Ziekenhuis Oost Limburg Genk
Ziekenhuis Oost Limburg Genk
Saad M.B.,Hasselt University |
Bleeser T.,Hasselt University |
Thomeer M.,Ziekenhuis Oost Limburg Genk |
Jans F.,Faculteit Geneeskunde en Levenswetenschappen
Tijdschrift voor Geneeskunde | Year: 2017
Minute ventilation is controlled by the body according to the partial pressure of oxygen (PaO2) and the partial pressure of carbon dioxide (PaCO2). These parameters are monitored by central (brainstem) and peripheral (aortic bodies and carotid bodies) chemoreceptors. In the past it was thought that high concentrations of oxygen (O2) should not be given to patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD), because this would remove the hypoxic stimulus to maintain alveolar ventilation. The resulting decrease of minute ventilation could even be fatal. This is how the hypoxic drive theory is described in literature (only in patients with the hypercapnic type of COPD), but in 1980 it was observed that there is only a little decrease in minute ventilation and the theory has therefore been questioned. The most important adverse effect of O2-administration in COPD patients with an acute exacerbation is the increase of the arterial PCO2 in a subpopulation of patients. This can be explained partially by hypoventilation, but other pathophysiological mechanisms are more important: increase of the ventilation-perfusion mismatch and Haldane effect (the CO2 affinity of hemoglobin decreases in the presence of a high PaO2). One should correctly administer O2 in COPD patients with acute respiratory failure. This could be achieved by titrated O2 treatment in which the arterial O2 saturation is held between 85 and 94%. In this way, the effects of fatal hypoxemia are avoided and the elevation in arterial PCO2 is minimized.
Pierot L.,University of Reims Champagne Ardenne |
Gubucz I.,National Institute of Clinical Neurosciences |
Buhk J.H.,University of Hamburg |
Holtmannspotter M.,Rigshospitalet |
And 10 more authors.
American Journal of Neuroradiology | Year: 2017
BACKGROUND AND PURPOSE: Flow disruption with the Woven EndoBridge (WEB) device is an innovative technique for the endovascular treatment of wide-neck bifurcation aneurysms. The initial version of the device (WEB Double-Layer) was evaluated in the WEB Clinical Assessment of IntraSaccular Aneurysm Therapy (WEBCAST) study, whereas the French Observatory study evaluated both WEB Double-Layer and Single-Layer versions of the device. WEBCAST 2 was designed to evaluate the WEB Single-Layer with Enhanced Visualization. MATERIALS AND METHODS: Patients with wide-neck bifurcation aneurysms for which WEB treatment was possible were included. Clinical data including adverse events and clinical status at 1 month and 1 year were collected and analyzed. A core laboratory evaluated anatomic results at 1 year following the procedure. RESULTS: Ten European neurointerventional centers included 55 patients (38 women; 27-77 years of age; mean, 54.4 ± 10.0 years) with 55 aneurysms. Aneurysm locations were the middle cerebral artery in 25 aneurysms (45.5%), the anterior communicating artery in 16 (29.1%), the basilar artery in 9 (16.4%), and the internal carotid artery terminus in 5 (9.1%). Procedural morbidity and mortality at 1 month were, respectively, 1.8% (1/55 patients) and 0.0% (0/55 patients). Morbidity and mortality at 1 year were, respectively, 3.9% (2/51 patients) and 2.0% (1/51 patients). At 1 year, complete occlusion was observed in 27/50 aneurysms (54.0%); neck remnant, in 13/50 (26.0%); and aneurysm remnant, in 10/50 (20.0%) (adequate occlusion in 40/50, 80.0%). CONCLUSIONS: WEBCAST 2 confirms the high safety and efficacy of WEB aneurysm treatment demonstrated in the WEBCAST and French Observatory studies. © 2017, American Society of Neuroradiology. All rights reserved.
Schaefer M.,Charité - Medical University of Berlin |
Capuron L.,French National Institute for Agricultural Research |
Friebe A.,Ruhr University Bochum |
Diez-Quevedo C.,Autonomous University of Barcelona |
And 6 more authors.
Journal of Hepatology | Year: 2012
Mental health problems frequently occur in chronic infection with the hepatitis C virus (HCV) and during antiviral treatment with pegylated interferon-alpha (PegIFNα) and ribavirin. Depression is one of the most important complications during antiviral treatment of chronic hepatitis C infection. However, an increased prevalence of depression, fatigue, and cognitive disturbances has also been reported in untreated HCV-positive patients. Patients with psychiatric disorders or drug addiction also have an increased risk of HCV infection. Furthermore, because of possible drug-drug interactions, new antivirals administered together with PegIFNα and ribavirin may complicate psychiatric side effect management, even if no specific psychiatric adverse events are known so far for these new drugs. The European liver patient's organization (ELPA) organised a European expert conference to review the literature and develop expert recommendations for the management of mental health problems in HCV infected patients. This paper results from the output of the 2011 EASL meeting and subsequent dialogue with patient groups and relevant experts in Europe. It summarises the current knowledge of HCV infection and the brain; prevalence, course, and neurobiology of IFN-α associated psychiatric side effects; possible risk factors for IFN-α associated depression and suicide attempts; psychiatric management of HCV infected patients before and during antiviral treatment; prevention of IFN- α associated psychiatric side effects; and psychiatric aspects of the new antivirals. The summarised current knowledge about mental health changes before and during antiviral treatment should improve interdisciplinary management of HCV infected patients. © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Moonen P.-J.,Ziekenhuis Oost Limburg Genk |
Mercelina L.,Ziekenhuis Oost Limburg Genk |
Boer W.,Ziekenhuis Oost Limburg Genk |
Fret T.,Ziekenhuis Oost Limburg Genk
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Year: 2017
Background: The Emergency Department (ED) is prone to diagnostic error. Most frequent diagnostic errors involved "minor" trauma. Our goal was to determine how frequently a missed diagnosis was detected during follow up and to determine the frequency and causes of primary missed diagnosis and diagnostic error. Methods: A retrospective single centre study review, during 6 months including all patients presenting to the outpatient clinic after ED admission with a minor trauma. We defined primary missed diagnosis versus diagnostic error. Demographic data were collected in Excel file and analyzed using X2 and unpaired T-test. Results: Inclusion of 56 patients leading to 57 missed diagnoses representing 1.39% of all minor trauma patients presenting to the ED. History and physical examination notes were incomplete or inadequate in respectively 17/56 and 20/56. Most frequently missed diagnoses were ankle (13/57), wrist (8/57) and foot (7/57) fractures. Causes for diagnostic error could be categorized into two main groups: failure to perform adequate history taking and/or physical examination and failure to order or correctly interpret technical investigation. In 6 cases (0.14%) diagnostic error was confirmed. All other cases were defined as primary missed diagnosis. Discussion: Emergency physicians have to remain vigilant to prevent and avoid primary missed diagnosis (PMD) and diagnostic error (DE), certainly in case of minor trauma patients, representing a large proportion of ED patients. We observed a prevalence of 1.39% of missed diagnoses within a six month study period. This is comparable to previous studies (1% ). However in our study both primary missed diagnoses and DE were included. Using this definition we saw that only one case could be attributed to negligence and DE had a prevalence of 0.14% (6 cases). X-rays remain the mainstay investigation for minor trauma patients, however in certain selected cases (pelvic and spinal trauma) we advise early CT-scan.Follow up in an outpatient clinic or other forms of planned follow up have to be provided and help to reduce PMD and DE. Conclusion: Both primary missed diagnosis and diagnostic error have relatively low prevalence but have a serious impact on patients, hospitals and medical services. Planned follow up after adequate explanation can help to prevent diagnostic error and detect primary missed diagnosis, thereby reducing time to final diagnosis and risks for medico legal litigation. Reassessment of diagnostic error on a timely basis can be used as a key performance indicator in a quality assessment program. © 2017 The Author(s).
Wassen M.,Maastricht University |
Miggiels L.,Maastricht University |
Devlieger R.,University Hospital Leuven |
Gyselaers W.,Ziekenhuis Oost Limburg Genk |
And 8 more authors.
Journal of Psychosomatic Obstetrics and Gynecology | Year: 2013
Background: This study describes variables related to women's prelabour preference for epidural analgesia (PEA) in two neighbouring countries with a comparable socio-economic and cultural background. Methods: Dutch women in midwifery (n = 164) or obstetrical care (n = 162), and Belgian women (n = 188) of 36 weeks gestation with a singleton in cephalic presentation completed questionnaires on demographic factors, received labour analgesia information, perceived attitude of the caregiver towards epidural analgesia (EA), pain catastrophising and coping with labour pain. Multiple logistic regression analysis was performed with PEA as dependent variable. Results: PEA was 9.9% in Dutch midwifery care, 25.5% in Dutch obstetrical care and 38.3% in Belgian care (p value < 0.001). In the Netherlands, maternal age of 35 years or older (OR 4.95; 95% confidence interval (CI) 2.03-12.08), positive attitude of the caregiver towards EA (OR 5.83; 95% CI 2.57-13.23) and a lower degree of coping (OR 3.61; 95% CI 2.24-5.82) were independently associated with PEA. In Belgium, only a lower degree of coping was associated with PEA (OR 4.06; 95% CI 2.45-6.73). Conclusions: In both countries, women with a lower degree of coping had a higher PEA. Care setting in the Netherlands was not an independent variable. © 2013 Informa UK Ltd All rights reserved.
PubMed | Ziekenhuis Oost Limburg Genk, Hasselt University and Intensive Care
Type: | Journal: Journal of clinical monitoring and computing | Year: 2016
This study assessed the influence of the evolution in Transcatheter Aortic Valve Implantation technology on cerebral oxygenation. Cerebral oxygenation was measured continuously with Near-Infrared Spectroscopy and compared retrospectively between balloon-expandable, self-expandable and differential deployment valves which were implanted in 12 (34%), 17 (49%) and 6 patients (17%), respectively. Left and right SctO
Vanoeteren X.,Ziekenhuis Oost Limburg Genk |
Meeuwissen J.,Ziekenhuis Oost Limburg Genk |
Daniels H.,Ziekenhuis Oost Limburg Genk |
Teuwen J.,Huisartsenpraktijk de Kluit
Tijdschrift voor Geneeskunde | Year: 2015
A Sister Mary Joseph's nodule is a metastatic cancer of the umbilicus, typically associated with a visceral malignancy. A 90-year-old man was referred to the consultation of internal medicine with symptoms of prolonged fatigue, anorexia and weight loss of 10 kg during the last few months. He developed a painless erythematous nodule on the umbilicus that had been developing slowly over the past few weeks. The diagnosis was made quickly: it concerned a Sister Mary Joseph's nodule, a result of advanced metastatic colon cancer. The therapeutic options were limited and the patient passed away at home, shortly after the presentation. A Sister Mary Joseph's nodule is a palpable nodule around the umbilicus. It is an uncommon and rare presentation. It indicates disseminated malignant disease and involves a poor prognosis.
Genbrugge C.,Hasselt University |
Meex I.,Hasselt University |
Boer W.,Ziekenhuis Oost Limburg Genk |
Jans F.,Hasselt University |
And 4 more authors.
Critical Care | Year: 2015
Introduction: By maintaining sufficient cerebral blood flow and oxygenation, the goal of cardiopulmonary resuscitation (CPR) is to preserve the pre-arrest neurological state. To date, cerebral monitoring abilities during CPR have been limited. Therefore, we investigated the time-course of cerebral oxygen saturation values (rSO2) during advanced life support in out-of-hospital cardiac arrest. Our primary aim was to compare rSO2 values during advanced life support from patients with return of spontaneous circulation (ROSC) to patients who did not achieve ROSC. Methods: We performed an observational study to measure rSO2 using Equanox™ (Nonin, Plymouth, MI) from the start of advanced life support in the pre-hospital setting. Results: rSO2 of 49 consecutive out-of-hospital cardiac arrest patients were analyzed. The total increase from initial rSO2 value until two minutes before ROSC or end of advanced life support efforts was significantly larger in the group with ROSC 16% (9 to 36) compared to the patients without ROSC 10% (4 to 15) (P = 0.02). Mean rSO2 from the start of measurement until two minutes before ROSC or until termination of advanced life support was higher in patients with ROSC than in those without, namely 39% ± 7 and 31% ± 4 (P = 0.05) respectively. Conclusions: During pre-hospital advanced life support, higher increases in rSO2 are observed in patients attaining ROSC, even before ROSC was clinically determined. Our findings suggest that rSO2 could be used in the future to guide patient tailored treatment during cardiac arrest and could therefore be a surrogate marker of the systemic oxygenation state of the patient. © 2015 Genbrugge et al.; licensee BioMed Central.
Corten K.,Ziekenhuis Oost Limburg Genk |
Struelens B.,University Hospital Pellenberg |
Evans B.,London Health Sciences Center |
Graham E.,London Health Sciences Center |
And 2 more authors.
Bone and Joint Journal | Year: 2013
A soft-tissue defect over an infected total knee replacement (TKR) presents a difficult technical problem that can be treated with a gastrocnemius flap, which is rotated over the defect during the first-stage of a revision procedure. This facilitates wound healing and the safe introduction of a prosthesis at the second stage. We describe the outcome at a mean follow-up of 4.5 years (1 to 10) in 24 patients with an infected TKR who underwent this procedure. A total of 22 (92%) eventually obtained a satisfactory result. The mean Knee Society score improved from 53 pre-operatively to 103 at the latest follow-up (p < 0.001). The mean Western Ontario and McMaster Universities osteoarthritis index and Short-Form 12 score also improved significantly (p < 0.001). This form of treatment can be used reliably and safely to treat many of these complex cases where control of infection, retention of the components and acceptable functional recovery are the primary goals. © 2013 The British Editorial Society of Bone & Joint Surgery.
Keupers M.,Ziekenhuis Oost Limburg Genk |
Gelin G.,Ziekenhuis Oost Limburg Genk |
Vandevenne J.,Ziekenhuis Oost Limburg Genk |
Grieten M.,Ziekenhuis Oost Limburg Genk
JBR-BTR | Year: 2012
Carpal boss is a bony prominence located dorsally on the base of the second and/or third CMC joint. We describe the imaging findings of the pathology in two patients and the relative contributive role of the different modalities and stress the decisive role of MRI.