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Biomedical subjects

R J Strack van Schijndel

Publications and source records attributed to R J Strack van Schijndel.

At least 19 recordsLinked to original sources
PubMed2006

Herpes simplex virus type 1 and respiratory disease in critically-ill patients: Real pathogen or innocent bystander?

Herpes simplex virus type 1 (HSV-1) has been associated with pulmonary disease, mostly in severely immunocompromised patients. After reactivation and shedding in the oropharynx, the virus may reach the lower respiratory tract by aspiration or by contiguous spread. HSV-1 can be detected in clinical specimens by virus culture or quantitatively by nucleic acid amplification techniques. With these techniques, HSV-1 is often detected in the respiratory secretions of critically-ill patients. However, a clear diagnosis of HSV-1 pneumonia is difficult to establish because clinical criteria, radiological features and laboratory findings all lack specificity. Lower respiratory tract HSV-1 infections have not been associated with specific risk-factors. There is also an absence of consistent data concerning the effect of antiviral treatment on the outcome of critically-ill patients. Further studies are needed to better define the pathogenic role of HSV-1 in the lower respiratory tract of these patients, to improve the diagnosis, and, especially, to assess the need for antiviral treatment in the individual patient.

Antiviral Agents↗
PubMed2001

[Clinical thinking and decision making in practice. The internist as a consultant for a patient with unexplained anemia in the cardiology department].

A man aged 73, admitted because of unstable angina pectoris also had a anaemia with a haemoglobin concentration of 2.8 mmol/l. The department of Consultative Internal Medicine was asked to elucidate this anaemia. The anamnesis proved to contain extensive diagnostic tests concerning the anaemia which had had no results. In spite of a negative anamnesis, the low serum iron level had prompted an unsuccessful search for a source of haemorrhage in the proximal and distal parts of the digestive tract. The bone marrow had been examined three times without a clear diagnosis. It was also found that there had been a deviation from the classification of anaemia which should be guided by the size of the erythrocyte and the reticulocyte count. This had resulted in diagnostics that where inconvenient to the patient; also the patient had been treated without success with ferrofumarate. Ultimately, he proved to suffer from autoimmune hypothyroidism; the anaemia was resolved by substitution therapy.

Aged↗
PubMed2001

Accuracy and reliability of APACHE II scoring in two intensive care units Problems and pitfalls in the use of APACHE II and suggestions for improvement.

Acute Physiology and Chronic Health Evaluation (APACHE) II scoring is widely used as an index of illness severity, for outcome prediction, in research protocols and to assess intensive care unit performance and quality of care. Despite its widespread use, little is known about the reliability and validity of APACHE II scores generated in everyday clinical practice. We retrospectively re-assessed APACHE II scores from the charts of 186 randomly selected patients admitted to our medical and surgical intensive care units. These 'new' scores were compared with the original scores calculated by the attending physician. We found that most scores calculated retrospectively were lower than the original scores; 51% of our patients would have received a lower score, 26% a higher score and only 23% would have remained unchanged. Overall, the original scores changed by an average of 6.4 points. We identified various sources of error and concluded that wide variability exists in APACHE II scoring in everyday clinical practice, with the score being generally overestimated. Accurate use of the APACHE II scoring system requires adherence to strict guidelines and regular training of medical staff using the system.

APACHE↗
PubMed2001

alpha-atrial natriuretic peptide, cyclic guanosine monophosphate, and endothelin in plasma as markers of myocardial depression in human septic shock.

OBJECTIVE: To assess the value of alpha-atrial natriuretic peptide (alpha-ANP), second messenger cyclic guanosine monophosphate (cGMP,) and endothelin as markers of myocardial depression in septic shock. DESIGN: Prospective observational study. SETTING: Medical intensive care unit (ICU) of a university hospital. PATIENTS: Fourteen consecutive patients with septic shock and arterial and pulmonary artery catheters in place. MEASUREMENTS AND MAIN RESULTS: Hemodynamic variables and plasma levels of alpha-ANP, cGMP, and endothelin were measured every 6 hrs for 3 days after admission. Eight patients died from shock in the ICU. The nadir left ventricular stroke work index (LVSWI) was below 35 g/m2 in all patients, and the median peak circulating alpha-ANP (n < 68 pg/mL) was 276 pg/mL (range, 79-1056), the median peak cGMP (n < 2.1 ng/mL) was 8.1 ng/mL (range, 3.2-29.7), and the median peak endothelin (n < 5.3 pg/mL) was 15.5 pg/mL (range, 8.5-33.9), supranormal in all patients. Outcome groups differed in the course of cardiac index and LVSWI, which were lower in nonsurvivors despite similar filling pressures and more intensive inotropic treatment (p < .01). The course of alpha-ANP, cGMP, and endothelin plasma levels also differed between groups, with higher levels in nonsurvivors (p < .05). As for pooled data, the mean daily or nadir LVSWI inversely related to mean daily or peak alpha-ANP, cGMP, and endothelin levels, respectively (p < .05). The area under the receiver operating characteristic curve for myocardial depression (LVSWI < 35 g/m2) was for alpha-ANP and endothelin 0.77, and for cGMP 0.85 (p < .01). The optimum cutoff values for alpha-ANP, cGMP, and endothelin were 172 pg/mL, 4.5 ng/mL, and 10.0 pg/mL, respectively. The sensitivity for myocardial depression of alpha-ANP, cGMP, and endothelin was 68%, 77%, and 72%, and the specificity was 82%, 93%, and 69%, respectively. CONCLUSIONS: Circulating alpha-ANP, endothelin, and, particularly, cGMP may be markers of the myocardial depression of human septic shock, which is associated with mortality.

Adult↗
PubMed2000

A contrast crisis.

Explore the source record for details and available documents.

Adrenocorticotropic Hormone↗
PubMed1999

[Stress ulcer prophylaxis in the intensive care unit].

In the early years of intensive care a stress ulcer related bleeding, occurring in 20-30% of the IC population, became recognized as a significant cause of morbidity and mortality. Due to improved intensive care medicine (including adequate early resuscitation, analgesia, sedation) the incidence of stress ulcer-related bleeding in the IC has decreased markedly. Without pharmacological prophylaxis incidences ranging from 0.6 to 6% were reported. It is not recommended to apply stress ulcer prophylaxis on a routine basis, it should be reserved for patients with an increased risk of a stress ulcer-related bleeding. In patients with neurotrauma, severe burn, recent peptic ulcer or bleeding and those with coagulopathy prophylaxis with ranitidine is advised.

Anti-Ulcer Agents↗
PubMed1999

[Increased frequency of icterus in parenterally fed patients after a change of lipid emulsion].

UNLABELLED: Parenteral nutrition is associated with liver enzyme abnormalities. Until 1993 the incidence of icterus was low in both academic hospitals in Amsterdam, the Netherlands (Academic Medical Centre (AMC) and Academic Hospital of the Free University (AZVU)). In 1993 Intralipid in the nutrition was replaced by Endolipid in the home total parenteral nutrition programme (AMC) and by Lipofundin S in AZVU. Fifty per cent of the patients in the home programme developed severe fatigue, jaundice and thrombocytopenia. These signs and symptoms disappeared over months when parenteral nutrition without fat was given. After reintroduction of Intralipid these signs and symptoms never recurred. In AZVU the incidence of jaundice increased from 21% in 1992 to 79% in 1993 (p = 0.0002). After reintroduction of Intralipid in 1994 the incidence of jaundice decreased to 16%. CONCLUSION: Although the lipid emulsions are equivalent according to the product specification, the described observation suggests that Lipofundin S and Endolipid cause more icterus than Intralipid, possibly caused bij an impurity in the fat emulsion.

Academic Medical Centers↗
PubMed1999

Hypernatremia in the intensive care unit: an indicator of quality of care?

OBJECTIVE: To assess the frequency of hypernatremia in patients who were admitted to an intensive care unit (ICU) and to determine the correlation of hypernatremia with the clinical outcomes, durations of the patients' stays in the ICU, and other clinical variables. DESIGN: Retrospective survey. SETTING: University teaching hospital. PATIENTS: All patients (total, 389) who were admitted to the medical ICU of the department of internal medicine during 1 yr. MEASUREMENTS: The database of our hospital's mainframe computer was searched for sodium values > or = 150 mmol/L that were registered in the year 1995. These data were then matched with the registration numbers of all patients who were admitted to our medical ICU between January 1 and December 31, 1995. In this way, we identified all patients in whom hypernatremia was present at admission or those who developed hypernatremia in the course of their stay in our ICU. The prevalence and duration of hypernatremia (defined as a serum sodium concentration of > or = 150 mmol/L or more) were determined; the correlation of hypernatremia with clinical outcome, duration of ICU stay, Acute Physiology and Chronic Health Evaluation II scores, and other clinical variables were evaluated; and changes in fluid administration in response to hypernatremia and fluid regimens in the period preceding hypernatremia were examined. MAIN RESULTS: Of a total of 389 patients who were admitted in 1995, hypernatremia was present at admission in 34 patients (8.9%). The average duration of hypernatremia in these patients was 16.2 (range, 4-56) hrs. A total of 22 patients (5.7%) developed hypernatremia in the course of their stay in the ICU. The average duration of hypernatremia in this group was 34.7 (range, 4-89) hrs. Moderately elevated levels of sodium had been detected in most of these patients (n = 21) in the days before the development of severe hypernatremia; however, adjustments in fluid infusion aimed at preventing the occurrence of hypernatremia were either lacking (n = 7) or inadequate (n = 11). Hospital-acquired hypernatremia vs. hypernatremia present at admission to the ICU was associated with a higher mortality rate (32% vs. 20.3%, respectively; p < .01). CONCLUSIONS: Despite frequent measurement of sodium levels in patients in the ICU, hypernatremia is a relatively common occurrence. Initial treatment of hypernatremia is often inadequate, and sometimes treatment is delayed. The development of hypernatremia is associated with adverse outcomes for patients developing hypernatremia in the ICU. Hypernatremia could potentially be used as an indicator of quality of care in the medical ICU.

APACHE↗
PubMed1998

[A wandering spleen].

A mobile asymptomatic abdominal mass was accidentally found in a 81-year-old man. Further studies revealed a wandering spleen. Wandering spleen is rare, the diagnosis can easily be made with ultrasonography. The patient presented was asymptomatic, but severe complications may occur. Congenital anomalies of ligaments, splenomegaly and pregnancy may be of aetiological importance. In young patients and in case of complaints splenopexia is the treatment of choice; the patient presented was treated conservatively.

Aged↗
PubMed1998

[Hyperthyroidism induced by iodinated roentgen contrast media].

Three patients with subclinical hyperthyroid goitre, women aged 63, 72 and 75 years following intravenous administration of an iodinated contrast medium developed hyperthyroidism with a marked rise of the concentration of free T4. Thyreostatic agents were unsuccessful in two patients, the third was left untreated. Hyperthyroidism improved spontaneously in all three. Iodine-induced hyperthyroidism is rare and is usually encountered in patients with a pre-existent autonomous thyroid function. Treatment of iodine-induced hyperthyroidism is essentially exclusively symptomatic. Prophylaxis with sodium perchlorate should be considered in cardiac patients with a goitre and a subnormal level of thyroid-stimulating hormone (TSH).

Aged↗
PubMed1998

Ten patients with refractory status epilepticus in an intensive care department.

Status epilepticus (SE) is a serious disease, associated with a high morbidity and mortality, particularly if refractory to initial therapy. We describe the clinical manifestations and outcome in ten cases with refractory SE admitted to our medical intensive care unit. Three of these selected group of cases with SE had pre-existent epilepsia. Of the seven patients with new-onset epilepsia, six had multiple underlying systemic diseases. The three patients with pre-existent epilepsia had a favourable outcome of their SE. However, in the seven patients without known structural and/or functional cerebral defects SE was also refractory to second or third line therapy. Administration of thiopental suppressed epileptic activity only temporarily. None of them survived due to coexistent pathology and the onset of secondary metabolic complications. Thus, especially cases with new-onset epilepsia debuting as refractory SE in the presence of underlying systemic diseases had a fatal outcome in our medical intensive care unit.

Adult↗
PubMed1998

The haemodynamic effects of ketanserin versus dihydralazine in severe early-onset hypertension in pregnancy.

OBJECTIVE: To compare the haemodynamic efficacy of ketanserin (a selective serotonin2-receptor blocker) with dihydralazine in the management of severe early-onset hypertension in pregnancy. DESIGN: Subgroup analysis within a randomised prospective multicentre trial to compare haemodynamic effects as measured by pulmonary artery catherization. SETTING: Departments of Obstetrics and Gynaecology and Intensive Care Medicine, Free University Hospital, Amsterdam and Sophia Hospital, Zwolle. PARTICIPANTS: Thirty-one women with a diastolic blood pressure > 110 mmHg and a gestational age between 26 and 32 weeks. RESULTS: The antihypertensive efficacy of both drugs was comparable. Dihydralazine significantly increased cardiac output (P < 0.01), while ketanserin induced only minor changes in cardiac output. Systemic vascular resistance decreased in both groups, but the decrease was significantly more pronounced with dihydralazine compared with ketanserin. Ketanserin induced a significant but not clinically relevant increase in heart rate (P < 001, while dihydralazine caused marked tachycardia (P < 0.005). Left ventricular stroke work index was reduced to similar values in both groups. CONCLUSIONS: The antihypertensive profile of ketanserin is characterised by an early and gradual reduction of blood pressure in combination with a moderate decrease in systemic vascular resistance and no significant change in cardiac output. Dihydralazine causes market tachycardia resulting in a considerable increase in cardiac output.

Adult↗
PubMed1996

Continuous quality improvement in the ICU and the role of a data management system.

Quality improvement may be defined as the effort to improve the level of performance of key processes in the ICU. Based on knowledge of the current level of performance and on systematic analysis of organizational aspects of the ICU, quality improvement will include the implementation of standards, the formulation and analysis of quality indicators (e.g. scores, rate of complications such as nosocomial infections) and the possible introduction of data management systems.

Critical Care↗
PubMed1996

Outcome of ICU treatment in invasive aspergillosis.

OBJECTIVE: To assess the outcome of intensive care treatment in invasive aspergillosis. DESIGN: Retrospective study. SETTING: University Hospital, Medical Intensive Care Unit (ICU). PATIENTS: Twenty-five patients with invasive aspergillosis who were admitted to the medical ICU in a 5 1/2 year period. Twenty-two had received high-dose chemotherapy for (mainly hematologic) malignancies, one had been treated with cyclosporine and prednisolone for systemic lupus erythematosus, one with high-dose methylprednisolone for polyarteritis nodosa and one had an ARDS after near-drowning. MEASUREMENTS AND RESULTS: The medical records were reviewed for patient and disease characteristics, outcome, reasons for admission to the ICU, supportive care and antifungal therapy as well as for the results of cultures and autopsy. Out of 25 patients, a definite ante mortem diagnosis could be established in seven. When autopsied patients were included, a total of 15 suffered from proven invasive aspergillosis. Although standard antifungal treatment and maximal available supportive care were given, 23 of 25 patients (92%) died after a mean of 15 (1-51) days in the ICU. Both patients who recovered had received high-dose chemotherapy for hematologic malignancy and showed bone marrow recovery and/or had a localized pulmonary infection. CONCLUSIONS: In patients with highly suspected or proven invasive aspergillosis, admission to an ICU and mechanical ventilation should be considered in cases of localized infection and obvious signs of hematologic recovery. In most other circumstances ICU admission for mechanical ventilation does not seem to improve survival.

Adolescent↗
PubMed1995

[Respiratory insufficiency due to pulmonary toxicity of amiodarone].

A 70-year-old woman suffering from atrial fibrillation was treated with amiodarone, but developed acute respiratory failure necessitating mechanical ventilation for four weeks. Pulmonary function remained restrictively impaired after weaning from the ventilation, due to pulmonary fibrosis. Pulmonary toxicity is a well-known adverse reaction to amiodarone, but it rarely requires mechanical ventilation. The Netherlands Centre for Monitoring of Adverse Reactions to Drugs received II reports of this life-threatening reaction since 1976.

Aged↗
PubMed1995

Disseminated aspergillosis after near-drowning.

We report a case of invasive pulmonary aspergillosis after near-drowning complicated by systemic disseminated disease to the heart, kidneys, left adrenal gland and brain. Detection of fungal micro-organisms in the sputum of near-drowning patients should be taken seriously.

Aspergillosis↗