful diagnostically. Cytology is unreliable as the tumour is heterogeneous. Histologically the tumour can be benign, borderline malignant or malignant. Surgical excision with a margin of > or = 1 cm is the therapy of choice. The risk of recurrence after insufficient excision is considerable and histological deterioration can occur. Multiple samples, examination of resection margins and investigation into atypia, mitotic activity and stromal overgrowth are essential for making a prognosis and a treatment plan. In case of doubt regarding radicality, surgeon and pathologist should compare views; non-radicality necessitates re-excision.

Adult↗
PubMed1991

Influence of methylprednisolone on the healing of intestinal anastomoses in rats.

Although steroids are generally thought to impair intestinal anastomotic healing, this effect has never been proven unequivocally in either clinical or experimental studies. We have investigated the influence of methylprednisolone (2.5 or 10.0 mg kg-1 day-1) given from 2 days before operation onwards, on 3-day-old and 7-day-old ileal and colonic anastomoses in rats. Anastomotic abscesses occurred more frequently in the ileum, but not in the colon, after steroid medication. However, methylprednisolone did not lower anastomotic bursting pressures in either of the bowel segments. Comparison of the hydroxyproline content of the anastomotic segment yielded no significant difference between control and methylprednisolone groups in either small or large bowel. Thus, healing of experimental colonic anastomoses remains unaffected by short-term administration of this corticosteroid.

Anastomosis, Surgical↗
PubMed1991

Intestinal anastomotic healing in the absence of suture material: an experimental study in rats.

In order to investigate the influence of sutures on intestinal anastomotic healing, 48 rats underwent both ileal and colonic resection. In 24 rats all intestinal sutures were removed 30 min after anastomotic construction (group 1), while in the remaining animals (group 2) the sutures were left in place. Bursting pressures and collagen (hydroxyproline) levels in anastomotic segments were measured 1, 3, and 7 days after operation. Two lethal ileal dehiscences and 9 anastomotic abscesses (5 ileal and 4 colonic) occurred in group 1, while in group 2 there were 3 ileal anastomotic abscesses. On the first day after operation, bursting pressures were significantly lower in sutureless ileal and colonic than in sutured anastomoses. During the post-operative course, changes in collagen concentrations in ileal and colonic segments did not differ between the groups. Thus, sutures are only essential in providing anastomotic strength during the immediate post-operative period, but do not seem to affect post-operative collagen metabolism.

Anastomosis, Surgical↗
PubMed1991

The influence of NSAIDs on experimental intestinal anastomoses.

Limiting degradation of collagen during the initial phase of wound healing is expected to improve postoperative intestinal strength and thereby decrease chances for anastomotic dehiscence. We studied the influence of four nonsteroid anti-inflammatory drugs on the healing of intestinal anastomoses in rats, with special regard to changes of collagen levels around the anastomoses. Four experimental groups of 20 rats each received daily oral doses of piroxicam, ibuprofen, aspirin, or indomethacin and were compared with a control group. Animals were sacrificed 3 or 7 days after operation. Both morbidity and mortality rate in the experimental groups were high. Collagen, measured as hydroxyproline, levels in anastomotic and adjoining 1-cm intestinal segments were compared with concentrations in control segments resected during operation. After an initial decrease on day 3, hydroxyproline concentrations increased on day 7. In the colon the lowering of hydroxyproline concentrations, which was more pronounced than in the ileum, was significantly reduced by administration of piroxicam and ibuprofen, both in the anastomosis and its proximal segment. On day 7, the increase of hydroxyproline concentrations in the ileum was inhibited by administration of anti-inflammatory drugs. It is concluded that nonsteroidal anti-inflammatory drugs may limit postoperative degradation of collagen in colonic anastomoses, but at the same time may increase the rat's susceptibility to surgical infections.

Analysis of Variance↗
PubMed1991

Bronchial suction by minitracheotomy as an effective measure against sputum retention.

Bronchial suction by means of a minitracheostomy is a new method for treatment of sputum retention and related pulmonary diseases. Through a small coniotomy, a specially designed cannula is inserted into the trachea, allowing frequent bronchial suction. The effectiveness of this method was prospectively analyzed in 74 consecutive patients and the results were compared with those reported in the literature. The operative procedure for insertion of the Minitracheotomy cannula caused nonlethal bleeding in three patients who were receiving anticoagulant medications. Thirty-eight of 43 patients treated on the intensive care ward were detubated and dismissed at an earlier stage than usual because of a minitracheostomy. The method failed in two comatose patients and in one patient with a laryngeal tumor. The method was effective in 18 patients who had serious pulmonary disease postoperatively. Thirteen patients at high risk for pulmonary infections, in whom the cannula had been prophylactically applied after extensive operations, did not have postoperative pulmonary complications. Over-all, the median period for bronchial suction was 4.0 days; decannulation followed on average 4.7 days later. No complications were caused by the presence of the cannula and the device was well tolerated by the patients.

Adolescent↗
PubMed1990

Healing of experimental intestinal anastomoses. Parameters for repair.

Anastomotic dehiscence remains a major complication in surgery of the large bowel, and studies on the healing sequence of experimental anastomoses are necessary to define underlying mechanisms and find ways to improve surgical outcome, particularly in high-risk situations. For the quantitative description of anastomotic repair, both mechanical and biochemical parameters are employed, each with their own limitations. Mechanical parameters, either bursting pressure or breaking strength, only reflect growing anastomotic strength as long as disruption occurs within the anastomotic area, which is less than one week after surgery for the bursting pressure and probably up to two weeks for the breaking strength. The biochemical description of anastomotic repair has been limited to behavior of collagen, as represented by its rather unique constituent amino acid hydroxyproline. Conclusions based on collagen concentrations--per unit weight--should be considered with caution since they may change as a consequence of changes in noncollagenous substances. In this respect, collagen content, per unit length, is probably a better parameter to describe anastomotic collagen levels. Few investigations have addressed the quality of collagen (e.g., crosslinking or type). Since, at this time, no distinct correlations have been demonstrated between development of mechanical strength or occurrence of leakage and collagen levels in the healing anastomosis, attention should not be restricted to a description of the quantity of collagen present: the quality of anastomotic collagen should be investigated, perhaps even more so.

Anastomosis, Surgical↗
PubMed1989

Small-bowel perforation complicating the open treatment of generalized peritonitis.

Fourteen patients were found to have developed 53 small-bowel perforations in the absence of pathogenic factors during "open abdominal treatment" for generalized peritonitis. They occurred after three to 17 laparotomies, on average at the eighth postoperative day (one to 120 days). Forty-nine lesions were located superficially. A relation with organ system failure, routine blood tests, type of nutrition, or microorganisms could not be demonstrated. The etiology of the lesions remains uncertain, but the open abdominal treatment must play some important role in its pathophysiology. Five patients survived. The therapy of choice appears to be mobilization of the bowel with resection of the affected part and primary anastomosis.

Adult↗
PubMed1989

Collagen changes around intestinal anastomoses in germ-free rats.

The changes in collagen, measured as hydroxyproline, concentration around both ileal and colonic anastomoses in germ-free and control rats have been investigated and compared with each other. The germ-free rats were raised, operated on and maintained under completely pyrogen-free conditions. Animals were killed 2, 3 or 7 days after operation. There was a significant reduction in the lowering of hydroxyproline concentrations around the colonic anastomosis of germ-free rats compared with control rats both in the anastomosis at days 2 and 3 (P = 0.04 and P = 0.006 respectively) and in the proximal segment at day 3 (P = 0.03). In ileal anastomoses, significant differences between control and germ-free rats were only found at 7 days. Here, the increase in hydroxyproline concentration observed in control rats was significantly reduced in germ-free rats. These data are taken to support the hypothesis that bacteria affect colonic anastomotic healing by contributing to postoperative collagen degradation.

Anastomosis, Surgical↗
PubMed1989

Piroxicam affects collagen changes around experimental intestinal anastomoses.

The effects of piroxicam on postoperative changes of collagen--measured as hydroxyproline--concentrations were measured around intestinal anastomoses in rats. Piroxicam, in a dose of 2 mg/kg/day, significantly reduced the decrease of hydroxyproline concentrations around colonic anastomoses during the first 3 days after the operation but also reduced the increase of hydroxyproline concentrations observed at day 7 around ileal anastomoses in the control group. 10 mg piroxicam/kg/day resulted in a 100% lethal peritonitis after the 5th postoperative day. We suggest that piroxicam affects collagen metabolism by inhibiting granulocyte functions.

Anastomosis, Surgical↗