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Jon A. van Heerden

Bio: Jon A. van Heerden is an academic researcher. The author has an hindex of 1, co-authored 1 publications receiving 98 citations.

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01 Oct 1992

98 citations


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Journal ArticleDOI
TL;DR: The development of women's sense of self is a basic concept in development as mentioned in this paper, and women's self-awareness and self-love are two basic concepts in women's development.
Abstract: Part I, A Developmental Perspective. The Development of Women's Sense of Self, Miller. Women and Empathy: A Basic Concept in Development, Jordan, Surrey & Kaplan. The \"Self-in-Relation: A Theory of Women's Development, Surrey. Empathy and Self Boundaries, Jordan. The Meaning of Mutuality, Jordan. Beyond the Oedipus Complex: Mothers and Daughters, Stiver. Women's Self-Development in Late Adolescence, Kaplan & Gleason. Part II, Applications. The Meanings of Dependency in Female-Male Relationships, Stiver. Relationship and Empowerment, Surrey. The Construction of Anger in Women and Men, Miller. Women and Power, Miller. The \"Self-in-Relation\": Implications for Depression in Women, Kaplan. Work Inhibitions in Women, Stiver. Eating Patterns as a Reflection of Women's Development, Surrey. The Meaning of Care: Reframing Treatment Models, Stiver. Female or male Therapists for Women: New Formulations, Kaplan. Empathy, Mutuality, and Therapeutic Change: Clinical Implications of a Relational Model, Jordan.

873 citations

Journal ArticleDOI
TL;DR: The authors reviewed the epidemiology, pathogenesis and various prevention strategies of adhesion formation, using Medline and PubMed search, and found that several preventive agents against postoperative peritoneal adhesions have been investigated but most are contradictory and achieved mostly in animal model.
Abstract: Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery. Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the pathological part of healing following any peritoneal injury, particularly due to abdominal surgery. The balance between fibrin deposition and degradation is critical in determining normal peritoneal healing or adhesion formation. Postoperative peritoneal adhesions are a major cause of morbidity resulting in multiple complications, many of which may manifest several years after the initial surgical procedure. In addition to acute small bowel obstruction, peritoneal adhesions may cause pelvic or abdominal pain, and infertility. In this paper, the authors reviewed the epidemiology, pathogenesis and various prevention strategies of adhesion formation, using Medline and PubMed search. Several preventive agents against postoperative peritoneal adhesions have been investigated. Their role aims in activating fibrinolysis, hampering coagulation, diminishing the inflammatory response, inhibiting collagen synthesis or creating a barrier between adjacent wound surfaces. Their results are encouraging but most of them are contradictory and achieved mostly in animal model. Until additional findings from future clinical researches, only a meticulous surgery can be recommended to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery. In the current state of knowledge, pre-clinical or clinical studies are still necessary to evaluate the effectiveness of the several proposed prevention strategies of postoperative peritoneal adhesions.

363 citations

Journal ArticleDOI
TL;DR: A complete understanding of the short esophagus and methods for surgical correction are critical to avoid “slipped” wraps and mediastinal herniation and to achieve the best patient outcome.
Abstract: The relation between the short esophagus and antireflux surgery has been a topic of keen interest in the esophageal literature of the past 40 years. 1–7 The result of this interest has been the generation of a wealth of data regarding its pathophysiology and treatment. There is, however, a striking paucity of reference to the short esophagus in the current laparoscopic literature. This is worrisome because it may imply that many patients undergoing laparoscopic surgery who have a short esophagus are unrecognized and perhaps treated inappropriately. This may also explain the higher failure rates and increased postoperative dysphagia reported by some authors. 8 Decades of experience with open fundoplications have established certain principles and surgical techniques as essential for successful surgical outcomes. These concepts include thorough preoperative testing, routine division of the short gastric vessels, crural closure, and repairs performed without tension around a 2.5- to 3-cm length of intraabdominal esophagus. 9–13 Such principles are no less important in laparoscopic surgery to ensure excellent results. 14 The defining aspect of a tension-free hiatal hernia repair is the proper treatment of an intrinsically shortened esophagus. When such a short esophagus is not recognized and treated, the risk of a “slipped” or misplaced fundoplication or a crural disruption with subsequent herniation of the wrap into the mediastinum is increased (Fig. 1). 15 This occurrence is thought to be responsible for 20% to 33% of the surgical failures after open or laparoscopic fundoplication. 16–19 The reoperative surgery that is required to correct such failures is known to have a higher rate of surgical complications and a less favorable long-term functional result. 16,20 Figure 1. (A) Barium esophagram showing a “slipped” or misplaced Nissen. (B) Computed tomography scan showing a herniated fundoplication resulting from a wrap performed under tension. The purpose of this review is to discuss the pathophysiology and incidence of the short esophagus, to review the history of treatment for the condition, and to describe its diagnosis and treatment in the era of laparoscopic surgery.

176 citations

Journal ArticleDOI
TL;DR: Removal of a Meckel's diverticulum is not advised in the patient with Crohn's disease but may be performed in the patients undergoing restorative proctocolectomy for ulcerative colitis, while surgical therapy is reserved for hemorrhage, obstruction, perforation, or failure of medical management.
Abstract: Congenital and acquired diverticula of the jejunum and ileum in the adult are unusual and occur in approximately 1 percent to 2 percent of the population. They are pulsion diverticula thought to be the result of intestinal dyskinesia. These lesions can produce a significant diagnostic and therapeutic dilemma. They are multiple in the jejunum and solitary distally and are characteristically found in 60- or 70-year-old males. The diagnosis may be confirmed with contrast studies of the small intestine, arteriography, or nuclear scan. Consider these disorders in patients with 1) unexplained gastrointestinal bleeding, 2) unexplained intestinal obstruction, 3) an unexpected cause of acute abdomen, 4) chronic abdominal pain, 5) anemia, or 6) malabsorption. Medical therapy is helpful in controlling diarrhea and anemia, while surgical therapy is reserved for hemorrhage, obstruction, perforation, or failure of medical management. Asymptomatic diverticula discovered on routine contrast studies need not be resected. At surgery, incidental diverticula should be removed when evidence of dilated, hypertrophied loops of small bowel with large diverticula is found. Intraoperative air distention will aid in diagnosis. Resection and primary anastomosis is the preferred treatment for non-Meckelian diverticula. Diverticulectomy is reserved for a Meckel's diverticulum without evidence of ulceration. An incidental Meckel's diverticulum should be removed in the presence of mesodiverticular bands or ectopic tissue. Removal of a Meckel's diverticulum is not advised in the patient with Crohn's disease but may be performed in the patient undergoing restorative proctocolectomy for ulcerative colitis.

175 citations

Journal ArticleDOI
TL;DR: Although total parenteral nutrition is initially necessary, treatment goals should focus on early transition to enteral nutrition followed by oral feeds, and the use of specific nutrients and growth factors to stimulate intestinal absorption and adaptation.
Abstract: Short bowel syndrome (SBS) comprises the sequelae of nutrient, fluid, and weight loss that occurs subsequent to greatly reduced functional surface area of the small intestine. Signs and symptoms of SBS include electrolyte disturbances; deficiencies of calcium, magnesium, zinc, iron, vitamin B12, or fat-soluble vitamin deficiency; malabsorption of carbohydrates, lactose, and protein; metabolic acidosis, gastric acid hypersecretion; formation of cholesterol biliary calculi and renal oxalate calculi; and dehydration, steatorrhea, diarrhea, and weight loss. Thorough nutritional management is the key factor in achieving an optimal outcome in SBS. Total parenteral nutrition is necessary in the early stages, as is replacement of excess fluid and electrolyte losses. Nutritional management of SBS has traditionally been divided into three phases: an acute phase when total parenteral nutrition is usually begun, an adaptation phase, and a maintenance phase. Recommendations regarding the need for parenteral nutrition vary depending on the presence or absence of certain factors: the ileocecal valve, jejunum, and functional colon. Patients with residual small bowel length of 100 cm or less usually require the administration of parenteral nutrition at home with good results. The total parenteral nutrition diet should consist of a majority of calories from fat, followed by protein, and the remaining as carbohydrates. Vitamins, minerals, and trace elements should also be added accordingly. Although total parenteral nutrition is initially necessary, treatment goals should focus on early transition to enteral nutrition followed by oral feeds. Other recent advances in the medical management of SBS include pharmacologic treatment and the use of specific nutrients and growth factors to stimulate intestinal absorption and adaptation. Both animal studies and clinical trials in humans have shown much promise in supplementation with growth factors and hormones. This strategy is likely to play a greater role in the treatment of SBS in the future.

150 citations