Biomedical subjects
Publications and source records attributed to K Huibregtse.
The vitamin B12 and bile acid metabolism was studied in 20 patients in whom a standardized Bricker procedure without irradiation was performed. No significant vitamin B12 malabsorption, steatorrhea, fecal bile acid loss or bile acid deconjugation was found. Therefore, no long-term adverse metabolic consequences of segmental preterminal ileal resection are to be expected in these patients.
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Fifteen patients (20 to 66 years) with long-standing chronic diarrhea of varying etiology were selected for an open trial of loperamide 2 mg capsules. The optimal daily dose for substantial reduction of the diarrhea ranged from two to seven capsules. Eleven patients showed a significant improvement in stool consistency and stool frequency, and a decrease of abdominal cramps. Loperamide appeared to be ineffective in two patients with cholerrheic diarrhea, and in one patient with laxative-induced diarrhea, and in one patient with diarrhea of unknown etiology. The eleven successfully treated patients then entered a double-blind placebo-controlled trial for ten days or until relapse, the daily dose being identical to the optimal one previously determined in the open phase. The investigator was able to guess the code correctly in ten out of eleven cases. Twenty ileostomy patients (ages 25 to 73 years) volunteered for the evaluation of the inhibitory activity on small intestinal peristalsis by loperamide in a double-blind placebo-controlled cross-over study. Mean daily ileostomy output decreased by 22% in the loperamide period, as compared with the drug-free study phase (P less than 0.001). Of the 20 patients, 16 were able to guess their code correctly, whereas four were uncertain, although their fecal weights were lower with loperamide. Many patients noticed an increased urinary production and experienced an improvement in their ileostomy care during loperamide treatment. Because of its effectiveness, its low side-effect liability and its lack of toxicity, loperamide is considered a promising drug in the symptomatic treatment of chronic diarrhea, and as a reliable agent in the treatment of ileostomy patients.
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Fifteen patients (20-66 years) with persistent diarrhoea of varying aetiology were selected for an open trial of loperamide 2 mg capsules. The optimal daily dose for substantial reduction of the diarrhoea ranged from two to seven capsules. Eleven patients showed a significant improvement in stool consistency, a highly significant decrease in stool frequency and a decrease of abdominal cramps. One ileostomy patient with abundant ileostomy output and intermittent leaking of the ileosotmy appliance at night experienced a substantial reduction of the stoma output with virtual disappearance of soiling accidents as night. Loperamide appeared to be ineffective in two patients with cholerrhoeic diarrhoea; in one patient with laxative-induced diarrhoea and in one patient with probable nervous diarrhoea. The eleven successfully treated patients then entered a doubleblind placebo-controlled trial for ten days or util relaps, the daily dose being indentical to the optimal one previously determined in the open phase of the study. The investigator was able to guess the code correctly in ten out of eleven cases. The drug was well tolerated. Because of its considerable efficacy and low side-effect liability, loperamide has to be considered a promising drug in the treatment of chronic diarrhoea.
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Self-expanding metal stents are claimed to prolong biliary-stent patency, although no formal comparative trial between plastic and expandable stents has been done. In a prospective randomised trial, we assigned 105 patients with irresectable distal bile-duct malignancy to receive either a metal stent (49) or a straight polyethylene stent (56). Median patency of the first stent was significantly prolonged in patients with a metal stent compared with those with a polyethylene stent (273 vs 126 days; p = 0.006). The major cause of stent dysfunction was tumour ingrowth in the metal-stent group and sludge deposition in the polyethylene-stent group. Treatment after any occlusion included placement of a polyethylene stent. In the metal-stent group none of 14 second stents occluded, whereas 11 of 23 (48%) second stents clogged in the polyethylene-stent group (p = 0.002). Overall median survival was 149 days and did not differ significantly between treatment groups. Incremental cost-effectiveness analysis showed that initial placement of a metal stent results in a 28% decrease of endoscopic procedures. Self-expanding metal stents have a longer patency than polyethylene stents and offer adequate palliation in patients with irresectable malignant distal bile-duct obstruction.
A nasopancreatic drain, pancreatic duct endoprostheses, and pancreatic stone extraction were used to treat 32 patients with chronic pancreatitis. Thirty patients were treated endoscopically. Endoscopic treatment via the minor papilla in 2 patients with pancreas divisum was not performed. Three patients had subsequent surgery because of complications; one of them died. Seventeen patients with chronic relapsing pancreatitis improved, with 15 patients asymptomatic during a follow-up of 2 to 69 months (median, 11). Seven of 10 patients with chronic pain improved, with 6 patients pain-free during a follow-up of 10 to 34 months (median, 11). In 7 patients, pancreatic pseudocysts could be drained endoscopically by positioning an endoprosthesis into the cyst or by performing a cystoduodenostomy. Six patients had concomitant placement of a biliary endoprosthesis to treat common bile duct strictures within the pancreatic head. One of 32 treated patients died as a result of a complication. We consider endoscopic therapy a viable alternative to surgery in select patients with chronic pancreatitis.
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Sixty patients in whom a biliary endoprosthesis was inserted were randomized to receive: (1) placebo, (2) aspirin, or (3) doxycycline, to study the effect on the process of sludge formation. After 2 months all endoprostheses were changed, and the amount and composition of the sludge in the patent stents was analyzed. Half of the patients dropped out. The major component (56%) of the sludge of all groups was protein. No insoluble residue was present. Major deposits of sludge were found at irregularities in the stent wall (side flaps). Both doxycycline and aspirin reduced the dry weight of the sludge. Doxycycline significantly reduced the amount of protein, but scanning electron microscopy still showed abundant bacterial growth. Aspirin reduced the content of all sludge components including protein, suggesting that it decreases "stickiness" of bile. Surprisingly, doxycycline significantly decreased the death rate in the 2 months of the study. We present further evidence for a primary role of protein deposition in the early stages of stent occlusion. This process can be partly inhibited by doxycycline and probably also by aspirin, which could lead to a significant increase in stent patency.
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This study evaluates the efficacy of endoscopic stenting in 70 patients with noncomplete post-operative biliary strictures. The treatment consisted of placement of two 10 F gauge straight endoprostheses with elective exchange trimonthly, for a 1-year period. Successful endoprosthesis placement was accomplished in 66 of 70 patients (94%). In all 66 patients jaundice subsided. During the stenting period six patients had an operation and six died. In 46 patients the endoprostheses were removed. The mean period of follow-up was 42 months (range, 4 to 99 months). Excellent (asymptomatic, normal, or stable liver enzymes) and good (only one episode of cholangitis) responses were achieved in 83%; restricturing occurred after stent removal in 17%. Prolonged biliary stenting appears to be a safe and effective treatment modality for benign post-operative strictures and a valid alternative to surgery.
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