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Biomedical subjects

F Derom

Publications and source records attributed to F Derom.

At least 109 records · Page 6Linked to original sources
PubMedDate not supplied

[The treatment of gastroesophageal reflux using the Kaunitz technic].

The Kaunitz' procedure in the surgical treatment of gastroesophageal reflux associated with a hiatal hernia. In patients with pathological gastroesophageal reflux associated with a hiatal hernia, simple repositioning of the lower esophageal sphincter (L.E.S.) without fundoplication can restore the competence of the L.E.S., provided there is adequate mobilisation of the esophagus and fixation to strong tissues. The procedure proposed by Kaunitz consists of a left thoracotomy, with fixation of the gastroesophageal junction to the diaphragm. In the period May 74-May 83 we performed the procedure on 85 patients. There was no operative mortality and a low early complication rate. All but one patient showed a good repositioning on the postoperative barium swallow and improved dramatically, with complete cessation of reflux symptoms. Seventy-eight patients (92,8%) are followed up regularly by means of a standard questionnaire, barium swallow and esophagoscopy. At this stage of the study, with follow-up periods ranging from 6 months to 9 years, 65 patients (83,3%) show an excellent result, six (7,7%) are greatly improved, with disappearance of the preoperatively existing esophagitis, but keep some mild residual reflux symptoms. In one patient repositioning was impossible. Six recurrences were noted, four of them in patients operated during the early period of our experience with the Kaunitz technique. This simple and effective procedure is a valuable alternative in the surgical treatment of pathological gastroesophageal reflux.

Adolescent↗
PubMedDate not supplied

[Therapeutic strategy in the cold nodule of the thyroid (author's transl)].

The benign or malignant nature of a cold nodule in the thyroid can never be definitely assessed before surgery. All cold nodules that show no tendency to regress must be resected. The nodule is resected with surrounding healthy tissue and immediately examined in freezen sections. Out of 108 cases of simple resection of the nodule only one diagnosis of carcinoma was missed at the operation. That patient was reoperated two weeks later with curative intention.

Biopsy↗
PubMedDate not supplied

Variations in the capacity of the steroid binding beta globulin (SBbetaG) in plasma from normal young twins.

The capacity of human plasma to bind specifically dihydrotestosterone (DHTBC) has been determined in normal monozygotic and dizygotic twins less than 20 years old. The total variation in DHTBC was analysed by stepwise multiple regression, combined with variance analysis, applied to the pair sums in DHTBC, body height and body weight, as well as to age. A significant part of the variation in DHTBC was explained. Due to the strong interwining between body weight, body height and age in growing children it was impossible to make out which one of the latter variable contributed most to the negative correlation which was observed. Previous studies in adults did, however, show that only body weight and not body height or age correlated negatively with DHTBC. By doing the same calculations for the within-pair differences in DHTBC, body height and body weight it was hoped to delineate the within-family part of the environmental variation in DHTBC. Body weight and body height did, however, not offer any significant explanation as to this part of the variation in DHTBC. The upper limit of heritability (h2) for DHTBC was estimated by comparing intraclass-correlation coefficients in monozygotic and dizygotic twins. According to the method used to calculate the latter intraclass-correlation coefficients h2 estimates for DHTBC of 0.774 and 0.960 were arrived at. However, due to the rather small number of dizygotic twins available the confidence limits of these estimates were rather large.

Adolescent↗
PubMedDate not supplied

Two-stage orchiopexy.

A number of well known complications and disorders force operative correction of cryptorchism, once the diagnosis of true cryptorchism is certain. In order to perform a successful orchiopexy, an extensive mobilization of the testis, up to the kidney, is sometimes needed. However, one can not always bring the testis down to the bottom of the scrotum. In this case it seems reasonable to bring the testis as low as possible. A second exploration can be planned, a few years later and, in most cases, the testis will then easily be brought down to the bottom of the scrotum. In our series (76 patients with unilateral or bilateral cryptorchism, between January 1967 and December 1978), 7 patients have been treated according to this procedure: four underwent a successful two-stage orchiopexy, two patients are waiting for the second intervention and one had a bilateral orchiectomy. A review of the literature reveals only a small number of attempts to staged orchiopexies. These small series are completely comparable to our series.

Adolescent↗
PubMedDate not supplied

[Treatment of resectable cancer of the stomach].

The results of 631 cancers of the stomach treated by gastrectomy between 1970 and 1983 were closely reviewed in six departments of surgery. This review showed that the prognostic factors determined by resectability, extension of the tumor and lymph node involvement are considered to be reliable following the various pre- and postoperative examinations. In addition, it was shown that most of the gastrectomies were performed following conventional procedures and that the widespread lymph node dissections are not applied in a systematic manner. The postoperative mortality is very low (4.4%) for all the gastrectomies and even lower for the radical gastrectomies (3%). The 5 year survival rate for all the gastrectomies is 15%; this rate amounts to 36% for the gastrectomies performed with a curative aim. In the discussion, the adjuvant radiotherapy and chemotherapy are discussed and their timeliness is shown.

Adenocarcinoma↗
PubMedDate not supplied

[Isolated lesions of the gallbladder, in closed abdominal injuries. Apropos of 7 cases].

The authors report 7 cases of isolated injuries of the gallbladder, in closed abdominal trauma. The literature indicates the frequency to lie between one and five percent. The postprandial period and fasting alcohol levels, responsible for the distention of the gallbladder, are mostly the cause of such lesions. Four groups of injuries are described: 1) laceration 2) avulsion 3) simple contusion 4) traumatic cholecystitis Early diagnosis of such injuries is difficult as abdominal signs are poor and little specific; the authors note the value of peritoneal puncture and lavage. The treatment of gallbladder trauma is always surgical, cholecystectomy giving the best results; raphy and cholecystostomy are second choice treatments. The prognosis is usually favorable, even if surgery is delayed, and depends essentially on the nature of associated extra-abdominal injuries.

Adult↗
PubMedDate not supplied

[Bochdalek's congenital diaphragmatic hernia: a clinical review of 114 cases].

During a retrospective multicentric study of the encountered congenital pathology of the diaphragmatic domes, we focused our special attention on the prevalence of the congenital Bochdalek hernia. 140 charts were statistically analysed. The seriousness of the medical and surgical emergency situation enticed the authors to examine the most important prognostic clinical features. The interval between diagnosis and surgical therapy should be as short as possible. Respiratory acidosis and resuscitation were a common denomination in all infants who succumbed in the post-operative period. The early occurrence (less than 6 hrs) of respiratory distress disclosed the seriousness of the associated pulmonary hypoplasia. Surgical technical problems were rare. This in contrast to the struggle against pulmonary arterial and capillary hypertension. Pulmonary vasodilator drugs have not convinced those who initiated their use.

Diaphragm↗
PubMedDate not supplied

[Truncal vagotomy with pyloroplasty as a routine procedure in perforated duodenal ulcer].

Truncal vagotomy and pyloroplasty for perforated duodenal ulcer. A retrospective study of 220 patients operated upon between 1959 and 1982 for perforated duodenal ulcer by truncal vagotomy and pyloroplasty shows that this operation can be performed as safely as suture plication, even in the critically ill patient. The advantages of this procedure as the routine treatment of perforated duodenal ulcer are discussed.

Adolescent↗
PubMedDate not supplied

Aorto-enteric fistula as clinical entity.

A 19 year experience (1958-1977) with aortoenteric fistulas is presented. An aorto-enteric fistula is a direct communication between the aortic lumen and the gastro-intestinal tract producing a gastro-intestinal bleeding. The commonest cause of a primary or spontaneous aorto-enteric fistula is aneurysm formation. If there has been an operation on the aorta then the aorto-enteric fistula is called secondary. No primary aorto-enteric fistulas were encountered but thirteen secondary aorto-enteric fistulas are reported on a total of 841 aorto-femoral by-pass operations reviewed. Six hundred and sixty-one of these had an acceptable follow-up: this gives a 2% incidence. Our survival rate is 40%. Four different possible mechanisms are proposed for the formation of the secondary aorto-enteric fistula: anastomotic aneurysm formation, fibrous reaction, intra- or postoperative contamination or a combination of these possibilities. Some etiological factors as type of anastomosis, suture material, prosthesis material, hypertension, end-arterectomy and preoperative aneurysmatic tendency are analysed. A study is made of the different available diagnostic tools and the different possible therapies are discussed.

Aortic Diseases↗
PubMedDate not supplied

[The use of nutritive mixtures in a surgical unit (author's transl)].

Fifty patients in whom different nutritive mixtures were used are presented. Eight solutions with increasing caloric and nitrogen contents were used. The purpose of the study was to improve the nutritional status of patients prepared to major surgical interventions. A daily nitrogen balance was made to find out in what measure a positive balance could be attained. The presence or absence of complication was of utmost importance in the evaluation.

Adult↗
PubMedDate not supplied

[Parenteral nutrition "à la carte" in major abdominal surgery with mixtures of Totamine concentrate and Vintène. A clinical study based on nitrogen balance].

The authors present a series of thirty patients who underwent major abdominal surgery. Each patient received preoperative total parenteral nutrition (TPN) during bowel preparation. After the operation the TPN was continued immediately, even if reanimation was necessary. The dosages of nitrogen and calories were individually adapted in function of the daily calculated nitrogen-balances. So the authors were able to administer a TPN "à la carte" using eight solutions mixed in a single bag, containing amino-acids (varying between 6 and 20 g of nitrogen), glucose (ad 150 Kcal/gN) lipids (constituting 40% of the calorie-intake), ions, vitamins and oligoelements. With a follow-up of minimum 10 days, the study proves the possibility of creating positive nitrogen-balances in 87% of the cases and an acceptable deviation in the daily measured glycemia and plasma-ionograms.

Abdomen↗
PubMedDate not supplied

Postvagotomy dysphagia necessitating surgical relief.

A case of severe dysphagia following transthoracic truncal vagotomy is reported. Stenosis of the esophagus was due to a periesophageal fibrotic band. Surgical treatment was mandatory and relief was brought by resection of the stricture and restoration of the continuity by colonic interposition. A review of the literature on the subject is presented.

Adult↗
PubMedDate not supplied

[Current trends in the surgical treatment of chronic pancreatitis].

Since May 1980, we started treating patients suffering from chronic pancreatitis with pancreatic duct obstruction. During surgery, prolamine, a alcoholic amino-acid solution, was injected into the pancreas through the papil of Vater or directly into the pancreatic duct following pancreatic tail resection. So far thirteen patients were treated this way. Operative mortality was nil and complications were minimal. There were no clinical recurrences of pancreatitis after nearly two years of follow-up.

Adult↗
PubMedDate not supplied

[Our experience in the treatment of imperforate anus. Anterior (Mollard's technic) versus posterior approach (Stephens' technic)].

The present series concerns the method of treatment for anus imperforatus as it was performed at the Academic Hospital Ghent (Belgium) between 1971 and 1980. Two different technics are confronted one with the other: the anterior perineal approach according to Mollard and the posterior transsacral approach according to Stephens. In agreement with the recent literature the anterior way of acceding to the puborectalissling has undeniable advantage. Even with a very short follow-up period the number of children with supralevatoric localization of anus imperforatus treated by the technic of Mollard and showing a proven continence is now already outnumber.

Anus, Imperforate↗
PubMedDate not supplied

Portal derivation surgery in children. A long-term follow-up report.

Eight children and two adults with portal hypertension were treated by portal diversion surgery. In all cases recurrent gastro-intestinal bleeding from esophageal varices was the indication for shunt-operation. Still in early childhood, three of these patients had had a splenectomy in other hospitals: one emergency splenectomy for hemoperitoneum and two elective splenectomies for hypersplenism. Three operative techniques were used: 5 spleno-renal shunts, 3 meso-caval shunts and 2 porto-caval shunts. All, but one, were followed over a period from 2 to 13 years after shunt-surgery. There was no mortality in this series. After shunting all children remained free of esophageal bleeding. We did not find any complication directly related to the shunt procedure.

Adolescent↗