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Biomedical subjects

C M Bruyninckx

Publications and source records attributed to C M Bruyninckx.

At least 19 recordsLinked to original sources
PubMed1995

The Gracz arteriovenous fistula evaluated. Results of the brachiocephalic elbow fistula in haemodialysis angio-access.

OBJECTIVES: To assess fistula patency and complication rates in braciocephalic elbow fistulas of both the Gracz and the side-to-side configuration. DESIGN: Retrospective clinical study. METHODS: Life table patency and complications of 50 Gracz fistulas and 23 side-to-side elbow fistulas created between 1988 and 1993 were reviewed. RESULTS: The cumulative patency for the elbow fistulas was 84% after 1 year and 78% after 3 years. No difference was found between the Gracz fistula and the side-to-side elbow fistula. Stenosis was the most frequent indication for revision and thrombosis was the most frequent cause of fistula failure. CONCLUSION: The elbow fistula has a long patency with few complications and performs as well as wrist fistulas and better than the graft fistulas reported in the literature. The Gracz elbow fistula has results as good as the side-to-side elbow fistula. Graft fistulas should be reserved for tertiary procedures only.

Adolescent↗
PubMed1994

The brachiocephalic elbow fistula: a useful alternative angioaccess for permanent hemodialysis.

PURPOSE: Wrist fistulas are increasingly difficult to establish in the aging hemodialysis population. We assessed fistula patency and occlusion rate in elbow fistulas compared with wrist and graft fistulas. METHODS: We analyzed all 104 fistulas created in all 68 patients who underwent hemodialysis during October 1993 at the St. Joseph General Teaching Hospital, Veldhoven, The Netherlands. Life-table patency and complications were analyzed for 31 elbow fistulas, 56 wrist fistulas, and 17 polytetrafluoroethylene or saphenous vein graft fistulas. RESULTS: The patency rate for elbow fistulas was 93% at 1 year and 80% at 3 years. Wrist fistulas had a patency rate of 76% at 1 year and 65% at 3 years. Graft fistulas had a poorer patency rate: 69% at 1 year and 62% at 3 years. There were significantly more failures in the wrist fistulas (p < 0.02). Thrombosis accounted for most fistula failures. Venous stenosis was the most frequent indication for revision. The high incidence of concomitant diseases was not related to fistula outcome. CONCLUSIONS: The elbow fistula performed better than the wrist fistula. Liberal use of the elbow fistula is justified, especially when the epifascial veins or the radial artery at the wrist is in poor condition. Graft fistulas should be reserved for tertiary procedures.

Adolescent↗
PubMed1993

[Traumatic carotid artery stenosis with cerebral infarct].

After an accident causing a wound beside the larynx a 17-year-old male was diagnosed as having a cerebral haemorrhagic contusion. He was treated conservatively, when six weeks later uncertainty about the diagnosis prompted angiography of the common carotid arteries. The diagnosis had to be revised: a traumatic occlusion of the carotid artery. The patient's favourable recovery was credited to development of a good collateral circulation to which his relative youth contributed. Traumatic occlusion of the carotid artery should be considered when neurological disorders are apparent but the patient is conscious, especially when there is a symptom-free interval.

Adolescent↗
PubMed1992

[Simple ligation superior to inversion of the appendiceal stump; a prospective randomized study].

OBJECTIVE: To compare two methods of treatment of the appendix stump after appendectomy for acute appendicitis. DESIGN: A prospective randomised trial of 134 consecutive appendectomies in which the appendix stump was either simply ligated or ligated and doubly invaginated. SETTING: Department of General Surgery, St Joseph Hospital, Veldhoven, the Netherlands. PATIENTS AND METHODS: During a period of 15 months all patients in whom an appendectomy for acute appendicitis was performed were allocated at random to the two groups. The following data were recorded: age, sex, histological diagnosis, hospital stay and occurrence of complications. All patients were followed until 6 months after the operation. The data were analysed statistically with the chi-square-test and the Mann-Whitney test. P less than 0.05 was considered significant. RESULTS: The appendix stump was ligated in 79 patients and invaginated in 55. Both groups were similar with respect to age, sex, degree of appendiceal inflammation, antibiotic treatment and hospital stay. There were significantly more wound infections in the 'invagination' group (p = 0.017). The other complications showed no statistical intergroup difference. CONCLUSION: Simple ligation facilitates and shortens appendectomy. It is a safe procedure, preventing deformation of the caecal wall and possibly reducing the risk of postoperative ileus due to adhesions. We therefore recommend simple ligation as the standard procedure at appendectomy.

Adolescent↗
PubMed1991

[Medium-long-term good results of vertical gastroplasty in the treatment of morbid obesity].

To determine the long-term results of the surgical treatment of patients with morbid obesity, a retrospective analysis of the patients in whom a vertical banded gastroplasty according to Mason was performed in the period 1982-1990 was carried out in the department of General Surgery, St. Joseph Hospital, Veldhoven, the Netherlands. In a series of 20 patients (4 men and 16 women) with a mean age of 32 (17-53) years who were eligible for treatment according to international criteria surgery was performed. The preoperative weight averaged 124 (94-207) kg and the mean preoperative excess weight was 60 (37-132) kg. Immediate postoperative complications occurred in 5 and late complications in 7 patients. Revision for technical complications was necessary in 2 patients. Twelve patients were followed up for more than 4 years. The mean weight loss after 4 years was 37 (18-89) kg, which was 28 (18-43) per cent of the mean preoperative weight and 62 (31-89) per cent of the mean preoperative excess weight. The 4-year results were unsatisfactory (less than 50 percent excess weight loss) in 3 of the 12 patients. It is concluded that vertical banded gastroplasty in our hands seems a relatively safe and effective surgical method of achieving sustained weight loss in most patients.

Adolescent↗
PubMed1991

[Initial experiences with laparoscopic cholecystectomy].

Laparoscopic cholecystectomy was performed in 45 patients for treatment of symptomatic gallbladder disease. The age distribution was 23 to 79 years. In four patients the procedure was not completed and a laparotomy was performed to remove the gallbladder: once because of a defective instrument, once because of bleeding of an omental adhesion and twice because of disturbed anatomy of the cystic duct region by inflammatory tissue. In four cases a laparoscopic cholecystectomy was performed because of an acute cholecystitis and in three cases a laparoscopic cholecystectomy à froid was performed. There were three postoperative complications: one case of bleeding and two cases of leakage of bile during five and ten days, respectively. In all these cases the treatment was conservative and laparotomy was not necessary. The postoperative hospital stay varied between 3 and 11 days with a mean of 4.2 days. The period of unfitness for work after leaving hospital ranged from one to three weeks. If for whatever reason the laparoscopic procedure cannot be completed, a laparotomy to remove the gallbladder should be performed in the same session. Laparoscopic cholecystectomy is a new, safe, less invasive method to remove the gallbladder with significant benefit to the patient. The morbidity is low and the hospital stay is short. A considerable reduction of costs is achieved with this treatment.

Adult↗
PubMed1991

A near fatal complication of an extra-anatomic aortic graft.

The case report is presented of a patient with a potentially lethal embolism secondary to thrombosis of a supraceliac distal thoracic aorta to femoral artery bypass. In view of this serious complication, wide use of this type of extra-anatomic bypass does not seem to be warranted.

Angiography, Digital Subtraction↗
PubMed1990

Carpometacarpal dislocation: report of three cases.

The case reports of three patients with carpometacarpal dislocations are described. The diagnosis of this condition may be difficult and is often missed. Swelling, dislocation and a palpable lump are the main clinical findings. X-ray findings, the key to the diagnosis, are loss of parallelism, interruption of the so-called M-line and overlapping of articular surfaces. Additional X-rays in different planes are to be recommended if carpometacarpal dislocation is suspected.

Adult↗
PubMed1988

The use of arm veins as peripheral vascular grafts.

Below-knee femoro-popliteal and especially femoro-distal bypass with nonautologous bypass material is met with poor patency rates. During an eight-year period, nine (composite) arm-vein grafts were done in eight patients. In only one patient, the arm-vein bypass was a primary procedure. In four patients this concerned a secondary procedure and in four a tertiary procedure. All eight patients demonstrated critical ischaemia of the affected limb. Distal anastomosis involved the below-knee popliteal artery in three cases and the tibial artery in the remainder six. In all but one case runoff was poor to extremely poor. Notwithstanding these unfavourable characteristics, eight out of nine bypasses have remained patent after a mean follow-up of 29 months (range five to 72 months). The only bypass that occluded did so without any symptoms or effect on the viability of the foot. In four patients, the arm veins were too narrow for grafting. Four to six weeks after construction of an arteriovenous fistula at the wrist their arm veins were at least partially suitable for grafting.

Aged↗
PubMed1987

Simulated hemodynamic comparison of arteriovenous fistulas.

The hemodynamic consequences of six current types of surgically constructed arteriovenous fistulas (AVFs) in the human arm are studied with the use of the model of a stationary electric resistance circuit. Variations in arterial and venous resistances and in anastomosis techniques are considered. With this model all possible AVFs can be compared in terms of risk (loss of distal perfusion pressure) and benefit (volume of fistula flow). According to our model the most efficient type of fistula is the end-to-end AVF at the wrist. In patients with abnormally high resistance of the arm arteries this fistula is inadequate for efficient hemodialysis treatment. To reduce the incidence of finger ischemia in more proximal AVFs our model indicates that the arterial anastomosis should be as proximal as possible and/or hemodynamically nonsmooth (i.e., side-to-side).

Arm↗
PubMed1986

Leiomyosarcoma of the inferior vena cava. Case report and review of the literature.

Leiomyosarcoma of the inferior vena cava is reported with increasing frequency but remains a rare lesion. In this article we report one case and review 69 cases. The disease affects mainly women approximately 50 years of age. The symptoms vary according to the location of the tumor; Budd-Chiari syndrome and leg edema occur in the more centrally located tumors and abdominal pain and swelling are seen in the more peripherally located ones. In 40% of the cases distant metastases are evident at the time of the patients' first presentation and are found most commonly in the liver and/or lungs. After resection the majority of the patients eventually die of metastatic disease with a mean survival of approximately 40 months.

Adult↗
PubMed1984

Shunt haemodynamics and extracorporeal dialysis: an electrical resistance network analysis.

A time-dependent resistance model is used to study haemodynamic aspects of haemodialysis treatment. In the first part of the paper one model circuit, consisting of a pressure source, upstream and downstream resistances and a branching resistance, is shown to represent the haemodynamics of any type of arteriovenous fistula (AVF). Simple algebraic relations are derived for the haemodynamic determinants of AVFS, including finger ischaemia and AVF-maturation. The second part of the paper analyses the influences of a two-needle extracorporeal dialysis (ECD) circuit on the systemic vascular haemodynamics. The main result of the analysis is that the ECD-circuit can be considered as virtually independent of the systemic circulation. Consequently the dialysis flow does not depend on systemic vascular determinants and there are no instantaneous changes in the systemic circulation after switching on the ECD circuit. The ECD flow at onset of AVF collapse is shown to be (slightly) larger than the undisturbed AVF flow. Hence, onset of collapse strongly depends on the systemic blood pressure and vascular resistances. It can be used diagnostically to assess AVF capacities. Optimisation of haemodialysis through the ECD circuit is predicted to be inefficient.

Arm↗