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R Daelemans

Publications and source records attributed to R Daelemans.

At least 19 recordsLinked to original sources
PubMed2006

Pseudo-pulmonary embolism as a sign of acute heparin-induced thrombocytopenia in hemodialysis patients: safety of resuming heparin after disappearance of HIT antibodies.

Heparin-induced thrombocytopenia (HIT) is a syndrome caused by platelet-activating antibodies that recognize complexes of platelet factor 4 (PF4) and heparin. Thrombocytopenia is the most common clinical feature of HIT. HIT can be considered as a hypercoagulable state, with a high risk of thrombosis. Another feature of HIT is an acute systemic reaction that characteristically begins 5-30 min after receiving an intravenous bolus of unfractionated heparin, such as is commonly given for hemodialysis (HD). Here we present 4 patients who developed acute HIT at or near the start of their chronic HD. All patients were anticoagulated with the low-molecular-weight heparin, nadroparin, for HD. Three of our patients underwent surgery approximately 1-2 weeks before developing HIT. All patients presented with an acute systemic reaction during HD. All patients were treated and further dialyzed with lepirudin. Under this treatment we observed a quick recovery of the platelet count, and patients remained symptom-free. Antibodies against the PF4-heparin complex were detected with a combination of a 'quick test' and an enzyme-linked immunosorbent assay test. The likelihood of having HIT previous to the detection of antibodies was estimated with the pre-test probability score criteria. The tests for PF4-heparin antibodies remained positive for an average of 165 days. Three patients underwent a rechallenge with nadroparin after disappearance of the HIT antibodies in their serum. All 3 remained symptomless when they were further hemodialyzed on nadroparin. Our observations indicate that nadroparin can be successfully reintroduced for HD anticoagulation once the patient's HIT antibodies have disappeared.

Aged↗
PubMed2004

Re-evaluation and modification of the Stuivenberg Hospital Acute Renal Failure (SHARF) scoring system for the prognosis of acute renal failure: an independent multicentre, prospective study.

BACKGROUND: A prognostic scoring system for hospital mortality in acute renal failure (Stuivenberg Hospital Acute Renal Failure, SHARF score) was developed in a single-centre study. The scoring system consists of two scores, for the time of diagnosis of acute renal failure (ARF) and for 48 h later, each originally based on four parameters (age, serum albumin, prothrombin time and heart failure). The scoring system was now tested and adapted in a prospective study. METHODS: The study involved eight intensive care units. We studied 293 consecutive patients with ARF in 6 months. Their mortality was 50.5%. The causes of ARF were medical in 184 (63%) patients and surgical in 108 (37%). In the latter group, 74 (69%) patients underwent cardiac and 19 (18%) vascular surgery. RESULTS: As the performance of the original SHARF scores was much lower in the multicentre study than in the original single-centre study, we re-analysed the multicentre data to customize the original model for the population studied. The independent variables were the score developed in the original study plus all additonal parameters that were significant on univariate analysis. The new multivariate analysis revealed an additional subset of three parameters for inclusion in the model (serum bilirubin, sepsis and hypotension). For the modified SHARF II score, r(2) was 0.27 at 0 and 0.33 at 48 h, respectively, the receiver operating characteristic (ROC) values were 0.82 and 0.83, and the Hosmer-Lemeshow goodness-of-fit P values were 0.19 and 0.05. CONCLUSION: After customizing and by using two scoring moments, this prediction model for hospital mortality in ARF is useful in different settings for comparing groups of patients and centres, quality assessment and clinical trials. We do not recommend its use for individual patient prognosis.

Acute Kidney Injury↗
PubMed2000

Prognostic value of a new scoring system for hospital mortality in acute renal failure.

AIM AND METHODS: In order to define a prognostic scoring system for hospital mortality of individual patients with acute renal failure (ARF), data were collected prospectively in a single centre study (Stuivenberg General Hospital, Antwerp, Belgium) on 197 adult patients consecutively admitted to the intensive care unit (ICU) during one year. Mean age was 69.8 (+/- 14.7), male/female ratio was 118/79. RESULTS: Hospital mortality was 53%, 26% of the patients who were treated with renal replacement therapy. For developing the model all parameters showing a significant difference between survivors and non-survivors were entered in the multivariate analysis. Two SHARF scores (= Stuivenberg Hospital Acute Renal Failure scores) were developed, one at the time of diagnosis of ARF (T0) and the other 48 hours later (T48): SHARF T0 (7 x age) + (6 x alb0) + (3 x PTT0) + (39 x vent0) + (9 x heartf0) + 52 SHARF T48 (7 x age) + (6 x alb0) + (3 x PTT0) + (43 x vent48) + (16 x heartf48) + 52 age, albumin (alb0) and prothrombine time (PTT0) at T0 are expressed as categories, respiratory support (vent) and heart failure (heartf) at T0 and T48 are presented as absent (0) or present (1). In the linear regression model, r2 was, respectively, 0.36 and 0.43. The area under the receiver operator characteristic (ROC) curves, judging the discrimination ability between survivors and non-survivors, for T0 and T48 were, respectively, 0.87 and 0.90. The Hosmer-Lemeshow goodness-of-fit C statistic for T0 was C = 8.47; df8; p = 0.3 89 and for T48 C = 11.05; df = 8; p = 0.199. CONCLUSION: We conclude that this scoring system, developed for all types of ARF, compares favorably with published scores and can become useful as a bedside tool for predicting hospital mortality in individual patients. A second measuring point increased the predictive value of the model. The results have to be confirmed in an ongoing prospective multicentre study.

Acute Kidney Injury↗
PubMed1999

Comparison of different routes of administration of nadroparin in hemodialysis.

AIM: In an open, crossover, randomized study in hemodialysis patients, we investigated possible differences of the effect of the low molecular weight heparin (LMWH) nadroparin/fraxiparine in relation to the route of administration. PATIENTS AND METHODS: The effect of nadroparin, administered by the venous line or by the arterial line after priming of the extracorporeal circuit with a part of the total dose administered, was compared with administration of the same dose by the arterial line as recommended by the manufacturer. Twelve stable, chronic hemodialysis patients were studied during 3 dialysis sessions for each treatment option. Concomitant medication was kept constant. RESULTS: Results obtained after administration of nadroparin by the venous line were comparable to those obtained after administration by the arterial line. When a part of the dose was added to the priming solution, the anti-Xa activity, measured after 2 hours of dialysis, was somewhat lower (p = 0.09). There was also a tendency towards longer manual compression time in this group. There was no difference in hemoglobin, serum urea and creatinine before the study and at the end of each treatment option. CONCLUSION: We therefore conclude that the safety and efficacy of administration of LMWH by the arterial and by the venous route are identical. There is no need for addition of a small dose of LMWH to the priming fluid.

Adult↗
PubMed1998

Drug-induced spongiform leucoencephalopathy, a case report with review of the literature.

A nineteen year-old girl developed rhabdomyolysis and central pyrexia after the ingestion of multiple drugs: amphetamines, benzodiazepines, methadone, ethanol, and cocaine. On admission, the patient was deeply comatose and during the hospitalisation asymmetrical spastic quadriparesis was noted. Brain biopsy was diagnostic of spongiform leucoencephalopathy. A review of the literature concerning drug-induced spongiform encephalopathy revealed a large amount of heroin-induced cases. The role of cocaine, however, is less well described. After prolonged hospitalisation, our patient improved clinically and radiologically and could be transferred to a rehabilitation center.

Adult↗
PubMed1998

Shoshin syndrome: two case reports representing opposite ends of the same disease spectrum.

Thiamine deficiency can have cardiovascular and neurological manifestations. Cardiac beriberi is classically thought to represent a high-output state with oliguria and lactic acidosis. The condition can, however, also present itself with a low cardiac output and fulminant vascular collapse, or as an acute fatal form, causing sudden death, without clear-cut signs of cardiomegaly. In the western society beriberi is mainly encountered in alcoholics. We report on two cases, one with high-output failure and the other with low-output failure and cardiovascular collapse. In both patients the diagnosis of shoshin syndrome was made, and and both showed a spectacular improvement of congestive heart failure symptoms after treatment with thiamine. A therapeutic trial with thiamine is the only way to rapid diagnosis.

Adult↗
PubMed1997

Treatment of severe thallium intoxication.

CASE REPORT: We report a successfully treated case of severe thallium intoxication. In spite of very high serum thallium (5,240 micrograms/L), symptomatology was minor and recovery complete. Prussian Blue was administered, diuresis was enhanced by intravenous fluids and a prolonged hemodialysis was started early. High blood flows (300 mL/min) and intravenous potassium chloride supplements, to mobilize thallium from the tissues, resulted in good clearances (96 to 150 mL/min). In order to prevent the well known complications, we recommend aggressive treatment of severe thallium intoxication.

Adult↗
PubMed1995

Reduced glutathione for the treatment of anemia during hemodialysis: a preliminary communication.

In 4 chronic hemodialysis patients we have tested whether the administration of reduced glutathione (GSH; Glutamed, Boehringer Mannheim Italia; 1,200 mg i.v.) at the end of each hemodialytic session during 90 days could minimize oxidative damage to the red blood cells (RBC) and reduce the recombinant human erythropoietin requirements. Treatment with GSH was followed by an increase in RBC GSH content (n = 3), a normalization of the ascorbine cyanide test (n = 4), an increase in RBC survival (n = 3), and a reduction in 2 patients of the erythropoietin need (41 and 26%, respectively, after 3 months of therapy). When the GSH supplements were terminated, we noticed after 3 months a re-establishment of the baseline values. On the other hand, malonyldialdehyde, RBC deformability, and RBC splenic pool were abnormal before and remain abnormal during the test period. Since no adverse reactions were noticed, these findings seem to indicate the GSH could ameliorate the intraerythrocytic oxidative defense and could be as useful drug in the treatment of anemia in patients affected by chronic renal failure.

Aged↗
PubMed1994

A massive, near-fatal cocaine intoxication in a body-stuffer. Case report and review of the literature.

The last decade an increase has been seen in drug smuggling. Body-packing and body-stuffing are the terms used for intracorporeal concealment of illicit drugs (mainly cocaine and heroine, but sometimes also amphetamines and cannabinoids). These body-packets are especially prone to rupture. In order to avoid systemic cocaine toxicity, which can involve nearly every organ and therefore nearly every subspecialty of medicine urgent diagnosis is necessary. Obtaining a detailed history remains crucial. Further clues to diagnosis are given by the urinary drug concentrations and the benzoylecgonine/cocaine ratio in urine. Plain abdominal films, CT and contrast studies of the bowel can be helpful in identifying the package but are of limited value. In addition to activated charcoal, polyethylene glycol-electrolyte lavage solution, enteral feeding and laxatives (not paraffin) can be used to eliminate the body-package by enhancing bowel transit. Alkalinisation of gastric fluids enhances hydrolysis to cocaine's major inactive metabolite benzoylecgonine. If the package fails to progress through the gut or if mechanical obstruction occurs surgical removal is indicated. In no way endoscopic removal of the package should be attempted. Systemic symptoms should be treated by blocking the sympathetic overreactivity; this can be done with diazepam (Valium), labetalol (Trandate) or esmolol. Flumazenil (Anexate), lidocaine (Xylocaine) and pure beta-blockers like propranolol (Inderal) are to be avoided.

Adult↗
PubMed1994

Neutrophil adhesion molecules in chronic hemodialysis patients.

The expression of the adhesion molecules LFA-1 (CD11a-CD18), Mac-1 (CD11b-CD18), and LAM-1 on predialysis and intradialysis neutrophils (PMN) was analyzed by flow cytometry in 10 chronic hemodialysis patients (CHD) and compared with age-matched normal controls. All patients were dialyzed either with a polyacrylonitrile, or a polysulfone membrane. To appreciate the influence of the interdialytic time, we compared the samples of Monday (3 days without dialysis), with those of Wednesday (2 days without dialysis). A patient group not treated with recombinant human erythropoietin (rHuEPO) was also included to analyze the influence of r-HuEPO. We found on the predialysis and intradialysis samples that the expression of CD11a was not different in the CHD patients and in the normal controls. Hemodialysis was associated with a rapid and significant reduction in LAM-1 on the 15- and 30-min samples (p < 0.05). This reduction was only transient, and returned to near predialysis levels after 120 min dialysis. The MAC-1 increased significantly after 30 min dialysis (p < 0.01), and remained at the end of the dialysis procedure still substantially above the predialysis levels (p < 0.01). On the other hand, we have found a significant (p < 0.005) up-regulating of the MAC-1, and a down-regulating of the LAM-1 in the predialysis samples. We noticed further a significantly lower expression (82 +/- 9.6%) for LAM-1 in these predialysis samples (p < 0.005). These results demonstrate that 'high MAC-1, low LAM-1' neutrophils were not only a dialysis-related phenomenon, but that they were already present before the hemodialysis session, nor was there any difference between the interdialytic times or compared with the r-HuEPO treatment.

Adult↗