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Biomedical subjects

J Lens

Publications and source records attributed to J Lens.

At least 19 recordsLinked to original sources
PubMed1990

Intraluminal Miller-Abbott tube stenting as treatment and prophylaxis of recurrent intestinal obstruction.

Chronic recurrent intestinal obstruction due to massive adhesions after abdominal surgery is a complication that is difficult to treat. The records were studied of 25 patients with acute intestinal obstruction due to massive adhesions. Since conservative measurements were unsuccessful, the patients were treated with internal intestinal splinting by means of a Miller-Abbott tube. These 25 patients underwent a total of 72 operations, 36 were performed for mechanical obstruction. Conservative treatment alone was effective during 25 admissions. The complaints of the patients lasted five years on an average. After lysis of adhesions the Miller-Abbott tube was introduced either via the nose, via a gastrostomy or via an enterostomy. The tube was left in situ for three weeks and then gradually withdrawn. There was no hospital mortality. There was one postoperative complication: a tube had to be removed under general anaesthesia. Long-term follow-up of the patients varied from 4.5 to 19 years with a mean of 11.3 years. One patient with recurrent intestinal obstruction due to adhesions, required surgical intervention after one year. A second patient with Peutz-Jeghers syndrome needed surgery because of an intestinal adenoma after six years. The mean symptom-free interval was 11.1 years in the cured patients.

Female↗
PubMed1988

Microbial flora and bile acid metabolism in patients with an ileal reservoir.

Bacterial flora of ileum effluent and bile acid metabolism were investigated in 11 patients 11-44 months after construction of a Kock's continent ileostomy. Bacteriologic investigation showed significantly more microorganisms per millilitre (p less than 0.01) and a more colon-like flora--that is, anaerobic microorganisms (p less than 0.001)--in ileum effluent of continent ileostomy patients than in ileum effluent of patients with a conventional ileostomy. The reabsorptive capacity of the reservoir mucosa was tested by direct introduction of a radioactively labelled conjugated bile acid, 23-75Se-25-homotaurocholic acid (SeHCAT), into the ileal pouch. After 4 h, 90% of the SeHCAT activity had been reabsorbed from the reservoir. Quantitative and differential analysis of bile acids in the ileum effluent showed unconjugated and predominantly primary (88%) bile acids, suggesting a minimal influence of bacterial flora on bile acid metabolism. Moreover, total bile acid loss appeared to be within normal limits.

Adult↗
PubMed1987

Mucosal alterations in the reservoir of patients with Kock's continent ileostomy.

Mucosal alterations in the reservoir of 10 patients with Kock's continent ileostomy were investigated and compared with normal ileal mucosa. Morphometric measurements showed a decreased villus length and an increased crypt length as compared with the control group. When the villus to crypt ratio was related to the time elapsed after the continent ileostomy operation, a decrease could be found. Light microscopy evaluations showed colon-like characteristics, which was confirmed by the detection of goblet-cell hyperplasia and the occurrence of sulphomucin-producing cells in the reservoir's mucosa. The number and type of neuroendocrine cells, however, remained unaltered. Dysplastic changes did not occur.

Follow-Up Studies↗
PubMed1984

Large-pore hemodialytic procedures in pigs with ischemic hepatic necrosis; a randomized study.

In order to define further the therapeutic role of hemodialytic procedures in acute hepatic failure, 20 pigs with ischemic hepatic necrosis underwent randomized hemodialysis against an electrolyte solution (n = 6), hemofiltration with re-infusion of an electrolyte solution (n = 5), control hemofiltration with re-infusion of autologous ultrafiltrate (n = 4) or no extracorporeal procedure at all (n = 5). Pigs on hemodialytic procedures survived significantly longer (51 +/- 11 hrs) than controls (36 +/- 8 hrs). There were no differences in the duration of survival between hemodialysis and hemofiltration, nor between controls undergoing and those not undergoing an extracorporeal procedure. Electroencephalograms showed more rapid (p less than 0.05) deterioration in control animals than in the treatment group. Putative toxins such as ammonia, glutamine, tyrosine, tryptophan, and methionine all decreased transiently in the treatment group; in the control group a continuous increase in the levels of the putative toxins was observed. Comparison of all pigs surviving 35 hrs or less (n = 6) and animals surviving more than 45 hrs (n = 7) showed that long-term survival was significantly associated with lower plasma ammonia and methionine concentrations and fewer abnormalities on the electroencephalogram 10 hrs after the start of extracorporeal procedures; moreover six of the 7 long-term survivors underwent hemodialysis or hemofiltration procedures. We conclude that hemodialytic procedures prolong survival in pigs with ischemic hepatic necrosis by slowing the development of encephalopathy; this effect of hemodialytic procedures may be mediated by the lowering of plasma ammonia and methionine levels.

Ammonia↗
PubMed1983

Comparison of large-pore membrane haemodialysis and cross-dialysis in acute hepatic insufficiency in pigs.

We studied the duration of survival and the removal of putative toxins in forty pigs with ischaemic hepatic necrosis, undergoing haemodialysis or cross-dialysis with a large-pore membrane. Ischaemic hepatic necrosis was induced in conscious animals by tightening a loop around the hepatic artery 3 days after construction of a portocaval shunt. Pigs treated by a dialysis procedure survived significantly longer (45.2 +/- 11.9 h) than controls (26.3 +/- 5.4 h). There was no difference between haemodialysis and cross-dialysis. Blood ammonia initially dropped significantly (P less than 0.05) more during haemodialysis (560 +/- 107 leads to 210 +/- 51 mumol/l) than during cross-dialysis (596 +/- 131 leads to 398 +/- 81 mumol/l) but it subsequently increased beyond initial values despite efficient removal during continuous dialysis. Removal of ammonia was greater during cross-dialysis than during haemodialysis, but haemodialysis was more effective in the removal of the ammonia precursors glutamine and urea. We conclude that dialysis procedures can prolong survival in pigs with ischaemic hepatic necrosis. The removal of ammonia-precursors is more effective in the prevention of hyperammonaemia than the removal of ammonia itself. Since dialysis cannot prevent progressive hyperammonaemia, control of excessive toxin production seems mandatory for effective hepatic support.

Acrylonitrile↗
PubMed1982

Sarcoidosis of the liver, complicated by bleeding oesophageal varices.

Case report of a 57-year-old woman with pulmonary and hepatic sarcoidosis. As a rare complication, portal hypertension developed and first became manifest as bleeding from oesophageal varices. A portocaval shunt was successfully performed and the patient remained in stable condition after a follow-up of two years.

Esophageal and Gastric Varices↗
PubMed1981

Results of split-ileostomy in Crohn's disease of the colon.

In a period of seven years split-ileostomies were performed in 30 patients with Crohn's disease of the colon. Patients with the previous resection of the bowel were excluded. The indications for the diverting-ileostomy were: 1 toxic colitis unresponsive to intensive conservative therapy, and 2 long standing colitis, with or without perianal fistulae, not adequately responding to conservative treatment. Regarding the results, a split-ileostomy would seem to be indicated in debilitated patients in whom a resection at the time of the primary laparotomy carries too great a risk. None of our nine patients died. In long-standing disease a split-ileostomy for the purpose of healing or limiting the ultimate resection is not satisfactory. In only four out of 21 electively performed ileostomies this goal was achieved. We have too little experience with split-ileostomies in the treatment of extensive perianal and rectovaginal fistulae.

Adolescent↗
PubMed1981

Acute acalculous cholecystitis.

Acute acalculous cholecystitis after trauma or non-related surgery is a rare and dangerous complication. The pathogenesis is multifactorial. Impairment of the circulation to the gallbladder and cystic duct obstruction by inspissated bile seem to be the most important factors. The disease runs a fulminant course, and since diagnosis is generally difficult and usually delayed, the mortality is unduly high. Awareness of the physician is therefore of paramount importance. Cholecystectomy is the recommended treatment. A series of 13 patients is presented and the pathogenesis, diagnosis, and management of this complication are discussed.

Acute Disease↗