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Biomedical subjects

J D Feuth

Publications and source records attributed to J D Feuth.

10 recordsLinked to original sources
PubMed1999

Risk factors for acquisition of Serratia marcescens in a surgical intensive care unit.

Between January 1996 and May 1997, a four-fold increased rate of isolation of Serratia marcescens was observed amongst patients admitted to the surgical Intensive Care Unit (SICU) of the Leiden University Medical Center compared to the preceding years. Random amplification of polymorphic DNA showed the involvement of genotypically distinct strains, implicating multiple different sources. After improvement of hygienic measures the frequency of isolation of S. marcescens returned to baseline. A case-control study was performed to assess patient-related risk factors for acquisition of S. marcescens. Nineteen cases and 38 controls were included. Hospital- and SICU-stay were significantly longer in case patients than in controls. By univariate analysis, statistically significant differences were found in body weight, the duration of mechanical ventilatory support, the cumulative use of antimicrobial agents, the use of aminoglycosides, parenteral nutrition and tube feeding. The sum of the number of days per invasive device (deep intravenous lines, arterial lines, wound drains and urinary catheters) was higher in cases than in controls (P = 0.08). Categorically, a cumulative number of device-days > 25 was a statistically significant risk factor for acquisition of S. marcescens. Multivariable logistic regression analysis showed that body weight, parenteral feeding and mechanical ventilation were independent predictors of acquisition of S. marcescens. As transmission of S. marcescens appears to be by the hands of personnel, the identified risk factors may act by necessitating an increased frequency and intensity of direct contacts.

APACHE↗
PubMed1997

[Acquired haemophilia A].

A 74-year-old man developed a severe bleeding disorder on the basis of acquired Factor VIII (F VIII) inhibitor. Coagulation assays showed a prolonged activated partial thromboplastin time (APTT) with a normal prothrombin time (PT);F VIII level was 0.07 IU and F VIII inhibitor level 8.8 Bethesda units (BU). At least half the cases of acquired haemophilia A are associated with pregnancy, the postpartum period or an underlying malignancy or autoimmune disease. Haemorrhagic diathesis can be severe and life-threatening. Treatment of acute haemorrhages consists of human or porcine factor VIII concentrate, activated prothrombin complex concentrate (FEIBA) or recombinant factor VIIa, depending on the antibody titre. Immunosuppressive therapy is successful in at least 60% of the patients in making the inhibitor disappear. In patients with a spontaneous haemorrhagic diathesis, a thorough medical history should be taken, coagulation assays should be performed and a specialist should be consulted.

Aged↗
PubMed1996

Heparin use in continuous renal replacement procedures: the struggle between filter coagulation and patient hemorrhage.

Heparin is the most widely used anticoagulant in continuous renal replacement procedures but little is known about the balance between filter coagulation and patient hemorrhage during treatment. Filter survival and hemorrhagic complications during 240 filter periods in 78 critically ill patients, treated with continuous arteriovenous hemofiltration and hemodiafiltration, were studied for this article. The crude incidence of filter coagulation was 17.7 +/- 2.5 (mean +/- SE) per 1000 h at an activated partial thromboplastin time (APTT) of 15 to 35 s, as determined in systemic blood samples. The incidence of filter coagulation gradually decreased to 9.0 +/- 2.7 per 1000 h at an APTT of 45 to 55 s (P = 0.031). The crude incidence of patient hemorrhage was 2.9 +/- 1.0 per 1000 h at an APTT of 15 to 35 s and increased almost threefold to 7.4 +/- 2.4 per 1000 h when the APTT was 45 to 55 s (P = 0.009). There was no difference in filter survival between treatment with hemofiltration only and hemodiafiltration. Mean survival of acrylonitrile filters (33.8 +/- 4.3) was significantly lower compared with the survival of polyamide filters (104.1 +/- 14.4 h, P = 0.003). After adjustment for the type of the filter, mean arterial blood pressure, and platelet count, the risk for filter coagulation decreased 25% (relative risk, 0.77; 95% confidence interval [CI], 0.62 to 0.96) for every 10-s increase in APTT. At the same time, the risk for patient hemorrhage increased 50% (relative risk, 1.57; 95% CI, 1.43 to 1.72). The occurrence of filter coagulation or hemorrhages were not correlated with the administered dose of heparin. Concurrent use of coumarin derivatives had a positive effect on filter survival, without increasing the overall incidence of hemorrhages. It was concluded that the systemic APTT is a good predictor of the risk for filter coagulation and patient hemorrhage. Safety and efficacy of heparin therapy seems optimal at an APTT between 35 and 45 s.

Acute Kidney Injury↗
PubMed1995

The potential of simple clinical information and electrocardiogram to predict mortality of primary elective abdominal aortic reconstruction.

OBJECTIVE: To assess the importance of simple clinical information to predict mortality after primary elective aortic reconstruction. DESIGN: Retrospective clinical study. MATERIALS: Four hundred-three consecutive patients (206 with aortic occlusive disease (51%) and 197 with aneurysmal disease of the abdominal aorta (49%) who underwent primary elective aortic reconstruction during an 8 year study period. METHODS: Eight potential clinical risk variables and six electrocardiogram related risk variables were studied. The predictive value for postoperative mortality was evaluated univariately for all separate variables by calculation of the odds ratio (OR). Determination of the most predictive sets of risk factors was performed by stepwise logistic regression. RESULTS: Five clinical risk factors showed significant odds ratio's: > 70 years (OR: 4.1), aortic aneurysm (OR: 9.0), myocardial infarction (OR: 8.6), angina pectoris (OR: 4.6), congestive heart failure (OR: 8.1), all p < 0.01. Furthermore, four electrocardiogram related factors showed significant odds ratio's: infarction pattern (OR: 4.3, p = 0.003), ischaemic changes (OR: 6.2, p < 0.001), conductance disturbances (OR: 3.2, p = 0.04), and non-sinus rhythm (OR: 6.2, p = 0.003). Stepwise logistic regression analysis demonstrated that 3 clinical risk factors (aneurysm (OR: 6.1, p = 0.02), myocardial infarction (OR: 3.7, p = 0.01), and congestive heart failure (OR: 5.3, p = 0.006)) contributed significantly to mortality. Addition of any of the electrocardiogram risk factors did not contribute to the prediction of mortality in the presence of these factors. CONCLUSIONS: The patients' history and clinical examination provides the most useful information for further selection of additional cardiac tests before elective primary aortic reconstruction. The additional value of the electrodiogram is somewhat overestimated.

Adult↗
PubMed1989

A prospective survey of risk factors in young adults with arterial occlusive disease.

Few studies have presented a thorough analysis of young adults with symptoms of arterial occlusive disease. To learn more about the possible risk factors of vascular disease playing a role in these young patients, we have reviewed all patients of 45 years of age and younger with symptoms of arterial occlusive disease who had been referred to our department between 1978 and 1987. Thirty-seven patients (28 males and 9 females) were included in the study. The mean age at which the first symptoms occurred was 34 years. Most patients presented with chronic arterial obliterations of the lower extremities (31/37, 84%). In addition, 4 patients showed signs of ischaemic heart disease. A strongly positive family history of arteriosclerosis was obtained from 13 patients (35%). Hypertension was present in 7 patients (19%), diabetes in three (8%) and nicotine abuse was found in 27 patients (73%). Fifty-four percent of the patients (20/37) had undergone vascular reconstructive surgery, 19% (7/37) underwent transluminal dilatation, and 3 had had subsequent treatment of newly developed lesions. For this study, all patients were recalled to the outpatient clinic. A complete case history was taken followed by a physical examination and ECG. Laboratory examinations were performed to analyse parameters of: (a) coagulation; (b) fibrinolysis; (c) fat- and (d) methionine metabolism. Clear-cut laboratory abnormalities were found in 33 patients (33/37, 89%). Coagulation parameters were abnormal in 11 patients (30%) (protein S deficiency: 3 pts). Fibrinolysis was impaired in 15 patients (40%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1981

Acute acalculous cholecystitis.

Acute acalculous cholecystitis after trauma or non-related surgery is a rare and dangerous complication. The pathogenesis is multifactorial. Impairment of the circulation to the gallbladder and cystic duct obstruction by inspissated bile seem to be the most important factors. The disease runs a fulminant course, and since diagnosis is generally difficult and usually delayed, the mortality is unduly high. Awareness of the physician is therefore of paramount importance. Cholecystectomy is the recommended treatment. A series of 13 patients is presented and the pathogenesis, diagnosis, and management of this complication are discussed.

Acute Disease↗
PubMedDate not supplied

Renal dysfunction after angiography; a risk factor analysis in patients with peripheral vascular disease.

Angiography is required for a detailed anatomical investigation before reconstructive surgery or percutaneous transluminal angioplasty can be performed. Although angiography is a safe procedure, it is associated with renal dysfunction, usually transient, in about 10% of the cases. This study concentrates on the evaluation of renal dysfunction induced by "conventional" (i.e. film-screen) Seldinger angiography and a consecutive series of 396 angiographic procedures have been evaluated. Induced Renal Dysfunction was defined as an increase of more than 10% in the serum creatinine after angiography. To identify "risk factors" for Induced Renal Dysfunction we have studied whether clinical and angiographical variables were associated with the occurrence of Induced Renal Dysfunction. These variables included: age, hypertension, the use of antihypertensive drugs, diabetes mellitus, technique of angiography, site of contrast injection and type and quantity of contrast medium. Induced Renal Dysfunction was found in 21 cases (5.7%) and appeared to be associated with age above 70, hypertension, administration of more than 150 ml contrast medium and the presence of renal disease prior to angiography. More than 95% of the 21 patients with dysfunction had two or more of these "risk factors". The presence of diabetes was not clearly associated with Induced Renal Dysfunction and haemodialyses was not required in any of the patients. The incidence of Induced Renal Dysfunction after angiography was 5.7% which is low but not negligible. However, renal dysfunction was always transient and never severe. Furthermore, the identification of "risk factors" allows the prompt identification of patients at risk before angiography, which may help to reduce the incidence of Induced Renal Dysfunction.

Acute Kidney Injury↗