Search PubMed⌕ Search

Biomedical subjects

J J Bergman

Publications and source records attributed to J J Bergman.

At least 37 records · Page 2Linked to original sources
PubMed1998

Improvement in the management of bile duct injuries?

BACKGROUND: Previous studies have suggested that improvements in diagnostic workup and treatment of bile duct injuries (BDI) sustained during laparoscopic cholecystectomy can be expected as experience increases with the laparoscopic procedure. Many published articles reported that early diagnosis, proper classification, and optimal timing of treatment of BDI increase the likelihood of successful treatment. This study determined whether diagnosis and management of BDI have improved over the years. STUDY DESIGN: Between June 1990 and November 1996, 106 patients were diagnosed and treated in the Amsterdam Academic Medical Center for BDI sustained during laparoscopic cholecystectomy. Detailed information was obtained about peroperative findings, time interval from laparoscopic cholecystectomy to symptoms, and interval from symptoms to diagnosis. Bile duct injuries were classified into four types. Two patient groups were compared: BDI patients diagnosed from 1990 until 1994 ("learning phase") and patients diagnosed from 1995 until 1996. RESULTS: Bile duct injuries combined with bile leakage were diagnosed significantly earlier in the second period after the learning phase. The percentages of injuries diagnosed peroperatively, "blind laparotomies," and suboptimal timed hepaticojejunostomies were not different between the groups. CONCLUSIONS: Except for earlier diagnosis of BDI in the later period than in previous years, there appeared to be no significant improvement in diagnostic workup and management during the past 2 years.

Bile Ducts↗
PubMed1998

A prospective randomized trial of Teflon versus polyethylene stents for distal malignant biliary obstruction.

BACKGROUND AND STUDY AIMS: Clogging of biliary stents continues to be a major clinical problem. Different polymer materials may have different effects on clogging. In vitro studies have shown a direct relation between the frictional coefficient of a polymer and the amount of encrusted material. Teflon appeared to be the best polymer for biliary stents. Two different types of stents made of Teflon have been tested in clinical practice and showed favourable patency rates. However, a randomized trial has never been performed. We compared the patency of an Amsterdam-type polyethylene stent with a Teflon stent in a prospective randomized trial. PATIENTS AND METHODS: Between September 1995 and November 1996, 42 patients received a Teflon stent and 42 patients a polyethylene stent. All patients had a distal malignant biliary stricture without a previous drainage procedure. Diagnoses included carcinoma of the pancreas (n = 76), papilla (n = 1), bile duct (n = 5) and metastases (n = 2). The internal and external diameter (10 Fr), length (9 cm) and stent design (a straight stent with two side flaps and one side hole at each end) were similar for both stents. RESULTS: A reduction in bilirubin of more than 20% within one week was seen in 91% of the patients. Early complication rates were similar in both groups (10%). The median follow-up was 142 days. Stent dysfunction occurred in 28 Teflon and 29 polyethylene stents. The thirty-day mortality was 14% in both groups. Patient survival did not differ significantly between the groups (median survival: Teflon 165 days, polyethylene 140 days). The median stent patency was 83 days for Teflon and 80 days for polyethylene stents, and was not significantly different either. CONCLUSION: Teflon material did not improve patency in biliary stents with an Amsterdam-type design.

Aged↗
PubMed1998

Endoscopic dilatation of the biliary sphincter for removal of bile duct stones: an overview of current indications and limitations.

Endoscopic balloon dilatation (EBD) of the biliary sphincter may be an alternative to endoscopic sphincterotomy (EST) for removal of bile duct stones. After EBD of the biliary sphincter to a diameter of 8 mm, stones are removed according to standard guidelines. In the event that stone removal fails after EBD, an additional EST is performed. The overall success rate of stone removal after EBD (90%) is comparable to that of EST. After EBD, an additional EST and mechanical lithotripsy are required in 10% and 30% of patients, respectively. In patients with bile duct stones < 10 mm and a stone number < or = 3, EBD is nearly always successful without the need for additional EST or mechanical lithotripsy. Pancreatitis post-EBD occurs at a rate of 5-7%, which is not significantly different from that after EST. Significant bleeding post-EBD has not been observed in over 400 patients undergoing EBD. EBD is a valuable alternative to EST, especially in patients with smaller bile duct stones and in patients with haemostatic disorders.

Catheterization↗
PubMed1997

Randomised trial of endoscopic balloon dilation versus endoscopic sphincterotomy for removal of bileduct stones.

BACKGROUND: Endoscopic sphincterotomy (EST) for the removal of bileduct stones is associated with acute complications and a permanent loss of biliary-sphincter function. Endoscopic balloon dilation (EBD) causes less trauma to the biliary sphincter, but may be less effective in allowing stone removal. METHODS: 218 consecutive patients with bileduct stones on endoscopic retrograde cholangiopancreatography (ERCP) were enrolled. 202 who met all eligibility criteria were randomly assigned EST or EBD. The patients were observed in hospital for at least 24 h and followed up at 1 month and 6 months. Complications were classified by an expert panel unaware of treatment allocation and outcome. Analysis was done by intention to treat. FINDINGS: After a single ERCP, all stones were removed from 92 (91%) of 101 patients assigned EST and 90 (89%) of 101 assigned EBD (p = 0.81); in nine of the latter, successful removal required additional EST. Mechanical lithotripsy was used to fragment stones in 31 EBD procedures and 13 EST procedures (p < 0.005). Early complications (before 15 days) occurred in 24 EST patients and 17 EBD patients (p = 0.29). One patient died of retroperitoneal perforation after EBD. Four patients had bleeding after EST. Seven patients in each group had pancreatitis. Complications during follow-up occurred in 23 EST patients and 18 EBD patients (p = 0.48). Acute cholecystitis was observed in seven EST patients and one EBD patient (p < 0.05). INTERPRETATION: The success rate of EBD was similar to that of EST. We found there is no evidence of the previously suggested higher risk of pancreatitis with EBD and suggest that EBD is preferred in patients at risk of bleeding after EST. Preservation of biliary-sphincter function after EBD may prevent long-term complications and reduce the risk of acute cholecystitis during follow-up. This procedure is a valuable alternative to EST in patients with bileduct stones.

Adult↗
PubMed1997

Biliary manometry, bacterial characteristics, bile composition, and histologic changes fifteen to seventeen years after endoscopic sphincterotomy.

AIM: To evaluate the function of the biliary sphincter 15 to 17 years after endoscopic sphincterotomy and to investigate if loss of sphincter function is associated with bacterial colonization, changes in bile composition, or inflammation of the biliary system. METHODS: Eight patients who had undergone endoscopic sphincterotomy for bile duct stones 15 to 17 years previously underwent ERCP with biliary manometry, bile sampling, and biopsy. Manometry was performed using a perfused triple-lumen manometry catheter and a station pull-through technique. Bile samples were cultured and analyzed for biliary lipids, bile salts, bacterial beta-glucuronidase, and phospholipase A2. Biopsy specimens were taken from the proximal common heptic duct for histologic examination. RESULTS: Manometry demonstrated absent basal sphincter pressure and no choledochoduodenal pressure gradient in all patients. Phasic contractions were observed in two patients. Cholangiography showed stones in one patient. Positive cultures were obtained in three patients, including the patient with stones. All bile samples showed a high content of biliary lipids and cholesterol. Some samples contained considerable amounts of hydrophobic bile salts. Five samples contained very high levels of phospholipase A2 activity. Significant bacterial beta-glucuronidase activity was found in one patient, the patient with stones. Biopsy specimens of the proximal common hepatic duct in three patients showed chronic inflammation with fibrosis and reactive epithelial changes. CONCLUSIONS: After endoscopic sphincterotomy for bile duct stones, the function of the biliary sphincter is permanently lost. This is associated with bacterial colonization, presence of cytotoxic components in the bile, and chronic inflammation of the biliary system.

Adult↗
PubMed1997

De novo protein synthesis in isolated axons of identified neurons.

Neurons are highly polarized cells that contain a wealth of cytoplasmic and membrane proteins required for neurotransmission, synapse formation and various forms of neuronal plasticity. Typically, these proteins are differentially distributed over somatic, dendritic and axonal compartments. Until recently, it was believed that all proteins destined for various neuronal sites were synthesized exclusively in the somata and were subsequently targeted to appropriate extrasomal compartments. The discovery of various messenger RNA molecules in both dendrites and axons is suggestive of de novo protein synthesis in extrasomatic regions. The latter process has been demonstrated in few neuronal svrstems, but direct proof for the axonal transcription of a specific protein from a given messenger RNA is still lacking. This lack of fundamental knowledge in the field of cellular and molecular neurobiology is due primarily to both anatomical and experimental difficulties encountered in most animal preparations studied thus far. In this study we developed a neuronal experimental system comprising of individually identified neurons and their isolated axons from the mollusc Lymnaea stagnalis. We injected a foreign messenger RNA encoding a peptide precursor into the isolated axons of cultured neurons; and utilizing cellular, molecular and immunocytochemical techniques, we provide direct evidence for specific protein synthesis in isolated axons. The Lymnaea model provides us with an opportunity to examine the role and specificity of de novo protein synthesis in the extrasomal regions.

Animals↗
PubMed1996

Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age.

BACKGROUND: Little is known about the long-term effects of endoscopic biliary sphincterotomy. METHODS: We retrospectively evaluated the rate of late complications after endoscopic sphincterotomy (EST) for bile duct stones. Patients had to meet the following inclusion criteria: (1) treated between 1976 and 1980, (2) complete stone removal after EST, (3) prior cholecystectomy or elective cholecystectomy within 2 months after EST, and (4) 60 years old or younger at the time of ERCP. A total of 100 patients were identified. Information was obtained from general practitioners and patients by telephone. Patients completed a postal questionnaire and a blood sample was obtained for liver function tests. RESULTS: Information was obtained for 94 patients (in the majority of cases [87%] from multiple sources). There were 26 men and 68 women with a mean age of 51 years at the time of ERCP (range, 23 to 60 years). Early complications (< 30 days) occurred in 14 patients (15%). One patient died of a retroperitoneal perforation secondary to EST. During a median period of 15 years (range, 3 to 18 years), 22 patients (24%) developed a total of 36 late complications. There were 21 patients with symptoms of recurrent bile duct stones and one patient with biliary pancreatitis. Other late complications, such as recurrent ascending cholangitis or malignant degeneration, were not observed. An ERCP was performed in 20 of the 22 patients with late complications and demonstrated bile duct stones in 13, combined with stenosis of the EST opening in 9 patients. Late complications were initially managed endoscopically and/or conservatively. One patient underwent surgery after failed endoscopic treatment and one patient died of cholangitis before she could undergo an ERCP. Twelve other patients died of unrelated causes during follow-up. CONCLUSIONS: After EST for bile duct stones, late complications occur in a significant proportion of patients. Stone recurrence remains the most important problem, but can in general be managed endoscopically.

Age Factors↗
PubMed1996

Wallstents for metastatic biliary obstruction.

BACKGROUND AND STUDY AIMS: In patients with obstruction of the common bile duct caused by primary pancreaticoblliary tumors, Wallstents have been shown to remain patent for a median duration of 273 days (range: 14-363). However, in one study that included both patients with primary pancreaticobillary malignancies and patients with metastatic malignant disease, the reported median Wallstent patency was found to be significantly shorter. We have studied the patency of Wall-stents in patients with metastatic billary obstruction. PATIENTS AND METHODS: All patients who had received a Wallstent for metastatic biliary obstruction between January 1990 and August 1994 were analyzed retrospectively. Follow-up was achieved by contacting referring physicians and general practitioners, and lasted up to the end of the study period (November 1994) or death of the patient. Follow-up was discontinued if a polyethylene stent was inserted through the Wallstent for treatment of stent dysfunction. RESULTS: 28 patients were identified, including 14 men and 14 women, with a mean age of 61.3 years (range 24-87). Long-term follow-up was possible in 27 patients (96%), for a median duration of 140 days (range 29- 561). Eleven patients died during the study period, and there were three deaths related to Wallstent dysfunction. The median duration of Wallstent patency was 265 days (range 11-519). Wallstent obstruction occurred in 13 patients; seven patients presented with cholangitis, six patients had jaundice. The cause of obstruction was established at endoscopic retrograde cholangiopancreatography in ten patients: seven had tumor ingrowth, and three had tumor overgrowth. Treatment consisted of insertion of a polyethylene stent in seven and placement of a second Wallstent in three patients. CONCLUSION: In patients with metastatic obstruction of the common bile duct, the duration of patency of Wallstents is comparable to that reported in series of Wallstents for primary pancreaticobiliary malignancies.

Adult↗
PubMed1996

Treatment of bile duct lesions after laparoscopic cholecystectomy.

From January 1990 to June 1994, 53 patients who sustained bile duct injuries during laparoscopic cholecystectomy were treated at the Amsterdam Academic Medical Centre. There were 16 men and 37 women with a mean age of 47 years. Follow up was established in all patients for a median of 17 months. Four types of ductal injury were identified. Type A (18 patients) had leakage from cystic ducts or peripheral hepatic radicles, type B (11 patients) had major bile duct leakage, type C (nine patients) had an isolated ductal stricture, and type D (15 patients) had complete transection of the bile duct. Endoscopic retrograde cholangiopancreatography (ERCP) established the diagnosis in all type A, B, and C lesions. In type D lesions percutaneous cholangiography was required to delineate the proximal extent of the injury. Initial treatment (until resolution of symptoms and discharge from hospital) comprised endoscopy in 36 patients and surgery in 26 patients. Endoscopic treatment was possible and successful in 16 of 18 of type A lesions, five of seven of type B lesions, and three of nine of type C lesions. Most failures resulted from inability to pass strictures or leaks at the initial endoscopy. During initial treatment additional surgery was required in seven patients. Fourteen patients underwent percutaneous or surgical drainage of bile collections, or both. After endoscopic treatment early complications occurred in three patients, with a fatal outcome in two (not related to the endoscopic therapy). During follow up six patients developed late complications. All 15 patients with complete transection and four patients with major bile duct leakage were initially treated surgically. During initial treatment additional endoscopy was required in two patients. Early complications occurred in eight patients. During follow up seven patients developed stenosis of the anastomosis or bile duct. Reconstructive surgery in the early postoperative phase was associated with more complications than elective reconstructive surgery. Most type A and B bile duct injuries after laparoscopic cholecystectomy (80%) can be treated endoscopically. In patients with more severe ductal injury (type C and D) reconstructive surgery is eventually required in 70%. Multidisciplinary approach to these lesions is advocated and algorithms for treatment are proposed.

Adult↗
PubMed1995

Biliary endoprostheses in elderly patients with endoscopically irretrievable common bile duct stones: report on 117 patients.

BACKGROUND: Endoscopic sphincterotomy and stone extraction can clear the bile ducts in 85% to 90% of patients. In case endoscopic stone extraction fails, insertion of a biliary endoprosthesis is an alternative. METHODS: Biliary endoprostheses were inserted in 117 patients (73 women and 44 men, median age 80 years). Follow-up was achieved by contacting referring physicians and general practitioners. RESULTS: Biliary drainage was established in all patients. Early complications occurred in 10 patients (9%) with a fatal outcome in 1. In 59 patients the endoprosthesis was a temporary measure before elective surgery or repeat endoscopy. Further treatment in these 59 patients caused only mild complications and there were no deaths. Endoprostheses were inserted as permanent therapy in 58 patients. Median follow-up in these 58 patients was 36 months (range, 1 to 117 months). A total of 34 complications occurred in 23 patients (40%), cholangitis being the most frequent. During follow-up, 44 patients died, 9 as a result of a biliary-related cause. CONCLUSIONS: These data favor temporary use of biliary endoprostheses in patients with endoscopically irretrievable bile duct stones. However, as a permanent therapy, late complications occur in many patients and the risk increases proportionally in time. Therefore, permanent biliary stenting should preferably be restricted to patients unfit for elective treatment at a later stage and with a short life expectancy.

Aged↗
PubMed1994

Addition of dimethylsulphoxide to methyl-tert-butyl ether and ethyl propionate increases cholesterol dissolving capacity and cholesterol gall stone dissolution in vitro.

There is a discrepancy between in vitro cholesterol dissolving efficacy of methyl-tert-butyl ether (MTBE) and ethyl propionate and cholesterol gall stone dissolution in vivo. This study investigated whether the presence of bile changes the cholesterol dissolving capacity of MTBE and ethyl propionate. The addition of dimethylsulphoxide to MTBE or ethyl propionate was also studied to discover if it improves the dissolving capacity for cholesterol gall stones. The presence of bile caused a 25% decrease in cholesterol dissolving capacity of both MTBE and ethyl propionate (p < 0.0001). This inhibitory effect of bile could be overcome by the addition of dimethyl-sulphoxide: dimethylsulphoxide caused an increase in cholesterol dissolving capacity of MTBE and ethyl propionate, the increase depending on the dimethyl-sulphoxide/bile ratio in the mixture. Mean dissolution time of weight, size, and patient matched cholesterol gall stones was 220 minutes in MTBE and 130 minutes in MTBE/dimethylsulphoxide (p < 0.0001). No stones dissolved completely in ethyl propionate or ethyl propionate/dimethyl-sulphoxide within 300 minutes. In conclusion, MTBE/dimethylsulphoxide is a more potent dissolving agent for cholesterol gall stones than MTBE, giving a 40% reduction in dissolution time. Addition of dimethylsulphoxide to ethyl propionate does not result in faster stone dissolution. MTBE and MTBE/dimethylsulphoxide are far superior to ethyl propionate as solvents for cholesterol gall stones.

Bile↗
PubMed1991

Evaluation of a physician education intervention to improve primary care for low-back pain. I. Impact on physicians.

In an effort to improve the cost-effectiveness of primary care for low-back pain, we developed, implemented, and evaluated a physician education intervention. The program was designed to provide family physicians with specific information, tools, and techniques that our previous studies and the literature suggested should be associated with more satisfying and cost-effective care for low-back pain. The in-clinic educational intervention included feedback of the findings of our previous studies of care for back pain (comparing family physicians and chiropractors), an up-to-date summary of scientific knowledge relevant to the management of back pain in primary care, a videotape contrasting ineffective and effective patient encounters, and a clinical assessment form for low-back pain. The back pain-related beliefs, attitudes, and behaviors of 15 primary care providers in a large health maintenance organization clinic and of 14 family physicians in six group practices were assessed before and after the intervention. Significant increases were noted in the proportions of providers who felt confident they knew how to manage low-back pain, who believed their patients were satisfied, and who claimed they reassured patients that they did not have serious disease. The intervention, however, had little impact on the prevalence of negative feelings about patients with back pain or frustration with patients who wanted their doctor to "fix" their problem. The intervention had a similar impact on health maintenance organization and fee-for-service physicians.

Back Pain↗
PubMed1988

How patients and physicians address each other in the office.

Six hundred four patients in three primary care office settings were asked whether they preferred to be addressed by their physician by their first or last name and whether they preferred to address their physician by first or last name. Actual use of first vs last name by the physician addressing the patient and the patient addressing the physician was also recorded. Of the patients expressing a preference, 96 percent preferred that their physician address them by first name while 87 percent noted that this gesture actually occurred. Forty percent of the patients preferred to address the physician by first name while 14 percent actually did so. These findings suggest that physicians can feel comfortable addressing almost all of their patients by first name and that many of their patients may desire to address them by their first name. It is suggested that the physician at the time of the patient's first visit clarify the manner in which each addresses the other.

Adolescent↗
PubMed1984

Establishing the cause of genitourinary symptoms in women in a family practice. Comparison of clinical examination and comprehensive microbiology.

We conducted a prospective study comparing the diagnostic yield of standard clinical examinations and of comprehensive microbiological studies in establishing the etiology of genitourinary (GU) symptoms and the prevalence of GU tract infections in 204 women seen in a university-based family practice. Two thirds were initially seen with GU symptoms and one third were seen for routine examinations. In each case we obtained demographic and historical information, a physical examination, and a variety of laboratory tests, including research procedures not commonly available. Diagnoses considered were urinary tract infection and sterile pyuria; trichomonal, yeast, and nonspecific vaginitis; and GU tract infection with Neisseria gonorrhoeae, Chlamydia trachomatis, or herpes simplex virus. Using strategies commonly employed in practice, we reached a diagnosis in only 34% of symptomatic women, a figure rising to 66% when selected, nonroutine laboratory examinations were added.

Adolescent↗
PubMed1984

Clinical comparison of microscopic and culture techniques in the diagnosis of Candida vaginitis.

This study compares potassium hydroxide (KOH), Microstix-Candida, and Nickerson's medium with Sabouraud agar in the isolation of Candida. Of 204 symptomatic and asymptomatic women, 36 had Sabouraud cultures positive for Candida. The KOH preparation demonstrated both poor sensitivity and poor predictive value in the isolation of Candida, while Microstix-Candida and Nickerson's medium were statistically indistinguishable from Sabouraud agar. The use of either Microstix-Candida or Nickerson's medium is recommended in the evaluation of Candida vaginitis when the KOH preparation is negative.

Adult↗
PubMed1984

Clothing factors and vaginitis.

Associations of clothing factors and vulvovaginal symptoms, signs, and microbiology were sought in 203 women seeking care at a university family medicine clinic. Clothing factors studied were use of panty hose, underwear for sleep, cotton lining panels, and pants vs skirts. Women wearing and not wearing panty hose had similar rates of vaginitis symptoms and signs, but yeast vaginitis was about three times more common among wearers. Relationships of other clothing factors to vaginitis were not found. Nonspecific vaginitis was not found to be related to clothing.

Adolescent↗