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Biomedical subjects

A F Grootendorst

Publications and source records attributed to A F Grootendorst.

16 recordsLinked to original sources
PubMed2000

Asystole during combination chemotherapy for non-Hodgkin's lymphoma: the acute tumor lysis syndrome.

The acute tumor lysis syndrome is a rare condition that has most frequently been documented in patients with rapidly dividing myeloproliferative and lymphoproliferative malignancies. It is characterized by the development of hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, acute renal failure and metabolic acidosis, as a result of massive tumor cell destruction, usually secondary to effective cytotoxic treatment. We want to present the case history of a 62-year-old woman who died from cardiorespiratory arrest during combination chemotherapy for non-Hodgkin's lymphoma due to acute tumor lysis syndrome. Despite general preventive measures, severe electrolyte abnormalities developed within 18 h of the start of chemotherapy. The general guidelines for the management of this potentially fatal oncologic emergency are discussed, with special emphasis on the pathogenetic mechanisms and risk factors in our patient.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1998

[Meningo-encephalitis and hydrocephalus caused by Epstein-Barr virus].

In a 35-year-old woman who presented with acute somnolence, confusion and slow irregular breathing, Epstein-Barr virus (EBV) meningoencephalitis was diagnosed after serological testing and a polymerase chain reaction of the cerebrospinal fluid. She developed papilloedema and bilateral nervus abducens paresis. A CT scan showed generalized oedema of the brain and triventricular hydrocephalus. Treatment with a ventriculoperitoneal shunt and ganciclovir led to complete recovery. Meningoencephalitis is a not uncommon, yet rarely reported complication of infectious mononucleosis. It usually runs a mild course with spontaneous and full recovery. Hydrocephalus secondary to aqueduct stenosis is a complication of Epstein-Barr virus (EBV) meningoencephalitis which has not been reported in adults before. The disease should be considered whenever the clinical condition deteriorates or neurological symptoms increase.

Adult↗
PubMed1998

Pneumomediastinum: an unusual complication of bronchial asthma in a young man.

We report a patient with bronchial asthma who presented with pneumomediastinum, pneumopericardium, pneumoretroperitoneum, pneumorrhachis and extensive subcutaneous emphysema, after a period of coughing. Pathogenesis, diagnostic procedures and treatment of pneumomediastinum and its complications are discussed.

Adult↗
PubMed1998

Chronic tophaceous gout in the elderly.

Gout in the elderly seems to represent a special subgroup. The presentation is often atypical and drug treatment poses special difficulties. We present two elderly patients with large subcutaneous tophi leading to grotesque deformities. Their clinical features, risk factors, diagnosis and treatment are discussed. Although the appearance and radiographic changes caused by tophi are characteristic, the definitive diagnosis of tophaceous gout is made by aspiration and crystal analysis, as is illustrated by colour photographs.

Age Factors↗
PubMed1994

High volume hemofiltration improves hemodynamics and survival of pigs exposed to gut ischemia and reperfusion.

This study assesses the influence of high volume continuous hemofiltration on hemodynamics of pigs subjected to bowel ischemia/reperfusion. Twelve anesthetized and ventilated pigs were studied for 60 min during clamping of the superior mesenteric artery (SMA) and subsequently for 90 min after release of the clamp, while measuring global hemodynamics, SMA flow, and jejunal pCO2. They were randomly divided into two groups: pigs in "control" group were subjected to SMA clamping only. Pigs in "hemofiltered" group received zero-balanced, high volume, veno-venous hemofiltration with the removal of 6000 ml of ultrafiltrate/h, starting 30 min before clamping until 90 min after removal of the SMA clamp. Thereafter, pigs were allowed to awake and sacrificed after 24 h for macroscopic assessment of bowel damage. The drop in cardiac output (CO) during SMA clamping in the hemofiltered group was 2.5 +/- .3 L/min (mean +/- SE) (1.1/4.0; 95% confidence interval) smaller than in the control group. At the end of the experiment, mean arterial pressure (MAP) in the hemofiltered group was 33 +/- 6 (19/48) mmHg higher than in the control group, CO was 2.0 +/- .2 (1.2/2.8) L/min higher in the hemofiltered group. After 60 min of SMA clamping, left ventricular stroke work in the hemofiltered group was 35 +/- 4 (14/56) g higher than in the control group, and higher by 33 +/- 3 (21/46) g at 90 min after release of the SMA clamp. The mean pulmonary artery pressure, right atrial pressure, pulmonary artery wedge pressure, SMA flow and bowel wall pCO2 at different time points did not differ between groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

Infusion of ultrafiltrate from endotoxemic pigs depresses myocardial performance in normal pigs.

We previously showed a beneficial effect of hemofiltration on hemodynamics of endotoxic shock pigs. To test the hypothesis that this effect of hemofiltration is caused by convective removal of factors that adversely affect hemodynamics during endotoxemia, we infused ultrafiltrate from endotoxic shock pigs into healthy pigs. Their hemodynamics were compared with those of pigs who were infused with ultrafiltrate from healthy pigs. Twelve anesthetized and ventilated pigs were hemodynamically monitored for 150 minutes following the infusion of 2 L of ultrafiltrate from 12 donor pigs. The acceptor pigs were randomly divided into two groups; group 1 received ultrafiltrate from pigs who were hemofiltered after the infusion of 0.5 mg/kg endotoxin over 30 minutes; group 2 served as a control group, receiving ultrafiltrate from healthy donor pigs. Group 1 showed a decrease in mean arterial pressure of 28 +/- 7 mm Hg (mean +/- SEM) versus an increase of 17 +/- 3 mm Hg in group 2 (P < 0.4). Mean pulmonary artery pressure increased more in group 1 than in group 2 (9 +/- 2 mm Hg versus 1 +/- 1 mm Hg, P < .04). The decrease in cardiac output in group 1 was greater than in group 2 (3.3 +/- 0.2 L/min v 0.3 +/- 0.3 L/min, P < .02) and was due to a decrease in stroke volume. The decrease in right ventricular ejection fraction was also greater (0.15 +/- 0.02 v 0.01 +/- 0.00, P < .01). Systemic vascular resistance, right atrial pressure, right ventricular end-diastolic volume, pulmonary wedge pressure and heart rate did not differ between groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1993

The role of hemofiltration in the critically-ill intensive care unit patient: present and future.

The development of acute renal failure (ARF) in intensive care unit (ICU) patients carries a poor prognosis. Today, most cases are no longer an isolated organ dysfunction but are part of a multiple system organ failure syndrome. Recently developed renal replacement therapies allow adequate metabolic control, even in highly catabolic and hemodynamically unstable patients. Whether these newer continuous techniques have resulted in a better outcome of these patients is unclear. Recent data suggest a possible beneficial effect of hemofiltration on outcome of ICU patients and the course of human and experimental septic shock, which may be ascribed to the removal of inflammatory mediators. The purpose of this paper is to review the history of hemofiltration techniques and to assess their present and future role in the management of ICU patients. Although hemofiltration has been shown to improve hemodynamics of experimental septic shock, convincing evidence that hemofiltration improves outcome of ICU patients is lacking. Available data suggest that high ultrafiltrate volumes may be needed to achieve clinically important beneficial effects of hemofiltration in these patients. Prospective, randomized trials in homogeneous patient groups are needed to assess the role of hemofiltration in patients with septic shock or multiple system organ failure.

Acute Kidney Injury↗
PubMed1992

High volume hemofiltration improves right ventricular function in endotoxin-induced shock in the pig.

This study assessed the influence of continuous high volume hemofiltration on right ventricular function of pigs with endotoxin induced shock. Eighteen anesthetized and ventilated pigs were studied for 240 min after the start of infusion of 0.5 mg/kg endotoxin over 30 min. Right ventricular ejection fraction (RVEF) was measured by rapid response thermodilution technique. After endotoxin infusion, the pigs were randomly divided into 3 groups: group 1 as a control group, receiving endotoxin only, group 2 to observe the effects of zero balance high volume veno-venous hemofiltration with removal of ultrafiltrate at a rate of 6000 ml/h, and group 3 to evaluate the effect of the extracorporeal circuit itself on RVEF. The decline of RVEF in group 2 was less than in group 1 (0.04 +/- 0.02 vs 0.21 +/- 0.03 (mean +/- SEM); p less than 0.001). The decline of RVEF in group 3 (0.24 +/- 0.02) was more pronounced than that in group 1 (p less than 0.05). The differences in the course of RVEF between group 1 and group 2 could not be explained by differences in heart rate, preload or afterload. Cardiac output and mean arterial pressure were significantly higher in group 2 than in group 1 (p less than 0.01). It is concluded that in this model, high volume hemofiltration improves RVEF and cardiac performance by removal of vasoactive mediators, responsible for myocardial depression.

Animals↗
PubMed1990

Hemodynamic aspects of multiple organ failure.

Multiple organ failure (MOF) secondary to sepsis is associated with a high mortality. A large body of evidence suggests that the disturbed relationship between oxygen supply and oxygen uptake plays an important role in the pathogenesis of MOF. The relationship between oxygen-supply dependency and MOF and the practical implications of the relationship are reviewed. It is concluded that, apart from the all-important eradication of the source of the sepsis, optimizing oxygen transport is the best method of preventing the development of MOF. Since the effects of hemodynamic and ventilatory treatments on oxygen uptake are often unpredictable, the impact of the treatments on oxygen uptake should be evaluated directly.

Hemodynamics↗
PubMed1988

Albumin abuse in intensive care medicine.

Albumin is a much abused and expensive drug in intensive care units. One of the motivations for its use is the prevention of pulmonary edema by enhancing the colloid osmotic pressure (COP). Fear of pulmonary edema has led to the formation of a magic (arbitrary) albumin value varying from one intensive care unit to another. Many intensive care units start substituting albumin when it is below 25 g/l. The objective of this paper is to look at the rationale of this policy. Our results show that in intensive care patients, with a variety of primary diagnoses, a poor correlation exists between COP and serum albumin concentration (r = 0.56; p less than 0.001). To get an index of the colloid osmotic status of the I. C.-patient measuring albumin concentration is useless and COP should be measured instead. From 19 patients with a COP in the 15.0-20.0 mmHg range (corresponding albumin range: 12.0-25.0 g/l) and from 10 patients with a COP in the 11.6-15.0 mmHg range (corresponding albumin range 10.5-19.2 g/l) none developed pulmonary edema. It is questionable if expensive, scarce albumin is the drug of choice with which to increase COP, for the mean increase (+/- SD) in COP after infusion of 100 grams albumin is 2.2 (+/- 1.5) mmHg (p less than 0.001). Adopting a COP action level of 15 mmHg can lead to considerable savings.

Albumins↗
PubMed1980

Adaptation of the vestibulo-ocular reflex in albino rabbits by selective exposure of the anterior sector of the visual field.

Horizontal optokinetic reflexes (OKN) are inverted in an anterior (90-180 degrees) sector of the visual field in albino rabbits. We investigated whether the inverted processing of direction-selective information would affect long-term adaptation of the vestibulo-ocular reflex (VOR). Normal posterior parts of the visual fields were masked for periods up to 80 days. The inversion of OKN, with instability of the eyes and head in the light, was not corrected in this period. The amplitude of the VOR was progressively reduced, but a true inversion was not achieved. Recovery was seen after removal of the masks. These changes were larger and more consistent in Himalayan than in Polish rabbits. Normal, Dutch pigmented rabbits which served as controls showed no significant reduction of VOR gain. Phase lead of the VOR for low stimulus frequencies increased in both pigmented and albino rabbits. In short-term experiments with forced oscillation, similar but smaller changes were observed.

Animals↗