Acta Clinica Belgica最新文献

{"title":"Prolonged ileus with pneumatosis cystoides intestinalis.","authors":"C-T Chao","doi":"10.1179/2295333714Y.0000000021","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000021","url":null,"abstract":"A 40-year-old woman with rectal cancer visited our emergency department for abdominal pain and vomiting. She had received operation and chemoradiotherapy 6 months ago with subsequent lymph node recurrence and obstructive uropathy. Ureteral stenting and pecutaneous nephrostomy were performed for relief then. Her abdominal symptoms were attributed to ileus, and consulting surgeon recommended against re-operation owing to poor performance status. Her ileus fluctuated in severity, with recurrent bacteremia. An abdominal film 3 weeks later revealed radiolucent areas surrounding the entire bowel contour (Fig. 1). Abdominal computed tomography demonstrated prominent pneumatosis cystoides intestinalis involving colon and small bowel (Fig. 1). Hypotension and profound metabolic acidosis ensued with consciousness loss, and a family decision was made not to resuscitate her. She passed away 1 day later. Pneumatosis cystoides intestinalis presents as air collection in bowel wall layers, and can be innocent as in idiopathic or post-endoscopic cases. Other causes could be life-threatening. The main aetiologies include mesenteric vascular diseases with bowel ischaemia, followed by inflammatory bowel diseases and intestinal obstruction/infection. Small intestine and right side colon are the most common sites involved. Our patient presumably suffered from Correspondence to: C.-T. Chao, Department of Internal Medicine, National Taiwan University Hospital Jin-Shan Branch, No. 51, Nan-Shih, Jin-Shan District, New Taipei City, Taiwan. Email: b88401084@gmail.com Figure 1 (Left) Abominal plain film disclosed clear contour of the, while colonic segments from right (curved arrow), transverse to left colon (straight arrow) as contrasted from radiolucent bowel wall gas. Small bowel wall pneumatosis was also identified. (Right) Computed tomography demonstrated the extensive bowel gas over small bowel and colon.","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 3","pages":"224-5"},"PeriodicalIF":1.6,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32228671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of infective endocarditis in a large Belgian non-referral hospital.","authors":"K Poesen,&nbsp;H Pottel,&nbsp;J Colaert,&nbsp;C De Niel","doi":"10.1179/0001551214Z.00000000046","DOIUrl":"https://doi.org/10.1179/0001551214Z.00000000046","url":null,"abstract":"<p><strong>Objectives: </strong>Guidelines for diagnosis of infective endocarditis are largely based upon epidemiological studies in referral hospitals. Referral bias, however, might impair the validity of guidelines in non-referral hospitals. Recent studies in non-referral care centres on infective endocarditis are sparse. We conducted a retrospective epidemiological study on infective endocarditis in a large non-referral hospital in a Belgian city (Kortrijk).</p><p><strong>Methods: </strong>The medical record system was searched for all cases tagged with a putative diagnosis of infective endocarditis in the period 2003-2010. The cases that fulfilled the modified Duke criteria for probable or definite infective endocarditis were included.</p><p><strong>Results: </strong>Compared to referral centres, an older population with infective endocarditis, and fewer predisposing cardiac factors and catheter-related infective endocarditis is seen in our population. Our patients have fewer prosthetic valve endocarditis as well as fewer staphylococcal endocarditis. Our patients undergo less surgery, although mortality rate seems to be highly comparable with referral centres, with nosocomial infective endocarditis as an independent predictor of mortality.</p><p><strong>Conclusion: </strong>The present study suggests that characteristics of infective endocarditis as well as associative factors might differ among non-referral hospitals and referral hospitals.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 3","pages":"183-90"},"PeriodicalIF":1.6,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/0001551214Z.00000000046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32288433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pyroglutamic acid-induced metabolic acidosis: a case report.","authors":"S Luyasu,&nbsp;M M C Wamelink,&nbsp;L Galanti,&nbsp;A Dive","doi":"10.1179/2295333714Y.0000000022","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000022","url":null,"abstract":"<p><p>High anion gap metabolic acidosis due to pyroglutamic acid (5-oxoproline) is a rare complication of acetaminophen treatment (which depletes glutathione stores) and is often associated with clinically moderate to severe encephalopathy. Acquired 5-oxoprolinase deficiency (penicillins) or the presence of other risk factors of glutathione depletion such as malnutrition or sepsis seems to be necessary for symptoms development. We report the case of a 55-year-old women who developed a symptomatic overproduction of 5-oxoproline during flucloxacillin treatment for severe sepsis while receiving acetaminophen for fever control. Hemodialysis accelerated the clearance of the accumulated organic acid, and was followed by a sustained clinical improvement. </p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 3","pages":"221-3"},"PeriodicalIF":1.6,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32228670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and tolerability of second-line therapy with vildagliptin versus other oral agents in type 2 diabetes (EDGE): post-hoc subanalysis of the Belgian data.","authors":"J Hoste,&nbsp;E Daci,&nbsp;C Mathieu","doi":"10.1179/2295333714Y.0000000018","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000018","url":null,"abstract":"<p><strong>Aim: </strong>To assess the efficacy and safety of vildagliptin versus other oral glucose-lowering drugs added to antidiabetic monotherapy in Belgian patients with type 2 diabetes mellitus, in comparison to the global EDGE study results.</p><p><strong>Methods: </strong>This is a pre-specified post-hoc subanalysis of the Belgian patient cohort from a worldwide 1-year observational study that compared the effectiveness and tolerability of vildagliptin to other oral antidiabetic agents in type 2 diabetes patients failing monotherapy with oral glucose-lowering agents (EDGE). A total of 1793 Belgian patients were enrolled. Physicians could add any oral antidiabetic drug and patients entered either into the vildagliptin or the comparator cohort. The primary effectiveness and tolerability endpoint was defined as the proportion of patients having a treatment response (HbA1c reduction from baseline to month 12 endpoint >0·3%) without hypoglycemia, weight gain, peripheral oedema, or gastrointestinal side-effects.</p><p><strong>Results: </strong>In the Belgian population, 37·8% of patients in the vildagliptin group and 32·8% in the comparator group had a decrease in HbA1c of >0·3% without the predefined tolerability issues of hypoglycemia, weight gain, oedema or, gastrointestinal complaints (primary endpoint), resulting in an unadjusted odds ratio of 1·24 (95% CI: 0·96-1·61). Mean HbA1c change from baseline was -0·81% in the vildagliptin cohort and -0·75% in the comparator cohort. Overall, vildagliptin was well tolerated with similarly low incidences of total adverse events (14·9% versus 14·5% in the compactor group) and serious adverse events (2·7% versus 2·5% in the comparator group).</p><p><strong>Conclusion: </strong>In this EDGE subgroup of Belgian patients with type 2 diabetes who do not achieve the glycemic targets with monotherapy, a similar trend as in the global EDGE study was observed. Adding vildagliptin as a second oral glucose-lowering agent resulted in lowering HbA1c to <7% without weight gain, hypoglycemia or peripheral oedema in a higher proportion of patients than comparator oral antidiabetic drugs, with no differences in the reported number of adverse events.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 3","pages":"171-6"},"PeriodicalIF":1.6,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32337367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the Flemish version of the Quality of Life in Short Stature Youth (QoLISSY) questionnaire.","authors":"A C Rohenkohl,&nbsp;J De Schepper,&nbsp;J Vanderfaeillie,&nbsp;K Fricke,&nbsp;S Hendrickx,&nbsp;K Lagrou,&nbsp;M Bullinger,&nbsp;J Quitmann","doi":"10.1179/2295333714Y.0000000024","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000024","url":null,"abstract":"<p><strong>Objectives: </strong>The Quality of Life in Short Stature Youth (QoLISSY) questionnaire was recently developed in five European countries to assess health-related quality of life in children and adolescents with idiopathic short stature or growth hormone deficiency from child and parent perspectives. In addition to the existing French version, a Flemish version is needed for use of QoLISSY in the Flemish speaking part of Belgium.</p><p><strong>Methods: </strong>Children (8-18 years) and their parents recruited from two Belgian paediatric endocrinology clinics completed the QoLISSY in a cross-sectional study. Cronbach's Alpha and test-retest reliability was assessed. Validity was examined by correlation with the generic KIDSCREEN questionnaire as well as by group comparisons according to diagnostic and treatment status.</p><p><strong>Results: </strong>The QoLISSY scales had an acceptable internal consistency with Cronbach's Alpha ranging from 0·80 to 0·94 (child version) and from 0·77 to 0·92 (parent version). Test-retest reliability correlation coefficients ranged from r = 0·75 to 0·89 in the child version and from r = 0·58 to 0·85 in the parent version. Moderate correlations with the generic KIDSCREEN questionnaire suggested construct validity. Differences between child groups according to child age, underlying diagnosis, and degree of height deficit were found. Correlations with the European QoLISSY were significant for all scales.</p><p><strong>Discussion: </strong>The Flemish QoLISSY instrument is a psychometrically sound, reliable, and valid short stature specific questionnaire measuring health-related quality of life. It is expected to be of great use in upcoming clinical research on growth disorders and growth hormone treatment in Belgium and Europe.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 3","pages":"177-82"},"PeriodicalIF":1.6,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32229762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Friable coronary arteries are link between pathogenesis and treatment of spontaneous coronary artery dissection.","authors":"M Vanhaverbeke,&nbsp;T Sarens,&nbsp;L Van Driessche","doi":"10.1179/2295333714Y.0000000020","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000020","url":null,"abstract":"Abstract Spontaneous coronary artery dissection (SCAD) is increasingly being diagnosed as the cause of an acute coronary syndrome, especially in young patients. We report the case of a 32-year-old woman with postpartum SCAD of the left main and left anterior descending coronary artery which required the implantation of two drug-eluting stents. We present a literature study that correlates the pathogenesis of SCAD to the treatment options. Non-atherosclerotic SCAD is clearly associated with connective tissue disorders, vasculitis, and the peripartum period with its hormonal and haemodynamic changes. The coronary arteries of these SCAD patients are friable and should be approached with caution. Percutaneous coronary intervention has a reported success rate of only 65% and may cause propagation of the dissection. Lately, more and more authors suggest the possibility of a conservative approach in the absence of remaining cardiac ischaemia, even in this era of percutaneous stent implantation.","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 3","pages":"217-20"},"PeriodicalIF":1.6,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32245399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reversible splenial lesion in auto-immune thyroid disease: a case report.","authors":"J De Greef,&nbsp;C Jaumotte,&nbsp;B Quivron,&nbsp;G Derue","doi":"10.1179/2295333713Y.0000000002","DOIUrl":"https://doi.org/10.1179/2295333713Y.0000000002","url":null,"abstract":"<p><p>Reversible lesions of the splenium of the corpus callosum constitute a clinicoradiological syndrome that has been associated to various medical conditions. We report the case of a 47-year-old man who presented with encephalopathy associated to auto-immune thyroid disease in which a reversible splenial lesion was isolated. Although encephalopathy associated to auto-immune thyroid disease is characterized by variable radiological findings, it has only been once associated with a reversible splenial lesion. </p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 3","pages":"208-9"},"PeriodicalIF":1.6,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333713Y.0000000002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32335163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gas-forming liver abscess in a patient with multi-organ failure: role of imaging and management.","authors":"M B Kachare,&nbsp;N S Desai,&nbsp;V K Patki,&nbsp;V K Patki,&nbsp;J A Ricci,&nbsp;Y-H Juan,&nbsp;S S Saboo","doi":"10.1179/2295333714Y.0000000025","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000025","url":null,"abstract":"<p><p>We present an unusual case of air-containing liver abscess demonstrated on plain film and ultrasonography with successful treatment utilizing ultrasound-guided drainage in a patient in septic shock. Although surgical drainage is often indicated, ultrasound-guided catheter drainage along with supportive antibiotic therapy can be a safe treatment alternative in critical patients. </p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 3","pages":"226-8"},"PeriodicalIF":1.6,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32428477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importance of preoperative anaesthetic consultation in perioperative medicine.","authors":"M Raes,&nbsp;J Poelaert","doi":"10.1179/0001551214Z.00000000058","DOIUrl":"https://doi.org/10.1179/0001551214Z.00000000058","url":null,"abstract":"<p><p>This report describes two patients for whom the preoperative, anaesthetic consultation led to postponing planned surgery because of important, undiagnosed health problems. In one of the two cases, this consultation was even life-saving. However, actual literature cannot prove any advantage on the outcome of the individual patient. The only proven advantages in favour of pre-operative consultation are a reduced length of stay in the hospital and a reduction in the cost of preoperative testing. </p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 3","pages":"200-3"},"PeriodicalIF":1.6,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/0001551214Z.00000000058","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32288434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost of 1-year left ventricular assist device destination therapy in chronic heart failure: a comparison with heart transplantation.","authors":"W Droogne,&nbsp;S Jacobs,&nbsp;K Van den Bossche,&nbsp;J Verhoeven,&nbsp;R R Bostic,&nbsp;J Vanhaecke,&nbsp;J Van Cleemput,&nbsp;F Rega,&nbsp;B Meyns","doi":"10.1179/2295333714Y.0000000017","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000017","url":null,"abstract":"<p><strong>Objective: </strong>To analyse overall cost involved with destination therapy (DT) in comparison to transplantation (HTX) and bridging to transplantation.</p><p><strong>Methods: </strong>Three groups of patients at one hospital were considered for this cost analysis: (1) patients included in the BENEMACS study starting May 2009 (n = 6); (2) all patients from May 2009 till May 2010 undergoing heart transplantation (n = 19); or (iii) undergoing Heartmate II implantation as a bridge to transplant (n = 13). Patients undergoing bridging were more sick (lower Intermacs class). DT patients were older (64±8 years). Cost was derived from actual hospital invoices, device, organ procurement and medical cost, and follow-up care during 1 year from implantation. Costs are presented in euro, by their mean values and standard deviation.</p><p><strong>Results: </strong>One-year survivals were 83, 84, and 77%, respectively, for DT, HTX, and bridging. Costs for initial and re-hospitalizations were not different between groups. Costs for medical follow-up and medication were significantly higher for transplanted patients. The 1-year total cost was €85 531±19 823 for HTX, €125 108±32 399 for bridging, and €137 068±29 007 for DT. As 42% of the transplanted patients were bridged, the cost of the medical pathway HTX was €138 076±19 823. Assuming a 5-year survival and a similar yearly follow-up cost, the average cost per year is €42 153 for HTX, €53 637 for transplantation including the bridging cost, and €47 487 for DT.</p><p><strong>Conclusion: </strong>Direct transplantation without bridging is the most cost-efficient treatment. The cost per patient per year for DT is similar to HTX considering its bridging activity.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 3","pages":"165-70"},"PeriodicalIF":1.6,"publicationDate":"2014-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32337366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}