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Biomedical subjects

H E Demey

Publications and source records attributed to H E Demey.

At least 19 recordsLinked to original sources
PubMed2006

High-dose cefepime as an alternative treatment for infections caused by TEM-24 ESBL-producing Enterobacter aerogenes in severely-ill patients.

This study evaluated retrospectively the efficacy of treatment with cefepime vs. a carbapenem, in combination with amikacin or ciprofloxacin, for seriously-ill patients infected with ESBL-producing Enterobacter aerogenes who were admitted to an intensive care unit. Forty-four episodes of infection were investigated in 43 patients: 21 treated with cefepime; 23 with a carbapenem. The two treatment groups did not differ statistically in terms of age, APACHE II scores, and infection sites, but the average duration of antibiotic exposure was significantly shorter in the cefepime group (8.5 days vs. 11.4 days; p 0.04). Clinical improvement was seen in 62% of patients receiving cefepime vs. 70% of patients receiving a carbapenem (p 0.59). Bacteriological eradication was achieved in 14% of patients receiving cefepime vs. 22% of patients receiving a carbapenem (p 0.76). The 30-day mortality rates related to infection were 33% in the cefepime group and 26% in the carbapenem group (p 0.44). Thus, outcome parameters did not differ significantly between the two groups. Nevertheless, a statistically significant increase in failure to eradicate ESBL-producing E. aerogenes was observed as the MICs of cefepime rose (p 0.017). Pulsed-field gel electrophoresis revealed three distinct clones, but one predominant clone harbouring the bla(TEM-24) gene was associated with most (42/44) of the episodes of infection. It was concluded that cefepime may be an alternative agent for therapy of severe infections caused by TEM-24 ESBL-producing E. aerogenes, although further studies are required to confirm these observations.

Adult↗
PubMed2001

Early diagnosis of cerebral fat embolism syndrome by diffusion-weighted MRI (starfield pattern).

BACKGROUND: Cerebral fat embolism syndrome is a rare, but potentially lethal, complication of long bone fractures. Neurological symptoms are variable, and the clinical diagnosis is difficult. The purpose of this case study is to demonstrate the value of diffusion-weighted MRI of the brain for early diagnosis of fat embolism syndrome. Case Description- A non-head-injured 18-year-old woman suffered acute mental status changes 21 hours after an uncomplicated fracture of the left tibia. MRI of the brain was performed 48 hours after injury. T2-weighted images showed multiple nonconfluent areas of high signal intensity, which, on the diffusion-weighted scans, were revealed as bright spots on a dark background ("starfield" pattern). We suggest that this indicates areas of restricted diffusion that are due to cytotoxic edema, resulting from multiple microemboli. CONCLUSIONS: High-intensity lesions in the brain on diffusion-weighted images may serve as an early-appearing and more sensitive indicator of the diagnosis of fat embolism in the clinical context of long bone injury without head trauma.

Accidents, Traffic↗
PubMed1998

Splenic rupture as a complication of P. falciparum malaria after residence in the tropics. Report of two cases.

Splenic rupture is an uncommon complication of malaria, which requires urgent medical investigation, close follow-up and adequate treatment. Until present, this complication was reported more often in P. vivax infections than in infections with other species. Rupture can happen spontaneously or as a result of trauma, which may be minor and unnoticed. The diagnosis is made by physical examination, ultrasound and CT-scan. Especially in malaria endemic areas the management of splenic rupture in malaria should be focused on splenic preservation. We describe two cases of splenic rupture during a P. falciparum infection, both requiring finally splenectomy.

Abdominal Injuries↗
PubMed1996

Acute poisoning with amphetamines (MDEA) and heroin: antagonistic effects between the two drugs.

A case of oral ingestion of large doses of both the amphetamine-derivative 3,4-methylene dioxyethamphetamine (MDEA) and heroin is reported. Despite high serum levels of both drugs, the patient did not present with the classic signs and symptoms normally seen during intoxication with these drugs. The patient recovered after symptomatic treatment. The possibility that opposite pharmacological properties of the two drugs prevented the patients death is discussed.

3,4-Methylenedioxyamphetamine↗
PubMed1992

Adult respiratory distress syndrome associated with Mycoplasma pneumoniae infection.

A 13-year-old boy is described who developed severe adult respiratory distress syndrome (ARDS), biochemical pancreatitis and skin vasculitis after an acute respiratory infection due to Mycoplasma pneumoniae. The boy was mechanically ventilated for 17 days, but could be discharged in good clinical condition after 36 days of hospitalization. However, major disturbances of the lung function tests persisted, suggesting interstitial fibrosis. To the best of our knowledge, this is the first case of ARDS after M. pneumoniae infection in childhood.

Adolescent↗
PubMed1991

Streptococcal myositis. A report of two cases.

Two patients are described with acute streptococcal myositis. One of them died after a brief duration of illness in multiple organ failure; the other survived extensive muscular damage complicated by diffuse intravascular coagulation, acute renal failure, adult respiratory distress syndrome, bronchopneumonia, Pseudomonas septicaemia and probably streptococcal toxic shock syndrome. Both patients received nonsteroidal antiphlogistics, purportedly involved in the pathogenesis of this syndrome. Based on a mouse model, clindamycin would seem to be the antibiotic of choice.

Adult↗
PubMed1991

Pneumoperitoneum--a rare complication of cardiopulmonary resuscitation.

Pneumoperitoneum following cardiopulmonary resuscitation (CPR) results from a thoracic air leak (pneumothorax, pneumomediastinum) with escape of the air through diaphragmatic apertures (mostly foramen of Winslow) or primary perforation of the gastrointestinal tract (stomach or esophagus). We report three cases of pneumoperitoneum complicating CPR. As there was no clinical evidence of peritonitis, and the patients remained stable, a conservative approach was followed without surgical exploration. All patients recovered completely.

Adult↗
PubMed1991

Haemodynamic monitoring. Problems, pitfalls and practical solutions.

The synthesis of adenosine triphosphate (ATP) depends on the coordinated interaction of oxygen delivery and glucose breakdown in the Krebs cycle. Cellular oxygen depots are non-existent, therefore the peripheral cells are totally dependent on the circulation for sufficient oxygen delivery. Shock is the clinical manifestation of cellular oxygen craving. The commonly measured variables--blood pressure, heart rate, urinary output, cardiac output and systemic vascular resistance--are not sensitive or accurate enough to warn of impending death in acutely ill patients nor are they appropriate for monitoring therapy. Calculated oxygen transport and oxygen consumption parameters provide the best available measures of functional adequacy of both circulation and metabolism. In order to optimise oxygen delivery (DO2), 4 interacting factors must be taken into account: cardiac output, blood haemoglobin content, haemoglobin oxygen saturation and avidity of oxygen binding to haemoglobin. For viscosity reasons, the optimal haemoglobin concentration is in the vicinity of 90 to 100 g/L, but for optimising the oxygen transport 100 to 115 g/L or a haematocrit of 30 to 35% seems better. The p50 (the pO2 at which haemoglobin is 50% saturated) describes the oxygen-haemoglobin dissociation curve; normally its value is +/- 27 mm Hg. It can be influenced by attaining normal body temperature, pH, pCO2 and serum phosphorous levels. In order to obtain an arterial blood saturation (SaO2) of more than 90% with acceptable haemodynamics, the ventilation mode and inspired oxygen fraction (FiO2) must be adapted; care must be taken not to stress the labile circulation with haemodynamic compromising ventilation techniques [e.g. high positive end expiratory pressure (PEEP) levels, inverse-ratio ventilation, etc.]. The factor most amenable to manipulation is the cardiac output, with its 4 determinants--preload, afterload, contractility and heart rate. In daily clinical practice, heart rate should be between 80 and 120 beats/min; small variations are acceptable. Important deviations must be treated by chemically [isoprenaline (isoproterenol)] or electrically (pacing techniques) accelerating the heart, or with the different antiarrhythmic drugs. A wide variety of agents is available to decrease the preload: diuretics [especially furosemide (frusemide)], venodilators like nitroglycerin (glyceryl trinitrate), isosorbide dinitrate (sorbide nitrate) and sodium nitroprusside, ACE inhibitors, phlebotomy, and haemofiltration techniques (peritoneal or haemodialysis, continuous arteriovenous haemofiltration). To increase the preload, volume loading using a rigid protocol ('rule of 7 and 3'), preferably with colloids, or vasopressor agents [norepinephrine (noradrenaline), epinephrine (adrenaline), dopamine] are useful. Arterial vasopressors are needed to improve perfusion pressure of 'critical' (coronary and cerebral) arteries. Afterload can be decreased by arterial vasodilators. Predominantly arterial dilators are hydralazine and clonidine, while sodium nitroprusside, nitroglycerin and isosorbide dinitrate have combined arterial and venous dilating actions.(ABSTRACT TRUNCATED AT 400 WORDS)

Blood Glucose↗
PubMed1991

Purulent pericarditis due to methicillin-resistant Staphylococcus aureus. A case report.

Purulent pericarditis is an infrequent complication of infections originating in another body location. Symptoms and signs are often absent; a high index of awareness is required for its diagnosis. A patient recovering from extensive necrotic-hemorrhagic pancreatitis presented with tamponade due to methicillin-resistant Staphylococcus aureus (MRSA) purulent pericarditis, further complicated by MRSA endocarditis. Treatment included pericardectomy, IV vancomycin and teicoplanin.

Anti-Bacterial Agents↗
PubMed1989

Mastitis and toxic shock syndrome.

Toxic shock syndrome (TSS) secondary to mastitis or breast abscess is only seldom described. We report a case of definite TSS due to postpartum staphylococcal mastitis which evolved over a period of 3 weeks to a breast abscess, recurring after 2 months. Only the episode of acute mastitis was complicated with TSS, while Staph. aureus could be isolated during the period of mastitis from milk and during drainage of the second breast abscess.

Abscess↗
PubMed1988

Hypoprothrombinemia due to cefamandole.

Two patients are described with severe coagulation disturbances, in one instance leading to extensive skin bleeding, secondary to the use of cefamandole. This cefalosporin antibiotic carries the same N-methylthiotetrazole side chain as moxalactam. Pathogenetic mechanisms leading to hypoprothrombinemia, its prevention and treatment are discussed.

Aged↗
PubMed1988

The body packer syndrome--cocaine smuggling in the gastro-intestinal tract.

Cocaine drug packets were found in the gastro-intestinal tract of seven persons, charged with and arrested for presumed drug smuggling. Plain abdominal roentgenograms were positive in 4, while computer tomography of the abdomen (CT-scan) was necessary in 3 others to make the diagnosis. There were no signs of acute intoxication or bowel obstruction. All patients were treated with enemas and/or laxatives in order to evacuate the hidden packets; no complications occurred. A clinical description of the seven cases is followed by a short review of the literature, mainly focused on the possible complications of ingested drug packets and possible methods of removal.

Adult↗
PubMed1988

The Paceport catheter: a new pacemaker system introduced through a Swan-Ganz catheter.

We describe a new stainless steel, teflon-coated 2.4 F pacemaker wire with a flexible tip that can be introduced through an extra lumen of a specially designed 7.5 F Swan-Ganz catheter. The extra lumen opens at 19 cm from the tip of the catheter; this opening can be positioned in the right ventricular cavity. The pacemaker wire can be introduced at the time of insertion of the Swan-Ganz catheter or later when the need for ventricular pacing arises. The Paceport catheter was tested in 23 patients. Satisfactory ventricular pacing was achieved in 19 patients at thresholds between 0.5 and 4.0 mA (median 2.0 mA). The threshold increased by 1 mA during long-term pacing (8-24 hr). Attempts to use the pacemaker were abandoned when short runs of ventricular tachycardia developed upon introduction, while an exceptionally high threshold was observed in another patient. The Paceport system is recommended for patients who require hemodynamic monitoring and urgent ventricular pacing.

Adult↗
PubMed1988

Propylene glycol-induced side effects during intravenous nitroglycerin therapy.

Propylene glycol, an alcohol frequently used as a solvent in medical preparations, is considered non-toxic. We found that this solvent, used in a commercially available IV nitroglycerin solution, may cause hyperosmolality, hemolysis and lactic acidosis. The influence of kidney function as the main determinant in causing accumulation of this solvent and consequently hyperosmolality is emphasized. A review of the literature dealing with propylene glycol is given. The possible mechanisms of neurological disturbances occurring during IV nitroglycerin therapy are discussed.

Acidosis, Lactic↗