Search PubMed⌕ Search

Biomedical subjects

A P Boll

Publications and source records attributed to A P Boll.

12 recordsLinked to original sources
PubMed1998

[The regional explantation team: an important contribution to organ procurement for transplantation in the Netherlands].

If organ donations concern not only the kidneys, but also the liver, pancreas and, sometimes, the heart and (or) lungs, several surgical removal teams, often from different (foreign) transplantation centres, may be involved. This has created organizatory problems resulting in loss of organs for transplantation. In the Nijmegen area since October 1994 a removal team has been active that in the regional donor hospital removes all abdominal organs from the donor on behalf of the various transplantation centres. This regional removal team performed 105 multi-organ explanations in the period from October 1994 to December 1997. The reports that came back from the transplantation centres that had received the organs showed that none of these organs had been lost for transplantation through organizatory problems or anatomical damage. Experiences of operating room staff involved were positive: it was especially the standard surgical techniques and the quiet in the operating room that were appreciated. Special removal teams may greatly improve the evolution of organ donation in the Netherlands.

Female↗
PubMed1998

[Two cold legs].

Bilateral acute lower limb ischaemia is rare. Usually the diagnosis is based on clinical findings. In four patients, three women aged 51, 48, and 72 and a man aged 64 years, bilateral acute ischaemia of the lower limbs was diagnosed, due to different causes: arterial cardiac myxoma embolism, arterial thrombosis probably due to paraneoplastic coagulopathy, aortic dissection, and arterial thrombosis due to cardiac insufficiency, respectively. The management of these conditions includes restoring the circulation as soon as possible. Reperfusion can be achieved by thromboembolectomy or thrombolysis. In patients with underlying atherosclerosis angiography is useful, but time loss must be avoided. The outcome in patients with bilateral ischaemia of the lower limbs depends on the preoperative ischaemia time and the cardiac situation. The mortality varies between 20 and 50%.

Aged↗
PubMed1998

High prevalence of abdominal aortic aneurysm in a primary care screening programme.

BACKGROUND: The mortality rate associated with ruptured abdominal aortic aneurysm (AAA) remains high. The objective of this study was to assess the feasibility of population screening for AAA. METHODS: In an area with a mixed rural and industrialized population of 60000 inhabitants, all 23 general practitioners (GPs) participated. The GPs selected from their patient lists men aged 60-80 years. Men whose condition was suitable for aortic surgery were invited for screening by a single postal letter. All men responding had aortic ultrasonography in or close to the GP surgery. Diagnosis of AAA was established when the aortic diameter was 30 mm or greater. Referral for surgery was advised for an aortic diameter of 50 mm or greater. RESULTS: Of 2914 invitations, 2419 men had ultrasonography, resulting in an attendance rate of 83.0 per cent. A total of 2416 aortic measurements were made; 196 aortic aneurysms were diagnosed (prevalence 8.1 per cent). In 40 men the aortic diameter was over 50 mm. CONCLUSION: Ultrasonographic screening for AAA is feasible in a primary care setting.

Age Distribution↗
PubMed1997

Doppler spectrum analysis versus direct femoral artery pressure measurement for rapid assessment of aortoiliac obstruction.

Adequate patient selection is required to limit the clinical workload and improve the cost-effectiveness of noninvasive hemodynamic evaluation of the aortoiliac system. In a prospective blinded fashion the traditional invasive technique of direct femoral artery pressure measurements and the computerized Doppler spectrum analysis of blood flow velocities in the common femoral artery were studied. Both tests for rapid assessment of aortoiliac obstruction were compared with duplex ultrasonographic imaging, using a peak systolic velocity ratio of 2.5 to demonstrate stenoses of 50% or more. In a series of 17 consecutive patients (34 aortoiliac segments) with suspected aortoiliac obstructive disease, a good level of agreement (kappa = 0.6) was found for both methods when compared with duplex scanning. Analysis of deviations from the duplex registrations indicated an overestimation of the pathologic cases using femoral artery pressure measurements and an underestimation using Doppler spectrum analysis of blood flow velocities in the common femoral artery. Both methods were well tolerated, but femoral artery pressure measurements had a higher technical failure rate. Because of its noninvasive character and its feasibility the Doppler technique is preferred for the selection of patients for more extensive duplex sonographic investigation.

Aortic Diseases↗
PubMed1996

Relevance of bacterial cultures of abdominal aortic aneurysm contents.

BACKGROUND: To establish further insight into the relevance of intraoperative bacterial cultures of abdominal aortic aneurysm contents a study was performed of the rate of occurrence of prosthetic graft infection after aneurysm repair. METHODS: Bacterial cultures were obtained from 216 patients, who were followed up for more than 3.5 years after operation and studied retrospectively in a single center analysis. RESULTS: Thrombus cultures yielded bacteria in 55 of 216 (25.5%) cases, including 11 of 44 (25%) cases with ruptured aneurysms. Prosthetic infections (4 of 216; 1.9%) occurred more frequently (p < 0.02) in patients with positive thrombus cultures (3 of 55; 5.5%) than in patients with negative cultures (1 of 161; 0.6%). In two patients the species isolated from the thrombus was also cultured from the vascular prosthesis, although in one graft infection other organisms were also isolated. CONCLUSIONS: The presence of bacteria in the intraluminal thrombus does not appear to be an important factor in the development of graft infection after primary elective and urgent abdominal aortic aneurysm repair. Therefore routine intraoperative cultures are unnecessary unless clinical signs of infective aortitis are present.

Aged↗
PubMed1996

Fate of renal allografts connected to vascular prostheses.

OBJECTIVE: The outcome of renal transplantation with an arterial anastomosis to a vascular prosthesis in the aortofemoral tract is evaluated. PATIENTS AND METHODS: All 7 Dutch transplant centers were invited to review their experience. Among a total of 5791 cadaveric renal transplantations performed between 1978 and 1994, 13 cases (0.2%) in 3 different centres were identified. In 6 cases the vascular reconstruction and transplant operation were performed simultaneously, and in 7 cases separately, with a mean interval of 3.5 yr. The indications for vascular reconstruction were aneurysmal disease in 4 and obstructive disease in 9 cases. RESULTS: The early vascular complications of these procedures were hemorrhage in 4 and renal vein thrombosis in 1 and led to graft loss in 3 cases. The perioperative mortality was 2/13 (15%). The graft and patient survival were 68 and 83% respectively after 1 yr and 17 and 37% after 5 yr. Late mortality was mainly due to cardiovascular disease. CONCLUSIONS: Renal transplantation with an arterial anastomosis to a vascular prosthesis in the aortofemoral tract is a hazardous procedure with relatively poor short- and long-term results. These observations should be considered in the choice of renal replacement therapy in this special patient population.

Adult↗