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Biomedical subjects

A Vos

Publications and source records attributed to A Vos.

At least 19 recordsLinked to original sources
PubMed1995

[Surgical treatment of life-threatening mediastinitis following esophageal perforation or leakage after esophagus surgery].

OBJECTIVE: Evaluation of the surgical treatment of life-threatening mediastinitis following oesophageal perforation or leakage after resection for oesophageal cancer. DESIGN: Descriptive retrospective. SETTING: Department of Surgery, University Hospital Utrecht. METHODS: Between June 1989 and October 1994, 18 patients with severe mediastinitis and sepsis following perforation of the oesophagus or leakage after oesophageal resection for oesophageal cancer were treated with aggressive surgery. (Peri-)anastomotic leakage was the cause of mediastinitis and sepsis in 14 patients, 3 patients perforated during endoscopy and 1 patient suffered a spontaneous perforation. Aggressive surgery consisted of removing the oesophageal replacement from the mediastinum, creating an oesophago-cutaneostomy and a feeding enterostomy and drainage of the mediastinum and interpleural spaces. RESULTS: All patients survived; however, postoperative morbidity was high. The alimentary tract was reconstructed in 15 patients. CONCLUSION: Aggressive surgical treatment of life-threatening mediastinitis and sepsis as described here can save severely ill patients. Because of the high postoperative morbidity level only patients with perforations of the oesophagus and early stages of oesophageal cancer should be operated.

Adult↗
PubMed1995

[Complications of an intravenous administration system (Port-A-Cath) in children with an oncologic disease].

OBJECTIVE: To describe complications of the use of an intravenous administration system (Port-A-Cath; PAC) in children. DESIGN: Retrospective record analysis. SETTING: Emma Children's Hospital, the Children Academic Medical Centre, Amsterdam. METHOD: From January 1989 to January 1992, 66 children aged 1 to 20 years were treated via a PAC system for malignant disease. 70 PACs were implanted with a cumulative period of use of 27,981 days. RESULTS: In one-third of the patients (36%) one or more complications arose. Most common were infection (16 times) and obstruction (8). Tip dislocation, secondarily infected haematoma, leakage, thrombosis and infiltrate occurred occasionally. Almost 50% of the complications could be treated effectively. In the other cases the PAC system had to be removed. CONCLUSION: The advantage of a PAC for oncological patients is the improvement of the quality of life, as it provides a simple and painless access to the venous system. Complications occur regularly, however. Reduction of the number of complications should be the start of further perfection of the PAC system.

Adolescent↗
PubMed1995

Long-term anorectal function after Duhamel operation for Hirschsprung's disease.

Long-term anorectal function was assessed in children operated on using Duhamel's technique for Hirschsprung's disease. The files of 75 patients (16 girls and 59 boys) operated on between 1977 and 1991 were reviewed. Questionnaires were analysed on 63 (12 girls and 51 boys) over 2 years of age. The median age at completing the questionnaire was 6.6 years. Forty-one of these 63 patients had aganglionosis of the rectosigmoid, 15 of a long colonic segment, and 7 of the total colon. Of 14 children age 4 or less, 6 had severe constipation, whereas 8 had regular spontaneous defaecation. Ten of the 49 over 4 years of age were continent without constipation, 22 had soiling and/or constipation, and 17 were incontinent, one of whom had a permanent colostomy. There was no correlation between age or sex and anorectal function. Anorectal function in children with long segment was not worse than in those with rectosigmoid aganglionosis, but only 1 of 7 with total colonic aganglionosis was continent. Because many adapt themselves to the handicap, symptoms are often underreported. A detailed questionnaire appears to be a reliable tool for elucidating the real situation. A systematic follow-up of patients with Hirschsprung's disease is proposed to anticipate the complications and to institute proper measures at an early stage.

Anal Canal↗
PubMed1995

Tracheal left mainstem bronchus and obstructive gastric mucosal intussusception associated with esophageal atresia.

A tracheal left mainstem bronchus and gastric outlet obstruction owing to gastric mucosal intussusception occurred in a child who had esophageal atresia and tracheoesophageal fistula. Bronchography and bronchoscopy, indicated because of persisting atelectasis and ventilation dependency, showed a tracheal left mainstem bronchus. The atelectasis disappeared after reimplantation of the left mainstem bronchus into the carina. Feeding problems and recurrent pulmonary infections complicated the postoperative course. Radiographic imaging and esophagogastroscopy showed severe reflux esophagitis and a prepyloric mass that consisted of a gastric mucosal intussusception. Subsequent gastrotomy and resection of the intussuscepted mucosal fold relieved the gastric outlet obstruction. An antireflux procedure was performed simultaneously. The child recovered satisfactorily. It is suggested that gastric mucosal intussusception may be associated with esophageal atresia rather than with the presence of a gastrostomy tube, as has been proposed in the literature.

Abnormalities, Multiple↗
PubMed1995

Primary liver tumours in children.

An overview is presented of current management strategies in primary hepatic tumours in children. Recent advances include research in the genetic and molecular properties, especially of hepatoblastoma, the application of pre-operative chemotherapy, and the development of pre-surgical staging. Problem areas include management of relapse, chemotherapeutic drug resistance and multifocality. Hepatocellular carcinoma continues to have a much worse outcome than hepatoblastoma.

Adolescent↗
PubMed1995

Posterior sagittal anorectoplasty: functional results of primary and secondary operations in comparison to the pull-through method in anorectal malformations.

BACKGROUND: Control of defaecation after surgical correction of high and intermediate types of congenital anorectal malformations is difficult. The posterior sagittal approach with careful reconstruction of the external sphincter is postulated to give a better outcome than the pull-through operation. The functional results of these procedures performed in one centre were evaluated in order to identify prognostic factors. MATERIAL AND METHODS: Between 1979 and 1992 66 patients with high or intermediate congenital anorectal anomalies were treated in our centre. In 16 patients a pull-through operation (Kĩesewetter-Rehbein) was performed. After 1984, the posterior sagittal anorectoplasty (PSARP) (Peña and deVries) was used in 35 patients as the primary operation. In 22 patients a PSARP operation was done as a secondary procedure, in one third of these patients after a previous pull-through operation in our centre. The functional results were analysed in retrospect. RESULTS: Sixty operations in 53 patients could be evaluated. The overall continence rate was 34%. After the pull-through operation six out of 15 patients (40%) were continent, after a primary PSARP 10 out of 25 (40%) and after a secondary PSARP operation five out of 20 patients (25%). Patients with a sacral defect were continent only in 16% as compared to 44% of the patients with a normal sacrum. Sex was also relevant: 67% of the girls were continent, compared to 30% of the boys. Ten out of 11 girls (90%) with a normal sacrum became continent. CONCLUSION: The PSARP for high and intermediate anorectal malformations does not give better functional results than the pull-through operation. The prognosis is determined by other factors than the type of operation, notably sex and the presence or absence of sacral defects.

Anal Canal↗
PubMed1994

A rare complication of acute appendicitis: complete bilateral distal ureteral obstruction.

Three children treated for appendicitis developed anuria and acute renal insufficiency several days after appendicectomy. Associated hydronephrosis or hydroureters were present in two. At cystoscopy, marked swelling of the trigonum and ureteric orifices was seen. One patient developed unilateral acute tubular necrosis, a complication not reported before. Recognition of this rare complication of acute appendicitis, which need not be accompanied by hydronephrosis, should lead to prompt decompression by the introduction of ureteric stents.

Acute Disease↗
PubMed1994

Ruptured aortic aneurysm: early postoperative prediction of mortality using an organ system failure score.

Ruptured abdominal aortic aneurysm (AAA) is a personal and public health catastrophe because of the high and unimproving mortality rate, increasingly long intensive care unit (ICU) stay and rising hospital costs. Criteria are needed to identify patients with a poor prognosis so that treatment and resources may be directed to those with a better outlook. This retrospective study reviews perioperative variables, outcome and length of ICU stay for 99 consecutive patients with operated ruptured infrarenal AAA between 1985 and 1992 who reached the ICU alive. Early death (within 48 h) occurred in 20 per cent using 24 ICU days and late death (after 48 h) occurred in 29 per cent using 420 ICU days; neither type of death could be predicted before operation. Multiple organ failure, the cause of 93 per cent of late deaths, was assessed for each patient 48 h after operation using an organ system failure score. There was a strong positive correlation between organ system failure score and mortality rate (P < 0.00001); all 20 patients with more than two failing organ systems died. If used in decision making the score would have saved 43 per cent of the ICU days associated with late mortality. Withdrawing postoperative treatment at an early stage in accordance with an organ system failure score may be a defensible and cost-effective option.

Aged↗
PubMed1994

Circulating cornea-specific antibodies in corneal disease and cornea transplantation.

In order to establish the significance of circulating cornea-specific antibodies, we determined the presence of anti-corneal antibodies in the serum of 100 patients with corneal disease and in 50 healthy controls, and subsequently followed the pattern of antibody reactivity in 46 patients who underwent corneal transplantation. An indirect immunofluorescence test on cryostat sections of rabbit corneas was used for screening. The reactivity against two known bovine corneal epithelial proteins was also tested: a 54-kD protein (BCP 54) and an 11-kD protein (BCP 11/24). No significant difference in the presence and specificity of anti-corneal antibodies was observed between the group of patients with corneal disease, taken as a whole, and the healthy controls. Patients with keratoconus or non-immunological graft failure, however, were significantly more often positive for anti-corneal antibodies. Neither the presence of antibodies prior to corneal transplantation nor their appearance post-transplantation had a predictive value for corneal graft survival.

Aldehyde Dehydrogenase↗
PubMed1994

Risks and benefits of antireflux operations in neurologically impaired children.

Gastro-oesophageal reflux (GER) in neurologically impaired children often causes feeding problems and complications of oesophagitis and is frequently resistant to medical treatment. Fifty neurologically impaired children underwent anterior gastropexy as anti-reflux operation, combined with gastrostomy in 23, between 1976 and 1992. There was no operative mortality. There were 25 early complications in 14 patients and 9 late complications in 9 patients. Twelve patients needed 17 re-operations for delayed gastric emptying [4], intestinal obstruction [3], para-oesophageal hernia [3], oesophageal stenosis [4], and recurrent GER, revision of gastrostomy, subphrenic abscess (one each). Nine patients died during the follow up period. Death in two children was related to the operation (incarcerated para-oesophageal hernia and blow-out of the stomach). Out of 41 survivors, the operation was judged successful in 35. It is concluded that antireflux operations in neurologically impaired children carry a high risk of complications. Preoperative identification of risk factors is not possible. The improvements in the quality of life achieved in the majority of patients outweigh the risks.

Adolescent↗
PubMed1994

Induced refractive errors and pattern electroretinograms and pattern visual evoked potentials: implications for clinical assessments.

Refractive errors were induced in normal subjects by means of positive dioptre lenses to reduce visual acuity (VA) from an initial level of 20/20 to 20/100 and then to 20/200. Pattern electroretinograms (PERGs) and pattern visual evoked potentials (PVEPs) were simultaneously recorded at each of these 3 levels of VA using high contrast checkerboard stimuli subtending 11' and 42' of visual arc. Attention was paid to PERG and PVEP variables used for clinical assessments. The findings confirmed the need to take refractive errors into account because, in some cases, latencies and particularly PERG amplitudes fell outside normal limits with decreased VA, especially when using smaller checks.

Adult↗
PubMed1994

Four cases of bladder exstrophy in two families.

Bladder exstrophy is a rare congenital anomaly, caused by abnormal development of the cloacal membrane. To our knowledge, 18 familial patients with this malformation have been described. Two sets of familial cases with bladder exstrophy are reported here: two cousins and a mother and son and the published reports of the 18 familial cases among 682 index patients with bladder exstrophy are reviewed. Ultrasonography is advocated as the investigation of choice for early prenatal diagnosis.

Bladder Exstrophy↗