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Biomedical subjects

J Valcke

Publications and source records attributed to J Valcke.

8 recordsLinked to original sources
PubMed2002

[Bilateral pleurisy and cardiac tamponade. A rare etiology: pancreatico-pleural fistula].

Pancreatico-pleural fistula is a rare complication of chronic pancreatitis. It commonly presents with small, but recurrent, pleural effusions. Pericarditis rarely occurs in this context. We report a case presenting with bilateral large pleural effusions associated with cardiac tamponade. The diagnosis was suspected on detection of high concentration of pancreatic enzyme in the pleural fluid and was confirmed by both endoscopic retrograde pancreatography and magnetic resonance pancreatography. Both examinations demonstrated a fistula and a calculus of the Wirsung duct. In addition, they identified a pancreas divisum, a congenital abnormality which can rarely lead to complications. The usual medical and endoscopic management of this condition failed and a surgical solution for the fistula was needed. This case is unique due to the dramatic presentation of this complication of pancreas divisum and to the complexity of treatment required.

Cardiac Tamponade↗
PubMed1998

Peaks of transforming growth factor-beta mRNA in alveolar cells of lung transplant recipients as an early marker of chronic rejection.

BACKGROUND: Chronic lung rejection (CLR) induces a fibroproliferative disorder leading to the occlusion of small airways. It has emerged as the major factor limiting the survival of lung transplant recipients. Predictive markers of CLR are lacking, and its diagnosis is generally ascertained when the fibrosis process is irreversible. METHODS: We have quantified the expression of transforming growth factor-beta (TGF-beta), a critical mediator of fibrogenesis, in alveolar cells from lung transplant recipients using a competitive reverse transcriptase polymerase chain reaction method. RESULTS: We have shown that patients with CLR presented marked peaks of TGF-beta mRNA expression, in contrast with patients without CLR. These peaks preceded the diagnosis of CLR by several months in two of three patients who died within 2 years of diagnosis. CONCLUSIONS: Our data suggest that TGF-beta expression in alveolar cells could serve as an early predictive and prognostic marker of chronic lung rejection.

Bronchoalveolar Lavage Fluid↗
PubMed1996

Mortality of nosocomial pneumonia in ventilated patients: influence of diagnostic tools.

The overmortality induced by nosocomial infections, especially pneumonia in ventilated patients (VNP), is still a matter of controversy because it is difficult to know precisely the respective effects of VNP per se and both the underlying illness and the severity of the disease that indicates ICU stay. During a 3-yr period, for each patient mechanically ventilated for more than 48 h we recorded underlying illness, reason for mechanical ventilation, clinical and therapeutic data collected during the first 48 h of ventilation, and death in the ICU. Patients with suspicion of VNP (S-VNP) according to clinical, radiologic, and biologic criteria underwent bronchoscopy with protected specimen brush (PSB) and bronchoalveolar lavage culture (BAL-C). VNP was confirmed (C-VNP) if PSB > or = 10(3) cfu/ml and/or BAL-C > or = 10(4) cfu/ml. Prognostic multivariate analysis was performed introducing S-VNP and C-VNP as time-dependent covariates. Of the 387 studied patients, 112 S-VNP and 56 C-VNP were observed with overall mortality of 43% (168 patients). MacCabe, APACHE II score, shock, use of sedatives and absence of enteral nutrition were additively associated with an increased mortality as well as C-VNP (relative risk [RR]: 1.8, p = 0.007). Nevertheless, when S-VNP and C-VNP were simultaneously introduced in the Cox model, only S-VNP remained associated with increased mortality. In patients suspected of VNP, confirmation of VNP using PSB and/or BAL-C adds no prognostic information. Whether this could be explained by the lack of sensitivity of protected distal samples or the severity of underlying conditions of S-VNP patients is still an open issue. A multivariate analysis based on follow-up data during the ICU course of ventilated patients will be initiated in the near future.

Aged↗
PubMed1975

[Anterior antehypaphyseal insufficiecency in the elderly].

The authors report 4 personal cases, and analyse 18 cases of anterior pituitary insufficiency in the elderly found in the world literature. The initial symptoms are not specific and are difficult to interpret. They are frequently attributed to physiological ageing. In the absence of early diagnois, the patient may become comatose, this coma is often irreversible in spite of hormone treatment. In 60% of cases, the cause of the pituitary failure was not found. In the onset of the latter, the role of ageing on pituitary function, the responsibility of circulatory failure between the hypothalamus and the pituitary and, finally, the existence of auto-immune mechanisms are then discussed.

Aged↗
PubMed1975

[2 cases of hepatorenal polycystosis].

The authors report two cases of polycystic liver andkidney in two women. They were unusual in that the liver first gave risr to symptoms and the renal lesions were completely latent. Both hepatic and renal lesions were well tolerated in spite of hepatomegally. They emphasize the interest of laparoscopy and biopsy of the liver under direct vision, and selective aortography, in the diagnosis. They discuss the basic differences between polycystic liver and kidney in adults, from that in children ornewborn, and caroli's disease. Finally, they emphasize the usually poor prognosis dominated by progressive renal failure which should guide treatment. The latter depends on periodic supervision of the patient for the disease usually evolves slowly. Treatment should therefore be conservative. Tn some cases, however, renal transplantaton should be considered before irreversible renal failure in young subjects, at an age when it is still possible. On the other hand, the liver lesions do not require any radical treatment, unless there is intercurrent infection or pressure on neighbouringorgans.

Adult↗
PubMed1975

[Acute non-tuberculous military lung].

The authors report the case of a young woman with acute miliary appearance of the lung with asphyxia, from which she rapidly recovered. No cause was demonstrated; this illustrates the difficulty in diagnosis of this disease. Contact with a bird, led the authors to consider exogenous, allergic granulomatosis, but immunological examinations did not confirm this. Apart from tuberculosis, almost 50 different pathogenic organisms may cause acute respiratory failure associated with a miliary or reticulo-nodular appearance of the lung. The main methods of diagnosis are discussed in relation to the most commonly observed causes in France.

Acute Disease↗