Antibiotic therapy and outcome in critically ill patients with pneumococcal bacteremia.
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Anti-Bacterial Agents↗
Biomedical subjects
P Depuydt
Publications and source records attributed to P Depuydt.
Inflammatory abdominal aortic aneurysm and bilateral complete ureteral obstruction: treatment by endovascular graft and bilateral ureteric stenting.
Inflammatory abdominal aortic aneurysms may present a challenge to the surgeon, especially because of associated retroperitoneal fibrosis and possible ureteral complications. We present a case of inflammatory abdominal aortic aneurysm with bilateral ureteral entrapment and complete anuria, successfully treated by endovascular grafting and temporary ureteral stenting.
Aortic Aneurysm, Abdominal↗
Ambient ozone concentrations induce airway hyperresponsiveness in some rat strains.
Ozone is known to induce airway hyperresponsiveness (AHR) in humans and animals. Previous studies in animals used high exposure levels and reported inconsistent results. The aim of this study was to investigate the effect of a single low-level ozone exposure on different inbred rat strains. Nine rat strains were exposed to 0.05 parts per million (ppm) for 4 h and airway responsiveness to intravenous 5-hydroxytryptamine (HT) examined. Bronchoalveolar lavage fluid (BALF) was examined for the presence of inflammatory cells and markers. Lewis, BDII and Long-Evans rats developed AHR 90 min after ozone exposure, whereas Wistar, Sprague-Dawley, Fisher 344, Brown-Norway, BDE and DA rats did not. Baseline airway responsiveness to 5-HT differed significantly between rat strains, but did not correlate with the presence or absence of ozone-induced AHR. No inflammatory cell influx was found in BALF of any rat strain. In Long-Evans rats, AHR lasted up to 12 h after ozone exposure despite the absence of an inflammatory cell influx or increase in lactate dehydrogenase, alkaline phosphatase or total protein in BALF. In conclusion, exposure to an ambient concentration of ozone induced airway hyperresponsiveness without airway inflammation in some highly inbred rat strains. Genetic factors are likely to account for the observed variability in sensitivity of the airways to ozone.
Alkaline Phosphatase↗
Implantable Holter may reveal cause of unexplained syncope.
A definitive diagnosis in patients with syncope is often problematic if the cause is not evident after initial clinical assessment. The cause of syncope may be not established due to the infrequent, episodic occurrence. A symptom-rhythm correlation is frequently an unattainable gold standard in many patients. The implantable Holter has added a powerful tool to the diagnostic armamentarium in the field of arrhythmia detection and may assume a prominent role in the investigation of syncope.
Adult↗
Mediastinal B-cell lymphoma with sclerosis: clinical features and treatment results in 10 patients.
Mediastinal large-B-cell lymphoma with sclerosis is now considered to be a discrete subtype of lymphoma. It probably originates in the thymus, a T-cell organ. Early publications consider this lymphoma as an aggressive disorder with poor prognosis. We studied retrospectively ten consecutive patients with mediastinal B-cell lymphoma with sclerosis seen in the department of hematology. Nine were women. The median age at diagnosis was 38.3 years (16-60). Dyspnea (experienced by 7 patients), chest pain (5) and cough (10) were the most common clinical features at presentation. Superior vena cava syndrome occurred in three patients. Five had infiltration of the chest wall or of the pulmonary tissue. Four patients were in clinical stage I (all bulky > 10 cm), four in stage IIE, one was in stage IIE and one in stage IV (Ann Arbor classification). All patients were treated with intensive chemotherapy, mostly containing cyclophosphamide, doxorubicin, vincristine or vindesine, bleomycin and prednisone, combined with etoposide or teniposide and methotrexate. Nine patients responded well to chemotherapy (tumor reduction > 75%). One patient progressed. Eight patients received involved field radiotherapy (36-40 Gy) after chemotherapy. The two other patients were treated with intensive chemotherapy (BEAC, BCNU, etoposide, cytarabine, cyclophosphamide), followed by autologous bone marrow transplantation. Two patients died: one patient received autologous bone marrow transplantation in partial remission and relapsed after 6 months; the other patient had progressive disease despite chemotherapy, surgery and radiotherapy. Mean follow-up is 54.6 months (15-118) with 8 patients still remaining in complete remission. In patients with mediastinal B-cell lymphoma, tumour localisation is often limited to the thorax.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
The superfast atrial recharge pulse: a cause of pectoral muscle stimulation in patients equipped with a unipolar DDD pacemaker.
Pectoral muscle stimulation may cause serious discomfort to patients equipped with a pulse generator. Insulation defects of the lead, connector problems and defective coating of the pacemaker can are common causes of local muscle contractions. This report describes pectoral muscle stimulation caused by the atrial superfast recharge pulse incorporated into the atrial channel of a commercially available unipolar DDD pacemaker. As pectoral muscle stimulation could not be eliminated by reprogramming the pacemaker to a lower atrial output in some patients a redesign of the pacemaker is highly required.
Cardiac Pacing, Artificial↗
Invasive aspergillosis in critically ill patients: analysis of risk factors for acquisition and mortality.
OBJECTIVE: To investigate outcome in patients who develop invasive aspergillosis in the ICU, and to evaluate whether specific risk factors for the acquisition of invasive aspergillosis are associated with mortality. DESIGN: Retrospective cohort study (07/1997-12/1999) with screening of 8988 admissions. SETTING: 54-bed ICU of the 1060-bed Ghent University Hospital. PATIENTS: 38 ICU patients with invasive aspergillosis. Invasive aspergillosis was defined as proven by positive histology and tissue culture and as probable by a combination of clinical suspicion as well as microbiological and radiological data. Seventeen patients had risk factors (neutropenia, haematological malignancy, immunosuppressive therapy). In the other 21 apparently immunocompetent patients, invasive aspergillosis was a complication following ARDS, COPD, pneumonia, acute liver failure, burns, severe bacterial infection and malnutrition. MEASUREMENTS: Population characteristics and outcome were compared for patients with and without risk factors for the acquisition of invasive aspergillosis. RESULTS: Patients with risk factors had higher APACHE II scores. No difference was found between patients with and without risk factors in in-hospital mortality (82% vs. 71%; p=0.431). In patients with specific risk factors, the observed mortality was not different from the mortality as expected on basis of the APACHE II (p=0.940). In patients without risk factors the observed mortality exceeded the expected mortality (p<0.001). CONCLUSION: The incidence of invasive aspergillosis in this series is 4/1000 admissions. No difference in mortality was found between patients with and without risk factors for the acquisition of invasive aspergillosis. Yet, the prognosis of the patients without risk factors seems to alter more seriously by the development of this infection.
APACHE↗
Ventilator-associated pneumonia in a tertiary care ICU: analysis of risk factors for acquisition and mortality.
OBJECTIVE: To investigate the incidence, risk factors and mortality of ventilator-associated pneumonia (VAP) in intensive care unit (ICU) patients. DESIGN: Prospective, observational, population-based study. SETTING: The medical (14-bed) and surgical ICU (26-bed) of the Ghent University Hospital. METHODS: All 1295 patients admitted to the ICU during 4 three-month periods between 1996 and 1998 were included. A set of demographic and clinical variables were collected at the day of admission and during the ICU course. RESULTS: The incidence of VAP among ICU patients ventilated at least 48 hours was 23.1%. The mean time to the development of VAP was 9.6 days with a median of 6 days. In the population of patients ventilated for at least 48 hours, a comparison was made between patients with (n = 89) and without VAP (n = 296). Patients with VAP had a significant longer ICU stay, with a longer ventilation dependency. Logistic regression analysis identified admission diagnosis other than trauma (OR: 0.51, 95% CI: 0.29-0.89; p = 0.02) and the length of ICU stay (OR: 1.05, 95% CI: 1.03-1.07; p < 0.001) to be independently associated with the acquisiton of VAP. In comparison with the total study population, patients with VAP had a higher ICU mortality (20.2% vs. 12.0%; p = 0.04), but not in the cohort group of patients at risk for VAP (ventilated > 48 hours)(20.2% vs. 31.3%; p = 0.03). The factors independently associated with death were higher SAPS II scores (OR 1.02, 95% CI: 1.003-1.032; p = 0.02), an admission diagnosis other than trauma (OR 0.36, 95% CI: 0.17-0.75; p = 0.006) and length of ICU stay (OR 0.97, 95% CI: 0.946-0.995; p = 0.02). This model did not recognize VAP as an independent predictor of death (OR 0.79, 95% CI: 0.41-1.53; p = 0.492). CONCLUSIONS: The incidence of VAP in our ICU is 23.1%. Length of ICU stay and an admission diagnosis other than trauma are major risk factors for the development of this nosocomial infection. VAP is associated with a high fatality rate. However, after adjustment for disease severity and length of ICU stay, VAP was not identified as an independent predictor of death.
Adult↗
Total correction of tetralogy of Fallot following palliation.
Fifty three patients with Tetralogy of Fallot were totally corrected following palliation. Intracardiac repair was not adversely influenced by a Blalock Taussig shunt or a Waterston shunt which did not produce kinking of the RPA. The results were less satisfactory after correction following a Potts shunt or a Waterston shunt with kinking at the site of the anastomosis.
Adolescent↗
[Obstruction of the superior vena cava and right subclavian vein: a propos of 2 unusual cases].
Two uncommon cases of vein obstruction are presented. In the first case a syndrome of superior, caval vein obstruction was caused by idiopathic fibrous mediastinitis involving the vein wall, and creating a tumefaction in the lumen of the vein simulating the existence of a benign tumor (fibroma) of the wall. This tumefaction was removed by endvenectomy, and the venotomy was repaired by a pericardial patch. In the second case the obstruction of the right subclavian vein was caused by a stenosed valve without signs of inflammation nor consecutive thrombosis. Until the present day no other similar case of a stenosed valve in the right subclavian vein has been reported.
Constriction, Pathologic↗