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Biomedical subjects

M J Lubbers

Publications and source records attributed to M J Lubbers.

10 recordsLinked to original sources
PubMed2006

[Local wound care: evidence-based treatments and dressings].

Patients with open wounds require specific local-wound care. There is huge variety in methods of local-wound care. This is due not only to the many different types of wounds but also to the widely varying preferences of doctors and nurses, and to the lack of strong evidence and relevant guidelines regarding the most appropriate form of local-wound care. In 19 systematic literature reviews from the Cochrane Collaboration on surgical and traumatic wounds and ulcers (venous, arterial and diabetic) information can be found on local-wound treatment. Eleven of these reviews were limited to strong evidence for the use of: tissue adhesives for surgical and traumatic wounds; foam dressings in surgical wounds healing by secondary intention; (intermittent) compression, bilayer artificial skin and lidocaine-prilocaine cream for venous ulcers; hydrogel and in-shoe orthotics for diabetic-foot ulcers; negative pressure for chronic wounds, and cleansing of acute wounds with clean tap water.

Anti-Infective Agents↗
PubMed1993

[Immunotherapy using the anti-endotoxin antibody HA-1A (Centoxin) in patients with sepsis syndrome; fair results following protocol selection of patients].

OBJECTIVE: Evaluation of HA-1A treatment in patients with the sepsis syndrome. DESIGN: Descriptive. SETTING: Department of intensive care, Academic Medical Centre, Amsterdam. PATIENTS AND METHODS: Intensive-care patients with the sepsis syndrome and shock or organ failure with a presumptive diagnosis of Gram-negative infection were eligible for treatment with HA-1A. We analysed and compared the results with those of the double-blind, randomized HA-1A study by Ziegler et al. RESULTS: Between May 1991 and March 1992, 27 patients were treated with HA-1A. The mortality rate was 59% (16/27). Among the 11 patients with a Gram-negative bacteraemia mortality was 7/11, much higher than in the Ziegler study (30%). In comparison with the HA-1A study we selected sicker patients: the mean APACHE II score was higher, 93% of our patients were in shock and 85% had organ failure. More patients presented with an intra-abdominal sepsis and mortality in this group was very high (11/14). In patients with a Gram-negative bacteraemia the delay between the onset of the sepsis syndrome and the administration of HA-1A was longer (median 22 h versus 14.3 h in the Ziegler study, mean 30 versus 20 h). CONCLUSION: HA-1A does not appear to be beneficial in critically ill patients with a longstanding sepsis syndrome, especially not if an intra-abdominal sepsis is apparent. Therefore, we decided not to use H-1A until additional data become available. Additional objective inclusion criteria are needed to improve the identification of the patient group that may benefit from treatment with HA-1A.

Adolescent↗
PubMed1992

Effectiveness of a human monoclonal anti-endotoxin antibody (HA-1A) in gram-negative sepsis: relationship to endotoxin and cytokine levels.

Gram-negative sepsis is caused by endotoxin-induced release of tumor necrosis factor (TNF) and other cytokines. HA-1A is a human monoclonal antibody that binds specifically to endotoxin. HA-1A should prevent death in endotoxemic patients and reduce serum levels of TNF and interleukin-6 (IL-6). This hypothesis was tested in 82 septic patients who were randomly allocated to receive a single intravenous 100-mg dose of HA-1A or placebo. Pretreatment endotoxemia was detected in 27 patients (33%). Death occurred within 28 days of treatment in 8 (73%) of 11 placebo recipients and in 5 (31%) of 16 HA-1A recipients (P = .02). The median decrease in serum TNF level 24 h after treatment was 12 ng/L in patients given HA-1A and 0 ng/L in placebo recipients (n = 65; P = .04). For IL-6, this was 204 ng/L in patients given HA-1A and 44 ng/L in placebo recipients (n = 67; P = .4). Thus, HA-1A reduces mortality in septic patients with endotoxemia and lowers serum TNF levels.

Adult↗
PubMed1991

[The relationship between predisposing factors in liver abscesses and the causative bacteria].

In order to assess the correlation between bacteria isolated from liver abscesses and factors predisposing to liver abscesses, a retrospective study of clinical and bacteriological data on 21 patients with 27 episodes of pyogenic abscesses was carried out at the University Medical Centre, Amsterdam. Out of 27 episodes, 15 (55%) were associated with biliary or pancreatic disease; in seven of these 15 episodes more than one microorganism was cultured. Enterobacteriaceae were isolated in 13 (85%) of 15 episodes. Anaerobic bacteria were recovered only when operations in the pancreatico-biliary area had been performed previously. Seven episodes (26%) were related to extrahepatic disease; anaerobic bacteria (Bacteroides and Fusobacterium spp.) were isolated in five of these seven episodes. Streptococcus milleri seemed especially prominent, since this bacterium was cultured in six of seven episodes. Enterobacteriaceae were not involved in these seven episodes. Other factors predisposing to liver abscesses (15%) were diabetes mellitus n = 2), paraproteinaemia (n = I), and metastatic carcinoid (n = I). Blood cultures were positive in 65% of 23 episodes, but 40% of the positive cultures contained a smaller number of bacterial species than could be cultured from the abscess itself. Bacteria isolated from liver abscesses are related to the underlying predisposing condition. For diagnosis of the underlying condition and antibiotic therapy, puncture and bacteriologic examination of the abscess is essential.

Adult↗
PubMed1991

EEG artefacts caused by a Clinitron bed.

Clinitron beds, often used to prevent decubitus ulcers, may cause an EEG artefact by static electricity. The best way to prevent this artefact is to turn off the bed during EEG registrations.

Beds↗
PubMed1986

Periampullary and pancreatic head carcinoma: facts and factors influencing mortality, survival, and quality of postoperative life.

From September 1983 to December 1985 40 patients from a total of 55 with periampullary and pancreatic head carcinoma underwent resectional surgery in our department. Following a policy of precise evaluation of each patient's operative findings, six patients underwent a Whipple duodenopancreatectomy, 29 patients underwent regional subtotal pancreatectomy, and five underwent regional total pancreatectomy. Five patients underwent vascular reconstruction of their regional vascular structures after transection of the invaded segments of their vessels and eight had positive lymph nodes. Lymph node involvement was confined to the regional area. Patients with distant lymph node involvement (paraaortic) were not considered eligible to resection. Three patients died and 10 required reoperation. Thirty-one had radical resection, one palliative and eight equivocal resection. From the survived patients (n = 37) 33 are alive and doing well at the time of this report (overall mean survival 18 months). The results of this study demonstrate that a radical approach based on a precise evaluation of operative findings of the individual patient might well offer a higher resectability rate and is probably the only chance for radical resection and for a longer survival in patients with periampullary and pancreatic head carcinoma.

Adult↗
PubMedDate not supplied

Hemodynamic effects of intermittent manual lung hyperinflation in patients with septic shock.

OBJECTIVE: The purposes of this study were to investigate the hemodynamic changes induced by intermittent manual lung hyperinflation (MHI) and to assess if these changes are adverse enough to warrant prohibition of MHI as a routine procedure in the care of patients with septic shock. DESIGN: The study's design was experimental prospective. SETTING: The settings were university hospital intensive care units. PATIENTS: Subjects included 13 consecutive mechanically ventilated patients with septic shock who met the inclusion criteria. MEASUREMENTS AND RESULTS: Phasic MHI-related increments in mean inspiratory airway pressure were concordant to changes in mean pulmonary artery pressure (MPAP) (r(2) = 0.67) with a 0.6 mm Hg rise in MPAP per cm H(2)O airway pressure. The magnitude of MPAP changes was not reflected in magnitude of stroke volume index (SVI) (r(2) = 0.06). On average, MHI did not induce statistically significant hemodynamic changes and mean values returned to baseline level within 15 minutes. SVI during MHI increased slightly in 9 patients, from 37 +/- 15 (mean +/- SD) to 41 +/- 17 mL/m(2) (P <.05), and decreased in 4, from 60 +/- 10 to 50 +/- 14 mL/m(2) (not significant). Patients with an increase in SVI had lower baseline values for SVI, cardiac index, and left ventricular stroke work index (P <.05) and higher values for systemic vascular resistance index compared with patients with a decrease in SVI (P <.05). Left ventricular stroke work index was higher in patients with a decrease in SVI than in patients with an increase in SVI (52 +/- 9 vs 34 +/- 8; P <.05). Tidal volume increased from 499 +/- 176 mL before MHI to 587 +/- 82 mL, 5 minutes after MHI (P <.05) with a return to baseline values within 15 minutes after the procedure. CONCLUSION: The hemodynamic effects of intermittent MHI in patients with septic shock are relatively small and insignificant and seem to be related to the cardiovascular state before the procedure. The risk of inducing hemodynamic changes with MHI should not be considered as a contraindication in patients with septic shock who are mechanically ventilated.

Adult↗
PubMedDate not supplied

Computed tomography in the diagnosis and treatment of solitary splenic abscesses.

Solitary splenic abscess is a rare entity and difficult to diagnose. Late recognition results in a high mortality. Recently percutaneous drainage has proved to be beneficial. The CT and ultrasound findings of two patients with splenic abscesses are reported. In one patient the solitary splenic abscess was drained percutaneously. In the other patient, a HTLV-III-positive man, a splenectomy was performed.

Abscess↗
PubMedDate not supplied

Evaluation of preoperative biliary drainage in the surgical management of pancreatic head carcinoma.

In a consecutive series of 38 patients, resectional surgery was performed for carcinoma of the caput pancreatis (ampullary, distal common bile duct and pancreatic duct). In group A (n = 19), preoperative biliary drainage was accomplished via an endoprosthesis introduced during endoscopic retrograde cholangiopancreatography. Group B (n = 19) had no preoperative biliary drainage. The interval from admission to operation averaged 15 days in group A and 4 days in group B. Two group B patients died of causes unrelated to absence of preoperative biliary drainage. In group B, however, the intrabiliary pressure was higher than in group A and was associated with heightened incidence of biliary infection, bacteremia and intraoperative bleeding. The intergroup difference in incidence of early complications was statistically significant. The findings support the value of preoperative biliary drainage in patients who are candidates for surgical treatment of carcinoma of the pancreatic head.

Bile↗