[Gallstones following considerable weight loss and recommendations for their prevention].
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Adult↗
Biomedical subjects
W L Hesp
Publications and source records attributed to W L Hesp.
Pneumopericardium, pneumomediastinum, pericarditis and mediastinal abscess secondary to diverticulitis of the sigmoid.
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Abscess↗
Mannitol-induced acute renal failure.
Mannitol is widely used because of its osmotic diuretic action and its presumed antioxidant properties. In pre-existent renal dysfunction, however, mannitol may accumulate leading to potentially deleterious effects. We describe a 71-year-old woman with moderate chronic renal failure due to diabetic nephropathy who developed acute anuric renal failure after mannitol administration for post-traumatic reflex sympathetic dystrophy. After haemodialysis symptoms of acute renal failure rapidly disappeared with recovery of pre-existent renal function. Daily measurement of the osmolal gap as a simple and accurate way of monitoring patients receiving mannitol infusion is emphasized. A rapid increase in the osmolar gap should prompt adjustment of the dose or even discontinuation of mannitol, especially in the case of pre-existent risk factors.
Acute Kidney Injury↗
[Expectant management concerning the breast in 5 patients with occult breast carcinoma].
Five women, between 53 and 78 years old, had axillary lymph node disseminations without a primary breast tumour being found at clinical and radiological investigations. There is much uncertainty about the treatment to be applied in such cases. The patients' breasts were left untreated. One patient had a manifest breast tumour after 6 months' follow-up. The other four patients did not show any sign of a primary tumour after a median follow-up of 26 months (21-96). An expectative policy has already found support in medical literature. The axilla should preferably be treated with axillary lymph node dissection.
Aged↗
Unstable Colles' fractures in elderly patients. A randomised trial of external fixation for redisplacement.
We report the results of a prospective randomised controlled trial of the management of 101 Colles' fractures in patients over the age of 55 years. Within two weeks of initial reduction 43 fractures had displaced with either more than 10 degrees dorsal angulation or more than 5 mm radial shortening. These patients were randomly divided into two groups: 21 were remanipulated and held by an external fixator; in the control group of 22 patients, the redisplacement was accepted and conservative treatment was continued. Patients treated with external fixation had a good anatomical result, but their function was no better than that of the control group. We found no correlation between final anatomical and functional outcome, and concluded that the severity of the original soft-tissue injury and its complications are the major determinants of functional end result.
Aged↗
Enterostomy as an adjunct to treatment of intra-abdominal sepsis.
In 60 patients a small bowel enterostomy was constructed as part of the treatment of various intra-abdominal infectious and obstructive conditions. Eleven patients (18 per cent) died in the immediate postoperative period from continuing sepsis. In one patient closure of the stoma was not considered because of disseminated malignancy. In the remaining 48 patients continuity of the gut was subsequently restored. In 22 patients (46 per cent) complications occurred, 12 (25 per cent) of which were intra-abdominal septic complications. The occurrence of intra-abdominal complications was found to be linked to premature (i.e. within 3 months) closure of the stoma. Reasons for premature closure were stomal difficulties and prerenal azotaemia. Stomal closure was attended by a 10 per cent mortality rate.
Abscess↗
The carcinoid of the intestine.
From 1956 to 1985, 38 patients with a carcinoid of the intestine were treated. Tumours originating from the duodenum, ileum and colon had the worst prognosis. Fourteen out of 15 patients showed lymph-node metastases, and eight liver secondaries. Metastatic spread was rare (9%) if the primary tumour was small or an incidental finding (appendix). Even with metastatic spread there may be a longer survival due to the slow growth pattern of carcinoid metastases, which often become manifest several years after resection of the primary tumour. Metachronous liver metastases should be considered for surgical resection. Three of the 38 patients suffered from a carcinoid syndrome.
Adolescent↗
Anastomotic insufficiency in small bowel surgery--incidence and treatment.
In the period 1977-1981 234 small bowel anastomoses were constructed in 143 patients. Eight anastomoses showed leakage (3.4%) and from nine anastomoses a fistula developed (3.8%): a total rate of disturbed healing of small bowel anastomoses (7.3%). In the presence of intra-abdominal infection this rate was 14.8%, in the absence of infection 0.8%. The results of treatment with oversewing and with resection and immediate anastomosis were disappointing. Better results were obtained by dismantling of the anastomosis, establishment of a split-enterostomy and reestablishment of continuity in a second stage. Mortality was 3/17 (18%). The literature is reviewed.
Adolescent↗
Solubility of tissue hydroxyproline in experimental intestinal anastomoses.
Salt and acid solubility of collagen are thought to reflect its degree of crosslinking. In order to examine postoperative changes in crosslinking of intestinal collagen, which are of importance to the stability of the intestinal wall, we have investigated the solubility of hydroxyproline in rabbit ileum and colon, both in unwounded intestine and after construction of an anastomosis. Solubility in salt and dilute acid was increased by a sonication procedure. This way, 9% of total hydroxyproline in the unwounded colonic wall was salt soluble and 65% acid soluble. A similar distribution was observed in ileum. Three days after operation the salt-soluble fraction was significantly elevated in samples from the anastomotic area. In colon, this increase also persisted 7 days postoperatively. Comparison of anastomotic samples collected 3 and 7 days after surgery shows a significant decrease in the acid-soluble and a significant increase in the solid fraction. This phenomenon occurs both in ileum and colon. These results indicate that during the first days after operation the integrity of the intestinal wall is weakened not only by a loss of collagen, but also by a changed solubility of the remaining collagen.
Animals↗
Loss of collagen from experimental intestinal anastomoses: early events.
Collagen lysis, which always occurs to some extent in the wound area, is thought to be the underlying cause for breakdown of intestinal anastomoses. Therefore, we have studied the loss of collagen around ileal and colonic anastomoses in New Zealand White rabbits during the first 48 hr after operation. In the ileum, significant lysis of collagen in the anastomotic area, as represented by a decreased level of hydroxyproline, occurs from 12 hr postoperatively onward. Maximal loss of hydroxyproline, as compared to preoperative values, is 27% measured 24 hr after operation. In the colon, significant lysis of collagen occurs after 3 hr. The lowest level of hydroxyproline measured during the experimental period is found 48 hr after operation, where the concentration is decreased by 38%. Changes in ileum are restricted to the anastomotic area, while in the colon the decrease in hydroxyproline extends along the intestinal wall, particularly in a proximal direction. The fact that total protein concentrations do not vary significantly indicates that the lowered hydroxyproline levels are specific. Microscopic examination of the wound area shows that the cellular response during the first 24 hr after wounding is restricted to granulocytes. It is suggested that granulocyte collagenase is mainly responsible for the observed lysis of collagen after intestinal anastomosis.
Animals↗
Unstable fractures and dislocations of the pelvic ring--results of treatment in relation to the severity of injury.
Between 1968 and 1984, III patients were treated for unstable fractures of the pelvic ring. Cause, incidence, accompanying local lesions, mortality, Injury Severity Score (ISS) and mode of treatment were retrospectively analysed. ISS and mortality were closely correlated. The overall mortality was 19% and the average ISS 53. The mortality of the conservatively treated patients was 21.8%, for the operative group the mortality was 8.3%, while the ISS was the same in both groups. From these results we conclude that unstable pelvic fractures, which are almost invariably associated with other serious injuries, should be treated aggressively by external and/or internal fixation.
Adult↗
Histological features of wound repair: a comparison between experimental ileal and colonic anastomoses.
Various histological parameters of wound repair have been studied in intestinal anastomoses in the rabbit in order to compare the healing processes in ileum and colon. The sequentional appearance of granulocytes, macrophages and fibroblasts has been studied from 3 h to 7 days after operation. Also, degree of necrosis, formation of capillaries and mucosal repair were analysed semi-quantitatively. Significant differences were observed between ileal and colonic anastomoses with respect to occurrence of granulocytes, necrosis and mucosal repair, particularly 7 days after operation. At that time, granulocytes and necrosis were virtually absent from ileal anastomoses, while mucosal integrity was restored in the majority of cases examined. In contrast, granulocytes and necrosis were still abundantly present in colonic anastomoses and mucosal repair was poor. These results support biochemical evidence that wounds in the ileum heal more rapidly than wounds in the colon. Possibly, the sustained presence of granulocytes, which are a potential source of collagenase activity, is important in this respect. Investigation of the same features of intestinal wound healing in rabbits with peritonitis induced by infection showed similar results and no differences were found between infected and non-infected animals.
Animals↗
Lisfranc dislocations: fractures and/or dislocations through the tarso-metatarsal joints.
Because of the anatomical configuration of the tarso-metatarsal joints with their strong ligamentous connections, pure dislocations in this region are rare. We describe our experience of 24 cases of Lisfranc dislocation. Classification is according to Wilson. In the long term, functional and radiological results appear to depend on the accuracy of reduction. For good anatomical results, immediate closed or, if necessary, open reduction and stabilization by percutaneous Kirschner wires is required. Because of the severity of soft tissue damage, decompression with dorsal skin incisions should also be considered.
Adolescent↗
A reproducible model for protracted peritonitis in the rabbit.
The intra-abdominal implantation of a gelatin capsule containing human fecal material introduces peritonitis in the rabbit. The severity of the disease and the length of survival depend on the volume of the inoculum. A 7-day survival chance varies between 45 and 92%, depending on fecal loading. All rabbits develop intra-abdominal abscesses and in the surviving animals infection persists for at least a week, allowing further study of several aspects of peritonitis.
Abscess↗
Papillary cystadenoma of the epididymis.
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Adult↗
Findings in patients with diverticulosis and diverticulitis of the colon.
During the period from 1957 up to and including December 1975, the surgical clinic of Nijmegen admitted 82 patients with the diagnoses of diverticulosis and diverticulitis of the colon: the diagnosis of diverticulosis was made in 16 cases; in 17 diverticulitis was diagnosed and these patients were treated by conservative methods. Forty-nine patients were subjected to operation for diverticulitis. Of the patients treated conservatively, none died; of those treated by operation, three (6%) died. There were nine patients with peritonitis and three with ileus who required emergency surgery. As a matter of principle these patients were treated in several stages; none of them died.
Adult↗
Conservative treatment of fractures of the acetabulum. Results after longtime follow-up.
In a retrospective study the long-term results of conservative treatment of acetabular fractures has been evaluated. From 1967 through 1983, 79 patients with 81 fractures of the acetabulum were treated. The fractures were classified according to Judet and Letournel (1). Out of these 79 patients 83% had multiple injuries. The mean Injury Severity Score was 34 (9-75). Follow-up examination was performed in 55 patients. Partial avascular necrosis of the femoral head appeared in 11%. Fractures without dislocation had all a good prognosis. Fractures with dislocation, where the anterior column was involved, had a relative similar prognosis. In 79% of patients, where the dorsal column or roof of the acetabulum was involved, had a moderate or bad result. We conclude that no optimal result can be expected, when in dorsal column or acetabular roof fractures the reposition achieved by conservative treatment is insufficient. In these cases operative reposition and fixation should be considered.
Acetabulum↗
Cyste per magna abdominalis.
A 79-year old woman, presented with fever and a large abdominal mass. She was operated on because an infected ovarian cyst was suspected. A very large pseudocyst was found, containing a surgical gauze pad, left behind 67 years earlier during a nephrectomy. This is the longest interval, the only infected and the largest pseudocyst reported in the literature till now.
Abdomen↗