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Biomedical subjects

J P Dierckx

Publications and source records attributed to J P Dierckx.

At least 19 recordsLinked to original sources

Measurement of effective elastance of the total respiratory system in ventilated patients by a computed method. Comparison with the static method.

We have studied 28 patients mechanically ventilated for acute respiratory failure at different levels of externally applied positive end-expiratory pressure (PEEPe). We describe and compare a computed method of measuring "effective" elastance of the total respiratory system (Ers,eff) with the static values of elastance of the total respiratory system (Ers,st), obtained with the end-inflation occlusion technique. Ers,eff was computed by an original device (Heres, R.P.A., Belgium), also the effective resistance of the total respiratory system was calculated. At zero end-expiratory pressure set by the ventilator (ZEEP). Ers,eff averaged 29.5 +/- 13.5 cm H2O x L-1 while Ers,st non-corrected for intrinsic PEEP (PEEPi) averaged 36.4 +/- 15.1 cm H2O x L-1 and Ers,st corrected for PEEPi averaged 28.2 +/- 13.4 cm H2O x L-1. The small difference between Ers,eff and Ers,st corrected for PEEPi was statistically significant and these two values were highly correlated (r = 0.98). This significant difference disappeared rapidly with PEEPe and probably reflects a frequency-dependance due to pendelluft. We also observed that PEEPi was present in 21 of 27 patients at ZEEP. Our results also indicate that low levels of PEEP may improve Ers in hyperinflated COPD patients, without inducing further hyperinflation. In conclusion, values of Ers,eff are very similar to static values corrected for PEEPi and permit an accurate and rapid approach to the management of ventilated patients.

Adult↗

Neisseria sicca pneumonia and bronchiectasis.

Neisseria sicca, although considered a harmless saprophyte, has been recognised as an etiologic agent in three cases of pneumonitis, and rare cases of endocarditis, meningitis, and osteomyelitis, particularly in immunocompromised hosts. We report the case of a 76-year-old man with a community-acquired pneumonia, in whom both sputum samples and bronchial secretions obtained with bronchoscopic protected catheter brush grew pure culture of N. sicca with abundant polymorphonuclear neutrophils. Dramatic clinical improvement only occurred after initiation of an appropriate antibiotherapy according to susceptibility spectrum of the isolated N. sicca. Bronchiectasis underlying lesions were disclosed by computed tomography. N. sicca should be added to the list of commensal organisms able to cause pulmonary infection. Moreover, the association of N. sicca and bronchiectasis has never been published.

Aged↗

Coxsackie B3 virus: an unusual cause of unilateral mediastinal nodal enlargement.

We report on a patient with febrile illness, right unilateral paratracheal widening, pulmonary infiltrates, pleural effusions, exanthema and diarrhea. The right paratracheal widening was due to lymph node enlargement confirmed by CT scan. Symptoms disappeared subsequently without specific treatment. On the basis of serological tests, we are able to diagnose a coxsackie B3 virus infection. No previous case report of unilateral mediastinal nodal enlargement contemporary to a coxsackie B3 virus infection was found in our review of the literature.

Aged↗

Comparison of central venous, oesophageal and mouth occlusion pressure with water-filled catheters for estimating pleural pressure changes in healthy adults.

The validity of the central venous and water-filled oesophageal catheter technique as a measure of pleural pressure changes was tested in ten healthy subjects in different body positions during inspiratory efforts with occluded airways, by comparing the simultaneous changes in mouth pressure (delta Pm) taken to represent pleural pressure changes, in central venous pressure (delta Pcv) and in oesophageal pressure (delta Poes). delta Pcv/delta Pm values were close to unity in the sitting and left lateral positions, whereas in the supine and right lateral position, substantial deviations from unity were found in some instances. delta Poes/delta Pm values were close to unity in all positions, except some rare instances. No appreciable phase difference between delta Pm/delta Poes and delta Pm/delta Pcv was found when the amplitude ratios were close to unity. We conclude that valid measurements of pleural pressure changes can be obtained in most instances with the central venous and the water-filled oesophageal catheter system according to the occlusion test procedure.

Adult↗

Pulmonary hypertension associated with portal thrombosis.

Pulmonary hypertension accompanying portal hypertension is a rare cause of plexogenic pulmonary arteriopathy, which etiopathogenesis is still unknown. The case report presented is that of a young man who underwent surgery at age 8 for ruptured esophageal varices associated with portal thrombosis, and who later developed pulmonary hypertension which led to death at age 21. Hepatic filtration shunt and similarity of this syndrome to pulmonary hypertension subsequent to ingestion of the appetite depressant Aminorex suggest the hypothesis that pressor substances, not detoxified by the liver, are released into the pulmonary circulation.

Adult↗

The results of pulmonary function tests in patients infected with Mycoplasma pneumoniae.

A comparative study was undertaken in order to ascertain the effects of a Mycoplasma pneumoniae infection on pulmonary function. It appears that the literature has many articles devoted to the clinical symptomatology of this type of infection but there is very little information available on the abnormalities which occur in the lungs with this infection. The patients who were used as a comparative model had lung lesions which gave a similar radiographic appearance. The significant finding was that an obstructive syndrome with increased airway resistance was noted in the M.pneumoniae pneumonia patients.

Humans↗

Contribution to the study of chest and lung mechanics in artificially ventilated normal man during surgery.

Firstly the authors describe the principle and the technical application of an original method of measurement of the mechanical ventilatory parameters. Then the method is illustrated with measurements of the pulmonary thoracic and thoraco-pulmonary mechanical parameters in 20 healthy subjects under going extra-thoracic surgery. The results show the lack of correlation between the value of the pulmonary mechanical parameters measured in the awake supine subjects breathing spontaneously and in the anesthetized supine subjects artificially ventilated. The decrease in chest wall elastance could explain the drop in ventilatory level and the unpredictable modifications in pulmonary mechanical parameters. Therefore it is impossible to establish meaningful reference values in healthy subjects undergoing artificial ventilation.

Anesthesia, General↗