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Biomedical subjects

H Obertop

Publications and source records attributed to H Obertop.

At least 217 records · Page 12Linked to original sources
PubMed1984

Treatment of pancreatic injuries.

Between 1972 and 1983 14 patients with pancreatic injuries have been treated. The diagnosis was often difficult and only made at laparotomy in most patients. Peritoneal lavage and serum amylase levels were of little help in diagnosis. Even at laparotomy, the diagnosis was initially missed in one patient. Six patients had injuries of the pancreatic head and were treated either by Whipple pancreatoduodenectomy (one patient), drainage with gastric and jejunal decompression (two patients) or simple drainage (three patients). Six patients had injuries of the pancreatic body, necessitating distal pancreatectomy and splenectomy in four cases. Two patients with contusion of the pancreatic tail were treated by drainage, followed by development of an infected pancreatic pseudocyst in one case. Six patients died (43%). It is concluded that complete inspection of the pancreas and peripancreatic hematoma is mandatory in the diagnosis and treatment of pancreatic injuries.

Accidents, Traffic↗
PubMed1984

The role of early surgery in the treatment of acute hemorrhagic necrotizing pancreatitis (AHNP).

A retrospective study of the effect of surgical treatment and the value of different biochemical criteria in the early identification of AHNP in 33 patients with this condition, as proven by laparotomy, is presented. Biochemical criteria were not specific for AHNP and could only infrequently be used for assessment of the severity of acute pancreatitis. Surgical treatment consisted of pancreatic resection in 22 patients and drainage in 11 patients. Twenty-six of the 33 patients died regardless of the type of surgery. Mortality was due to multiple organ failure, either shortly after operation (eight patients) or after a protracted septic clinical course (18 patients). In total AHNP early subtotal pancreatectomy is probably not the treatment of choice since it did not improve the outcome.

Acute Disease↗
PubMed1984

A new technique for pancreatojejunostomy.

In the presence of a nonobstructed pancreas, a pancreatojejunostomy can be performed with relative simplicity using a GIA automatic stapler when the pancreatic stump is invaginated in a jejunal loop after removing some of the staples.

Ampulla of Vater↗
PubMed1983

Acute abdominal pain due to early postoperative elemental feeding by needle jejunostomy.

Early postlaparotomy needle jejunostomy feeding with an elemental diet resulted in a typical clinical entity in six of 160 patients (4 per cent). In all, an acute condition of the abdomen developed with a grossly distended intestine, filled with fluid and gas, and an empty stomach as confirmed roentgenographically or at a second laparotomy. This complication is presumably caused by carbohydrate hyperosmolarity of the elemental diet and carbon dioxide production by fermentation. The complication was seen predominantly in patients with a Roux-en-Y reconstructed pancreatectomy. In two patients, a negative second laparotomy was performed. In two others, a pancreaticojejunostomy suture line blowout followed, resulting in death. One patient died after aspiration of the gastric contents.

Abdomen↗
PubMed1983

Needle catheter jejunostomy (NCJ) for early postoperative feeding: experience in 210 patients.

Enteral feeding has many advantages over total parenteral nutrition (TPN) in the early postoperative period. The risk of sepsis is small, the nutrients are cheap and metabolic problems are rare. In the period April 1980 to January 1983, needle catheter jejunostomy (NCJ) was applied in 210 patients after surgery of the oesophagus, stomach, duodenum, liver or pancreas. All but 14 of these patients were fed by NCJ for a certain period postoperatively, NCJ feeding being initiated within 48 hours after the operation in 63% of the cases. In 14 patients, it was decided not to use NCJ feeding because of counter-indications observed postoperatively. The mean duration of the feeding by NCJ was 17 days (range two to 84 days). The complications observed were intraperitoneal leakage in four patients (1.9%), ileus in seven patients (3.3%) and diarrhoea in 54 patients (25.7%). The total number of feeding days was 2,906. This form of feeding resulted in savings of Dfl. 115,00 per patient per day compared with TPN, for a 12,600 Joule intake. NCJ feeding is a relatively safe, economical procedure that can be applied as a matter of routine after abdominal surgery.

Adolescent↗
PubMed1983

Bile-duct cysts--diagnosis and treatment in 14 patients.

Between 1978 and 1982 14 patients were treated for bile-duct cysts. The predominant clinical signs were obstructive jaundice and hepatomegaly in the younger patients, while pain was the most common symptom in the older patients. Ultrasonography was a valuable diagnostic technic but percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) were associated with septic complications; as an alternative, routine preoperative cholangiography is recommended to visualize the type of bile-duct cyst. Excision of the bile-duct cyst was considered the treatment of choice. Excision was performed in 11, and internal drainage in three patients. Cholangitis developed in four children after excision of the cyst. In our series the prognosis was good following surgical treatment, even in younger patients.

Adolescent↗
PubMed1983

Effective reconstruction after pharyngolaryngo-oesophagectomy with an ileal autograft.

Total pharyngolaryngo-oesophagectomy is performed for carcinoma of the cervical oesophagus, the piriform sinuses and the postcricoid region. A safe effective way of reconstructing the cervical oesophagus is of the utmost importance in these patients. Use of a revascularized intestinal segment for this purpose is described. Twenty-one patients who underwent reconstruction of the cervical oesophagus with an ileal autograft were studied, with a follow-up period of one to .58 months. The low postoperative mortality and morbidity, quick resumption of oral intake, short hospitalization and good functional results obtained with this method yield benefits for these patients.

Adult↗
PubMed1983

Surgical treatment of chronic pancreatitis by distal pancreatectomy.

No consensus exists on the best surgical treatment for chronic pancreatitis. In a retrospective study on 29 patients it was found that pain caused by chronic pancreatitis can be treated effectively by a 95% DP or a 40-80% DP. However, after a 40-80% DP the incidence of endocrine and exocrine pancreatic insufficiency is less frequent than after a 95% DP. Therefore, distal pancreatectomy can be advised as a treatment of pain, caused by chronic pancreatitis. In order to minimize the chance of pancreatic insufficiency resection should be done as conservatively as possible.

Chronic Disease↗
PubMed1982

Active trypsin and reflux oesophagitis: an experimental study in rats.

In order to clarify the role of active trypsin, bile acids and pepsin in reflux oesophagitis, a comparable series of experiments was performed in rats before and after reflux-inducing operations. Three control procedures were used--laparotomy (n = 10), oesophageal transection and reanastamosis (n = 7) and a Roux-en-Y reconstruction (n = 9)--and seven experimental procedures in order to produce gastric, bile and pancreatic reflux (G + B + P) (n = 9), gastric and pancreatic reflux (B + B) (n = 8), bile and pancreatic reflux (B + P) (n = 10), pancreatic reflux alone (P) (n = 9), gastric reflux alone (G) (n = 8), bile reflux alone (B) (n = 9) and gastric with bile reflux (G + B) (n = 9). Macroscopic and histologically confirmed oesophagitis was produced in groups G + B + P, G + P, B + P and P. The trypsin levels were significantly elevated in these groups, compared to both the control and other experimental groups (P less than 0.01). Bile acid levels were insignificantly different between the groups. Because these experiments involved vagal transection, no oesophagitis was found in the gastric juice reflux group. This study has shown for the first time a correlation between the presence of active trypsin in the oesophagus and the occurrence of oesophagitis. It is possible that active components of duodenal juice may contribute to the development of reflux oesophagitis in man.

Animals↗
PubMed1982

Operative approach to cancer of the head of the pancreas and the peri-ampullary region.

A retrospective study was made of 75 consecutive patients treated for a tumour of the head of the pancreas and the peri-ampullary region from January 1978 to August 1981. These patients underwent either pancreatic resection--pancreatoduodenectomy (n = 24) and total pancreatectomy (n = 10)--palliative procedures (n = 29) or exploratory laparotomy (n = 12). Clinical signs and diagnostic procedures, such as ultrasonography and coeliac arteriography, were studied for their value in preoperative assessment of operability. Vaso-invasion, as revealed by arteriography and, to a lesser extent, ultrasonographic signs of a tumour and the absence of jaundice were poor prognostic signs. The operative mortality was 8 per cent for the group as a whole, but somewhat higher (13 per cent) for the group that underwent pancreatoduodenectomy. No patient died after total pancreatectomy. The operative mortality was 27 per cent in all patients aged 70 years or older, but only 3 per cent in patients under 70 years. One-year patient survival was 94 per cent after pancreatoduodenectomy for peri-ampullary cancer and 57 per cent after resection for cancer of the head of the pancreas. The results of this study point to pancreatic resection as the treatment of choice for resectable tumours of the peri-ampullary region and the head of the pancreas in patients under 70 years of age. Coeliac arteriography and ultrasonography have been found to be useful for preoperative classification of tumour stage.

Adenocarcinoma↗
PubMed1982

Adverse effect of pretransplant blood transfusions on survival of matched kidney allografts in dogs.

Previous studies from our laboratory have already shown that pretransplant blood transfusions from third-party donors significantly prolong kidney allograft survival in mismatched unrelated immunosuppressed dogs. In the present study, a similar effect was found in related donor-recipient pairs mismatched for two haplotypes (P less than 0.05); no significant effect was observed in one-haplotype-mismatched combinations (P = 0.34). Pretransplant blood transfusions did not have a beneficial influence on kidney allograft survival in immunosuppressed DLA-identical, related donor recipient pairs. After withdrawal of immunosuppressive therapy, transfused dogs in this group rejected their kidneys even more frequently than did nontransfused dogs (P = 0.16). A comparable undesired effect of blood transfusions was found for recipients of unrelated kidneys which were identical with respect to DLA-A, B, and D: transfused recipients of those kidneys rejected the graft significantly more often than the untransfused controls (P less than 0.01). The most likely explanation for this adverse effect is that blood transfusions given to the recipient may cause crossimmunization for undefined, probably minor, antigens of the donor kidney. Apparently, differences arising from these minor histocompatibility antigens become manifest only after withdrawal of the immunosuppressive therapy. Furthermore, it appeared that the effect of histocompatibility matching on kidney allograft survival is less for transfused than for untransfused dogs. The most important conclusion is, however, that the beneficial effect of blood transfusions appears to be dependent on the degree of matching: while blood transfusions are on the whole beneficial for unmatched kidneys, they are likely to have no effect, or even to be harmful, for matched kidneys.

Animals↗