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Biomedical subjects

K Huibregtse

Publications and source records attributed to K Huibregtse.

At least 73 records · Page 4Linked to original sources
PubMed1996

Biliary excretion of ciprofloxacin and piperacillin in the obstructed biliary tract.

Biliary excretion of ciprofloxacin and piperacillin was determined in cholestatic patients who had undergone endoscopic cholangiography. The median concentration of ciprofloxacin (n = 9) was 2.36 micrograms/ml (range, 0.29 to 19.8 micrograms/ml) in bile compared with 1.66 micrograms/ml (range, 0.73 to 2.69 micrograms/ml) in serum. The median concentration of piperacillin (n = 7) was < 5 micrograms/ml (range, < 5 to 26) in bile compared with 14.3 micrograms/ml (range, 5.3 to 80) in serum. Ciprofloxacin, but not piperacillin, can be actively excreted into bile in the presence of a biliary tract obstruction.

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↗
PubMed1996

Clinical significance of K-ras oncogene activation in ampullary neoplasms.

AIMS: To investigate the prevalence of K-ras codon 12 point mutations in ampullary neoplasms, to explore their clinical usefulness, and to test whether the detection of these mutations could be used to identify ampullary malignancies at an early stage. METHODS: Forty one tumour specimens from 28 patients with ampullary neoplasms were analysed for activating point mutations in K-ras codon 12 using a sensitive polymerase chain reaction (PCR) based assay. RESULTS: Eleven (39%) of the 28 primary tumours harboured point mutations in K-ras. Mutations were identified in seven (41%) of the 17 carcinomas and four (36%) of the 11 adenomas. Four of the possible six permutations in codon 12 were found in these 11 samples. This spectrum of mutations is different from pancreatic carcinoma but resembles that of colorectal neoplasms. Cytological brush specimens were available in 11 cases, and in all of these specimens, the K-ras status in the primary tumour and brush specimens was identical. CONCLUSIONS: K-ras codon 12 point mutations occur in about 40% of ampullary neoplasms at a relatively early stage in tumorigenesis. The pattern of mutations in these tumours resembles that of the adenoma-carcinoma sequence in the colorectum. These results indicate that ampullary neoplasms can be detected at an early stage by searching for genetic alterations in the K-ras oncogene in cytological brush specimens.

Adenocarcinoma↗
PubMed1996

Benign biliary strictures and sclerosing cholangitis.

Inadvertent injury to the biliary tree at surgery and sclerosing cholangitis present particular difficulties to the clinician. Therapeutic ERCP is effective in the management of the immediate and late complications of the bile duct injury. The role of endoscopy in primary sclerosing cholangitis remains to be defined. Endoscopic biliary drainage protocols have yielded favorable results.

Aged↗
PubMed1996

Preoperative biliary drainage, colonisation of bile and postoperative complications in patients with tumours of the pancreatic head: a retrospective analysis of 241 consecutive patients.

OBJECTIVE: To analyse the outcome of preoperative biliary drainage in patients being operated on for a tumour in the pancreatic head. DESIGN: Retrospective study. SETTING: University hospital, The Netherlands. SUBJECTS: Consecutive series of 241 patients. MAIN OUTCOME MEASURES: Decline in bilirubin concentrations and bacterial contamination of bile as a result of preoperative drainage. Incidence of postoperative complications in patients who underwent preoperative drainage and those who did not. RESULTS: 184/241 patients underwent preoperative biliary drainage. Endoscopic drainage was the most effective, shown by a median reduction in bilirubin concentrations of 82%, 74%, and 50% after endoscopic drainage (n = 149), papillotomy (n = 25) and external drainage (n = 10), respectively. Bacterial contamination of bile was significantly more common when an endoprosthesis was used, but did not result in a higher rate of infective complications. 163 Whipple's resections, 33 total pancreatectomies, and 45 biliary-enteric bypasses were performed. 137/241 (57%) patients had postoperative complications. There was no significant difference in the incidence of postoperative complications between patients who had preoperative biliary drainage and those who did not (p = 0.4).

Adult↗
PubMed1995

Long-term results of pancreatic stents in chronic pancreatitis.

BACKGROUND: Pancreatic stenting is a new nonsurgical treatment for patients with chronic pancreatitis and pain. We studied the long-term safety and efficacy of pancreatic stenting. METHODS: Between 1982 and 1993, 51 patients with chronic pancreatitis and persistent pain with dominant strictures in the pancreatic duct were treated with plastic pancreatic stents. RESULTS: Stent insertion was successful in 49 of 51 patients. Early complications occurred in 9 of the 51 patients (18%). Patients were followed for a median of 34 months (range 6 to 128). Nine of the 49 patients (82%) had clinical improvement. Sixteen of these 40 patients still had their stents in place. Stents were removed in 22 of the 40 patients with persistent beneficial response in all (median follow-up 28.5 months). The long-term effect of stenting could not be evaluated in the remaining 2 patients because they had a double bypass operation. Stent dysfunction occurred in 27 of the 49 patients (55%) and was successfully treated by exchanging the stent. CONCLUSIONS: Pancreatic stenting was associated with minimal early complications, but stent dysfunction remained a frequent late complication. Pancreatic drainage resulted in clinical improvement in 40 of the 49 patients (82%). Twenty-two of these 40 patients maintained the beneficial response after stent removal (28.5 months).

Cholangiopancreatography, Endoscopic Retrograde↗
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↗
PubMed1995

The efficacy of endoscopic treatment of pancreatic pseudocysts.

BACKGROUND: Endoscopic drainage of pancreatic pseudocysts is a new nonsurgical treatment modality. We retrospectively studied the efficacy of endoscopic drainage of pseudocysts in 37 patients with chronic pancreatitis. METHODS: Endoscopic retrograde pancreatic drainage was performed in 12 patients, endoscopic cystogastrostomy in 10 patients, and endoscopic cystoduodenostomy in 7 patients. In the remaining 8 patients, combinations of drainage routes were used. RESULTS: ECG failed in 3 patients. Procedure-related complications were seen in 6 patients: bleeding in 3, perforation in 2, and apnea in 1 patient. There was no procedure-related mortality. Seven patients had complications in relation to stents or drains: pseudocyst infection due to stent clogging in 2, stent migration in 4, and kinking of the drain in 1 patient. Twenty-four patients had complete resolution of pseudocysts, 7 had partial resolution, and 6 had no resolution. Three patients had pseudocyst recurrences. Mean follow-up was 32 months. Finally, 10 patients underwent surgery. CONCLUSIONS: Endoscopic drainage was technically feasible in 92% of the patients. Procedure-related morbidity was 16% and mortality was 0%. Endoscopic drainage was a definitive treatment for two thirds of the patients (65%). Surgery can be reserved for those patients in whom endoscopic therapy fails.

Adolescent↗
PubMed1995

Endoscopic Sphincterotomy and Stone Extraction.

Recent development of new cannulation techniques, improvement of lithotripsy methods, and the advent of laparoscopic cholecystectomy have extended the efficacy and broadened the application of endoscopic sphincterotomy and stone extraction. Choledocholithiasis, a condition that once was believed to invariably require surgical intervention, now can successfully be treated endoscopically in 85% to 90% of cases, with a complication rate of 7% to 10% and a mortality rate of 0.5% to 1.0%. In patients scheduled for laparoscopic cholecystectomy in whom bile duct stones are suspected, the indication and timing of perioperative endoscopic retrograde cholangiopancreatography depend on the likelihood of ductal stones being present as well as local endoscopic expertise. The increase in the number of younger patients referred for endoscopic stone extraction, mainly as a consequence of the advent of laparoscopic cholecystectomy, and the unknown long-term effects of sphincterotomy have led to the development of techniques in which stones are extracted from the bile duct without sphincterotomy. This article concentrates on the technique of endoscopic sphincterotomy and stone extraction, defines its indications (with special reference to laparoscopic cholecystectomy) and discusses occurrence and management of complications.

Journal Article↗
PubMed1995

Results of the new nitinol self-expandable stents for distal biliary structures.

BACKGROUND AND STUDY AIMS: The nitinol stent is a self-expandable spiral stent made of nickel-titanium alloy. We performed a pilot study to evaluate the method of stent insertion and stent efficacy. PATIENTS AND METHODS: Twenty-eight patients with irresectable malignancy had nitinol stents inserted for obstructive jaundice due to distal biliary strictures. They were followed prospectively for a median of ten weeks (range 1-48) until stent occlusion or death. All patients underwent sphincterotomy prior to stent insertion. Stent deployment was assisted by subsequent balloon dilation of the stent in two patients. Plastic stent insertion was used to temporarily brace the nitinol stent in another three patients. RESULTS: Short-term relief of jaundice was achieved in 20 of the 28 patients (71%). The remaining eight patients had persistent jaundice due to failure of stent insertion (three patients) or early stent dysfunction (five patients). Long-term success was achieved in 12 of 28 patients (43%). Ten of the 12 patients died without complications after a median of 13.5 weeks (range 3-48). One of the 12 patients is still alive with the stent in place for 40 weeks, and one patient underwent elective bypass surgery, and the stent was removed surgically. Eight of the 28 patients had recurrent symptoms due to late stent dysfunction after a median of 19 weeks (range 6-32). CONCLUSIONS: Nitinol stents are technically difficult to insert. The problem of stent dysfunction (13 of 28, 46%) is not improved by the use of nitinol stents. Whether improvement of the insertion technique and enhancement of the expanding force of the stent may improve stent efficacy merits further evaluation.

Aged↗
PubMed1995

Pancreatic and ampullary carcinoma.

Surgery should be the first therapeutic modality considered in patients with pancreatic and ampullary carcinoma. Surgery is the only potentially curative therapy and offers the best form of palliation in patients with impending or overt duodenal obstruction. Patients with clearly unresectable tumors or those considered unfit for surgery should be offered palliative therapy, preferably endoscopically. The difficulty, however, arises in patients who undergo laparotomy and who subsequently are found to have unresectable tumors. The problem of stent occlusion and frequent associated hospital visits has been an argument to proceed to palliative double bypass surgery. Against this is the low mortality and shorter hospital stay of nonsurgical endoscopic palliative therapy. Direct comparisons of surgery versus endoscopic therapy have shown that both are equally effective in the initial relief of jaundice (Table 6). Surgery has a higher initial mortality and complication rate, but more long-term complications and hospital visits were seen in the endoscopic group, suggesting that it offered a poorer long-term palliation. There was no significant difference in the survival of the patients in the two groups. Patient choice is a major factor in the final decision, but current recommendations probably should be that patients with a poor short-term survival outlook should be offered nonsurgical palliative therapy and those with a longer life expectancy may best be handled with surgery. Predicting patient survival, of course, remains a major difficulty. A recent publication of the laparoscopic formation of a cholecystojejunostomy for palliation of malignant biliary obstruction also offers a promising approach that requires further evaluation.

Adenocarcinoma↗
PubMed1994

Management of bile duct stones in the era of laparoscopic cholecystectomy.

The introduction of laparoscopic cholecystectomy has resulted in increased options for the management of bile duct stones and has stimulated a fundamental reappraisal of the situation before the laparoscopic era. This article reviews the natural history of bile duct stones and details the different ways in which they may now be treated. New areas of controversy are highlighted and the need for further studies is emphasized.

Aged↗
PubMed1994

The role of endoscopic retrograde cholangiopancreatography in cholestatic infants.

Conjugated hyperbilirubinemia in infants is a serious problem, and one that requires further investigation. Early differentiation between extrahepatic and intrahepatic causes of cholestasis is essential for the proper management of cholestasis in infancy. A successful outcome in patients with extrahepatic biliary atresia is significantly influenced by the age at which the Kasai procedure (hepatoportoenterostomy) is performed. However, extensive diagnostic workup may fail to distinguish definitively between intrahepatic and extrahepatic disease, and exploratory laparotomy and intraoperative cholangiography are sometimes necessary to exclude extrahepatic disease. In the last four years, 20 cholestatic infants were referred to our center in whom no definite diagnosis was possible, despite thorough diagnostic evaluation. In an attempt to increase the accuracy of our diagnostic work-up, we performed ERCP during the anesthetic period planned for liver biopsy. We succeeded in performing ERCP in 18 children (90%); in five of them (28%), patent bile ducts were demonstrated, and unnecessary laparotomy could be avoided. In four patients (22.2%), a stricture of the common bile duct was seen, in three combined with a choledochal cyst. In two patients (11.1%), only the common bile duct and gallbladder were opacified. Five of seven patients in whom only the pancreatic duct was visualized had complete occlusion of the extrahepatic biliary ducts at surgery. The other two patients did not undergo surgery because initially no signs of extrahepatic obstruction were found in their biopsy. One of these patients deteriorated and needed a liver transplant one year later. This patient proved to have extrahepatic biliary atresia. No severe complications of ERCP were observed; only sporadically, a slight elevation of pancreatic enzymes was noted. We advocate this procedure in the workup of infants with unexplained conjugated hyperbilirubinemia. Anomalies in the biliary tree can be demonstrated, and when patent bile ducts are found, laparotomy can be avoided.

Biopsy, Needle↗