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Biomedical subjects

H Obertop

Publications and source records attributed to H Obertop.

At least 91 records · Page 5Linked to original sources
PubMed1999

Treatment with recombinant bactericidal/permeability-increasing protein to prevent endotoxin-induced mortality in bile duct-ligated rats.

BACKGROUND: Operation in patients with obstructive jaundice is associated with substantial morbidity because of increased susceptibility to endotoxin (lipopolysaccharide) and the inflammatory cascade. Different interventions to reduce endotoxemia and cytokine induction, and resulting complications, have been studied. Bactericidal/permeability-increasing protein (BPI) is a naturally occurring endotoxin-binding protein produced in neutrophils. It binds endotoxin, neutralizing the activity and inhibiting cytokine production by mononuclear cells. In experimental endotoxemia in animals and in healthy human volunteers, BPI has shown a protective effect. The aim of this study was to determine whether BPI could protect against increased endotoxin sensitivity in rats with obstructive jaundice and reduce endotoxin-induced mortality. STUDY DESIGN: Male Wistar rats were used. Intraperitoneal Escherichia coli 2mg/kg was given 1 week after sham operation or bile duct ligation (BDL). Three groups were studied: sham, BDL with placebo, and BDL with 5 mg/kg recombinant BPI21. RESULTS: BDL rats were jaundiced (mean bilirubin 186 micromol/L; no difference between BDL rats without or with BPI). Bilirubin remained less than 1 micromol/L in sham-operated rats (p = 0.002). Endotoxin levels were 3.4pg/mL in sham controls and 3.1 pg/mL in BDL rats before administration of lipopolysaccharide (p = NS). Two hours after administration, levels were 615.4ng/mL in placebo BDL rats and 10 times less in BPI-treated BDL rats, at 60.2ng/mL (p=0.03). The same trend was found at 6 hours. At 24 hours, mortality was 1 of 6 in sham-operated rats (15%) versus 8 of 11 in untreated BDL rats (75%). BPI intervention reduced the death rate to 1 of 12 BDL rats (8%) (p = 0.003). CONCLUSIONS: Intraperitoneal recombinant BPI21 in rats having BDL reduced endotoxin-induced mortality from 75% to 8%, a death rate comparable to that in nonjaundiced rats. BPI could be an interesting perioperative treatment in clinical obstructive jaundice.

Animals↗
PubMed1999

Staging laparoscopy and laparoscopic ultrasonography in more than 400 patients with upper gastrointestinal carcinoma.

BACKGROUND: Resection offers the only chance of cure to patients with esophageal, gastroesophageal junction, and hepatopancreatobiliary tumors. Staging is essential to select patients who will benefit from operation because palliation can also be performed nonoperatively. Several studies, including limited numbers of patients, have shown that laparoscopic staging prevents unnecessary laparotomies, but it is doubtful whether general application of this staging method can be advised. The aim of this study was to assess the benefit of diagnostic laparoscopy for staging patients with esophageal, gastroesophageal junction, and hepatopancreatobiliary tumors. STUDY DESIGN: Between June 1992 and December 1996, 420 patients with a resectable tumor after conventional staging underwent diagnostic laparoscopy combined with laparoscopic ultrasonography. Histologic proof of metastases or ingrowth was used to cancel laparotomy. RESULTS: Laparoscopic staging avoided laparotomy in 20% of patients (sensitivity 0.70): 5% with an esophageal tumor, 20% with a gastroesophageal junction tumor, 15% with a periampullary tumor, 40% with a proximal bile duct tumor, 35% with a liver tumor, and 40% with a pancreatic body or tail tumor. Complications and port-site metastases were seen in 4% and 2% of patients, respectively. CONCLUSIONS: Laparoscopic staging is a safe procedure with low morbidity and without mortality in this series. It has shown no benefit in esophageal cancer, but seems beneficial for staging tumors located at the gastroesophageal junction, proximal bile duct tumors, liver tumors, and pancreatic body and tail tumors. The value of laparoscopic staging for patients with periampullary tumors is not as great as stated in previous studies and is still the subject of investigation.

Endosonography↗
PubMed1999

Diaphragmatic herniation following oesophagectomy.

BACKGROUND: Intrathoracic herniation of abdominal viscera is a potentially life-threatening condition, especially when diagnosis is delayed. The aim of this study was to estimate its incidence following oesophageal resection and to define contributing factors that might influence its occurrence. METHODS: All radiographic studies of the chest that were made during follow-up in a series of 218 patients who underwent oesophagectomy between 1993 and 1997 were reviewed. RESULTS: Herniation of bowel alongside the oesophageal substitute was detected in nine patients (4 per cent). Four hernias occurred within the first week after operation and five were detected at late follow-up. Surgical treatment was indicated in six patients. Analysis of predisposing factors revealed that extended incision and partial resection of the diaphragm were associated with an increased risk of postoperative hernia formation (four of 29 following extended enlargement versus five of 189 after routine opening of the oesophageal hiatus; P = 0.02). CONCLUSION: Diaphragmatic herniation was found in 4 per cent of patients after oesophagectomy. After extended iatrogenic disruption of the normal hiatal anatomy, narrowing of the diaphragmatic opening may be indicated to avoid postoperative herniation of bowel into the chest. Awareness of its possible occurrence may help prevent the development of intestinal obstruction and strangulation.

Adult↗
PubMed1999

Impaired healing of extraperitoneal intestinal anastomoses.

BACKGROUND: The extra-anatomical position of a cervical oesophagogastrostomy might be a reason for impaired anastomotic healing. METHODS: This hypothesis was tested in a rat model. Jejunal resection with an end-to-end jejunojejunostomy was placed intra-abdominally in group 1 (n = 24) and subcutaneously in group 2 (n = 30). Jejunum without anastomosis was placed subcutaneously in group 3 (n = 12). After 3, 7 or 14 days the rats were killed; the bursting pressure of the anastomosis or jejunum was measured and the hydroxyproline level was determined. RESULTS: Two of 24 rats in group 1 and eight of 30 in group 2 died following anastomotic leakage (P not significant) and were excluded from other measurements. Bursting pressure was decreased after 3 days in group 1 (mean(s.e.) 62(10) mmHg) and group 2 (57(10) mmHg) compared with that in group 3 (204(17) mmHg) (P < 0.001). After 7 days, it was in the normal range in group 1 (200(14) mmHg), but lower in group 2 (104(15) mmHg) compared with that in group 3 (230(8) mmHg) (P < 0.001). Differences in hydroxyproline levels were not statistically significant between the groups after 3, 7 and 14 days. CONCLUSION: Healing of jejunojejunostomies is impaired in an extraperitoneal position compared with an intra-abdominal position.

Anastomosis, Surgical↗
PubMed1999

Vocal cord paralysis after subtotal oesophagectomy.

BACKGROUND: Although vocal cord paralysis is a well known complication of subtotal oesophagectomy, precise data concerning origin, incidence and associated morbidity are lacking. METHODS: A retrospective study was performed of 241 patients who underwent transhiatal oesophagectomy for carcinoma of the mid/distal oesophagus between 1994 and 1998. Preoperative and postoperative laryngoscopy results were available for 140 patients. RESULTS: There were 109 men and 31 women, of mean age 63 years. Thirty-one patients (22 per cent) with recurrent laryngeal nerve paralysis were identified, three with bilateral and 28 with unilateral dysfunction. Paralysis occurred ipsilateral to the side of the cervical incision in 22 of 28 patients. It was permanent in six patients. The associated morbidity was substantial: pulmonary complications were more common in patients with vocal cord paralysis (12 of 31 versus 26 (24 per cent) of 109), leading to significantly more reintubations, and a significantly prolonged ventilation time and stay in the intensive care unit. CONCLUSION: Although mostly transient, vocal cord paralysis is a frequent complication with significant associated morbidity. In an extended transthoracic resection (including a lymphadenectomy in the aortopulmonary window where the left recurrent laryngeal nerve is at risk) the cervical anastomosis should be made on the left side, to minimize the risk of bilateral vocal cord paralysis.

Esophageal Neoplasms↗
PubMed1999

Efficacy of monoclonal antibody 131I-B72.3 immunoscintigraphy of pancreatic adenocarcinoma xenografts in nude mice.

OBJECTIVE: To assess the efficacy of monoclonal antibody (MoAb) B72.3 for in vivo-immunoscintigraphy of pancreatic carcinoma in nude mice. DESIGN: Experimental controlled animal study. SETTING: University hospital, The Netherlands. SUBJECTS: 11 nude mice with subcutaneously xenografted human pancreatic carcinoma. INTERVENTIONS: Specific MoAb B72.3 and non-specific MoAb MOPC21 were iodinated with 131I and injected intraperitoneally in nude mice. Scintigrams were taken on days 1-10 and tumour:non-tumour ratios of the regions of interest (tumour, thorax, abdomen, background) were calculated. The mice were then killed for in vitro tissue counts. MAIN OUTCOME MEASURES: Tumour:non-tumour ratios in vivo and in vitro. RESULTS: Results of immunoscintigraphy on days 1, 2, and 6 were compared. In the B72.3-group all ratios were only moderately raised, the tumour:background ratio being the highest (2.35 (SD 0.67)) on day 6. There were no obvious differences between the ratios of the B72.3-group and the MOPC21-group. The results of tissue counts done at the end of the study, showed that tumour:non-tumour ratios were twice as high in the B72.3-group, suggesting some specificity of this MoAb. CONCLUSION: The results of our study suggest that MoAb B72.3 is not powerful enough for in vivo detection of pancreatic cancer as assessed in this xenograft model in nude mice.

Adenocarcinoma↗
PubMed1999

Open versus laparoscopic adjustable silicone gastric banding: a prospective randomized trial for treatment of morbid obesity.

OBJECTIVE: To perform the first prospective trial of laparoscopic versus open adjustable silicone gastric banding (ASGB) in patients with morbid obesity. SUMMARY BACKGROUND DATA: Vertical banded gastroplasty has been used for many years to treat morbid obesity, but the size of the stoma has remained a source of failure after the procedure. ASGB has the advantages of maintaining gastric integrity and the potential for readjustment of the band, if needed. It has been suggested that laparoscopic ASGB, recently introduced to reduce postoperative complications and hospital stay, has a negative impact on outcome. METHODS: Fifty patients with morbid obesity of >5 years' duration and a body-mass index (BMI) > 40 kg/m2 were randomized to undergo laparoscopic or open ASGB. The difficulty of the procedure, surgical time, postoperative complications, and hospital stay were assessed. Stoma adjustments, long-term complications, readmissions, weight loss, and BMI were determined. RESULTS: All procedures were successfully carried out. Of 25 patients assigned to laparoscopic ASGB, 2 were converted to an open procedure. Surgical time was significantly longer for laparoscopic ASGB (150 minutes vs. 76 minutes for open ASGB). There was no difference in complications. Mean hospital stay was 5.9 days for the laparoscopic procedure versus 7.2 days for open ASGB (p < 0.05). The total number of readmissions (6 vs. 15) and overall hospital stay in the first year (7.8 vs. 11.8 days) were lower after laparoscopic ASGB (p < 0.05). Weight and BMI were reduced significantly in both groups, but there was no difference between the groups. CONCLUSION: Laparoscopic and open ASGB were equally effective in terms of early (first-year) weight loss, reduction of BMI, and postoperative complications. The laparoscopic procedure was associated with a shorter initial hospital stay and fewer readmissions during follow-up and is therefore the preferred treatment in morbidly obese patients undergoing ASGB.

Adolescent↗
PubMed1999

Treatment of self-referred patients with abdominal complaints by emergency physicians. A prospective observational study in an emergency department in The Netherlands.

The quality of the treatment by emergency physicians of patients with abdominal complaints, who visited the emergency department (ED) of a city hospital (OLVG), Amsterdam, The Netherlands, was evaluated in a prospective observational study. During 6 months 1853 patients with abdominal complaints visited the emergency department of the OLVG hospital, 1221 patients (66%) without referral by a general practitioner (GP). Of these 1221 patients, 933 (76%) were treated by the emergency physician without consulting a specialist. Of these 933 patients, 814 were included in our follow-up study. A questionnaire was sent to them 1 week after visiting the ED. The response rate was 81% (663 patients). Of these 633 patients 48 patients sought medical help within 2 weeks after being discharged from the ED (38 patients in the same hospital and 10 patients in another hospital). Of these 48 patients, 17 were admitted to the hospital and 14 of them were operated on. After evaluation of these 17 patients we could conclude that seven patients were initially misdiagnosed by the emergency physician (1.1%). It is concluded that most patients with abdominal complaints visit the ED of this hospital without referral by their GP. Of these patients, the emergency physician can treat 76% without further specialist consultation. In seven patients (1.1%) the diagnosis was missed.

Adolescent↗
PubMed1999

Disturbed enterogastric inhibitory reflex after esophageal resection and narrow gastric tube reconstruction.

BACKGROUND/AIMS: The gastric emptying pattern after esophageal resection and narrow gastric tube reconstruction is determined by multiple factors. One of the possible factors is a disruption in the neurohumoral enterogastric inhibitory reflex. The aim of the present study was to determine the possible alterations of this reflex after esophageal resection and narrow gastric tube reconstruction. METHODS: Nine patients each underwent two gastric tube emptying studies, one without and one with high caloric duodenal tube feeding. The dual isotope scintigraphic data were corrected for subject movement, radionuclide decay, downscatter and gamma-ray attenuation. RESULTS: The median gastric tube emptying rate of solid food was 57%/h (range 27-195). The median T(1/2) of liquid food was 67 (range 4->80) min. Both for solid and for liquid food, the gastric tube emptying patterns without and with duodenal tube feeding were not significantly different. CONCLUSION: The neurohumoral enterogastric inhibitory reflex is disrupted after esophageal resection and narrow gastric tube reconstruction, which may contribute to disturbed gastric emptying.

Adenocarcinoma↗
PubMed1999

A surgical and pathological based classification of resective treatment of pancreatic cancer. Summary of an international workshop on surgical procedures in pancreatic cancer.

BACKGROUND: The extent of pancreatic resection and lymphadenectomy, both for Kausch-Whipple pancreatoduodenectomy and for left pancreatectomy, is variable between surgeons, according to their training. METHODS: On May 30, 1998, a consensus conference on the surgical treatment of pancreatic cancer took place in Castelfranco Veneto, Italy. A group of 29 European surgeons and pathologists, recognized as international experts, analyzed the surgical and pathological procedures used in European countries to resect pancreatic cancer and examine the specimen. RESULTS: A general agreement was reached on the definitions of standard , 'radical and 'extended radical Kausch-Whipple pancreatoduodenectomy for carcinoma of the head of the pancreas, and standard and 'radical left pancreatectomy for carcinoma of the body and tail of the pancreas. Segmental venous resection, as well as adjacent organ resection, can be performed at the time of standard, radical or extended radical pancreatoduodenectomy or left pancreatectomy if required. The pylorus-preserving procedure is contraindicated only for carcinomas of the anteriorsuperior part of the head of the pancreas. Guidelines for a standardized pathological examination of the resected specimen were produced. CONCLUSION: Adoption of the recommended terminology will improve outcome comparisons between institutions performing the different procedures. Moreover, standardization of operations, terminology and pathological reporting is essential for prospective randomized trials comparing different operations either alone or within the context of adjuvant therapy studies.

Humans↗
PubMed1999

A free peritoneal patch does not affect the leakage rate but increases stricture formation of a cervical esophagogastrostomy.

BACKGROUND: Healing of a cervical esophagogastrostomy is frequently impaired, resulting in a higher incidence of leakage and stricture formation, as compared to an intrathoracic anastomosis. Lack of mesothelial factors is hypothesized to contribute to this impaired anastomotic healing. The aim of this prospective study was to determine whether a free peritoneal patch around a cervical esophagogastrostomy can improve anastomotic healing. METHODS: In 23 consecutive patients a free peritoneal patch was fixed around a cervical esophagogastrostomy. Results were compared to those of a historical control group of 41 patients. Clinical and/or radiographic leakage and stenosis requiring endoscopic dilatation were used as endpoints. RESULTS: Three patients died in the early postoperative period (in-hospital mortality 3/64 = 5%). Leakage rate was 13% (3/23) in the group with a patch and 15% (6/41) in the control group (p = 0.90). At 6-month follow-up, the incidence of stenosis was significantly higher (65%) in the group with a patch, compared to 31% in the control group (p = 0.02). CONCLUSION: A peritoneal patch does not affect the leakage rate but increases the incidence of postoperative stenosis of a cervical esophagogastrostomy. Therefore, its clinical application is contraindicated.

Aged↗
PubMed1999

Internal drainage of infected pancreatic pseudocysts: safe or sorry?

BACKGROUND: External drainage is the traditional surgical therapy for infected pancreatic pseudocyst, although associated with high morbidity and mortality rates. In this study it was determined whether internal drainage is feasible with acceptable postoperative morbidity and recurrence rates. METHODS: A retrospective comparison was made of the outcome of internal versus external drainage of infected pseudocysts in 15 patients. All patients were known to have a (sterile) pseudocyst and presented with symptoms suggestive of infection of the cyst, proven by positive cultures and Gram staining. RESULTS: Internal drainage was performed in 8 and external drainage in 7 patients. Patient characteristics appeared comparable, as was the time of sterile cyst presence before infection occurred (6 and 9 weeks, respectively). No major complications occurred, although hospital stay was prolonged after external drainage due to development of pancreaticocutaneous fistulas along the drain tract in 4 patients. Enteric microorganisms were cultured in 11 patients, of whom 10 had undergone ERCP just prior to infection. During follow-up no pseudocyst recurred. CONCLUSION: Surgical internal drainage of an infected pseudocyst is safe and effective and, in selected patients, is first-choice treatment. ERCP seems to play an important role in the secondary infection of pseudocysts.

Adult↗
PubMed1999

Laparoscopic staging of biliopancreatic malignancy.

The main benefit of laparoscopic staging (LLU) of (distal) bilio-pancreatic malignancy is the detection of small superficial metastases at the liver surface and peritoneum and local tumor ingrowth. The different aspects of laparoscopic staging have been described extensively in the literature and the benefit is generally expressed in terms of prevention of laparotomy. The impact of this final staging procedure on outcome for the patient in terms of the efficacy of the subsequent non-surgical palliative treatment have been analysed scarsely. In this review the results of laparoscopic staging of bilio-pancreatic tumors concerning the detection of metastases and tumor ingrowth as well as the results of long term follow up after subsequent non-surgical treatment and the preferred palliative treatment after laparoscopic staging are discussed.

Bile Duct Neoplasms↗
PubMed1999

Differential diagnosis of focal pancreatitis and pancreatic cancer.

UNLABELLED: The differentiation of focal, chronic pancreatitis (CP) and pancreatic cancer (PAC) poses a diagnostic dilemma. Both conditions may present with the same symptoms and signs. The complexity of differential diagnosis is enhanced because PAC is frequently associated with secondary inflammatory changes and CP may develop into PAC. The aim of this study was tot analyze two sets of patients (group A and B) who were misdiagnosed to have either CP or PAC. The clinical and radiographical features of these patients were reviewed. Group A consisted of 22 patients (median age 54.5 years) who were referred with PAC after a previous diagnosis of PC. Eleven patients had a history of CP of > 12 mths (mean 40.2 mths) whereas in 11 patients, PAC became apparent within 12 mths (mean 4.9 mths) after the diagnosis of CP was made. The etiology of CP was alcohol abuse in 9 patients, pancreas divisum in 3 patients and was undefined in the remaining 10 patients. Imaging studies showed features of CP (parenchymal calcifications, irregularities and stenoses of the pancreatic duct wall). Pseudocysts were present in 13 patients. A mass lesion was detected in 13 patients. At the time of diagnosis, 20 patients had unresectable tumors and 2 patients underwent a Whipple resection which proved non-radical. Group B consisted of 14 patients (median age 53 years) who underwent a Whipple resection for a presumed PAC that on histopathology of the lesion proved to be CP. These patients accounted for 6% of all 220 patients who had undergone resection for PAC in the same period. Reassessment of clinical presentation and all imaging studies confirmed a high index of suspicion on PAC in these patients. CONCLUSION: In patients known with CP, misdiagnosis of PAC is a potential pitfall leading to delay of treatment. For any lesion suspicious of PAC an aggressive surgical approach is justified lest a potentially curable lesion is missed. As a consequence, there is at least a 5% chance of resecting a lesion based on CP, mimicking PAC.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1999

Essentials in biliopancreatic staging: a decision analysis.

Two possible strategies for diagnosis and staging of patients with suspected biliopancreatic cancer and obstructive jaundice were tested in a decision analysis. One strategy was called 'surgical' strategy and consisted of only Ultrasonography and (spiral) CT scan and exploratory laparotomy in all patients without irresectable disease or distant metastases according to this work-up. The other strategy was called 'non-surgical' strategy and consisted of the above strategy, but also included ERCP and endoscopic internal drainage (stent) and diagnostic laparoscopy and laparoscopic ultrasound. In the decision analysis incidences of the outcomes after the two strategies were estimated based on the literature and our own experience, and a utility (0-1) was attributed to each separate outcome, according to the expected quality of life as judged by the team. Total utility of each strategy was calculated. It could be concluded that a non-surgical strategy would lead to a somewhat higher total utility in case the yield (i.e. prevention of unnecessary laparotomies) could be high and supposed that a beneficial effect of pre-operative internal biliary drainage was present. In case of low yield of diagnostic laparoscopy the superiority of the 'non-surgical' strategy is doubtful.

Biliary Tract Neoplasms↗