Acta Clinica Belgica最新文献_第9页

Charcot spinal arthropathy in a diabetic patient. 糖尿病患者Charcot脊柱关节病1例。

IF 1.6 4区医学

Acta Clinica Belgica Pub Date : 2014-08-01 DOI: 10.1179/2295333714Y.0000000031

S van Eeckhoudt, M Minet, F Lecouvet, C Galant, X Banse, M Lambert, C Lefèbvre

引用次数: 11

A determination of the current causes of hyperkalaemia and whether they have changed over the past 25 years. 确定高钾血症的当前原因，以及它们在过去25年中是否发生了变化。

IF 1.6 4区医学

Acta Clinica Belgica Pub Date : 2014-08-01 Epub Date: 2014-06-18 DOI: 10.1179/0001551214Z.00000000077

X Muschart, C Boulouffe, J Jamart, G Nougon, V Gérard, L de Cannière, D Vanpee

{"title":"A determination of the current causes of hyperkalaemia and whether they have changed over the past 25 years.","authors":"X Muschart, C Boulouffe, J Jamart, G Nougon, V Gérard, L de Cannière, D Vanpee","doi":"10.1179/0001551214Z.00000000077","DOIUrl":"https://doi.org/10.1179/0001551214Z.00000000077","url":null,"abstract":"Objective: Hyperkalaemia is a potentially lethal electrolyte disorder. The objective of this study was to determine if the causes of hyperkalaemia-related visits to the emergency department (ED) have changed since 25 years.Methods: All patients presenting to the ED with hyperkalaemia between January 2009 and August 2011 were included in this retrospective, single-centre study. Patients were divided into one of these three categories: mild (5·2≤ K(+)<5·8 mEq/l), moderate (5·8≤K(+)<7·0 mEq/l) or severe hyperkalaemia (K(+)≥7·0 mEq/l). The causes of hyperkalaemia were divided into three groups: renal failure (RF), potassium-increasing drugs (PIDs) or others.Results: Overall, 139 patients with hyperkalaemia were included in the study (mean K(+) of 6·2 mEq/l): 35% with mild, 49% with moderate and 16% with severe hyperkalaemia. Eighty-three per cent of patients (n = 115) had RF with creatinine levels ≥1·25 mg/dl or estimated glomerular filtration rate (eGFR) levels ≤60 ml/min/1·73 m(2). Serum potassium levels were significantly related with creatinine and eGFR values (P<0·001). The severity of hyperkalaemia was significantly related with creatinine levels ≥1·25 mg/dl (P = 0·002) and eGFR values ≤60 ml/min/1·73 m(2) (P = 0·005). Seventy-five per cent of patients (n = 105) were taking PIDs. Potassium levels were significantly related with PIDs (P<0·001), in particularly spironolactone (P = 0·001) and angiotensin-converting enzyme inhibitors (P = 0·008). The category 'others' included 7% of patients (n = 10).Conclusions: RF (83%) and PIDs (75%) remain common causes of hyperkalaemia. Hyperkalaemia is significantly related with four variables: creatinine levels, spironolactone, ACEIs and beta-blocker intake. The causes of hyperkalaemia have not changed in recent years.","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 4","pages":"280-4"},"PeriodicalIF":1.6,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/0001551214Z.00000000077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32437131","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}

引用次数: 13

Hospital doctors behave differently, and only by respecting the fundamentals of professional organizations will managers be able to create common goals with professionals. 医院医生的行为不同，只有尊重专业组织的基本原则，管理者才能与专业人员建立共同的目标。

IF 1.6 4区医学

Acta Clinica Belgica Pub Date : 2014-08-01 Epub Date: 2014-05-20 DOI: 10.1179/0001551214Z.00000000068

H Van Dijck

{"title":"Hospital doctors behave differently, and only by respecting the fundamentals of professional organizations will managers be able to create common goals with professionals.","authors":"H Van Dijck","doi":"10.1179/0001551214Z.00000000068","DOIUrl":"https://doi.org/10.1179/0001551214Z.00000000068","url":null,"abstract":"Hospital doctors behave differently from other hospital workers. The general and specific characteristics of the doctors' behavior are described. As professionals, doctors want to make autonomous decisions and more specifically, they negotiate differently. The best description of their negotiation style is one that features multi-actor, multi-issue characteristics. They behave as actors in a network in never-ending rounds of negotiations with variable issues up for discussion: one time you lose, the next you win. A doctor's career starts with a long residency period in which he or she absorbs professional habits. His or her knowledge and way of organizing are implicit. It is hard for him or her to explicitly describe what he or she is doing. This makes it difficult for managers to discuss quality issues with doctors. Dealing with disruptive behavior is not easy either. The difficult tasks of the chief medical officer, who acts as a go-between, are highlighted. Only when managers respect the fundamentals of the professional organization will they be able to create common goals with the professionals. Common goals bring about better care in hospitals. ","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 4","pages":"309-11"},"PeriodicalIF":1.6,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/0001551214Z.00000000068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32355109","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}

引用次数: 1

Frailty indexes, screening instruments and their application in Belgian primary care. 衰弱指标、筛查仪器及其在比利时初级保健中的应用。

IF 1.6 4区医学

Acta Clinica Belgica Pub Date : 2014-08-01 Epub Date: 2014-04-29 DOI: 10.1179/2295333714Y.0000000027

E Sieliwonczyk, S Perkisas, M Vandewoude

{"title":"Frailty indexes, screening instruments and their application in Belgian primary care.","authors":"E Sieliwonczyk, S Perkisas, M Vandewoude","doi":"10.1179/2295333714Y.0000000027","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000027","url":null,"abstract":"Objectives: The complex and expensive medical care for a rising number of older patients presents a significant challenge to the health care system. Identifying cost-effective preventive interventions and systematically applying them in the elderly population could help address this challenge. Frailty assessments could prove to be valuable tools by identifying at-risk individuals to which these interventions would be offered. This review seeks to provide the reader with an overview of frailty and explain how frailty assessments could contribute to daily practice.Methods: PubMed was searched for articles concerning frailty assessment (July 2013). Articles discussing prominent frailty models and articles primarily focused on comparing frailty assessments in the home-dwelling population were used for this article. Domus Medica was searched for guidelines concerning the use of frailty in Belgian primary care.Results: Several notable models of frailty are summarized and discussed to provide the reader with an overview of available frailty assessments. Frailty screening modalities in primary care are discussed, as well as the current recommendations for the use of frailty assessments in Belgian primary care. The advantages of a systematic frailty assessment in primary care and other settings are highlighted.Conclusion: This article recommends the assessment of frailty status as a screening tool for the evaluation of the older person in primary care. An overview of available frailty models is offered for this purpose. A consensus should be reached on which model is most appropriate. The screening for frailty promotes early intervention and timely involvement of specialists with the purpose of avoiding unfavourable outcomes, such as death or disability.","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 4","pages":"233-9"},"PeriodicalIF":1.6,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32297776","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}

引用次数: 12

D-dimer and D-dimer/fibrinogen ratio in predicting pulmonary embolism in patients evaluated in a hospital emergency department. d -二聚体和d -二聚体/纤维蛋白原比值预测医院急诊科评估患者肺栓塞

IF 1.6 4区医学

Acta Clinica Belgica Pub Date : 2014-08-01 DOI: 10.1179/2295333714Y.0000000029

H Kara, A Bayir, S Degirmenci, S A Kayis, M Akinci, A Ak, B Celik, A Dogru, B Ozturk

{"title":"D-dimer and D-dimer/fibrinogen ratio in predicting pulmonary embolism in patients evaluated in a hospital emergency department.","authors":"H Kara, A Bayir, S Degirmenci, S A Kayis, M Akinci, A Ak, B Celik, A Dogru, B Ozturk","doi":"10.1179/2295333714Y.0000000029","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000029","url":null,"abstract":"Objectives: The D-dimer level, fibrinogen level, and D-dimer/fibrinogen ratio are used in the diagnosis of pulmonary embolism, but results vary. We evaluated these parameters in the diagnosis of pulmonary embolism in emergency clinic patients.Methods: In this prospective study, 200 patients (pulmonary embolism, 100 patients; no pulmonary embolism, 100 patients) had D-dimer and fibrinogen levels measured before intervention. Pulmonary embolism was diagnosed with computed tomography angiography or ventilation-perfusion scintigraphy.Results: Compared with patients who did not have pulmonary embolism, patients who had pulmonary embolism had significantly greater mean D-dimer level (pulmonary embolism, 6±7 μg/ml; no pulmonary embolism, 1±1 μg/ml; P⩽0·001) and D-dimer/fibrinogen ratio (pulmonary embolism, 3±3; no pulmonary embolism, 0·4±0·4; P⩽0·001), but similar mean fibrinogen levels (pulmonary embolism, 337±184 mg/dl; no pulmonary embolism, 384±200 mg/dl; not significant). In patients who had pulmonary embolism, mean D-dimer level and D-dimer/fibrinogen ratio were greater in high-risk than non-high-risk patients. With D-dimer cutoff 0·35 μg/ml, sensitivity was high (100%) and specificity was low (27%) for pulmonary embolism. With D-dimer/fibrinogen ratio cutoff 0·13, sensitivity was high (100%) and specificity was low (37%) for pulmonary embolism.Conclusion: A D-dimer level <0·35 μg/ml may exclude the diagnosis of pulmonary embolism. At a D-dimer cutoff 0·5 μg/ml and D-dimer/fibrinogen ratio cutoff 1·0, the D-dimer/fibrinogen ratio may have better specificity than D-dimer level in the diagnosis of pulmonary embolism, but the D-dimer/fibrinogen ratio may lack sufficient specificity in screening.","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 4","pages":"240-5"},"PeriodicalIF":1.6,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32496094","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}

引用次数: 19

Epstein-Barr virus serology and PCR: conflicting results in an immunocompetent host. A case report and review of literature. 爱泼斯坦-巴尔病毒血清学和PCR:在免疫功能强的宿主中相互矛盾的结果。病例报告及文献复习。

IF 1.6 4区医学

Acta Clinica Belgica Pub Date : 2014-08-01 Epub Date: 2014-06-10 DOI: 10.1179/2295333714Y.0000000037

L Cattoir, V Van Hende, P De Paepe, E Padalko

{"title":"Epstein-Barr virus serology and PCR: conflicting results in an immunocompetent host. A case report and review of literature.","authors":"L Cattoir, V Van Hende, P De Paepe, E Padalko","doi":"10.1179/2295333714Y.0000000037","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000037","url":null,"abstract":"We present the case of a 27-year-old immunocompetent man who progressively developed a generalized lymphadenopathy and B symptoms. Results of Epstein-Barr virus (EBV) serology were suggestive for a past infection, but the EBV viral load in whole blood was high. Also, core needle biopsy of the largest lymph node showed an image which could fit an EBV-driven reactive lymphoproliferation. Despite the absence of an immune disorder, all medical evidence points to an EBV-driven lymphoproliferative proces. In immunocompetent patients, it seems extremely uncommon to detect a high EBV viral load in the absence of serological evidence of an acute EBV infection or reactivation. We reviewed literature on this topic and on the selection of the appropriate sample type for EBV PCR, as this is known to be a critical point. Serological testing for the diagnosis of EBV infection is the gold standard in immunocompetent patients. Measuring EBV viral load is only recommended when dealing with immunocompromised patients. Although extremely rare, this case report shows that there is a place for EBV PCR in certain situations in immunocompetent patients. Besides, there is still no consensus regarding the specimen of choice for the determination of the EBV viral load. The preferred specimen type seems to depend on the patient's underlying condition. ","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 4","pages":"262-6"},"PeriodicalIF":1.6,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32411838","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}

引用次数: 3

Pulmonary embolism with Hampton's hump. 肺栓塞伴汉普顿驼峰。

IF 1.6 4区医学

Acta Clinica Belgica Pub Date : 2014-08-01 DOI: 10.1179/2295333714Y.0000000009

C H Lee, W P Chan

引用次数: 2

A case of transient lymphangiectasis of the penis. 阴茎暂时性淋巴管扩张1例。

IF 1.6 4区医学

Acta Clinica Belgica Pub Date : 2014-08-01 Epub Date: 2014-05-20 DOI: 10.1179/2295333714Y.0000000028

A Misson, A C Deswysen, D Tennstedt, X Muschart

引用次数: 1

An unexpected complication of bacillus Calmette-Guérin therapy. 卡介苗-谷氨酰胺治疗的意外并发症。

IF 1.6 4区医学

Acta Clinica Belgica Pub Date : 2014-08-01 Epub Date: 2014-05-20 DOI: 10.1179/2295333714Y.0000000032

H Yildiz, G Colin, M Lambert

{"title":"An unexpected complication of bacillus Calmette-Guérin therapy.","authors":"H Yildiz, G Colin, M Lambert","doi":"10.1179/2295333714Y.0000000032","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000032","url":null,"abstract":"A 78-year-old man presented with a history of fever and night sweats of 1-month duration. His relevant medical history was a transitional-cell bladder cancer treated with intravesical instillation of bacillus Calmette–Guérin (BCG) 5 months previously. Abdominal palpation revealed a pulsatile mass in the left lower quadrant. Laboratory tests only showed an elevated C-reactive protein at 5.7 mg/dl. Contrast-enhanced CT scan of the abdomen demonstrated a saccular aneurysm of the infra-renal aorta (Fig. 1) suggestive of mycotic aneurysm. An aneurysmal resection was then performed. Aerobic and anaerobic culture of the aortic tissue remained negative but a Ziehl–Nielsen stain was positive consistent with a mycobacterial infection. Acid-fast culture and PCR were positive for Mycobacterium bovis. The diagnosis of mycotic aneurysma following intravesical BCG therapy was then retained. Vascular complications after intravesical instillation of BCG, a live attenuated strain of Mycobacterium bovis, are extremely rare. Haematogenous or lymphatic spread is the most common hypothesis proposed to explain an arterial infection by M. bovis. Both medical and surgical approach are requested in the management of BCGinduced mycotic aneurysm. A combination with at least three antituberculous agents for 9–12 months is recommended. Pyrazinamide should not be used due to widespread resistance of M. bovis.","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":"69 4","pages":"312"},"PeriodicalIF":1.6,"publicationDate":"2014-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32355113","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}

引用次数: 5

Bluish vomiting: a rare clinical presentation of poisoning. 蓝色呕吐:中毒的罕见临床表现。

IF 1.6 4区医学

Acta Clinica Belgica Pub Date : 2014-08-01 Epub Date: 2014-05-20 DOI: 10.1179/2295333714Y.0000000033

J Higny, D Vanpee, C Boulouffe

引用次数: 8