14 research outputs found
Spontaneous bacterial peritonitis : pathogenesis, diagnosis and management
Conclusie:
Gedurende de periods 1987 -1992 werden 60 episoden van spontane bacteria Ie peritonitis
geregistreerd bij 52 patienten. S8P bleak aen ernstige complicatie t6 zijn bij patienten met
levercirrose en ascites met aen hoge mortaliteit en een lage 1 jaars overleving van 23%
(Betrouwbaarheids interval 17%-35%). Dria van de 12 patienten die meer dan 1 jaar
overleefden ontvingen een levertransplantatie. Toegenomen alertheid en bekendheid met
het ziektebeeld van S8P, en aen lagere drempel om paracentese te verrichten met hierdoor
vraagere behandelingsmogelijkheden hebben mogelijk geresulteerd in aen iets betera
overleving dan gemeld in hoofdstuk 7. Verbeterde kweek tBchnieken en aen precieze
leucocyten telling met differentiatie in de ascites dragsn bij tot een juiste diagnose stelling.
Uit de literatuur zijn gegevens bekend dat het gebruik van selectieve darm decontaminatie,
met als doel de gram negatieve flora te verminderen met het relatief sparen van de
resterende anaerobe flora, bij patienten met een hoog risico op het krijgen van SSP, de
incidentie van SSP doet afnemen.
Echter, een episode van SSP dient geinterpreteerd te worden als een symptoom van ernstig
levertalen en bij patienten die een dergelijke infectieuze complicatie ontwikkelen moet het
verrichten van een levertransplantatie ernstig overwogen worden. Als zodanig is een
doorgemaakte episode van SSP een van de vele factoren die meegenomen moeten worden
in de vaak moeilijke besluitvorming over de noodzaak tot, en het tijdstip van een
levertransplantatie.This thesis describes several aspects of spontaneous bacterial peritonitis in patients with
cirrhosis of the liver and ascites. Most of the data discussed and submitted in this thesis
are based on clinical studies during the years 1987-1992 at the Department of Internal
Medicine II, University Hospital Rotterdam-Dijkzig
Peritonitis following endoscopic polypectomy in a peritoneal dialysis patient: The need for antibiotic prophylaxis
Life-threatening hypokalaemia and quadriparesis in a patient with ureterosigmoidostomy
We report quadriparesis as a result of severe hypokalaemia and acidosis in
a 50-year-old man who had undergone ureterosigmoidostomy for bladder
extrophy 48 years earlier. Aggressive suppletion with intravenous
potassium and bicarbonate combined with potassium-sparing diuretics and
ACE inhibitors resulted in complete restoration of the serum potassium and
resolution of the neurological symptoms. The underlying mechanism as well
as the treatment of hypokalaemia and hyperchloraemic metabolic acidosis
after ureterosigmoidostomy are briefly discussed
Levels of soluble intercellular adhesion molecule 1, eicosanoids and cytokines in ascites of patients with liver cirrhosis, peritoneal cancer and spontaneous bacterial peritonitis
The levels of the eicosanoids leukotriene B4, prostaglandin E2, prostacycline and thromboxane B2, the cytokines interleukin-1β, interleukin-6 and tumour necrosis factor-α and soluble intercellular adhesion molecule 1 were measured in ascites and plasma samples of patients with liver cirrhosis (53), peritoneal cancer (26) and spontaneous bacterial peritonitis (10) to assess their value as a possible diagnostic and prognostic parameter in the course of the disease. Soluble intercellular adhesion molecule 1, of the eicosanoids prostaglandin E2 and leukotriene B4, and the protein concentration in ascites were all significantly elevated in ascites of patients with peritoneal cancer in comparison to ascites of patients with liver cirrhosis. In ascites of patients with spontaneous bacterial infection interleukin-6 concentration was significantly elevated and the protein concentration was significantly lower in comparison to the other two groups. None of these parameters, however, seems to be of practical use as a diagnostic parameter, as there is an overlap between all the levels of these mediators in ascites of liver cirrhosis, peritoneal cancer and spontaneous bacterial peritonitis group. Soluble intercellular adhesion molecule 1 levels were much higher in plasma than in ascites, in contrast to interleukin-6 levels which were much higher in ascites than in plasma. Soluble intercellular adhesion molecule 1 in ascites correlated with soluble intercellular adhesion molecule 1 in plasma (r = 0.6926, P = 0.0001). Soluble intercellular adhesion molecule 1, interleukin-6 and the number of polymorphonuclear cells in peritoneal fluid correlated during episodes of infection in patients with a peritonitis. For this reason soluble intercellular adhesion molecule 1 and interleukin-6 could be of prognostic value for patients with peritonitis
Spontaneous coronary artery dissection during pregnancy and post partum.
Contains fulltext :
86681.pdf (publisher's version ) (Open Access)This report describes a 35-year-old 40 week pregnant woman who was hospitalized with a diagnosis of acute anteroseptal myocardial infarction. She sustained another, infero-posterior, infarction 4 days later. Coronary arteriography performed after successful Cesearean section displayed primary dissections of the right as well as both left coronary arteries. Her subsequent clinical course was uneventful with medical therapy. This patient is the first non-surgically treated survivor of peripartal spontaneous coronary artery dissection with a myocardial infarction prior to delivery.1 januari 199
Maintenance treatment with budesonide 6 mg versus 9 mg once daily in patients with Crohn's disease in remission.
Item does not contain fulltextBACKGROUND: In previous trials, budesonide 6 mg/day was able to prolong the time to relapse in patients with quiescent Crohn's disease and budesonide 9 mg/day was effective in active disease with limited side effects. The aim of this study was to compare the effectiveness of budesonide 9 mg vs 6 mg once daily on the maintenance of remission and occurrence of adverse events. METHODS: Double-blind, randomised trial in patients with Crohn's disease in remission. Patients were randomised to receive 6 mg/day or 9 mg/day of budesonide (Budenofalk) without concomitant treatment for Crohn's disease. Endpoints were the time to relapse and relapse rates after one year. RESULTS: Seventy-six patients were randomised to 6 mg/day and 81 patients to 9 mg/day. Survival analysis showed no differences in the time to relapse. One-year relapse rates were not significantly different (6 mg group 24%; 9 mg group 19%). Any adverse event was reported in 61 and 68% of patients in the 6 mg and 9 mg groups, respectively; none of the 12 serious adverse events were drug related. CONCLUSION: The one-year relapse rates were low and not significantly different between the group of patients treated with budesonide 6 mg vs 9 mg/day. Also, time to relapse and the number of adverse events were similar in both treatment groups
Impact of multidisciplinary tumor board discussion on palliation of patients with esophageal or gastro-esophageal junction cancer: a population-based study
Background: The Dutch guidelines for esophageal and gastro-esophageal junction (GEJ) cancer recommend discussion of patients by a multidisciplinary tumor board (MDT). Despite this recommendation, one previous study in the Netherlands suggested that therapeutic guidance was missing for palliative care of patients with esophageal cancer. The aim of the current study was therefore to assess the impact of an MDT discussion on initial palliative treatment and outcome of patients with esophageal or GEJ cancer.Material and methods: The population-based Netherlands Cancer Registry was used to identify patients treated for esophageal or GEJ cancer with palliative intent between 2010 and 2017 in 7 hospitals. We compared patients discussed by the MDT with patients not discussed by the MDT in a multivariate analysis. Primary outcome was type of initial palliative treatment. Secondary outcome was overall survival.Results: A total of 389/948 (41%) patients with esophageal or GEJ cancer were discussed by the MDT before initial palliative treatment. MDT discussion compared to non-MDT discussion was associated with more patients treated with palliative intent external beam radiotherapy (38% vs. 21%, OR 2.7 [95% CI 1.8-3.9]) and systemic therapy (30% vs. 23%, OR 1.6 [95% CI 1.0-2.5]), and fewer patients treated with stent placement (4% vs. 12%, OR 0.3 [95% CI 0.1-0.6]) and best supportive care alone (12% vs. 33%, OR 0.2 [95% CI 0.1-0.3]). MDT discussion was also associated with improved survival (169 days vs. 107 days, HR 1.3 [95% CI 1.1-1.6]).Conclusion: Our study shows that MDT discussion of patients with esophageal or GEJ cancer resulted in more patients treated with initial palliative radiotherapy and chemotherapy compared with patients not discussed by the MDT. Moreover, MDT discussion may have a positive effect on survival, highlighting the importance of MDT meetings at all stages of treatment
Proton pump inhibitor therapy in gastro-oesophageal reflux disease decreases the oesophageal immune response but does not reduce the formation of DNA adducts
BACKGROUND: Chronic oesophageal inflammation and related oxidative stress are important in the pathogenesis of erosive oesophagitis (EO) and its malignant progression. AIM: To study the effect of proton pump inhibitors (PPIs) on oesophageal cellular immune response and oxidative damage in EO patients. METHODS: Forty gastro-oesophageal reflux disease (GERD) patients [non-erosive reflux disease (NERD): 15, EO: 25] were included, after 7 days off antisuppressive drugs. EO patients were randomized to 20-mg rabeprazole once daily for either 4 or 8 weeks with baseline and follow-up endoscopy with distal oesophageal biopsies. T lymphocytes, macrophages and mast cells were quantified by immunohistochemistry. DNA adducts were measured by analysis of 8-oxo-deoxyguanosine levels. RESULTS: Erosive oesophagitis patients had more T lymphocytes and CD8(+) T lymphocytes in squamous epithelium than NERD patients (P = 0.001, P = 0.002, respectively). Levels of DNA adducts between both groups were, however, not different (P = 0.99). Four- and eight-week rabeprazole treatment in EO patients resulted in a significant decrease in number of T lymphocytes and CD8(+) T lymphocytes (all P < 0.05). PPIs did not, however, affect levels of DNA adducts. CONCLUSIONS: Short-term PPI therapy in EO patients reduces the oesophageal cellular immune response, but does not change oxidative damage. PPI therapy may therefore not be effective in reducing the risk of oesophageal cancer in GERD patients