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L Duinslaeger

Publications and source records attributed to L Duinslaeger.

15 recordsLinked to original sources
PubMed2002

High frequency percussive ventilation and conventional ventilation after smoke inhalation: a randomised study.

Inhalation injury and bacterial pneumonia represent some of the most important causes of mortality in burn patients. Thirty-five severely burned patients were randomised on admission for conventional ventilation (CV; control group) versus high frequency percussive ventilation (HFPV; study group). HFPV is a ventilatory mode, introduced 10 years ago which combines the advantages of CV with some of those of high frequency ventilation. Arterial blood gases, ventilatory and hemodynamic variables were recorded for 5 days at 2h intervals. Incident complications were classically managed. A statistical analysis (Student's t-test and Wilcoxon signed rank test) demonstrated a significant higher PaO(2)/FiO(2) from days 0 to 3 in the HFPV group. No significant differences were observed for the other parameters. Our findings suggest that HFPV can improve blood oxygenation during the acute phase following inhalation injury allowing reduction of FiO(2). No significant differences were observed between groups for mortality nor incidence of infectious complications in this study.

Acute-Phase Reaction↗
PubMed2000

Quantitation of Pseudomonas aeruginosa in wound biopsy samples: from bacterial culture to rapid 'real-time' polymerase chain reaction.

STATEMENT OF FINDINGS: We developed a real-time detection (RTD) polymerase chain reaction (PCR) with rapid thermal cycling to detect and quantify Pseudomonas aeruginosa in wound biopsy samples. This method produced a linear quantitative detection range of 7 logs, with a lower detection limit of 103 colony-forming units (CFU)/g tissue or a few copies per reaction. The time from sample collection to result was less than 1h. RTD-PCR has potential for rapid quantitative detection of pathogens in critical care patients, enabling early and individualized treatment.

Bacterial Typing Techniques↗
PubMed1998

The usefulness of combined high-frequency percussive ventilation during acute respiratory failure after smoke inhalation.

Inhalation injury and bacterial pneumonia represent some of the most important causes of mortality in burn patients. We describe 11 severely burned patients with acute respiratory failure due to inhalation injury who did not respond adequately to conventional respiratory support. High-frequency percussive ventilation (HFPV) is a recent ventilatory mode, which combines the advantages of conventional ventilation with some of those of high-frequency ventilation. Seven patients developed pulmonary infection during the acute phase; one patient died of multiple organ failure on day 25. All the other patients survived; two developed bronchiolitis obliterans symptoms before discharge. No side-effects were noted and haemodynamic tolerance of HFPV was excellent. Our findings suggest that HFPV can improve pulmonary function and gas exchange in these catastrophic pulmonary failures following inhalation injury.

Acute Disease↗
PubMed1997

Analysis of epidemic Pseudomonas aeruginosa isolates by isoelectric focusing of pyoverdine and RAPD-PCR: modern tools for an integrated anti-nosocomial infection strategy in burn wound centres.

The Gram-negative bacterium Pseudomonas aeruginosa is an important life-threatening nosocomial pathogen in burn units. In this study we analysed epidemic P. aeruginosa isolates from patients and their hospital environment using two new molecular techniques in order to establish strain relatedness for epidemiological purposes. One technique was pyoverdine typing by isoelectric focusing (PVD-IEF) and the other was a genomic PCR-based fingerprinting technique called random amplification of polymorphic DNA actually referred to as RAPD-PCR. The described short epidemic (6 weeks) included 37 consecutive isolates from 9 different patients as well as two environmental isolates recovered, at the same time, from one of the hydrotherapy facilities. Only two of the three known pyoverdine types of P. aeruginosa could be found. Type I was absent while type II represented 49 per cent and type III, 51 per cent of the isolates. The two consecutive isolates from the environment were both of type III. The RAPD-PCR fingerprinting discriminated four patterns. Profile 1 represented 60 per cent; profile 2, 34 per cent; and profiles 3 and 4 only 3 per cent of the isolates respectively. The environmental isolates also had a RAPD-PCR 1 profile, arguing for the hydrotherapy facility as a possible contamination source. Prompt measures could prevent an outbreak. The study demonstrates the applicability of the techniques in a routine microbiology lab as well as their usefulness, in combination with other techniques, in the fight against nosocomial infections, which are so critical in burn units. Both techniques showed undoubtable evidence of the occurrence of polymicrobial infection of individual patients by P. aeruginosa species. Meanwhile pyoverdine typing by IEF seems suited to studying more profoundly the role of pyoverdines in burns.

Bacterial Typing Techniques↗
PubMed1997

HIV transmission by transplantation of allograft skin: a review of the literature.

The fear of human immunodeficiency virus (HIV) transmission by means of allograft skin has led to a cautious approach to allograft donor selection. However, no irrefutable diagnostic test exists to determine the possible presence of HIV at the time of donation. In order to find ways of improving HIV donor screening practices for skin banks, we review the presence of HIV in human skin, explore the possible transmission of HIV by transplantation of human allograft skin, and discuss the reliability of existing HIV tests. The use of the polymerase chain reaction (PCR) as a sensitive detection system for HIV infection of skin biopsies, in combination with conventional routine HIV blood screening tests; could lower the risk of transmitting HIV to severely burned patients.

Guidelines as Topic↗
PubMed1997

Direct detection and identification of Pseudomonas aeruginosa in clinical samples such as skin biopsy specimens and expectorations by multiplex PCR based on two outer membrane lipoprotein genes, oprI and oprL.

A multiplex PCR test based on the simultaneous amplification of two lipoprotein genes, oprI and oprL, was designed and evaluated for its ability to directly detect fluorescent pseudomonads (amplification of oprI open reading frame, 249 bp) and Pseudomonas aeruginosa (amplification of oprL open reading frame, 504 bp) in clinical material. A collection of reference strains including 20 different species of fluorescent pseudomonads was tested. Positive PCR results for both genes were observed only for P. aeruginosa isolates (n = 150), including strains of clinical and environmental origin, while only one gene, oprI, was amplified from the other fluorescent pseudomonads. All other bacteria tested (n = 15) were negative by the amplification test. The lower detection level for P. aeruginosa was estimated to be 10(2) cells/ml. Preliminary evaluation on testing skin biopsy specimens from patients with burns (n = 14) and sputum samples from cystic fibrosis patients (n = 49) and other patients (n = 19) showed 100% sensitivity and 74% specificity in comparison with culture. This multiplex PCR assay appears promising for the rapid and sensitive detection of P. aeruginosa in clinical specimens. Further evaluation of its specificity in longitudinal clinical studies is warranted.

Bacterial Outer Membrane Proteins↗
PubMed1997

Treatment of chronic postoperative otorrhea with cultured keratinocyte sheets.

Cultured allogeneic ear keratinocyte sheets were used to treat 26 ears presenting with long-standing (average 37 months) chronic otorrhea, resistant to regular treatment, long after surgery for atresia (n = 8), cholesteatoma (n = 10), and chronic otitis media (n = 8). Complete epithelial healing and cessation of otorrhea were obtained in 18 cases (69%), following an average of 2.2 weekly applications. Temporary epithelial healing lasting at least 3 months was observed in 3 patients (12%) subsequently needing repeated applications. Lack of complete epithelialization was documented in 5 cases (19%). In 3 of those 5 cases, a reason could be determined. The authors speculate that the allocultured keratinocytes are able to promote migration and proliferation of resident cells at the wound edges, despite their short survival time, by release of keratinocyte-stimulating factors.

Adolescent↗
PubMed1997

Stimulation of epithelial healing in chronic postoperative otorrhea using lyophilized cultured keratinocyte lysates.

OBJECTIVE: After tympanoplasty, despite a closed tympanic graft, some patients continue to have persistent otorrhea due to insufficient epithelial healing and granulation tissue formation in the depths of the outer ear canal. When all medical therapies fail, many otologists undertake revision surgery, usually with free skin grafting. To avoid surgery, the authors sought to improve this condition with a lysate of lyophilized cultured allogeneic keratinocytes. STUDY DESIGN AND PATIENTS: In this prospective pilot study, lyophilized cultured allogeneic keratinocyte lysates have been administered in 27 patients. These patients had uncontrollable otorrhea that resisted medical (topical) therapy for at least 6 months. MAIN OUTCOME MEASURE: The criterion of success was a complete epithelialization and cessation of otorrhea. RESULTS: After an average of 2 applications, cessation of otorrhea was achieved in 20 cases (74%). Three patients (11%) relapsed after 3 months. The other ears (63%) still were dry at the 1-year final evaluation. CONCLUSIONS: These results are similar to those obtained after application of sheets of viable cultured keratinocytes of autologous as well as of allogeneic origin. Because the soluble lysate can be incorporated into ototopical drops, the lysate technique is more "user-friendly" and can be applicable in any outpatient clinic. Because keratinocytes contain many growth factors (e.g., epidermal growth factor, basic fibroblast growth factor, platelet-derived growth factor, transforming growth factor), the authors speculate that the release of those intracellular growth factors is responsible for the observed therapeutic effect. This form of therapy by its combination of several growth factors might be considered a more physiologic method than the, also still experimental, growth factor therapy in which high doses of only single growth factor are used.

Adolescent↗
PubMed1996

Lyophilized keratinocyte cell lysates contain multiple mitogenic activities and stimulate closure of meshed skin autograft-covered burn wounds with efficiency similar to that of fresh allogeneic keratinocyte cultures.

For several years, grafting with allogeneic keratinocyte cultures has been used successfully as a wound-healing therapy both by us and by many other groups. Since their postgrafting survival time is limited, the effect of these cultures is generally explained by the production of wound repair-stimulating factors that promote proliferation and migration of resident cells. In this study we show that lysates of cultured keratinocytes contain mitogenic activity for keratinocytes, endothelial cells, and fibroblasts. In addition, the lysates inhibit the contraction of collagen gels by human skin fibroblasts. On the basis of these observations and of in vivo data obtained by ourselves and others, we have evaluated the effect of total keratinocyte lysates on the healing of meshed skin autograft-covered burn wounds. Twenty burn wounds were tangentially excised and autografted with one to three meshed conventional skin transplants. An area treated with a gel containing lysated keratinocyte cultures was compared with an area treated with placebo-gel in terms of epithelialization on day 5. In six patients an additional fresh keratinocyte alloculture was applied as a positive control. Results indicate that the newly formed epithelium (difference between percentage of epithelialization on day 5 and on day 0) was 31.1 percent in the treated area compared with 16.5 percent in the placebo area. This result is comparable with the value obtained by treatment with fresh keratinocyte allocultures, namely, 33.8 percent. These figures show a twofold stimulation of epithelialization.

Adolescent↗
PubMed1996

Lysates from cultured allogeneic keratinocytes stimulate wound healing after tympanoplasty.

In the past, cultured keratinocyte allografts have been used with benefit in the treatment of burn wounds and leg ulcers. Since in burn wounds autologous and allogeneic fresh keratinocyte cultures were found to give similar favorable results as lysates of allogeneic cultured cells, the authors investigated whether this lysate mixed in an antibiotic suspension would also accelerate the epithelial healing after routine tympanoplasty. In a double blind setting the healing process in 50 consecutive tympanoplasty ears was studied: an acceleration of healing of 8 days was observed in the lysate-treated group (39.25 days) as compared with the control group (47.23 days). The percentage of ears which healed within 6 weeks (after 5 weekly applications of 200 microliters suspension in both groups) was significantly higher in the treated group (61%) than in the control population (36%). Although the therapeutical effect of the keratinocyte lysate in this study is believed to be due primarily to its mitogenic activity through growth factors or cytokines, at present it is still unclear which growth factors are involved and which combinations of these factors have to be present to modulate the different stages of the complex healing processes.

Administration, Topical↗
PubMed1995

Burns induced by plants.

Plants of the family Umbelliferae are known to cause a phytophotodermatitis due to a phototoxic reaction caused by furocoumarin (psoralens) and simultaneous exposure to sunlight. We report four patients with partial skin thickness burns, induced by this phototoxic reaction. One occurred after contact with parsley (Apium petroselinum) and three others after contact with giant hogweed (Heracleum mantegazzianum) and simultaneous exposure to sunlight.

Adolescent↗
PubMed1995

Gastric emptying in critically ill patients is accelerated by adding cisapride to a standard enteral feeding protocol: results of a prospective, randomized, controlled trial.

OBJECTIVE: To investigate the effect of cisapride, a relatively new prokinetic agent, on gastric emptying in critically ill patients. DESIGN: Prospective, randomized, controlled study. SETTING: Adult medical/surgical intensive care unit in a university hospital. PATIENTS: Twenty-one consecutively enrolled patients, requiring prolonged mechanical ventilation and enteral feeding. INTERVENTIONS: Patients were randomized to receive either no cisapride or 10 mg of cisapride four times daily, which was added to a standard enteral nutrition feeding protocol. MEASUREMENTS AND MAIN RESULTS: Gastric emptying was evaluated by daily measurements of gastric residue and on days 5 through 7 by bedside scintigraphy. Normal values for gastric clearance of a tracer-labeled test meal and for measurements obtained in the supine position were determined in ten healthy volunteers. The mean time at which 50% of the technetium 99m-labeled test meal was eliminated from the stomach (T 1/2) in this control group was 31 +/- 15 mins. In ten critically ill patients (enteral nutrition group), gastric emptying was markedly delayed after 5 to 7 days of enteral feeding (mean T 1/2 = 78 +/- 40 mins; p < .002 as compared with the control group). In contrast, patients treated with cisapride (cisapride group) showed an accelerated gastric emptying (mean T 1/2 = 18 +/- 7 mins; p > .05 as compared with controls; p < .005 as compared with enteral nutrition group). The mean gastric residue over a 1-wk period was also significantly lower in the cisapride group than in the enteral nutrition group (17.7 +/- 8.9 vs. 94.5 +/- 33.4 mL; p < .001). CONCLUSIONS: The data indicate that gastric emptying in critically ill, sedated, and mechanically ventilated patients can be significantly improved by adding cisapride to a routine enteral feeding protocol.

Aged↗
PubMed1987

Vascular leiomyoma in the hand.

Two patients with vascular leiomyomas of the hand are reported. These lesions are probably not as rare as the literature suggests. There are three pathologic types--solid, cavernous, and venous type tumors. All are composed of smooth muscle bundles surrounding vascular channels.

Adult↗
PubMedDate not supplied

Diagnostic and therapeutic value of thoracotomy in advanced pulmonary neoplasms.

This study analyses retrospectively 100 consecutive thoracotomies performed for lung cancer before end 1986. Chest CT scan assessed mediastinal lymph node disease, chest wall invasion and mediastinal invasion, with an overall accuracy of 75, 93 and 91 per cent respectively; mediastinal lymph node disease was significantly more underestimated in the stage III group. Characteristics, type of surgical and adjuvant therapy and follow-up were analysed in the T3 (16 patients) and the N2 (18 patients) group. Complete resection was possible in only a minority of the cases: 3 in the T3 group and one in the N2 group. Of the T3 group, 3 patients have survived more than 3 years and 3 are actually still alive. Of the N2 group, only 2 patients are still alive. Most deaths were due to generalization of the disease.

Adult↗