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Biomedical subjects

M A Kemler

Publications and source records attributed to M A Kemler.

22 records · Page 2Linked to original sources
PubMed1997

Femoral hernia: is a conservative policy justified?

OBJECTIVE: To find out the incidence of complications among patients who present with femoral hernias and whether they are preventable. DESIGN: Retrospective study. SETTING: Teaching hospital, The Netherlands. SUBJECTS: 111 patients whose femoral hernias were operated on between 1 January 1983 and 31 June 1994. INTERVENTIONS: Emergency (n = 33) and elective repair (n = 78). MAIN OUTCOME MEASURES: Morbidity and mortality, and associated factors. RESULTS: Patients who underwent emergency repair were significantly older (median age 77 years, range 28-106 compared with 54, range 19-85, p < 0.001), were more likely to have cardiopulmonary disease (14/33 compared with 6/78, p < 0.001), and were more likely to need a bowel resection (9/33 compared with 0/78, p < 0.001). Three patients died in the emergency group compared with none in the elective group. CONCLUSION: An initial conservative policy led to higher subsequent morbidity and mortality because of the relatively high incidence of strangulation in older patients and those with cardiopulmonary disease. We therefore recommend elective repair as the treatment of choice.

Adult↗
PubMed1997

Adventitial stripping does not strip the adventitia.

This study investigates the process of stripping the adventitia off a blood vessel, which is a normal procedure prior to performing a microvascular anastomosis. In five rats, the common carotid and the superficial femoral arteries of one side were stripped sharply, whereas the arteries of the other side were left unstripped to serve as controls. In a further set of five rats, the arteries were stripped bluntly. Immediately following stripping, experimental and control arterial segments were removed. Histology of cross sections of the segments was studied. In no case was there complete removal of the adventitia. When stripped and control arterial sections were compared, no significant difference between cross-sectional adventitial areas could be demonstrated. Morphologic study revealed that stripping mainly removes large collagen fibers from the adventitia. The small collagen fibrils that are still in place fan out in such a way that although considerable tissue is removed, the volume that the adventitia occupies remains the same. Stripping the adventitia does not cause complete removal of the adventitia, and in this study no significant reduction in the adventitial volume could be found. Stripping does, however, allow a better view of the cut edge of the vessel wall under an operating microscope. Since blunt stripping could cause damage to other vessel wall layers, sharp stripping is to be preferred.

Anastomosis, Surgical↗
PubMed1993

[Treatment of obstructive ileus useful in patients with a malignity in their medical history].

OBJECTIVE: To determine whether treatment of patients with obstructive ileus and a malignancy in the anamnesis is still useful or leads to increased morbidity and reduced quality of the remaining life. DESIGN: Retrospective. SETTING: University Hospital Utrecht. METHOD: Data were collected concerning 89 patients who in the period August 1987 to July 1992 were admitted with the clinical picture of obstructive ileus and who all had a history of a malignancy treated longer than 30 days previously. RESULTS: The patients were 53 females and 36 males. Over one-half of the tumours were of colorectal or gynaecological origin. In all, 56 patients were operated (17 without delay, 39 after failure of conservative treatment), the others were given only conservative treatment. The cause of the obstructive ileus in the operated patients was malignant in 38, benign in 17 and unknown in one case. Of the patients, 22 died in hospital, mostly as the consequence of progression of the original malignancy, and 2 at their own request at home. Major complications occurred in 21 of the 56 operated patients. Nevertheless 65 of the 89 patients could be discharged free of ileus. CONCLUSIONS: Treatment of obstructive ileus in patients with a malignancy in the anamnesis is useful. In most cases, operation is indicated, but initial conservative treatment is justified.

Adult↗