Search PubMed⌕ Search

Biomedical subjects

A Van Meerhaeghe

Publications and source records attributed to A Van Meerhaeghe.

At least 19 recordsLinked to original sources
PubMed2006

Operating characteristics of the Finapress system to predict elevated left ventricular filling pressure.

BACKGROUND: Dyspnea is a common symptom and can be caused by many different conditions. The detection of congestive heart failure (CHF) is sometimes difficult. HYPOTHESIS: The pulse amplitude ratio (PAR) measured by the Finapress procedure during a Valsalva maneuver can detect elevated left ventricular end-diastolic pressure (LVEDP) accurately over a wide range of values. METHODS: Comparison of the estimated LVEDP by PAR with the invasively measured LVEDP before and after ventriculography during coronography was made in 101 consecutive stable patients referred for chest pain and/or chronic dyspnea. RESULTS: A significant correlation was found between the catheter-measured LVEDP (range 3-40 mmHg) and the PAR (R2 = 0.70, p < 0.001). The receiver operator characteristics (ROC) of the PAR to detect an LVEDP > 15 mmHg can be considered to be excellent, with an area under the ROC curve achieving 0.92 (95% confidence interval [CI] 0.87-0.96; p < 0.001). A PAR of > 0.675 predicted the presence of an LVEDP > 15 mmHg with a sensitivity of 0.865 (95% CI 0.780-0.926) and a specificity of 0.847 (95% CI 0.730-0.928). The positive and negative LRs were 5.70 and 0.16, respectively. CONCLUSIONS: The observed likelihood ratios confirm that the PAR determined by the Finapress procedure may be a useful bedside diagnostic tool in patients with cardiac conditions.

Adult↗
PubMed2006

[Malignant peripheral nerve sheath tumor in the posterior mediastinum].

We report the case of a 52-year-old male patient who developed a malignant peripheral nerve sheath tumor (MPNST) localized in the posterior mediastinum. The diagnosis of this rare tumor is difficult because the clinical presentation of the benign or malignant types is often similar, i.e. elective pain and bone erosions. Similarly, radiological procedures do not always allow distinction between the two types. MNR and CT-scan are the first line procedures: they localize and characterize the lesions, and CT-scan can also be a guide for biopsies. Histological diagnosis is required, but diagnosis can be compromised by the heterogeneous nature of the tumor. Surgical treatment should be undertaken whenever possible. Survival was unusually long in our patient, more than 5 years after discovery of the MPNST. This type of sarcoma is often very aggressive with frequent development of local recurrences and metastases.

Diagnosis, Differential↗
PubMed2004

Operating characteristics of the negative expiratory pressure technique in predicting obstructive sleep apnoea syndrome in snoring patients.

BACKGROUND: This study examines the operating characteristics of the expiratory flow response to a negative pressure (NEP) applied to the mouth in the prediction of obstructive sleep apnoea syndrome (OSAS) in snoring patients. METHODS: Two hundred and thirty eight patients with normal spirometric values were studied. Full laboratory polysomnography was performed and an NEP of -5 cm H(2)O was applied in the sitting and supine positions. RESULTS: A significant correlation was found between the degree of flow limitation measured by NEP in both positions (expressed as the percentage of the expired tidal volume over which NEP induced flow did not exceed spontaneous flow) and the apnoea-hypopnoea index (AHI). This correlation was significantly higher in the supine position (p<0.0001) where an expiratory flow limitation cut off value of >/=27.5% of the tidal volume produced a sensitivity of 81.9% and a specificity of 69.1% in predicting OSAS. CONCLUSION: These findings show that the degree of instability of the upper airway measured by NEP is correlated with the severity of OSAS. NEP had moderate sensitivity and specificity and may be useful in predicting OSAS in a clinic based population.

Adult↗
PubMed2003

Pulmonary nodular lesions in a 70-year-old man.

Bronchiolitis obliterans organizing pneumonia (BOOP) is an uncommon but increasingly recognized clinicopathologic syndrome. This report illustrates a proteiform clinical presentation of BOOP in a 70-year-old patient with cough, low-grade fever, weight loss, and hemoptysis. Chest radiograph and computed tomography (CT scan) showed nodular lesions. A video-assisted thoracoscopic procedure for biopsy of the largest nodule was performed at the end of an extensive work-up. A diagnosis of BOOP was established and, because of persistent symptomatology, corticosteroid therapy was initiated. This observation illustrates that the clinical and radiological findings of BOOP are non-specific and can sometimes mimic primary and/or secondary pulmonary malignancies.

Journal Article↗
PubMed2003

[Subcutaneous emphysema in a borderline patient].

This report concerns a 31-year-old woman. It is an intricate case including bilateral self-induced pneumoparotitis, cervical and facial subcutaneous emphysema and limited pneumomediastinum. Besides, this borderline patient simulated asthma attacks. The clinical picture was characteristic of Munchausen's syndrome with multiple hospitalisations in various hospitals, automutilations and intentional production of physical symptoms. The diagnosis and the treatment are discussed.

Adult↗
PubMed2002

[Evaluation of diagnostic tests performance: the ROC curve].

Most of the diagnostic tests applied in clinic measure continuous or discrete ordinal variables and do not provide an "yes or no" response. Therefore, we can not assess tests nor compare them on the basis of a single pair of values of sensitivity and specificity. The ROC curve plots values of sensitivity against 1-specificity and allows evaluation of the discriminatory power of a test for all ranges of sensitivity and specificity when applied in two populations, one presenting the target disease and the other not. Evaluation of the discriminatory power or comparison of different tests are further deducted from the measure of the area under the curve. The discriminatory power of the test demonstrated, one has to determine the cutoff point on the ROC curve, that will provide the best information for clinical application.

Diagnostic Tests, Routine↗
PubMed1999

[Decision analysis and initiation of an "empiric" therapy].

For more than 25 years, quantitative approaches were applied to evaluate the outcome of diagnostic and therapeutic strategies. Decision analysis is but one quantitative approach that guides therapeutic decisions. It allows careful analysis of the therapeutic outcome taking into consideration the effects of medical treatment, quality of life and economic costs. The goal of this kind of approach is to choose the management with the greatest benefit for the patient through systematic and logic reduction of the diagnostic uncertainty. It uses a model represented by a decision tree that helps the clinician tot quantify the outcomes. Followed by sensitivity analysis, it may provide a robust basis for the final decision.

Cost-Benefit Analysis↗
PubMed1995

[Pulmonary embolism and pregnancy: report of a case; review of the literature].

Pulmonary embolism occurring during pregnancy is a rare accident but that still brings about a high mother mortality; it seems to be five to six times more frequent during the pregnancy and the post-partum than for non-parturient women who don't take any estro-progestogens, pulmonary embolism would involve complications for 0.5/1000 pregnancies before delivery. As it presents a lot of diagnostic problems, it is under-estimated. The vascular radiological examinations expose the foetus or embryo to considerable radiation and to a risk of foetal hypothyroidism leading to backwardness. The lung perfusion scanning has the advantage of not injecting iodine but is not specific. Fortunately, some medical examinations such as plethysmography or Doppler echography are safe and can also guide the clinician. As far as therapy is concerned, intravenous heparin is the first intention treatment, it can be replaced subsequently by subcutaneous heparin (low molecular weight heparin). In case of heavy pulmonary embolism endangering the vital prognosis of the patient, in case of clinical or biological resistance to the medical treatment, it could be necessary to perform a pulmonary embolectomy with, if necessary, vena cava interruption with insertion of a mechanical filter.

Adult↗
PubMed1992

[Pulmonary embolism: which diagnostic approach?].

The recent literature dealing with the diagnosis of pulmonary embolism is reviewed. Clinical signs, electrocardiogram and arterial blood gases analysis are not very helpful whereas a normal level of blood D-dimers makes the diagnosis of pulmonary embolism very unlikely. Lung scanning must be interpreted carefully in parallel with chest radiography. It is most useful if the pattern is either normal or of high probability. All intermediate scans are inconclusive and need a pulmonary arteriogram. Another option in patients with good cardiorespiratory reserve is the use of repeated non-invasive investigations of the lower limbs.

Blood Gas Analysis↗
PubMed1989

[The gold standard and optimalization of diagnostic choice: the pulmonary nodule and transthoracic pulmonary puncture-biopsy].

In this review of the literature, it is emphasized that the published results about the transthoracic pulmonary needle biopsy (TPNB) cannot be readily evaluated due to the inconsistency of the reference tests, the methods and the investigated subjects. Gold-standards for evaluation of lung tumors have been described and are recalled. The limits of the TPNB are pointed out in the diagnosis of solitary pulmonary nodules and benign lesions. In a bayesian approach, it is shown that the TPNB is only useful in confirming an a-priori diagnosis of cancer.

Bayes Theorem↗
PubMed1986

Functional evaluation in stage I pulmonary sarcoidosis.

A functional evaluation was performed in 9 non-smoking patients suffering from sarcoidosis characterized, on chest roentgenograms, by hilar adenopathies (stage I). Frequency dependence of compliance (5 cases) and decreased conductance of the upstream segment (3 cases) were the major findings. From this it is concluded that, even at stage I, small-airway impairment may be documented in some patients, suggesting the existence of peribronchiolar granulomatous infiltration.

Adult↗
PubMed1986

Breathing pattern and neuromuscular drive during CO2 rebreathing in normal man and in patients with COPD.

In 11 normal subjects and in 10 patients with chronic obstructive pulmonary disease we evaluated breathing pattern and mouth occlusion pressure (PO.1), while breathing room air and during reinhalation of a hypercapnic hyperoxic gas mixture. In the breathing pattern we analyzed the time and volume components of the respiratory cycle: tidal volume (VT), inspiratory time (Ti), expiratory time (Te), total time of respiratory cycle (Ttot); mean inspiratory flow (VT/Ti) and Ti/Ttot ratios, respiratory frequency (RF) and instantaneous ventilation (VE). In the normal subjects, increase in VE during rebreathing mainly depended on an increase in both VT and VT/Ti without significant changes in Ti. During CO2 rebreathing the patients exhibited a lesser increase in VE compared to normals, due to a lesser increase in VT. However, expressing VT in percent of resting inspiratory capacity showed that VT attained at the end of rebreathing (VTmax) was similar to that noted in the normal subjects at the same minute of rebreathing. Furthermore, percent increase in VE, VT, VT/Ti and PO.1 between resting value and that at 56 mm Hg (delta %), were significant in both groups with a major increase in the normal subjects for VE and VT/Ti. In comparison, delta % decreases in both Te and Ttot were found to be significant only in the normal subjects. VT/Ti was related to VE in a similar way in the two groups. In contrast, in the normal subjects, Ti/Ttot did not increase with increasing VE. During rebreathing increase in PO.1 was found to be similar in the normal subjects and in patients. However, for a given neuromuscular drive VE and VT/Ti were greater in the normal subjects than in the patients. These data show that in the patients as a whole no significant changes in breath intervals occur during CO2 rebreathing. Furthermore, in patients, in spite of a similar increase in neuromuscular drive, the efficiency by which inspiratory muscle output (PO.1) is converted into VT/Ti was found to be reduced.

Adult↗