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M W Nijsten

Publications and source records attributed to M W Nijsten.

15 recordsLinked to original sources
PubMed2001

The abdominal compartment syndrome: a complication with many faces.

BACKGROUND: Lately renewed attention has been given to the abdominal compartment syndrome. Despite of this there still remain a lot of controversies with regard to the pathophysiological mechanisms underlying this syndrome and the therapeutic options. METHODS: Two cases of patients with this syndrome are described and the data from animal and human trials concerning the abdominal compartment syndrome are presented and discussed. RESULTS: A variety of clinical disorders may lead to the abdominal compartment syndrome. It mainly affects the cardiovascular, pulmonary and renal organ systems. Although some clinical effects are clearly described, the exact mechanisms underlying these changes in humans are incompletely understood. It is still unclear why some patients develop abdominal compartment syndrome and others do not. The intra-abdominal pressure can easily be assessed by measuring the urine bladder pressure, which correlates well with the actual intra-abdominal pressure. All authors agree that a decompression of the abdomen by means of a laparotomy is the treatment of choice for the abdominal compartment syndrome. Which parameters should determine the indication however, remains controversial, since the correlation between clinical signs and pressure is not straightforward. CONCLUSIONS: The abdominal compartment syndrome is a well-recognised disease entity related to acutely increased abdominal pressure. Urgent laparotomy can be lifesaving in some cases. However no single threshold of abdominal pressure can be applied universally. Pending further clinical trials the best therapeutic option seems to be to decompress the abdomen surgically if the intravesical pressure is 25 mmHg or higher in patients with refractory hypotension, acute renal failure or respiratory failure due to abdominal distension.

Abdomen↗
PubMed2000

Procalcitonin behaves as a fast responding acute phase protein in vivo and in vitro.

OBJECTIVES: Procalcitonin (PCT) is a 13 kD protein of which plasma concentrations are strongly increased in inflammatory states. PCT concentrations are claimed to have a more powerful discriminatory value for bacterial infection than the acute phase proteins serum amyloid A (SAA) or C-reactive protein (CRP). The source of production and its mechanism of induction are unknown. We investigated the inducibility of PCT both in vivo and in vitro and compared the behavior of PCT with those of SAA and CRP. DESIGN: A prospective descriptive patient sample study and a controlled liver tissue culture study. SETTING: A university hospital. PATIENTS: Cancer patients who were treated with human tumor necrosis factor-alpha (rhTNF-alpha; 5 patients) or interleukin-6 (rhIL-6; 7 patients). MEASUREMENTS AND MAIN RESULTS: Serial serum samples were collected for analysis of concentrations of PCT, SAA, and CRP. In the TNF-alpha group, frequent sampling was performed on the first day to allow analysis of initial responses. In a human liver slice model, the release of PCT, SAA, and CRP was measured on induction with rhTNF-alpha and rhIL-6 for 24 hrs. We found that PCT displayed acute phase reactant behavior in vivo after administration of both rhTNF-alpha and rhIL-6. After rhTNF-alpha-administration, PCT reached half-maximal concentrations within 8 hrs, 12 hrs earlier than either SAA or CRP did. PCT, SAA, and CRP were produced in detectable quantities by liver tissue in vitro. PCT production by liver slices was enhanced after stimulation with rhTNF-alpha or rhIL-6; SAA and CRP concentrations were elevated after stimulation with rhTNF-alpha. CONCLUSIONS: We found that PCT and acute phase proteins such as CRP are induced by similar pathways. The liver appears to be a major source of PCT production. Thus, PCT may be considered an acute phase protein. The different kinetics of PCT, rather than a fundamentally different afferent pathway, may explain its putative diagnostic potential to discriminate bacterial infection from other causes of inflammation.

Bacterial Infections↗
PubMed2000

Blunted rise in platelet count in critically ill patients is associated with worse outcome.

OBJECTIVE: To test the hypothesis that a low rate of change of platelet counts (PCs) after admission to the intensive care unit (ICU) is associated with mortality. Low PCs are known to be associated with disease severity in critically ill patients, but the relevance of time-dependent changes of PCs has not been investigated. DESIGN: Retrospective study. SETTING: A 12-bed surgical ICU of a university hospital. PATIENTS: All adult patients admitted to the ICU for at least 4 days during a 7-yr period. INTERVENTIONS: At admission, Acute Physiology and Chronic Health Evaluation scores were calculated. PCs and leukocyte counts were analyzed from admission to day 10. The daily rise of the PCs (deltaPC/deltat from day 2 to day 10 was calculated. Rates for 30-day mortality as well as hospital mortality were determined. MEASUREMENTS AND MAIN RESULTS: A total of 1,415 admissions were studied. Median PCs (interquartile range) initially decreased and subsequently increased, with a higher PC in 1,203 survivors than in 212 nonsurvivors from day 2 onward (302 [range,181-438] x 10(3)/mm3/day vs. 129 [range, 62-228] x 10(3)/mm3 at day 10; p < 0.001). After stratification of patients per type of surgery, within each group PC was also higher in survivors. Mean deltaPC/deltat was more than five times higher in survivors compared with nonsurvivors: 30 +/- 46 x 10(3)/mm3/day vs. 6 +/- 28 x 10(3)/mm3/day (p < 0.001). The area under the receiving operating characteristic curve of deltaPC/deltat for 30-day survival was 0.743 compared with 0.728 for the Acute Physiology and Chronic Health Evaluation. Leukocyte counts showed marginal differences between nonsurvivors and survivors. CONCLUSION: A blunted or absent rise in PCs in critically ill patients is associated with increased mortality. deltaPC/deltat is a readily available and simple parameter to improve assessment of critically ill patients.

APACHE↗
PubMed1992

Hand injuries in volleyball.

We studied the long-term sequelae of hand injuries as a result of playing volleyball. In a retrospective study, 226 patients with injuries of the hand who were seen over a 5-year period at our Trauma Department, were investigated. Females accounted for 66% of all injuries. The mean age was 26 years, with a peak in the age group of 15 to 29 years. Sprains and strains were observed most frequently (39%), followed by fractures (25%) and contusions (16%). The fingers were involved in 44% of the cases. Most injuries of the hand occurred in recreational players. Recreational players had more left-sided injuries, whereas competition players had more right-sided injuries (P less than 0.005), suggesting that lack of skill is an important determinant. Left-handedness was associated with an increased risk of hand injury in recreational players. One third of the volleyball players did not go to work or school for a median of 4 weeks as a result of the injury. In a survey after a mean period of 5 years, a high percentage of patients had complaints: 28% cited stiff and crooked fingers with limitations and tenderness in the movements as main inconveniences. We consider this incidence disturbingly high, regarding the seemingly innocent nature of these injuries.

Adolescent↗
PubMed1991

[Accidents a matter of chance? The significance of lunar phases and biorhythms in trauma patients].

The belief that supernatural forces influence man's fate appears to be increasing. Many people are convinced that unknown forces can cause injuries. From a multitude of proposed possibilities, we selected two factors that are claimed to affect the incidence of accidents. The first theory holds that more accidents occur at the time of full moon. The second theory concerns the three so-called biorhythms with their supposedly critical days (physical, emotional, intellectual). The effect of the lunar phase and the three biorhythms on accidents was determined from the dates of accident and birth of trauma patients admitted to the University Hospital in Groningen. We analysed data on all 29085 patients who were seen at the outpatient department in the years 1981-1983 and on 930 severely injury patients admitted in the years 1985-1989. At full moon even slightly fewer patients than expected (24 percent vs 25 percent) were seen at the emergency department. The number of severely injured patients was the same during the four moon phases. The 'critical' biorhythm days were not associated with increased number of accidents, neither for the patients seen at the emergency department, nor for the severely injured patients.

Accidents↗
PubMed1991

Treatment of humeral shaft fractures related to associated injuries. A retrospective study of 237 patients.

The results of treatment in 237 patients with humeral shaft fractures in relation to the severity of associated injuries were reviewed. Three groups were defined with the Injury Severity Score: multiply injured (ISS greater than or equal to 18; n 58), moderately injured (4 less than ISS less than 18; n 52), and singly injured patients (ISS = 4; n 127). Three basic forms of therapy were evaluated: operative stabilization, traction, and bracing. In singly injured patients the best results were obtained by bracing, and no cases of delayed union were observed. In multiply injured patients, the incidence of delayed union was low after operative stabilization. In moderately injured patients who had to remain in bed, traction therapy was warranted. The majority of 21 primary and 19 secondary radial nerve injuries showed good recovery, independent of surgical exploration.

Adolescent↗
PubMed1991

Interleukin-6 and its relation to the humoral immune response and clinical parameters in burned patients.

The cytokine interleukin-6, which has been shown to be increased in patients with burn injuries, is produced by activated monocytes and endothelial cells and has many in vitro activities, including stimulation of acute-phase protein synthesis in hepatocytes, immunoglobulin synthesis in B lymphocytes, and stimulation of growth of megakaryocytes. In 13 patients with a mean of 31% full-thickness burns, we studied the relation of serum interleukin-6 to clinical parameters and parameters of the acute-phase response and immunoglobulin production. Interleukin-6 was already elevated within hours after the injury was sustained, and it remained elevated for several weeks. All components of the acute-phase response were observed: fever, tachycardia, leukocytosis with an associated left shift, elevation of C-reactive protein and alpha 1-antitrypsin, and a decrease in albumin levels. In the second week after burn injury, immunoglobulin M levels peaked, followed by a prolonged elevation of immunoglobulin G levels. Thrombocyte counts initially decreased and rebounded to supranormal levels after 2 weeks. Interleukin-6 levels were positively correlated with acute-phase responses. We believe that the production of interleukin-6 induces the synthesis of acute-phase proteins. High interleukin-6 levels may also be an etiologic factor in the marked immunoglobulin response observed. Likewise, the relation between the megakaryocyte-promoting activity of interleukin-6 and the rebound thrombocytosis requires further investigation.

Adult↗
PubMed1990

Changes in the serum concentration and the glycosylation of human alpha 1-acid glycoprotein and alpha 1-protease inhibitor in severely burned persons: relation to interleukin-6 levels.

The relation between interleukin-6 (IL-6) levels and changes in serum concentrations and glycosylation (concanavalin A affinity) of two human acute-phase glycoproteins, alpha 1-acid glycoprotein (AGP) and alpha 1-protease inhibitor (PI), was studied in sequential serum samples of burn patients. The level of IL-6 was already increased at the first day following injury, and after a dip at day 2 or 3 rapidly reached a second maximal value at day 4 or 5. The serum concentrations of AGP and PI reached their maximal values after day 5 and remained at a high level throughout the total period studied (7 weeks). The concanavalin A reactivities of both acute-phase glycoproteins were found to be elevated only during the first 2-2.5 weeks. Maximal values were observed on day 2 and from day 7 to 16, following closely the rise and fall of the IL-6 serum level. After day 16, the concanavalin A affinity rapidly declined long before a decrease was observed in the serum concentrations of AGP and PI. Our previous in vitro studies have indicated an involvement of IL-6 in the induction of both secretion and increased concanavalin A affinity. This study indicates that IL-6 could play a causal role in the induction of both phenomena in vivo.

Adult↗
PubMed1988

A modified competitive inhibition radioimmunoassay for the detection of C3a. Use of 125I-C3 instead of 125I-C3a.

Levels of C3a in plasma are currently measured by a competitive inhibition radioimmunoassay (RIA) in which 125I-C3a is used as a tracer. In this paper, we describe a modification of this RIA: 125I-C3 instead of 125I-C3a is used. The lower limit of detection of this modified RIA is 6 ng of C3a per ml of plasma (i.e. 0.66 nmol/l). This RIA, performed with polyclonal anti-C3a antibodies coupled to a solid phase, appeared to be 30 times more sensitive compared with an RIA in which a monoclonal antibody against C3a is used. In vitro activation of the complement system in serum by aggregated IgG, zymosan, and cobra venom factor resulted in the generation of significant amounts of C3a. Assessment of the C3a levels by the modified RIA in serial plasma samples from patients who underwent cardiopulmonary bypass, yielded results very similar to those described in the literature for the established C3a-RIA. Thus, the modified C3a-RIA offers a convenient alternative for the detection of C3a in plasma samples.

Antibodies, Monoclonal↗
PubMed1988

Fat embolism in patients with an isolated fracture of the femoral shaft.

Analysis of basic pathophysiologic variables in fat embolism patients is often restricted by the complexity of the different injuries present in each individual patient. To avoid this problem we investigated the presence of the fat embolism syndrome in patients with an 'isolated' fracture of the femoral shaft. Two groups were distinguished: those who had an open fracture or a closed fracture treated operatively within 24 hours after the accident (decompression group), and those who were treated initially conservatively (nondecompressed group). Clinical fat embolism occurred only in patients in the nondecompressed group (3.5%). They showed significantly higher initial temperatures, lower pulse rates, a progressive hemoglobin decrease, and a fracture localization more proximal (p less than 0.025) than the other patients in the nondecompressed group; they also showed significantly different pathophysiologic patterns from the patients in the decompressed group. Although the pathophysiologic mechanism of the onset of clinical fat embolism remains unclear, initial temperature elevations in combination with 'typical' fracture localization and fracture type appear to have a predictive value.

Adolescent↗
PubMed1987

Superficial lightning injuries--their "fractal" shape and origin.

The origin of superficial lightning burns was studied. A recently developed mathematical model was invoked to identify fern-shaped burns as 'so-called' fractals. On the basis of this model and discharge experiments, we conclude that 'fractal burns' are caused by surface discharges of a positive polarity. The recognition of such burns can help to elucidate the type and mechanism of the lightning strike.

Adult↗