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Biomedical subjects

P Steenvoorde

Publications and source records attributed to P Steenvoorde.

At least 19 recordsLinked to original sources
PubMed2006

Necrotizing soft tissue infection of the thigh: consider an abdominal cause.

BACKGROUND: Necrotizing soft tissue infection (NSTI) is a disastrous infection of the subcutaneous tissue and underlying fascial layers. Even if urgent treatment is started, mortality rates are high. Due to the paucity of specific cutaneous signs, early recognition is extremely difficult. This in turn causes a delay in diagnosis and worsens prognosis. Although NSTI can develop after a wide variety of causes, specific clues such as initial gram staining and a high index of suspicion should alert the clinician to an abdominal causative agent, which alters surgical treatment strategy. If detected early, prognosis for the patient is improved. METHODS: Four patients with NSTI of the thigh due to an abdominal origin are detailed regarding their clinical presentation, gram stain or culture, abdominal focus, and treatment. Based on our clinical experience and a review of the relevant literature, we address clinical challenges and controversies of importance. RESULTS: Current literature on NSTI recommends prompt surgical debridement and broad-spectrum antibiotic therapy. Our cases revealed that an abdominal focus is not uncommon; however, it can be easily missed, which delays treatment. All cases demonstrated polymicrobial gram stains and cultures, which can raise suspicion of and lead to determination of an abdominal focus. CONCLUSIONS: High clinical suspicion or a polymicrobial gram stain or culture should quickly lead to determination of an abdominal source. Early surgical exploration and focus treatment, together with prompt surgical debridement and broad-spectrum antibiotic therapy, could reduce mortality significantly.

Adult↗
PubMed2006

[Maggot therapy for treatment of severe infections in trauma surgery: "back to the future!"].

The ancient method of larval therapy for treatment of acute and chronic infections has become a revival and a new dimension with introduction of the Biobag (Vitapad). With use of this therapy trauma patients suffering infectious complications can be treated very effective, which can reduce the overall time needed for treatment and can result in diminished invalidity.

Animals↗
PubMed2006

Perforation of the esophagus caused by the insertion of an intragastric balloon for the treatment of obesity.

Obesity is an enduring chronic disease, with multifactorial etiology. Many procedures and solutions have been proposed in the last 25 years. If patients do not meet the criteria for bariatric surgery, intragastric balloons may be used to achieve weight reduction. Contraindications to balloon therapy are a large hiatal hernia, severe esophagitis, peptic ulceration and previous gastric surgery. Although intragastric balloons are advocated as safe devices, major complications such as intestinal obstruction, gastric perforation and gastric ulceration have been described. We report a case of esophageal rupture due to insertion of an intragastric balloon for the treatment of morbid obesity, for which no contraindication existed. When abnormal pain or discomfort arises, or esophageal damage is noted after insertion of an intragastric balloon, patients must be closely monitored to diagnose a possible esophageal rupture early and thereby prevent severe complications.

Esophageal Perforation↗
PubMed2005

[The abdominal compartment syndrome].

In two patients, a man aged 67 and a woman aged 80, an abdominal compartment syndrome was diagnosed. The man had been treated surgically for an abdominal aortic aneurysm; he recovered after re-operation. The woman had been treated by sigmoidectomy because of ileus. A Bogota bag and a vacuum-assisted wound-closure system were applied to the abdominal wound. Her condition deteriorated, an intestinal perforation became apparent, of which she did not recover and died. An abdominal compartment syndrome should always be kept in mind when a patient at risk presents with increased intra-abdominal pressure and at least one of the following symptoms: oliguria, decreased cardiac output, increased pulmonary-artery pressure, hypotension and acidosis. Measurement of the bladder pressure remains the method of choice to establish the abdominal pressure level. However, there is a lack of correlation between the measured pressure and the clinical condition of the patient. Therefore, the combination of clinical findings and the observed trend in serial measurements of the bladder pressure is preferred to a single pressure measurement.

Abdomen↗
PubMed2005

Determining pain levels in patients treated with maggot debridement therapy.

OBJECTIVE: Pain as a complication of maggot debridement therapy (MDT) has been a topic of some controversy. This study set out to determine pain levels in patients treated with MDT. METHOD: A retrospective analysis using a visual analogue scale (VAS) was performed: 41 patients were treated with MDT for non-healing wounds (22 men and 19 women; average age: 67 years). Average wound duration was 14 months (range: two weeks to 132 months). Maggots were applied using the contained or the free-range techniques. Paracetamol (1 g three times daily) and Durogesic plaster (25 microg every three days and 50 microg the day before the maggot change) were given for pain relief in the outpatient clinic. RESULTS: Diabetic patients experienced the same amount of pain before and during MDT. Eight out of 20 non-diabetic patients experienced more pain during MDT than before; the remaining non-diabetic patients had the same amount of pain before and during the therapy. The difference between diabetic and non-diabetic patients was statistically significant (p<0.05) for all applications combined. CONCLUSION: In 78% of patients (29/37) pain can be adequately treated with analgesic therapy. However, if pain is unmanageable in the outpatient department, we believe that options include hospital admission, using the contained method of application or, in the worst case scenario, cessation of treatment. A standardised but individually tailored pain management protocol is mandatory.

Acetaminophen↗
PubMed2004

The antimicrobial activity of maggots: in-vivo results.

In the literature maggot therapy is discussed as a promising and potent form of debridement therapy. The number of maggots needed to debride a wound is estimated at 10 per cm2, and more in case of a higher percentage of necrosis or slough. In the authors' hospital, from March 1999 to May 2002, 16 patients were successfully treated with maggot therapy. The average maggot treatment time was 27 days, with an average of seven maggot changes. Most patients were treated for osteomyelitis, with trauma being the leading aetiological factor. In accordance with in-vitro findings, maggot therapy was found to be more effective in gram-positive infected wounds. Gram-negative bacteria are cultured more often after maggot treatment than before it (p=0.001). The opposite effect was found for gram-positive infected wounds (non-significant p=0.07). In vivo maggots seem to be less effective against gram-negative infected wounds. The authors believe that a higher number of maggots is needed not only for a larger wound or a wound with a higher percentage covered with slough, but also for a wound infected with gram-negative bacteria.

Adult↗
PubMed2004

Can laboratory investigations help us to decide when to discontinue larval therapy?

OBJECTIVE: This study investigated retrospectively whether three laboratory investigations--testing for leucocyte levels, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)--can be used to guide the decision of when to discontinue larval therapy. METHOD: Between 1999 and 2002 we administered larval therapy to 16 inpatients. In all cases the decision to discontinue therapy was a clinical one made by the surgeon who headed the trauma department. We retrospectively analysed laboratory investigations, testing for leucocyte levels, CRP and ESR, on the first and last days of therapy to ascertain if the results could have guided this decision. RESULTS: The median leucocyte count on the first day of larval therapy was 10.5 (x 10e9/L) compared with 8.4 (x 10e9/L) on the last day (Friedman test: p < 0.05). CRP and ESR showed a non-significant tendency towards lower values. CONCLUSION: Although the methodological limitations of this open-label non-comparative cohort study preclude a definite conclusion, we believe that laboratory investigations, particularly leucocyte count, can guide the decision of when to discontinue larval therapy. However, this objective parameter cannot replace clinical judgement.

Adolescent↗