Search PubMed⌕ Search

Biomedical subjects

M J Slooff

Publications and source records attributed to M J Slooff.

At least 181 records · Page 10Linked to original sources
PubMed1987

Acute abdomen in hemodialysis patients--a diagnostic dilemma.

Nine hemodialysis patients with an intra-abdominal emergency were retrospectively studied to investigate possible disguise of symptoms and signs. Physical examination of the abdomen, body temperature and WBC were assessed and compared with the data (mean and range) recorded one year before, so that each patient could serve as his own control. All patients were in an advanced stage of the disease and presented with signs of peritoneal irritation. Temperature response in all patients was adequate, but most patients had a low basal body temperature. There was either leukocytosis or a shift to the left. Symptoms and signs of acute abdominal disease may be attenuated at the onset of disease, therefore proper interpretation of body temperature and laboratory findings, with the patient as his own control, may facilitate early diagnosis.

Abdomen, Acute↗
PubMed1987

Conservative surgical treatment for acute pancreatitis: the Lawson procedure.

Twenty-seven patients with acute necrotizing pancreatitis were treated with the Lawson procedure, consisting of closed drainage of the lesser sac, cholecystostomy, gastrostomy and jejunostomy. Retrospectively, the effect of the treatment was judged in relation to mortality and morbidity. Thirteen patients (48%) died, all of them due to sepsis and multiple organ failure. This considerable mortality was undoubtedly also influenced by the serious condition of most patients as reflected by the number of positive Ranson criteria. Seven patients (26%) had to be reoperated on because of abscesses. The high incidence of abscesses and the sepsis in all deceased patients indicate an insufficient drainage of the lesser sac with this method. Of the three stomas only jejunostomy proved to be useful for quick resumption of enteral feeding.

Acute Disease↗
PubMed1986

Vesicocalicostomy as ultimate solution for recurrent urological complications after cadaveric renal transplantation in a patient with poor bladder function.

We report a case of a neurogenic bladder in which hydronephrosis recurred early after renal transplantation. After 2 unsuccessful attempts at ureteroneovesicostomy of the donor ureter a vesicocalicostomy was performed, since reconstruction with the donor pelvis or ureter was impossible owing to the extended fibrosis and scar formation around the renal hilus and ureter. During the 23 months of followup renal function has been good without serious infectious sequela with a regimen of self-catheterization and no antibiotic maintenance therapy.

Adult↗
PubMed1986

Management of oesophageal perforations; a tailored approach.

The results of treatment of 20 oesophageal perforations were retrospectively studied in 19 consecutive patients. Most complications occurred after endoscopic procedures, after a delay in treatment of more than 12 hours, in patients with intrinsic oesophageal disease and in cases where only drainage procedures were possible. Because of the many factors that influence the outcome of the treatment of oesophageal perforation it is stressed that the therapeutic approach should not be dogmatic, but tailored to the individual patient. Although morbidity is still high, mortality has markedly decreased by this differentiated approach, the only death not being directly related to the perforation. Early recognition remains the most important factor in the prognosis of patients with oesophageal perforation.

Adolescent↗
PubMed1985

Effect of captopril on blood pressure and renal function in patients with transplant renal artery stenosis.

We evaluated 9 patients with transplant renal artery stenosis. Captopril treatment always resulted in a dramatic decrease in renal function. Moreover, only in patients (n = 2) with a stenosis in one out of more renal arteries a satisfying fall in blood pressure was achieved. Surgical reconstruction of the stenosis was successful in 4 out of 5 patients. Angiotensin I-converting enzyme inhibition in transplant renal artery stenosis often leads to loss of graft function, probably due to efferent vasodilation.

Acute Kidney Injury↗
PubMed1985

Pneumatosis intestinalis in patients after cadaveric kidney transplantation: possible relationship with an active cytomegalovirus infection.

Four patients are presented with pneumatosis intestinalis following kidney transplantation, all with severe cytomegalovirus (CMV) infection. Two patients had a primary infection and two patients had CMV reactivation. One patient died because of disseminated CMV infection. Two patients had concomitantly an active, non-obstructive duodenal ulcer. In a control population of 17 patients who suffered from a duodenal ulcer post-transplant without any evidence of CMV infection, we could not demonstrate pneumatosis intestinalis. We suggest a possible relationship between pneumatosis intestinalis and active CMV infection. The possible mechanisms responsible for this relationship are discussed.

Adult↗
PubMed1985

Results of transplantation of kidneys from diabetic donors.

Diabetic donors are still reluctantly accepted as potential organ donors because of supposed poor graft function caused by diabetic lesions. The results of transplantation of six kidneys from three donors with insulin dependent diabetes mellitus are reported. All three donors had a normal creatinine clearance and absence of proteinuria. Renal biopsies were taken. Five grafts are still functioning, six months to two years after transplantation with a mean creatinine clearance of 69ml/min (range 51-95). Three of five biopsies taken six months after transplantation showed marked decrease of the diabetic lesions. On the basis of these findings it seems justified to accept kidneys from diabetic donors for transplantation.

Adult↗
PubMed1985

The use of cyclosporine only in cadaveric renal transplant recipients: conversion to prednisolone and azathioprine after four months.

After conversion from cyclosporine (Cys) only to prednisolone and azathioprine four months after cadaveric renal transplantation, effective renal plasma flow (ERPF), glomerular filtration rate (GFR) and filtration fraction (FF) all improve. However, this improvement is not uniform. GFR and FF improve in all patients after one week of combined Cys and prednisolone treatment. ERPF improves under the same circumstances only in recipients without previous rejection episodes. After discontinuation of Cys and addition of azathioprine ERPF improves further in all patients. These findings suggest the presence of a low grade rejection, together with Cys nephrotoxicity. The conversion procedure seems to be safe at least during a follow-up period of 9-14 months.

Azathioprine↗
PubMed1985

Choledochocholedochostomy, a relatively safe procedure in orthotopic liver transplantation.

The biliary anastomosis has been considered the Achilles heel of liver transplantation, and especially the choledochocholedochostomy has been reported to be ill-fated. However, based on previous experimental experiences we decided to use the choledochocholedochostomy as the biliary anastomosis of preference in orthotopic liver transplantation. A choledochocholedochostomy has been performed in 29 of the 31 patients who have undergone transplantation since 1979. Five complications (17%) were diagnosed, of which one proved to be fatal. Two complications were related to the handling of the T-tube and required simple laparotomy to solve the intraperitoneal bile leakage. The other three complications were major: in one patient the choledochocholedochostomy was stenosed, requiring a conversion into a hepaticojejunostomy, while in two patients the donor common bile duct became necrotic. One of these patients underwent successful retransplantation, while the other died of sepsis. In both patients the hepatic artery anastomosis proved to be thrombosed, while in all patients without biliary complications the hepatic artery anastomosis was patent angiographically or at autopsy. The total incidence of sepsis was 26%, but in only four patients (13%) was sepsis related to the choledochocholedochostomy. The relationship between the necrosis of the donor bile duct and the patency of the hepatic artery anastomosis emphasizes an impeccable surgical technique. The low incidence of biliary complications in our 31 patients characterizes the choledochocholedochostomy as a relatively safe biliary procedure in clinical liver transplantation.

Common Bile Duct↗
PubMed1985

Beta-cell response and insulin sensitivity after segmental pancreatic autotransplantation with systemic venous drainage.

It is hypothesized that heterotopic segmental pancreatic autotransplantation with removal of the remaining segment compromises glucose tolerance in dogs in the long run. In 10 dogs the left lobe of the pancreas was heterotopically autotransplanted, in 5 dogs the left lobe remained in situ, after denervation. Duct drainage was provided by a pancreaticoileostomy. Six months after transplantation, decreased beta-cell response, combined with increased insulin sensitivity was observed in the heterotopically transplanted dogs. Five dogs in this group developed an insulin dependent diabetes mellitus. These results are explicable by the diversion of insulin from the liver and the late effects of continuous endocrine pancreatic stimulation on the beta-cell function.

Animals↗
PubMed1985

The Biocarbon vascular access device (DiaTAB) for haemodialysis.

The Biocarbon vascular access device (DiaTAB) is a relatively new method in secondary access surgery. Punctures, often the cause of complications can be avoided because it is a no-needle method of dialysis. However thrombosis due to stenosis of the venous anastomosis or of the efferent vein is a continuing problem. A new experience is the fibrin flap formation under the plug of the device, which can be removed easily.

Adult↗
PubMed1984

Pneumatosis intestinalis in patients after cadaveric kidney transplantation. Possible relationship with an active cytomegalovirus infection.

Four patients are described with pneumatosis intestinalis following cadaveric kidney transplantation, all with severe cytomegalovirus (CMV) infection. Two patients had a primary infection and 2 patients had a reactivation of CMV. One patient died because of disseminated CMV infection. Multiple inclusion bodies were found at postmortem examination in lungs and liver, and at the site of the ulcers in the gastrointestinal tract. Two patients had, concomitantly, an active, nonobstructive duodenal ulcer. In a control population of 17 patients who suffered from a duodenal ulcer post-transplant without any evidence of CMV-infection, we could not demonstrate pneumatosis intestinalis. We suggest a possible causal relationship between pneumatosis intestinalis and active CMV infection. The mechanisms that could be responsible for this relationship are discussed.

Adult↗
PubMed1984

Choledochocholedochostomy is successful in orthotopic liver transplantation.

The viability of the extrahepatic bile ducts of liver grafts depends on their arterial blood supply, and consequently, on the patency of the arterial anastomosis. Thrombosis of the hepatic artery leads almost inevitably to necrosis of the extrahepatic bile ducts of the liver graft. An impeccable technique of arterial anastomosis is essential to avoid biliary complications resulting from ischemia. The low incidence of biliary complications (17%) in our 31 patients indicates that choledocho-choledochostomy is a relatively safe biliary procedure in clinical liver transplantation, especially when compared with other commonly used biliary anastomoses.

Adult↗
PubMed1984

The surgical treatment of postgastrectomy reflux gastritis.

Eighteen patients with postgastrectomy reflux gastritis were treated between 1970 and 1981 by Roux-en-Y diversion. All of the patients had a typical history of midepigastric burning pain and the majority had bilious vomiting as well. The diagnosis was confirmed by endoscopic results and histopathologic study of the gastric mucosa. Twelve surviving patients--one patient died postoperatively--experienced a dramatic relief of the symptoms. In five patients, gastrointestinal tract complaints reappeared but did not have the typical character of reflux gastritis. The macroscopically apparent gastritis subsided completely after revisional operations; while the histologic signs and symptoms of chronic gastritis remained. The Roux-en-Y diversion for patients with post-gastrectomy reflux gastritis proved to be a safe and relatively simple procedure with a high chance of relieving the complaints of the patient. The preoperative and postoperative gastric mucosal biopsies were not of much use in confirming the diagnosis or substantiation of the beneficial effect of the remedial operation.

Adult↗
PubMed1983

Five years' experience in access surgery for polychemotherapy. An analysis of results in 100 consecutive patients.

In 100 consecutive patients with various malignancies, 142 operations were performed to establish an arteriovenous fistula giving vascular access for chemotherapy. The fistula of choice was always an end-to-side fistula between the cephalic vein and the radial artery (radiocephalic fistula). A fistula of this type was established in 88 operations on 76 patients and functioned well in 64% of this group. In 29 patients in whom this fistula failed or was not feasible, an elbow fistula was performed in 32 operations and functioning well in 59%. In 13 patients whose arms offered no alternative possibility, 15 long saphenous vein (LSV) autografts were implanted in the inguinal region. A radiocephalic fistula was successfully performed in 77% of the patients who had received preoperative chemotherapy during less than 4 weeks, versus 26% of those who had received preoperative chemotherapy during a longer period. The radiocephalic fistula is the fistula of choice to gain vascular access for chemotherapy. It has proved necessary to perform this operation before chemotherapy is started. When this type of fistula is not feasible, alternatives are an elbow fistula or an (LSV) autograft in the inguinal region.

Adolescent↗