Biomedical subjects
Publications and source records attributed to R Van Hee.
The authors present a case of postoperative enterogastric intussusception after previous Billroth II-gastrectomy, associated with a Braun's W-anastomosis of the efferent small bowel loop. Loss of viability of the incarcerated jejunal loop required segmental small bowel resection. Total recovery was obtained. Literature is reviewed concerning diagnosis and treatment of adult intestinal intussusception.
Antoine Depage, born near Brussels in 1862, was one of the founders and first Secretary General of the Société Internationale de Chirurgie (ISS-SIC). After an excellent medical education at the Free Brussels University, he became professor at the same university at the age of 27. Surgically trained by Prof. Thiriar, he became one of the leading Belgian surgeons at the end of the nineteenth century, and he published more than 100 articles in national and international journals. In 1907 he founded a school for nurses in Brussels, to be directed by Edith Cavell. He also vigorously transformed the organization of the public hospitals in the Belgian capital. During World War I Queen Elisabeth appointed him surgeon-in-chief of the Océan-hospital in De Panne, where more than 50,000 soldiers with wounds, fractures, cerebral trauma, nitrous gas intoxication, and infectious diseases, among other problems were treated. The results he and his team obtained were excellent, and mortality was low. Many surgeons, including Alexis Carrel, as well as distinguished political leaders came to visit him in the hospital barracks. After the war he was honored by many political and scientific organizations, including the Société Internationale de Chirurgie. He served our Society not only as Secretary General from 1902 to 1912 but became President of the 4th Congress of the ISS-SIC in New York. Antoine Depage died after a long illness in 1925.
OBJECTIVE: Analysis of the long-term results of video-assisted thoracic surgery (VATS) for spontaneous pneumothorax in patients treated in two surgical centres from May 1994 until December 2000. METHODS: A cohort of 86 patients was studied retrospectively. For final analysis, 74 patients undergoing 76 VATS procedures were included. RESULTS: Sixty-three procedures for primary spontaneous pneumothorax (PSP) and 13 procedures for secondary spontaneous pneumothorax (SSP) were performed. In 78.9% (n = 60) blebs or bullae were resected with an endostapler device. In 2.6% (n = 2) an apical fibrotic zone was resected. In 71.1% (n = 54) a subtotal pleurectomy was performed combined with an abrasion in 41 cases. In 21.1% (n = 16) a total pleurectomy and in 7.8% (n = 6) an abrasion was performed. Operative mortality was 1.3% (n = 1) and total operative morbidity 25.4% in the PSP group and 76.9% in the SSP group. Mean follow-up was 36 months. The global recurrence rate was 5.3% (n = 4), being 4.8% (n = 3) in the PSP group and 7.7% (n = 1) in the SSP group. Recurrences occurred at 1 (n = 2), 2 (n = 1) and 16 (n = 1) months after the initial operation. The incidence of postoperative neuralgia was 17.1% (n = 13). One patient needed analgesics for the neuralgia. CONCLUSION: VATS treatment of spontaneous pneumothorax proves to be effective. In cases of SSP, VATS treatment is feasible but a higher morbidity rate should be anticipated.
Over a period of 5 years, 101 patients were treated for abdominal stab wounds at our emergency department. Exploratory laparotomy was performed in 41 of these cases. The indication for laparotomy was set by clinical investigation in 20 cases, instrumental exploration in six patients, ultrasound in six, paracentesis in seven and computerized tomography scanning in two cases. A review of the results of the treatment of these abdominal stab wounds is compared with the literature. Routine laparotomy for this type of penetrating trauma to the abdomen proves to be no longer warranted. Clinical and especially diagnostic studies should be able to select patients in whom laparotomy should be performed. When these studies are unable to exclude severe injury, laparotomy remains more prudent than expectant observation.
Cardiac injuries can be life threatening. The possibility of late complications urges the practitioner to search for any evidence of cardiac trauma. But the diagnosis of cardiac injury remains difficult. Electrocardiography and cardiac enzyme determination are most widely used, because they are readily available. Many studies advocate creatine-kinase-MB (CK-MB) isoenzyme levels as a sensitive test for cardiac contusion. Others have discarded CK-MB testing as useless in trauma situations. An elevated CK-MB value in haemodynamically stable patients may confuse the individual practitioner. To better clarify its role we investigated the course of CK/CK-MB release after trauma, with no or only a very small chance of cardiac injury and compared it with patients with severe chest trauma having cardiac complications. A total of 25 trauma patients with only skeletal muscle injury were studied. Blood samples were taken during the first 4 days after trauma. These results were compared with those of a group of 91 consecutive patients with severe chest injury, including 10 with cardiac complications. Initial results in skeletal trauma patients were indicative of cardiac injury (CK > 5% of total CK and at least 20 U/l) in 10 patients. These findings were identical to those found in patients with severe chest injury having cardiac complications. CK/CK-MB tests are frequently positive after trauma without cardiac injury, even when selective criteria are used. The time each isoenzyme is released from muscle tissue after trauma greatly influences the outcome of the test. As this release does not occur at the same moment for each isoenzyme, the test result is very much time-dependent. As a result of these findings CK-MB testing tends to cause more confusion than clarification in trauma situations. We therefore eliminated CK-MB testing from our trauma protocol as a screening investigation for cardiac injury.
BACKGROUND: A new intragastric balloon is available for weight reduction. METHODS: Patients consulting for a weight reduction plan and refusing any kind of actual surgery, or suffering from obesity but not meeting the IFSO standards for surgery, were offered the possibility of weight reduction by the BioEnterics intragastric balloon (BIB). A preoperative questionnaire was completed by all patients, inquiring about medical history, co-morbidity factors, dietary habits, previous treatments for weight and social, psychological, relational and economic impact of the obesity. BIB placement was done on an inpatient basis, under general anesthesia. Inflation was standardized at 500 ml saline. Intravenous antiemetic and spasmolytic drugs were given to control post-insertion nausea for 24 hours, and oral medication was administered on the patient's discharge. A standard 800 calorie diet was prescribed after dietitian's consultation. Extraction of the balloon was left to the patient's discretion at 3 or maximum 6 months after placement. Patients choosing for the maximal period received a formal invitation to extract the balloon. Evaluation of weight reduction was done at extraction and by questionnaire. RESULTS: 126 patients (5 M, 121 F) with mean age of 35.6 years (20-62) were included after preoperative evaluation. Mean preoperative BMI was 37.7 kg/m2 (26.7-57.7 kg/m2), with a mean initial excessive weight of 35.3 kg (8.8-96.4 kg) and mean initial % excess weight of 32.2 (6.3-102). 69 patients were eligible for review; mean excess weight loss after 3 months was 48.6% and after 6 months 50.8%. Mean weight loss was 15.4 kg (0-35 kg). 76.8% of the patients (41/69) complained of severe nausea and vomiting lasting an average of 1 week (1 day-6 months), resulting in 3 patients in early removal of the balloon (at 1 day, 1 week, 1 month after placement respectively). 2 patients suffered gastric perforation presenting as acute peritonitis 3 and 4 months after placement and were operated. Extraction of the balloon was performed in 3 patients after 3 months and in 66 patients after 6 months. In 11 patients (22%), esophagitis was present (8 grade 1, 2 grade II, 1 grade III), and one patient showed diffuse gastric erosion. One patient required removal of the balloon by rigid esphagoscopy following technical failure of the endoscopic extraction device. 45 patients replied to the mailed, questionnaire; 15% (7/45) were very satisfied, 13% (6/45) satisfied, 22% (10/45) reasonably satisfied, 8.8% (4/45) unsatisfied and 40% very unsatisfied. Degree of satisfaction correlated poorly with weight loss. Results may be better with close continuous guidance by a counselor. CONCLUSION: BIB as a means of weight reduction in the obese patient led to a 50.8% loss of excess weight after 6 months. Although severe morbidity can occur, the BIB provides a means for short-term weight reduction in conjunction with dietary measures.
BACKGROUND: Biliopancreatic diversion (BPD) according to Scopinaro's method is a safe and effective technique for treatment of morbid obesity. In this operation a side-to-side enteroenterostomy is created 60 cm proximal to the ileocecal valve. Malabsorption of fat and starch is one of the main goals of the BPD. Ingestion of an excess of fat leads to steatorrhea. As a side-effect, malabsorption of iron, calcium and other elements can occur causing anemia and hypocalcemia. The blind loop syndrome gives the same symptoms. METHODS: A lady was admitted with a long history of steatorrhea, anemia and hypocalcemia due to a blind loop syndrome after a BPD. The diagnostic problem in this patient is illustrated. RESULTS: The diagnosis was only made at exploratory laparotomy. CONCLUSION: The blind loop syndrome was then treated with resection of the blind loop and antibiotics.
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OBJECTIVE: To compare the outcome of emergency and elective haemorrhoidectomy. DESIGN: Retrospective study. SETTING: Teaching hospital, Belgium. SUBJECT: 104 patients who had haemorrhoidectomy for acutely ulcerated or strangulated haemorrhoids, and 545 who had elective haemorrhoidectomy. RESULTS: Early complications (26/104, 25%), reoperation (7/104, 7%) and late anal stenosis (7/104, 7%) were more common after emergency than elective haemorrhoidectomy, for which the corresponding figures were 74/545 (3.6%), 9 (1.7%) and 1/545 (0.2%). Late outcome was similar for the two groups. CONCLUSIONS: Emergency haemorrhoidectomy is indicated for the treatment of the acute complications of haemorrhoids.
OBJECTIVE: Narrowing of vascular anastomoses is a frequently encountered surgical problem, with intimal hyperplasia being one of its most important causes. The aim of the present study was to compare in a rabbit model 'manual' (hand-sewn) with 'stapled' anastomoses (using a staple device) with respect to occurrence and severity of intimal hyperplasia. MATERIALS AND METHODS: Twenty-four male rabbits (mean weight 2,849 g) were randomly allocated to one of two groups (n = 12). An end-to-end anastomosis of the left femoral artery was performed in all animals under general anesthesia. The anastomosis was hand sewn in group 1, while a vascular closure stapler (VCS) was used in group 2. Both anastomotic time and total operation time were recorded. After 28 days, the rabbits were sacrificed. The femoral artery of operated and nonoperated sides were removed and prepared for anatomopathological examination. The I/M ratio (= difference between tunica intima and tunica media) was determined on hematoxylin-eosin stained slides. All results were analyzed using Student's t test. RESULTS: Mean anastomotic times were 25 +/- 7 min for the 'manual' group and 17 +/- 9 min for the 'stapled' group (p = 0.02). There was no significant difference in the total operation time (55 +/- 15 vs. 41 +/- 18 min, p = 0.057). All animals survived the anastomosis procedure. In the group of 'manual' anastomosis, morbidity was significantly higher. At the moment of sacrifice, all anastomoses were patent. There was no difference in the I/M ratio between the groups. CONCLUSIONS: The use of VCS is a promising alternative to hand-sewn anastomoses. It takes less time to perform a stapled anastomosis, the technique has a shorter learning period and morbidity seems to be lower when vascular anastomoses are applied with the VCS in this rabbit model.
BACKGROUND: In vertical banded gastroplasty (VBG), a small proximal gastric pouch is created, which is believed to fill rapidly and to empty slowly. METHODS: In 13 patients who underwent VBG, gastric emptying rate was measured. A radiolabelled solid test meal was used before and 2 weeks after operation. From a region of interest above the whole stomach, the proximal pouch and the distal stomach, half emptying time as well as retention percentage were derived. RESULTS: All patients experienced early satiety and gastric fullness after ingestion of a small test meal. The proximal pouch emptied rapidly. The evacuation of the test meal from the whole gastric region as well as the distal stomach were not altered significantly by the operation. CONCLUSION: VBG is a safe operation which reduced weight significantly. Early satiety, however, induced by this technique, cannot be explained alone by slow emptying of the proximal pouch. The nature of the outlet of the pouch as well as the behavior of its wall must be considered.
OBJECTIVE: The purpose of this study was to determine if geometrical correction is necessary in the study of gastric emptying rate (GER) for liquids, using a low-energy radionuclide, such as 99mTc. Solid test meals were considered the reference. METHODS: Both solid and liquid GERs were investigated using regional analysis. Anterior data were compared with geometrically corrected values in 15 dogs and 9 partial gastrectomy patients. RESULTS: Anterior and geometrically corrected measurements differed significantly for solid food in the whole gastric region and in the antrum. Geometrically corrected values differed slightly from anterior data after partial gastrectomy. No difference was found for liquid food. Liquids redistributed much faster than solids within the stomach. CONCLUSION: Measurement of GER using a single-phase liquid meal does not require geometrical correction. This is due to the rapid intragastric redistribution of the liquid. Geometrical correction for solid food can be omitted only after partial gastrectomy.
BACKGROUND: Access to the peritoneal cavity in laparoscopic procedures is generally achieved by means of a pneumoperitoneum, following introduction of a Veress needle. Because this procedure must be done blindly, it is not without visceral or vascular hazards. Therefore, we sought an alternative technique that might obviate these complications. METHODS: In a series of 803 patients, a modified Hasson technique was used to obtain a pneumoperitoneum without risking the complications associated with the introduction of a Veress needle. RESULTS: The modified Hasson technique proved to be feasible in all cases. No visceral or vascular complications resulted, but 10 patients had a transient serous discharge. Follow-up ranged between 5 and 52 months. CONCLUSION: The modified Hasson technique should always be used in laparoscopic procedures.
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PURPOSE: We conducted a study to determine the treatment of perineal and genital burns, the results of therapy and the complications of such burns. MATERIALS AND METHODS: A review of the records of 4,216 patients treated between 1981 and 1995 at the Burn Center of the Academic Surgical Center Stuivenberg, revealed 87 male and 30 female patients, 6 months to 86 years old who had associated burns to the perineum or genitalia. Mean burn size was 21% of the total body surface area. Causes of burn injury were scald in 55% of the cases, flame in 24%, chemical in 16% and others in 4%. RESULTS: There were 16 deaths in this group (13.6%) but none was related to the perineal or genital burns. Of the 101 survivors 41% required Foley catheters but the catheters were indwelling during resuscitation only (range 1 to 99 days). Perineal and genital burns were treated by topical antimicrobials. Only 10 patients (9.9%) required split-thickness skin grafts. As late complication 2 patients had scar formation of the penile shaft, which was treated with multiple Z-plasties, and of the prepuce, which was treated by circumcision, respectively. In 1 patient, who presented with erectile dysfunction diagnostic evaluation was negative. CONCLUSIONS: Conservative management of perineal and genital burns is recommended.
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A prospective series of 106 inguinal hernias in 91 patients is studied, comparing two methods of laparoscopic hernia repair: a transperitoneal technique with preperitoneal stapled mesh fixation (TransAbdominal PrePeritoneal or TAPP-technique) performed in 33 patients, and a totally extraperitoneal placement of non stapled mesh (Totally ExtraPeritoneal Approach or TEPA-technique) performed in 58 patients. Conversions to open repair were equally frequent (5% vs. 7% respectively) and were due to adhesions, haemorrhage, irreducible intestinal loop in the hernial sac or important subcutaneous emphysema. Minor postoperative complications included regional seroma or haematoma, testicular pain and meralgia paraesthetica. There was no mortality nor long lasting complication. Recurrence rates in both groups amounted 2.7% (TAPP) and 2.8% (TEPA) respectively after a mean follow-up of 15.8 months (TAPP) and 17.6 months (TEPA). In both groups early recovery of normal activities was noted, after a mean of respectively 13.6 days (TAPP) and 12.9 days (TEPA). It is concluded that the transabdominal route and the totally extraperitoneal approach for laparoscopic herniorrhaphy are both adequate techniques for inguinal hernia repair with similar complication and short-term recurrence rates.