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Biomedical subjects

A Hubens

Publications and source records attributed to A Hubens.

At least 73 records · Page 4Linked to original sources
PubMedDate not supplied

Surgical training in a statutory health insurance system: Belgian experience.

Health care delivery in Belgium is based on a compulsory insurance system, installed and controlled by the government since 1945 for employees; in 1963 the system was expanded to include self-employed citizens. Mutual benefit organizations act as insurance carriers for all patients, whether cared for in the office or hospital. The cost of state-financed medical care has grown to such an extent during the last few decades that cost-sharing in ambulatory practice is being extended to in-clinic services. The free choice of practitioners as well as free access to medical and specialist education have always been keystones of the Belgian medical care system. A well regulated scheme of surgical training combined with strict rules imposed on instructors, hospitals, and trainees guarantee high quality and state-controlled surgical education. Developments in the Belgian political landscape may considerably affect health care delivery and surgical education. A constant rise in the number of medical practitioners and the sociopolitical discrepancies between the Flemish and French speaking parts of the federalized kingdom have paralleled burgeoning medical health care costs and have induced rationalization and possibly federalization of health care delivery as well as ongoing debates concerning the limitation of medical and surgical practitioners.

Belgium↗
PubMedDate not supplied

Late recurrence following treatment of anal canal carcinoma.

A late pelvic recurrence of a cloacogenic anal canal carcinoma, occurring eleven years after an abdominoperineal resection, is reported in a 61-year old female patient. The primary tumour, 2.5 cm in diameter had infiltrated the rectal wall but did not show any evidence of local lymph node involvement on pathological examination. Recurrence of this disease is frequently considerably delayed, with several cases recurring after 5 or more years. This tendency to late recurrence clearly limits the reliability of short-term survival data. Current concepts concerning the management of malignant tumours of the anal canal are discussed from this point of view.

Anus Neoplasms↗
PubMedDate not supplied

The value of short-term peripheral parenteral nutrition after colorectal surgery: a comparative study with conventional postoperative intravenous fluid.

The potential beneficial effect of postoperative peripheral parenteral nutrition (PPN) was assessed in ten patients undergoing colorectal surgery and compared with the conventional use of intravenous fluids in ten controls. Clinical and biological parameters were checked. A significant improvement in the nitrogen-balance, which was not positive during the first postoperative days was observed. All other daily measured parameters (lipid metabolism, electrolytes, glucose levels and plasma pH) remained within normal ranges. In our opinion, short-term postoperative PPN may lessen protein losses and is indicated in those patients who may have a prolonged paralytic ileus without risking complications of central venous access. However, peripheral solutions may cause phlebitis and PPN is by no means an alternative to central TPN.

Aged↗
PubMedDate not supplied

Emergency oesophageal stripping, an aggressive approach to acute, necrotic caustic burns of the oesophagus and stomach.

The authors describe a patient who was admitted with total necrosis of the oesophageal and gastric mucosa after ingestion of concentrated sodium hydroxide solution. An emergency total gastrectomy and blunt, thoracic oesophageal stripping was performed. Three months later, the continuity of the digestive tract was restored by a retrosternal colon interposition. The necessity of an aggressive diagnostic and therapeutic approach after the ingestion of caustics is recommended. An emergency endoscopic evaluation of the upper G.I. tract is mandatory. If a third degree oesogastric mucosal burn is diagnosed urgent laparatomy should be performed to assess transmural wall necrosis. If present an oesophageal gastrectomy should be performed as a life saving intervention.

Adult↗
PubMedDate not supplied

A prospective comparative clinical study between monofilament absorbable and non-absorbable sutures for abdominal wall closure.

One hundred and sixty-seven patients undergoing laparotomy were randomly allocated to a continuous layered closure technique with absorbable monofilament polyglyconate (PG) (Maxon*) or non-absorbable polyamide (PA) (Ethilon*). Laparotomy wounds were closely observed during the postoperative hospital course and all patients were reviewed at one month, six months and one year. Any wound complications were noted. Two patients in the PA group (3.0%) presented with burst abdomen and one (1.9%) in the PG group (ns). The incidence of incisional hernia was not statistically different between the two groups (4/64, 6.0% in PA group and 4/65, 6.2% in PG group). The postoperative wound infection rate was 21.0% in the Pa group and 15.4% in the PG group (ns). The present study clearly shows a major increase in incidence of wound failure in patients with infected abdominal wounds in both groups (28.6% vs 3.8% in PA group p less than 0.025; 20% vs 5.5% in Pg group p less than 0.05). This clinical trial confirms the important roles of wound infection and respiratory failure in the occurrence of wound failure; the choice of an absorbable or a non-absorbable suture material seems to play a minor role only.

Abdominal Muscles↗
PubMedDate not supplied

Colostomy closure: still a hazardous procedure.

Seventy nine patients with closure of a loop (51 patients) or a terminal (28 patients) colostomy were reviewed retrospectively. Operative mortality was 2.5%. Wound infection in 19% and anastomotic breakdown in 7.7% were the most important postoperative complications. Restoring continuity after a Hartmann intervention, closure of left sided colostomies and early closure (before 12 weeks) all accounted for a statistically significant higher complication rate, while age and sex, the underlying disease, bowel preparation and the method of closure had no influence on the operative outcome.

Colostomy↗
PubMedDate not supplied

Problems in the surgical treatment of motility disorders occurring after gastric surgery.

Delayed or accelerated gastric emptying and excessive reflux of upper intestinal contents into the stomach are the main disorders of motility occurring after gastric surgery. Most of these syndromes may be treated by conservative measures. When surgical therapy is needed attention must be paid to the possible specific side effects of remedial treatment. Interposition of a reversed jejunal loop in the treatment of dumping after Billroth I gastrectomy may be responsible for the development of an anastomotic ulcer. Roux-en-Y biliary diversion for the surgical treatment of postoperative reflux alkaline gastritis may result in a Roux-en-Y syndrome characterized by severe, delayed gastric emptying. Whenever possible, the pyloric sphincter should be preserved in gastric surgery as the elimination of the pylorus is the main cause of postoperative motility disorders.

Duodenogastric Reflux↗
PubMedDate not supplied

Upper gastrointestinal bleeding due to benign tumours of the stomach.

Benign tumours of the stomach are usually asymptomatic and are discovered incidentally during radiology, endoscopy or pathological examination. In some cases, however, these tumours produce overt clinical symptoms. The authors report eight patients with significant upper gastrointestinal bleeding due to benign gastric tumours, who required surgical resection of their lesion. Histologically, the growths proved to be leiomyoma in five cases, polyps in two and lipoma in one. Surgical treatment consisted in local excision in three patients and subtotal gastrectomy in five patients. Bleeding was stopped in all cases and there was no operative mortality.

Aged↗
PubMedDate not supplied

[Enteral nutrition in gastrointestinal fistulas. Review of the literature].

The use of enteral feeding systems in patients with enterocutaneous fistulae is reviewed. The following problems are discussed: methods of administration, effects of enteral nutrition on patients with a gastro-intestinal fistula, clinical results (nutritional schemes, timing of nutritional support and caloric input). It is concluded that an enteral feeding system is the first choice in cases of distal GIT-fistulae, and in low-output fistulae. In other cases, it may be used in combination with TPN. The need for fistula-registration is thought to be of importance in view of prospective studies in this field.

Energy Intake↗
PubMedDate not supplied

The use of muscle flaps in leg soft tissue defects.

The use of muscle transpositions following the technique of Ger is discussed in fifteen cases where important soft tissue defects in the leg, some of them combined with complicated fractures, made spontaneous healing or coverage with split skin grafts impossible.

Adolescent↗
PubMedDate not supplied

[Treatment of anal fistulas].

It is generally accepted that laying-open constitutes the only effective cure for anal fistulae. The sacrifice of at least some part of the anal sphincter apparatus is therefore the inevitable consequence of every operation for fistula. In the case of an intersphincteric or low-trans-sphincteric fistula, only the internal sphincter or the lower half of the external sphincter need to be incised. This may usually be performed without endangering postoperative faecal continence. High trans-sphincteric or suprasphincteric fistulae, however, involve the entire external sphincter and/or the puborectalis muscle. Straightforward trans-section of these sphincters would lead to faecal incontinence. For this reason such high fistulae should be progressively laid open in staged procedures, after encircling the sphincters for some weeks with a seton. The same procedure should also be employed for complex horseshoe-shaped fistulae. Contrary to traditional teaching, anal fistulae in Crohn's disease are no exception to these general therapeutic guidelines. Finally, exploration for an underlying fistula and, if possible, immediate fistulotomy are advocated for all patients with an acute perianal abscess.

Abscess↗
PubMedDate not supplied

The screening value of the amylase-creatinine clearance ratio in acute pancreatitis.

The screening value of the amylase creatinine clearance ratio in acute pancreatitis is studied. A series of 28 patients with pancreatic disease is compared with 80 controls and 82 patients with other intra-abdominal disease. The greatest specificity of the amylase creatinine clearance ratio value is reached at the 3.5 level. The amylase creatinine clearance ratio value proves to be of interest, not only in the diagnosis of acute pancreatitis but also in differentiating mild and heavy forms of pancreatitis.

Abdomen, Acute↗