Verhandelingen - Koninklijke Academie voor Geneeskunde van Belgie最新文献_第2页

Verhandelingen - Koninklijke Academie voor Geneeskunde van Belgie Pub Date : 2011-01-01

M-C Herregods

{"title":"Infective endocarditis.","authors":"M-C Herregods","doi":"","DOIUrl":"","url":null,"abstract":"Despite the progress in medicine, infectious endocarditis is often diagnosed late, as its symptomatology is subject to a high variability. The clinical features are usually atypical. Since the introduction of the Duke criteria, clinical, bacteriological and echocardiographical findings are being integrated, allowing an earlier definitive diagnosis. The incidence remains practically stable. The decrease in post-rheumatic valvular heart disease at population level is compensated by an increase in degenerative valvular heart disease as predisposing factor. Moreover, the share of patients with intravascular foreign material is increasing. Endocarditis is usually characterized by a complicated development. About half of the patients develop heart failure as a consequence of the destruction of the affected valve with serious valvular insufficiency. One third of the patients present cerebral or peripheral embolization. Embolization predominantly occurs at the beginning, until the first two weeks of antibiotic treatment. Abscess formation occurs more frequently than is suspected based on echographical examinations. Particularly a Staphylococcus aureus infection in the presence of an artificial valve leads to extravalvular extension with abscess formation around the artificial valve. Treatment should be initiated promptly. High doses of antibiotics, tailored to the microorganism and the valve type (native or artificial valve), are administered intravenously during four, or more frequently, six weeks. In more than half of the patients cardiac surgery is also required. As soon as an indication for cardiac surgery is present, the operation should not be postponed. Experience learns that a smaller risk is associated with an early intervention. The operation is performed in a technically easier way. Eventually, also the total duration of hospitalization is shorter. Despite the available antibiotics and the technical progress in cardiac surgery, mortality remains high. This is the consequence of an increasing share of aggressive hospital germs, on the one hand, and an older population, characterized by a higher comorbidity, on the other hand.","PeriodicalId":76790,"journal":{"name":"Verhandelingen - Koninklijke Academie voor Geneeskunde van Belgie","volume":"73 3-4","pages":"153-61"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30557159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Worry about talent in first line health care]. [担心一线医疗人才短缺]。

Verhandelingen - Koninklijke Academie voor Geneeskunde van Belgie Pub Date : 2011-01-01

B Himpens

引用次数: 0

The influence of air pollution on health: mechanistic implications. 空气污染对健康的影响:机制影响。

Verhandelingen - Koninklijke Academie voor Geneeskunde van Belgie Pub Date : 2011-01-01

J Emmerechts, M F Hoylaerts

引用次数: 0

Malaria: host-pathogen interactions, immunopathological complications and therapy. 疟疾:宿主-病原体相互作用，免疫病理并发症和治疗。

Verhandelingen - Koninklijke Academie voor Geneeskunde van Belgie Pub Date : 2011-01-01

P E Van Den Steen, K Deroost, N Geurts, H Heremans, J Van Damme, G Opdenakker

引用次数: 0

Monochorionic diamniotic twin pregnancies pregnancy outcome, risk stratification and lessons learnt from placental examination. 单绒毛膜双羊膜双胎妊娠结局、风险分层及胎盘检查的经验教训。

Verhandelingen - Koninklijke Academie voor Geneeskunde van Belgie Pub Date : 2010-01-01

L Lewi

{"title":"Monochorionic diamniotic twin pregnancies pregnancy outcome, risk stratification and lessons learnt from placental examination.","authors":"L Lewi","doi":"","DOIUrl":"","url":null,"abstract":"Monochorionic diamniotic twin pregnancies have a more hazardous intrauterine stay than their dichorionic counterparts because of the vascular anastomoses that connect the two fetal circulations. The survival of monochorionic twins diagnosed in the first trimester is 89%. Twin-to-twin transfusion syndrome (TTTS) occurs in 9% and is the most important cause of death. Risk assessment by ultrasound scan in the first and early second trimester identifies a subgroup of monochorionic twins with a more than 70% risk of a complicated outcome and a survival rate of only 69%. For complicated monochorionic twin pregnancies, umbilical cord coagulation for selective feticide has a survival rate of 83% with a normal development in 92%. Umbilical cord coagulation also results in a good outcome for the healthy co-twin of a heterokaryotypic monochorionic pair. Unequally shared placentas have a more elaborate blood exchange, which reduces the birthweight discordance. In these cases, the anastomoses fulfill a beneficial role by increasing the availability of oxygen and nutrients to the twin on the smaller placental share. Pairs with early onset discordant growth have a higher mortality and a more unequally shared placenta than pairs with late onset discordant growth. Unequal placental sharing therefore appears to be the cause of early onset discordant growth, whereas a late intertwin transfusion imbalance may be involved in some cases with late onset discordant growth. Finally, placental examination after laser treatment for TTTS demonstrated that successful coagulation of all visible anastomoses cures TTTS. However, anastomoses can be missed and lead to a complicated pregnancy outcome.","PeriodicalId":76790,"journal":{"name":"Verhandelingen - Koninklijke Academie voor Geneeskunde van Belgie","volume":"72 1-2","pages":"5-15"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29200474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Beta-cell transplantation in type 1 diabetic patients: a work in progress to cure. 1型糖尿病患者的β细胞移植:一项正在进行的治疗工作。

Verhandelingen - Koninklijke Academie voor Geneeskunde van Belgie Pub Date : 2010-01-01

P Gillard, B Keymeulen, C Mathieu

{"title":"Beta-cell transplantation in type 1 diabetic patients: a work in progress to cure.","authors":"P Gillard, B Keymeulen, C Mathieu","doi":"","DOIUrl":"","url":null,"abstract":"Type 1 diabetes is characterized by a selective destruction of the insulin producing beta-cells leading to frank hyperglycemia. Daily insulin injections are lifesaving but can often not avoid suboptimal glycemic control, an increased risk for hypoglycemia and the development of chronic diabetic complications. Therapies replacing the destroyed beta-cells aim to prevent or delay these detrimental complications while avoiding hypoglycemic episodes. The main objective of our multicenter study was to define conditions under which a beta-cell implant safely induces and maintains long-term metabolic control in type 1 diabetic recipients. We demonstrated that cultured beta-cell preparations, fully morphologically characterized by their cell number and cellular composition, and functionally correlated with beta-cell mass can be used to prepare grafts with reproducible clinical metabolic outcome. At least 2 million beta-cells per kg bodyweight were needed to achieve signs of functioning grafts, reduced glycemic variability and a reduced risk for hypoglycemic events. We demonstrated that the hyperglycemic clamp can be used to measure the in vivo functional beta-cell mass after transplantation. In insulin independent recipients of a beta-cell and pancreas-kidney graft, the functional beta-cell mass represents respectively 25 and 63% of that in healthy controls. We showed that ATG-sirolimus monotherapy resulted in a worse outcome of beta-cell transplantation compared to ATG-sirolimus-tacrolimus combination therapy. Moreover, use of sirolimus was accompanied with unacceptable side effects. In conclusion, we showed that characterizing the beta-cell graft in vitro, measuring the functional beta-cell mass in vivo and defining a save and efficient immunosuppressive regimen are important steps to a cure for diabetes.","PeriodicalId":76790,"journal":{"name":"Verhandelingen - Koninklijke Academie voor Geneeskunde van Belgie","volume":"72 1-2","pages":"71-98"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29200478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

[Single embryo transfer]. [单胚胎移植]。

Verhandelingen - Koninklijke Academie voor Geneeskunde van Belgie Pub Date : 2010-01-01

P De Sutter, I Delbaere, J Gerris, M Temmerman

引用次数: 0

Novel alternatives for anti-angiogenetic therapy and therapeutic angiogenesis. 抗血管生成治疗和治疗性血管生成的新方法。

Verhandelingen - Koninklijke Academie voor Geneeskunde van Belgie Pub Date : 2010-01-01

M Mazzone

引用次数: 0

Intimate partner violence. The gynaecologist's perspective. 亲密伴侣暴力。妇科医生的观点。

Verhandelingen - Koninklijke Academie voor Geneeskunde van Belgie Pub Date : 2010-01-01

K Roelens

{"title":"Intimate partner violence. The gynaecologist's perspective.","authors":"K Roelens","doi":"","DOIUrl":"","url":null,"abstract":"From a questionnaire-based surveillance study among pregnant women constituting a regional probability sample of East-Flanders, we estimated that IPV occurred overall with one in ten women (10.1%, 95% CI 7.7-13.0%) and with about one in 30 women (3.4%, 95% CI 2.1-5.4%) during pregnancy and/or in the year preceding pregnancy. We also revealed that women experiencing IPV rarely disclose abuse spontaneously to the widely available health care services and providers, but in general approve routine questioning by their GP or gynaecologist. The crux of IPV is that most victims will not present with overt signs of abuse, but rather with a wide variety of vague and non-specific symptoms, if any. Hence there seems to exist a window of opportunities to detect women suffering from IPV through screening in the health care sector. From a questionnaire based Knowledge-Practice and Attitude Survey among OB/GYN in Flanders, it appeared that OB/GYN feel uncomfortable with a routine screening policy. They underestimate the prevalence and perceive a lack of self-efficacy in dealing with the problem and properly referring patients, they lack time and perceive it as inappropriate to question patients about IPV. On the other hand they acknowledge that there is a need for training on violence. It therefore appears that most barriers should be remediable through proper OB/GYN training and education, together with enabling strategies such as screening tools and formal referral pathways. In concordance with the National Action Plan to combat IPV, health care workers, including gynaecologists, need to develop guidelines, in order to deal with this important public health problem.","PeriodicalId":76790,"journal":{"name":"Verhandelingen - Koninklijke Academie voor Geneeskunde van Belgie","volume":"72 1-2","pages":"17-40"},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29200475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Identification and characterization of novel oncogenes in chronic eosinophilic leukemia and T-cell acute lymphoblastic leukemia. 慢性嗜酸性粒细胞白血病和t细胞急性淋巴细胞白血病新癌基因的鉴定和表征。

Verhandelingen - Koninklijke Academie voor Geneeskunde van Belgie Pub Date : 2010-01-01

J Cools

引用次数: 0