Acta clinica Belgica. Supplementum (Acta Clin Belg Suppl)

Publisher: Acta Clinica Belgica

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Other titles Acta clinica Belgica. Supplementum
ISSN 0567-7386
OCLC 1781259
Material type Series
Document type Journal / Magazine / Newspaper

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Acta Clinica Belgica

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Publications in this journal

  • Acta clinica Belgica. Supplementum 01/2014; 69(3):14.
  • Acta clinica Belgica. Supplementum 01/2014; 69(3):13.
  • Acta clinica Belgica. Supplementum 05/2007; 62(1):30.
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    ABSTRACT: Most frequent reasons for intensive care unit (ICU) admission in vasculitis patients are severe respiratory insufficiency due to diffuse alveolar haemorrhage, sepsis and/or pneumonia and an acute abdomen due to bowel infarction. Other reasons are massive gastrointestinal bleeding, thromboembolism and/or scissures. In a patient, not previously diagnosed as having vasculitis, diagnosis can be difficult and must be made as soon as possible, since immunosuppressive therapy should be instituted immediately. Immunosuppressive therapy in severe cases consists of high-dose corticosteroids and cyclophosphamide. In addition, in many cases plasma exchange has to be instituted as well. Prognosis is related to disease activity scores of vasculitis and of severity of illness as measured by the APACHE III scoring system and/or the SOFA score. Septic shock is still the leading cause of death in patients with vasculitis. Nowadays, death due to active untreated vasculitis is rare in experienced clinics.
    Acta clinica Belgica. Supplementum 02/2007; 62(2):417-21. DOI:10.1179/acb.2007.094
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    ABSTRACT: Gastrointestinal failure (GIF) has been postulated as the motor of multiple organ dysfunction syndrome (MODS) but is not commonly included among other organ failures in scoring systems identifying MODS. Relevant articles and published reviews were identified and analyzed through a PubMed search of English language literature on gastrointestinal problems. Wide variability in terms and definitions was observed. Data on the incidence of GIF and its impact on mortality in critically ill patients are controversial. Very few objectively measurable variables of GI function are available. Most of the definitions of GIF are diagnosis-, but not function-based. Diagnosis-based approach to GIF differs significantly from the function-based assessment of other organ failures and has not justified itself over time. There is no consensus on definition of GIF and different medical specialties have different approaches. Development of a proper definition of GIF is warranted.
    Acta clinica Belgica. Supplementum 02/2007; DOI:10.1179/acb.2007.62.s1.022
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    ABSTRACT: Bone marrow transplantation (BMT) is a life-saving intervention that has changed the prognosis of a wide range of haemato-oncologic, immunological and metabolic diseases over the last decades. The incidence of both autologous and allogenic BMT exponentially increased in both the adult and paediatric populations since the 1980s. One of the most frequent complications of BMT is renal failure, with 5% to 15% of all BMT developing acute kidney injury (AKI) and 5% to 20% of the survivors developing chronic renal failure (CRF). From those patients, about 50% will require renal replacement therapy (RRT). Risk factors for BMT-associated AKI are numerous and the pathogenesis is usually complex. Primary diagnosis, drug toxicity, total body irradiation, preexisting kidney dysfunction, veno-occlusive disease, sepsis, relative dehydration, non HLA-identical-related or matched-unrelated donors are risk factors for AKI after BMT. As AKI has been recognized to be predictive of long-term kidney dysfunction, prompt recognition and control of the risk factors are crucial to avoid increased morbidity and mortality due to CRF. With the improvement of BMT techniques, a better recognition of risk factors and aggressive management, there appears to be a steady decline with time in the occurrence of both AKI and CRF.
    Acta clinica Belgica. Supplementum 02/2007; 62(2):401-4. DOI:10.1179/acb.2007.090
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    ABSTRACT: Pregnancy, obesity, peritoneal dialysis, pneumoperitoneum, prone position and application of positive end-expiratory pressure are associated with elevated intraabdominal pressure (lAP). To review the relation between these conditions and procedures, and intraabdominal hypertension (IAH) or abdominal compartment syndrome (ACS). Search of PubMed and Google Scholar and review of article bibliographies. Only obesity, peritoneal dialysis, and pneumoperitoneum are associated with symptoms related to IAH and these symptoms are reversible.
    Acta clinica Belgica. Supplementum 02/2007; DOI:10.1179/acb.2007.62.s1.010
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    ABSTRACT: South Africa has very high levels of accidental trauma as well as interpersonal violence. There are more admissions for trauma in South Africa than for any other disease; therefore it can be regarded as the Number 1 disease in the country. Complex abdominal injuries are common, requiring specific management techniques. The aim is to document our experience with the Modified Sandwich Vacuum Pack technique for temporary closure of abdominal wounds. After providing a short historical overview, we will demonstrate the technique which we carefully adapted over the last decade to the present Modified Sandwich Vacuum Pack technique. In the Last 5 years we utilized our Modified Sandwich Vacuum Pack technique 153 times in 69 patients. Five (5) patients were under the age of 12 years. In the patient group over 12 years the most common indication for using our technique were penetrating injuries (40), abdominal sepsis (28), visceral edema (10), abdominal compartment syndrome (9), abdominal packs (6),Abdominal wall defects (2). In the group under 12-years the 2 children had liver ruptures (posttraumatic) and 3 liver transplantations. The average cost for the materials used with our technique was ZAR 96. (10 Euro and 41 cents). In our experience the Modified Sandwich Vacuum Pack technique is an effective, cheap methodology to deal with open abdomens in the African setting.A drawback may be the technical expertise required, particular in centers dealing with low numbers of complex abdominal trauma.
    Acta clinica Belgica. Supplementum 02/2007; DOI:10.1179/acb.2007.62.s1.029
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    ABSTRACT: Diagnostic imaging technology has advanced considerably during the past two decades. Different imaging techniques have been proposed for abdominal imaging in critically ill patients like plain radiography, sonography, computed tomography (CT), magnetic resonance and positron emission tomography. Sonography has been proven to be effective to detect free intra-peritoneal fluid and it is considered one of the primary diagnostic modalities for abdominal evaluation for trauma assessment. In our opinion sonography should replace other invasive techniques to rapidly triage blunt trauma patients with unstable vital signs and examine the peritoneal cavity as a site of major haemorrhage to expedite exploratory laparotomy. On the other hand, CT has become the imaging modality of choice in hemodynamically stable patients with multisystem blunt and penetrating trauma. New developments in the quantitative analysis of the CT images will improve our knowledge of pathophysiology, diagnostic and therapeutic management of abdominal pathologies in critically ill patients.
    Acta clinica Belgica. Supplementum 02/2007; DOI:10.1179/acb.2007.62.s1.023
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    ABSTRACT: There has been an exponentially increasing interest in intraabdominal hypertension (IAH) and the abdominal compartment syndrome (ACS) over the last decade, and different definitions have been suggested. Nevertheless, there has been an impetus from experts in the field to modify these definitions to reflect our current understanding of the pathophysiology of these syndromes. An international multidisciplinary group of interested doctors met with the goal of agreeing on a set of definitions that could be applied to patients with IAH and ACS. The goal of this consensus group was to provide a conceptual and practical framework to further define ACS, a progressive injurious process that falls under the generalized term 'IAH' and that includes IAH-associated organ dysfunction. In total, 21 North American, Australasian and European surgical, trauma and critical care specialists agreed to standardize the current definitions for IAH, ACS and related conditions in preparation for the second World Congress on Abdominal Compartment Syndrome (WCACS). The WCACS-meeting was endorsed by the European Society of Intensive Care Medicine (ESICM) and the World Society on Abdominal Compartment Syndrome (WSACS). The consensus conference (Noosa, Australia; December 7, 2004) was attended by 21 specialists from Europe, Australasia and North America and approximately 70 other congress participants. In advance of the conference, a blueprint for the various definitions was suggested. After the conference the participants corresponded electronically with feedback. A writing committee was formed at the conference and developed the final manuscript based on executive summary documents generated by each participant. The final report of the 2004 International ACS Consensus Definitions Conference has recently been published. This article will describe the long road towards this final publication with the evolution of the different definitions and recommendations from the initial suggestions in 2004 to the further refinement and final publications in 2006 and 2007. It will try to explain how we got there and will also give the percentage of agreement with each proposed definition by the participants. New definitions were offered for some terms, while others were discarded and not kept in the final manuscript. Different cut-offs for defining IAH and ACS were given, as well as broad definitions of primary, secondary and recurrent IAH/ACS. A classification system was introduced taking into account the duration, origin, and etiology of IAH. The use of an organ severity scoring method, by means of the Sequential Organ Failure Assessment (SOFA) score when dealing with ACS patients was not recommended as an adjunctive tool to assess morbidity in the final publication. This document reflects a process whereby a group of experts and opinion leaders suggested definitions for IAH and ACS. This document should be used as a reference for the next consensus definitions conference in March 2007.
    Acta clinica Belgica. Supplementum 02/2007; 62(1):44-59. DOI:10.1179/acb.2007.62.s1.007
  • Acta clinica Belgica. Supplementum 02/2007; DOI:10.1179/acb.2007.081
  • Acta clinica Belgica. Supplementum 02/2007; DOI:10.1179/acb.2007.078
  • [Show abstract] [Hide abstract]
    ABSTRACT: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are increasingly recognized in critically-ill patients. They are independently associated with mortality and organ dysfunction. The kidney is especially vulnerable to the effect of increased intra-abdominal pressure (IAP) due to its anatomical position and blood supply. Several animal and human studies have provided insights into the mechanism of renal dysfunction in IAH. It is now also accepted that the adverse effects of elevated IAP on renal function can occur at lower levels of IAP, long before development of overt ACS. The mechanism of renal impairment in ACS is not yet completely understood, but there is evidence available that renal blood flow and/or altered hormone levels are involved.
    Acta clinica Belgica. Supplementum 02/2007; 62(2):371-4. DOI:10.1179/acb.2007.083
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    ABSTRACT: Abdominal compartment syndrome and intra-abdominal hypertension are frequently associated with peritonitis. The aim of this study is to establish the relationship between intra-abdominal hypertension and intra-abdominal sepsis especially in critically ill patients. Relevant information was identified through a Medline search (1966-October 2006). The terms used were "intra-abdominal sepsis", "peritonitis", "abdominal compartment syndrome", "intra-abdominal hypertension" and "relaparotomy for sepsis". The search was limited to English- and French-language publications. Only a few clinical trials exist on this specific topic. Further investigations are required to define the incidence of intra-abdominal hypertension in intra-abdominal sepsis, and the prognostic impact of this setting and finally the potential specific treatment. Abdominal compartment syndrome is more likely linked to the abdominal surgery than to peritonitis itself. Intra-abdominal pressure monitoring can be valuable in critically ill patients with suspicion of persisting intra-abdominal sepsis after surgical peritonitis treatment.
    Acta clinica Belgica. Supplementum 02/2007; DOI:10.1179/acb.2007.62.s1.021