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R H Geelkerken

Publications and source records attributed to R H Geelkerken.

11 recordsLinked to original sources
PubMed1995

Mesenteric vascular disease: a review of diagnostic methods and therapies.

Mesenteric vascular disease is a relatively rare disease; however the morbidity and mortality are significant. Improved diagnosis and treatment of mesenteric obstructive arterial disease and its complications have occurred. Biplanar angiography of the mesenteric arteries remains the best method of diagnosing mesenteric vascular diseases, though duplex sonography of the mesenteric arteries appears to be a valuable screening tool. Magnetic resonance angiography has the potential to improve on the diagnostic accuracy. Mesenteric artery reconstructive surgery remains the treatment of choice. Newer surveillance techniques such as tonometry may enhance perioperative monitoring and consequently improve the results of mesenteric artery reconstructive surgery. Aggressive support medical therapy plays a significant role in the treatment and reduces patient morbidity and mortality in carefully selected cases. There remains a dearth of prospective controlled trials in patients with this condition.

Angiography↗
PubMed1994

[Surgical strategy in acute or elective sigmoid resection in The Netherlands; survey based on a marketing model].

OBJECTIVE: To gain insight into the operative strategies used by Dutch surgeons for complicated diverticulitis and sigmoid carcinoma, and into the influence of patient risk factors and surgeon's experience on the preferred operative strategy. DESIGN: Descriptive. METHOD: A questionnaire was sent to all 148 members of the Dutch Society of Gastrointestinal Surgery, concerning 32 fictitious patients with sigmoid pathology. It was based on conjoint-analysis, a model used in marketing research. This model analyses qualities that make a product preferable to another product of the same product group. The operative choices were: resection with Hartmann's procedure, resection with primary anastomosis after on-table lavage, or with primary anastomosis only, or no primary resection but diverting stoma only, or some personal technique. The survey focused on experience of the surgeons with the operative procedures, and on treatment choices in four fictitious cases frequently encountered in general surgery. RESULTS: There was little agreement concerning the preferred surgical option for treatment of complicated diverticular disease or sigmoid carcinoma. With the exception of one fictitious young, electively operated 'ideal' patient (resection with primary anastomosis) there is hardly any consensus among the surgeons with respect to preferred treatment. CONCLUSIONS: Reasons to depart from the conceptually optimal treatment (resection and anastomosis) in complicated cases (from the point of view of the surgeon or the patient), and absence of agreement on responsible other treatment could be differences in appraisal of the importance of several risk factors, or differences in acquired decision making strategies. The literature offers no answer to the question which techniques should be preferred under various circumstances.

Adult↗
PubMed1994

Pressure sores and pressure-decreasing mattresses: controlled clinical trial.

Pressure sores are a problem, especially in elderly patients. Our study was designed to determine the effectiveness in pressure-sore prevention of a new interface-pressure decreasing mattress. In a prospective randomised controlled clinical trial we tested the Comfortex DeCube mattress (Comfortex, Winona, USA) against our standard hospital mattress in 44 patients with femoral-neck fracture and concomitant high pressure-sore risk score. In addition both groups were treated according to the Dutch consensus protocol for the prevention of pressure sores. On admission and 1 and 2 weeks after admission, pressure sores were graded. The two groups were similar in patient characteristics and pressure-sore risk factors. At 1 week, 25% of the patients nursed on the DeCube mattress and 64% of the patients nursed on the standard mattress had clinically relevant pressure sores (grade 2 or more). At 2 weeks the figures were 24% and 68%, respectively. The maximum score over the several body regions of the pressure-sore grading, measured on a 5-point sale, was significantly different in favour of the DeCube mattress at 1 week (p = 0.0043) and 2 weeks (p = 0.0067) postoperatively. We show that the occurrence of pressure sores and their severity can be significantly reduced when patients at risk are nursed on an interface-pressure decreasing mattress.

Aged↗
PubMed1994

Sweet syndrome associated with liposarcoma: a case report.

A 36-year-old woman with a dedifferentiated liposarcoma is described who had suffered from Sweet syndrome in the past. From the literature a relationship between this syndrome and malignancy is known to exist. However, the combination of Sweet syndrome with a sarcoma has not previously been reported.

Abdominal Neoplasms↗
PubMed1991

Chronic mesenteric vascular syndrome. Results of reconstructive surgery.

Since 1961, 14 patients at the University Hospital of Leiden, the Netherlands, have undergone reconstructive surgery for treatment of chronic mesenteric vascular syndrome. Of the 42 mesenteric arteries, 31 were severely obstructed (mean, 2.2 stenotic arteries per patient). A total of 23 mesenteric arteries were repaired. Long-term follow-up data were available for all 13 surviving patients (mean follow-up, 11.8 years). Symptoms were relieved immediately after surgery, and relief was maintained during follow-up. Digital subtraction angiography at long-term follow-up evaluation was performed in eight patients (13 reconstructions) with these results: 11 (85%) of the 13 reconstructions were patent and severe stenoses were found in eight (33%) of the 24 mesenteric arteries (mean, 1.0 stenotic artery per patient). We conclude that reconstructive surgery for patients with chronic mesenteric vascular syndrome promptly relieves symptoms, provides excellent patency, and has long-lasting beneficial results.

Abdominal Pain↗
PubMed1990

Coeliac artery compression syndrome: the effect of decompression.

The effects of operation to decompress the coeliac artery were evaluated in 11 consecutive patients with coeliac artery compression syndrome. Immediately after the operation all patients were free of symptoms. Three months later three of the 11 had recurrent abdominal pain. Long-term follow-up between 15 and 23 years, obtained by questionnaire, was available for eight patients. All eight had return of symptoms similar to those before surgery. These unsatisfactory results suggest that operation should not be undertaken in patients with vague upper abdominal complaints and compression of the coeliac artery by the median arcuate ligament, who do not otherwise have pathological conditions which might explain their symptoms.

Adolescent↗
PubMed1990

Surgical treatment of intestinal artery aneurysms.

Intestinal artery aneurysms are usually asymptomatic. However, occasionally they occur as a vascular emergency and when rupture occurs, mortality rates of up to 75% have been reported. Therefore, elective surgery of asymptomatic intestinal artery aneurysms seems indicated provided that the procedure is safe with a low morbidity and mortality. We have reviewed the results of surgical treatment of eight patients with intestinal artery aneurysm who were operated on electively and seven who had emergency procedures over a 20 year period. Mortality was high when rupture had occurred, despite acute surgical intervention. After elective procedures however mortality and morbidity were substantially lower. Elective surgical intervention should therefore be performed as soon as an intestinal artery aneurysm is diagnosed.

Aneurysm↗
PubMed1990

Acute mesenteric embolism: an appeal for a pro-active diagnostic approach.

Acute mesenteric ischaemia can be caused by arterial embolism. The initial aspecific symptoms mostly lead to late recognition of acute mesenteric ischaemia which leads to intestinal infarction. Intestinal infarction with signs of peritonitis has a very high mortality. Since 1982, a pro-active approach is followed in our department. After thorough exclusion of other causes, patients with serious acute abdominal complaints undergo an emergency angiography and/or emergency laparotomy. After confirmation of the diagnosis, primary vascular reconstructive surgery is performed if possible. We have treated eight patients with acute mesenteric embolism according to this policy. Per- and post-operatively, three patients died of extensive intestinal infarction. The five surviving patients were on a normal diet and had normal bowel functions at the time of discharge from the hospital. This limited experience shows that a pro-active approach in patients with acute mesenteric embolism can result in survival and preservation of a normally functioning alimentary tract.

Acute Disease↗
PubMedDate not supplied

Systolically gated 3D phase contrast MRA of mesenteric arteries in suspected mesenteric ischemia.

OBJECTIVE: Our goal was to assess the value of MRA for detecting stenoses in the celiac (CA) and superior mesenteric (SMA) arteries in patients suspected of having chronic mesenteric ischemia, using an optimized systolically gated 3D phase contrast technique. MATERIALS AND METHODS: In an initial study in 24 patients who underwent conventional angiography of the abdominal vessels for different clinical indications, a 3D phase contrast MRA technique (3D-PCA) was evaluated and optimized to image the CAs and SMAs. Subsequently, a prospective study was performed to assess the value of systolically gated 3D-PCA in evaluation of the mesenteric arteries in 10 patients with signs and symptoms of chronic mesenteric ischemia. Intraarterial digital subtraction angiography and surgical findings were used as the reference standard. RESULTS: In the initial study, systolic gating appeared to be essential in imaging the SMA on 3D-PCA. In 10 patients suspected of mesenteric ischemia, systolically gated 3D-PCA identified significant proximal disease in the two mesenteric vessels in 4 patients. These patients underwent sucessful reconstruction of their stenotic vessels. CONCLUSION: Cardiac-gated MRA may become a useful tool in selection of patients suspected of having mesenteric ischemia who may benefit from surgery.

Adult↗