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Biomedical subjects

K Huibregtse

Publications and source records attributed to K Huibregtse.

At least 127 records · Page 7Linked to original sources
PubMed1986

Therapeutic investigations in primary sclerosing cholangitis.

There is no consensus about the necessity and the possibility of therapy in primary sclerosing cholangitis. In some patients rapid deterioration of liver function may occur due to recurrent cholangitis and cholestasis. In one such patient, we obtained radiological evidence that the cholestasis was caused, not entirely by end-stage fibrotic scarring as interpreted upon surgical exploration, but, at least in part, by biliary stasis secondary to marked irregular narrowing of the extrahepatic bile ducts, together with precipitate formation. Moreover, the biliary ductular narrowing appeared to be partly reversible, indicating that edema and inflammation were responsible for part of the narrowing. These observations prompted us to evaluate topical lavage by nasobiliary drainage, first with saline, and then followed by corticosteroid solution in eight consecutive patients with recurrent cholangitis. Based upon clinical and biochemical evaluation, our preliminary results may be summarized as favorable. However, a large-scale multicenter controlled study will be required to prove the usefulness of this approach.

Adolescent↗
PubMed1986

Endoscopic palliative treatment in pancreatic cancer.

Patients with carcinoma of the head of the pancreas will develop obstructive jaundice at some point in their course in 80% to 90% of the cases. Surgical biliary digestive anastomosis carries a high 30-day mortality (20%), and hospitalization may be prolonged for several weeks owing to postoperative morbidity. We attempted endoscopic endoprosthesis placement in 221 patients with pancreatic carcinoma for palliation of obstructive jaundice. The procedure was successful in 200 of 221 (90%) with a procedure-related mortality of only 2% and a 30-day mortality of 10%. The serum bilirubin level normalized in 92% of those who survived, and the mean survival of 6 months is comparable to that achieved with biliodigestive anastomosis. Early cholangitis (8%) and late clogging of the endoprosthesis (21% at a mean of 5 months) are problem areas that need to be improved. We believe these results justify considering endoscopic biliary prosthesis as the treatment of choice in nonresectable jaundiced patients with carcinoma of the head of the pancreas.

Adolescent↗
PubMed1986

Endoscopic treatment of postoperative biliary strictures.

Benign postoperative biliary tract strictures may present with jaundice and/or cholangitis. Surgical reconstruction of these usually proximal biliary strictures carries high morbidity and mortality. In addition, recurrences following surgery are common. We attempted endoscopic therapy in 29 consecutive patients with benign biliary strictures, by the placement of one or two large-bore 10 French endoprostheses. The procedure was successful in 27 out of 29 (93%) patients. All 27 had rapid clearance of jaundice and/or cholangitis. Clinical follow-up of 21 patients for at least 6 months (range 6 months to 4 years) shows that 19 out of 21 have good (3) or excellent (16) results. There was no morbidity or mortality associated with the procedure. Although placement of an endoprosthesis in this group of patients is technically difficult, we believe it should be considered as the initial therapeutic modality in this clinical situation.

Adult↗
PubMed1986

A new surgical approach for the management of carcinoma of the junction of the main hepatic ducts.

In the present study we discuss our early results and some technical aspects of a new surgical approach in dealing with high-lying malignant biliary obstruction. After transection of the common bile duct we proceed through a cephalad reflection of its proximal end in a meticulous dissection of the intrahepatic biliary tree. During dissection we follow the intrahepatic course of the right and left portal vein, which leads us to follow the respective course of the main right and left hepatic ducts and to reach the levels of their subsequent consecutive segmental bifurcations. By transecting at high levels, we excise completely or partially the tumor with the confluence of common hepatic duct. We reconstruct the biliary tree by multiple intrahepatic cholangiojejunostomies by use of a Roux-Y jejunal loop and a varied number of segmental hepatic ducts. Transanastomotic tubes were used only temporarily. Fifteen patients underwent operations by the described surgical approach without mortality. All were relieved of their jaundice completely and in all the tumor was either completely (5) or partially (10) removed. All patients had a good quality of postoperative life without being obliged to carry transanastomotic tubes and the complications and problems associated with them.

Adenoma, Bile Duct↗
PubMed1984

Treatment of solitary rectal ulcer syndrome with high-fiber diet and abstention of straining at defecation.

Twenty-one patients with a solitary ulcer of the rectum were treated with instructions for a high-fiber diet and abstention of straining at defecation, since there is evidence that the solitary ulcer syndrome is caused by chronic mechanical and ischemic trauma, by hard stools, and intussusception of the mucosa. In 15 patients disappearance of symptoms and complete ulcer healing was obtained in an average period of 10.5 months (range 2.5-21 months). In the other six patients the lesions remained unchanged. The results demonstrate that softening of stools and normalization of defecation habits should be the mainstay in the treatment of this otherwise chronic disorder with poor healing tendency.

Adolescent↗
PubMed1984

Treatment of instrumental oesophageal perforation.

Results of a conservative approach in the treatment of instrumental oesophageal perforation were evaluated in 54 patients. The perforations occurred either during introduction of/or manipulation with fibre-endoscopes (six), during dilatation procedures with metal olives (five), mercury bougies (six) or during pneumodilatation (two) in 19 patients without malignancy and during an intubation procedure of a plastic prosthesis in 35 patients with an inoperable malignant oesophageal narrowing. In the majority of patients (94.4%) the diagnosis of oesophageal perforation was made within two hours. Conservative treatment consisted of nothing by mouth, antibiotics and naso-oesophageal suction. Of the 19 patients without malignancy, 14 were treated conservatively and five by surgery (primary closure and drainage) with no deaths. All patients with an oesophageal perforation caused by palliative intubation received conservative treatment with three deaths (8.6%). Non-surgical treatment of instrumental oesophageal perforation is feasable and acceptable, provided the perforation is detected early, before major contamination has occurred and is indicated in case of perforation in patients with malignancy.

Adult↗
PubMed1984

Endoscopic screening for malignancy in the gastric remnant: the clinical significance of dysplasia in gastric mucosa.

Five hundred and four asymptomatic patients in whom gastrectomy had been performed between 1931 and 1960 were investigated by endoscopy plus biopsy. Ten stump carcinomas were detected (1.98%). In five patients the tumour was limited to the mucosa and was not seen at endoscopy. In three patients with previously noted severe dysplasia intramucosal carcinoma was detected during follow up and in two the carcinoma was found at the site of the preceding severe dysplasia. True regression of severe dysplasia could not be shown. In 23 patients with previous mild or moderate dysplasia no progression was seen during follow up. Severe gastric dysplasia is a serious marker of malignancy demanding close follow up with repeated endoscopy and biopsy. The clinical significance of mild and moderate dysplasia remains unclear. Early detection of stump carcinoma is indeed possible. Physicians should rely not so much on the endoscopic appearance but on the results of multiple biopsies.

Adult↗
PubMed1984

The operated stomach: a premalignant condition? A prospective endoscopic follow-up study.

2633 consecutive patients in whom a gastric operation had been performed between 1931 and 1960 were selected for an ongoing prospective follow-up study. In 741 already deceased patients mortality due to gastric cancer was 5.13%. 504 asymptomatic postgastrectomy patients participated in an endoscopic-bioptic screening program. Up to now, 10 stump cancers have been detected. Seven had a radical curative resection, and all are still alive. In five of them the cancer was limited to the mucosa and not visible at endoscopy. Gastric dysplasia was found in 70 patients. In three patients with severe dysplasia carcinoma was detected during follow-up study. In 22 patients with prior mild or moderate dysplasia no progression could be demonstrated. Cancer in postgastrectomy patients is estimated to be at least twice as high as in an age-matched Dutch control population with intact stomach. The risk depends on the postoperative interval and the age at which the initial operation was performed. In general, patients from the age of 50 onwards or more than 10-15 years after initial surgery are at risk.

Adult↗
PubMed1983

A pepsinogen from dog stomach.

1. A pepsinogen has been purified from dog stomach in 20% yield. 2. At pH values below 4 it spontaneously converts to a pepsin, the first order rate constant at pH 2, 22 degrees C, being 11 min-1. 3. The pepsinogen is stable to denaturation at pH values up to 9, in contrast to the pepsin which is irreversibly denatured above pH 7. 4. Its proteolytic activity against denatured hemoglobin is equal to that of pig pepsin, but in the milk-clotting assay at pH 5.5 its has only 14% the activity.

Amino Acids↗
PubMed1983

A pepsinogen from rainbow trout.

1. A pepsinogen, Ia on the basis of its electrophoretic mobility, from rainbow trout stomach, has an optimum pH near 2 for activation. 2. The cognate pepsin is denatured at pH values above 7, in contrast to the zymogen, which is slightly more alkali-stable. It has an optimum pH of 3 for proteolysis of denatured hemoglobin. 3. The intrinsic reactivity of the zymogen and pepsin (rates of activation and of proteolysis, respectively) are quite high, but as they operate at the environmental temperature of the fish, are remarkably similar to rates of activation and proteolysis by mammalian pepsinogens and pepsins.

Animals↗