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Biomedical subjects

J N Keeman

Publications and source records attributed to J N Keeman.

At least 55 records · Page 3Linked to original sources
PubMed1987

Operative treatment of unstable distal radial fractures.

The results of operative treatment of unstable distal radial fractures were evaluated in 46 patients according to the criteria of Steinmann and Spier. The overall results were excellent or good in 35 patients (76.1%) and fair in 11 patients (23.9%). There were no poor results. Intra-articular fractures with volar dislocation (Smith type II) and fractures with severe comminution (Sarmiento type IV) are unstable and require surgery. Special attention must be paid to the Sarmiento type-II fracture with severe comminution of the dorsal cortex, severe radial shortening (greater than 10 mm) and dorsal tilt (greater than 25 degrees). Although not intra-articular, this fracture type may also prove to be unstable. The treatment of a Smith type-II fracture is a volar buttress plate unless extended comminution is present. Then, and in all other unstable fracture types, external fixation should be employed. In cases with severe loss of the dorsal cortex, bone grafting may be indicated.

Adult↗
PubMed1986

Acute pseudo-obstruction of the colon.

Five patients were treated for pseudo-obstruction of the colon. The symptoms, diagnostic procedures and treatment of Ogilvie's syndrome are discussed. A definitive diagnosis can be established only at laparotomy when no mechanical obstruction is found to be present. Progression of ileus and signs of peritonitis constitute an indication for laparotomy. Delay in operative therapy implies the risk of (coecal) perforation with increased mortality. Coecostomy is an adequate therapy that spares the patient a second procedure for closure of a colostomy.

Aged↗
PubMed1985

Shoulder function following early mobilization of the shoulder after mastectomy and axillary dissection.

A prospective clinical trial was conducted to determine the effect of axillary node dissection for breast carcinoma on shoulder function and seroma production. 59 Operations were carried out in 57 patients. The patients were divided into two groups. In group A, shoulder exercises were started, under the guidance of a physiotherapist, immediately following surgery, and in group B the exercises were begun on the seventh postoperative day. A full range of motion within six months was achieved in 25 patients of group A (81%) and in 22 of group B (79%). There was no significant difference in wound drainage between the two groups. Restricted shoulder movement was often seen after local wound complications following axillary radiotherapy or after seriously disturbed wound healing.

Adolescent↗
PubMed1985

Correlation between a positive gallbladder culture and subsequent wound infection after biliary surgery--a retrospective study of 840 patients.

The possible correlation between a positive culture of samples from the gallbladder wall and/or bile at the time of cholecystectomy and subsequent wound infections was retrospectively studied in a series of 840 patients. Positive cultures were present in 138 patients (16.4) and 19 different bacterial species could be identified. Cultured bile showed Escherichia coli in 36% of cases. The wound infection rate was 9% (72 patients) with Staphylococcus aureus cultured from the infected wounds in 64%. Fifty-eight of these 72 patients (80%) were at high risk. In contrast with the literature, no correlation existed between a positive bile culture and subsequent wound infection. In view of these results there is no need to evaluate a Gram-stain during surgery. Antimicrobial prophylaxis should be restricted to high-risk patients and the antibiotics used must be effective against exogenic wound contaminants.

Adult↗
PubMed1983

Long-term follow-up of Lord's procedure for haemorrhoids.

86 Patients treated for first or second degree haemorrhoids by Lord's manual dilatation of the anus were followed up for a mean period of 7.2 years. The outcome in the 76 patients traced was satisfactory or good in 76.3%. In only 14.5% was the result unsatisfactory. Lord's anal dilatation is a relatively simple procedure; the results of this study show that it gives good long-lasting results.

Adolescent↗
PubMed1981

Computerized tomography and radionuclide scan in surgical patients -- a comparative prospective study in detecting liver metastases.

A prospective study was carried out in 100 patients with carcinoma of the digestive tract, in whom a CT-scan and a radionuclide scan were made prior to operation. The CT-scan and the radionuclide scan had the same degree of diagnostic relaibility (about 80% correct diagnoses). Routine pre-operative CT or isotope scans do not in our experience alter the surgical management. From the in vitro investigation in which the liver is cut into the same slices as the computerized tomography, it appears that liver metastases larger than 3.5 cm diameter are always seen, while smaller metastases may be missed. The alkaline phosphatase and the gamma CT are no reliable estimations in establishing the diagnosis of liver metastases.

Diagnostic Errors↗
PubMed1981

Clinical applications of magnetic rings in colorectal anastomosis.

Based upon experiments on animals, an anastomotic apparatus, consisting of two magnetic rings of polymer bonded, rare earth cobalt magnets embedded in polyester, was developed. There are three types of polyester device with diameters of 25, 28, and 30 millimeters, respectively. The force between the magnets varied between 2.5 Newtons at 4 centimer separation and 11.8 Newtons at union. For the low colorectal anastomosis, a magnet holder, connecting rod and spherical cap were developed. The aim of the technique is a quick restoration of the underbroken submucosal intestinal cylinder by optimal circular apposition of the submucosal layer. The working mechanism is based upon progressive compression, leading to necrosis of the intermediate mucosal and submucosal layers by increasing the magnetic force while intestinal healing takes place. After seven to 12 days, the magnets cut through the disappear from the anastomotic region by intestinal peristalsis. From the initial series of 21 patients, 11 resections of the sigmoid colon and nine low anterior resections were performed. Dehiscence of the suture line was noted in two instances. One patient required reoperation. The other patient had a small area of dehiscence at the suture line after evacuation of an infected hematoma with a further uncomplicated course. One patient died on the third postoperative day of recurrent myocardial infarction. In the other 18 patients, primary intestinal healing was demonstrated roentgenologically and sigmoidoscopically.

Aged↗
PubMed1981

The importance of the apposition of the submucosal intestinal layers for primary wound healing of intestinal anastomosis.

This study was undertaken to examine the importance of the apposition of the submucosal layers in healing of the intestinal anastomosis. On 18 mongrel dogs, weighing between 8 and 15 kilograms, four anastomoses were performed on the small intestine. Two with a conventional anastomosis and two with rings of polyester-polyethyleneterephtalate, containing small Ticonal magnets. The force between the rings with the magnets varied from 0-3 newton between, respectively, 15 millimeters and zero millimeter distance. After three to four days, the rings cut through and disappeared from the anastomosis. Morphologic and microangiographic studies, undertaken at ten days, revealed that, in instances of good submucosal apposition, direct bridging of the defect in the submucosal layer was seen with rapid restoration of the villous epithelium and an undisturbed vascular pattern in the anastomotic area. This we called primary intestinal healing. In instances of bad submucosal apposition, we saw indirect bridging of the submucosal layer defect by smaller and longer strands of newly synthesized collagen tissue in the outer intestinal layers with a collateral circulation from the submucosal plexus to the arterial plexuses in these layers. In all instances, an epithelial defect still persisted at ten days. This type of wound healing we called secondary intestinal healing. The results showed that, with the magnetic rings, a significantly better apposition of the intestinal layers was achieved.

Animals↗
PubMed1980

Early experiences with magnetic rings in resection of the distal colon.

We have developed an anastomosis technique for resection of the distal colon based on the principle of submucosal layer apposition. The anastomosis apparatus consists of two rings of Ertalyte (polyester-polyethyleneterephtalate) containing two magnetic rings of polymer bonded rare earth cobalt. For low anastomoses we developed a magnetic ring holder, protecting cap and hexagonal connecting rod. The working principle is based on progressive compression leading to necrosis of the intermediate mucosal and submucosal layers by increasing magnetic force while bowel healing takes place. After 7 to 17 days the magnets cut through and are propelled by peristalis out of the anastomotic region. From our initial series of five patients we performed three sigmoid resections and two low anterior resections. There were no postoperative complications. Sigmoidoscopic and radiological investigations two weeks postoperatively, showed no evidence of leakage or anastomotic narrowing. The technique and the special advantages of the apparatus are discussed.

Aged↗