Search PubMed⌕ Search

Biomedical subjects

Steven Vanderschueren

Publications and source records attributed to Steven Vanderschueren.

14 recordsLinked to original sources
PubMed2006

Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study.

AIMS: The aim here is to analyse epidemiology, optimal treatment, and predictors of 6-month mortality in infective endocarditis (IE). METHODS AND RESULTS: A prospective observational cohort study included 193 patients with 203 episodes of definite IE by the modified Duke criteria. Thirty-four percent of episodes involved prosthetic valves. Thirty-three percent of episodes were nosocomial. Forty-three percent included staphylococci, 26% streptococci, and 17% enterococci. At least one complication occurred in 79% of the episodes and 63% had surgical intervention. Six-month mortality was 22%: 33% for staphylococci, 24% for enterococci, and 8% for streptococci. Seventy-four percent of patients with a contraindication to surgery died when compared with 7% with medical treatment without a contraindication and 16% with surgical treatment. In multivariable logistic regression, predictors of 6-month mortality were age (P=0.03), the causative microorganism (P=0.04), and treatment group (P<0.001). CONCLUSION: Compared with older series, we observed more prosthetic valve IE, nosocomial IE, and surgery. Staphylococcus aureus and Enterococcus faecalis were predominant microorganisms. Age, staphylococci, and a contraindication to surgery predicted 6-month mortality. Nearly half of deaths had a contraindication to surgery. Six-month mortality did not differ significantly between patients who received surgical treatment as against those who received medical treatment without a contraindication to surgery.

Adolescent↗
PubMed2006

Repetitive 18F-fluorodeoxyglucose positron emission tomography in giant cell arteritis: a prospective study of 35 patients.

OBJECTIVE: To study fluorodeoxyglucose (FDG) uptake in the different vascular beds and in the large joints of patients with giant cell arteritis (GCA) at diagnosis, during steroid treatment, and at relapse. METHODS: All consecutive patients admitted to our department with a diagnosis of GCA underwent FDG-positron emission tomography (PET) scan before treatment with methylprednisolone was started. PET scans were repeated at 3 and 6 months, if the initial PET scans showed vascular FDG uptake. PET scans were scored at 7 different vascular areas and a total vascular score (TVS) was calculated, ranging from 0 to 21. RESULTS: A total of 35 patients entered the study. At diagnosis, vascular FDG uptake was noted in 29 patients (83%), especially in the subclavian arteries (74%), but also in the aorta (>50%) and up to the femoral arteries (37%). TVS decreased from a mean +/- SD score of 7.9 +/- 5.5 at baseline to 2.4 +/- 3.5 on repeat PET scan at 3 months (P < 0.0005), but did not further decrease at 6 months. The patients who relapsed had similar earlier decreases of TVS compared with those who did not relapse. FDG uptake in the shoulders at diagnosis correlated significantly with the presence of polymyalgia rheumatica (P = 0.005). CONCLUSION: FDG uptake in the large vessels is a sensitive marker for GCA, which can involve the larger thoracic, abdominal, and peripheral arteries. Polymyalgia rheumatica symptoms in patients with GCA correlate with (peri)synovitis of the shoulders. Relapses of GCA cannot be predicted by results of former PET scintigraphies.

Aged↗
PubMed2006

Idiopathic renal infarction.

BACKGROUND: Renal infarction may be an underrecognized disorder. Classical teaching holds that cardioemboli, notably in the setting of arterial fibrillation, are responsible. The expanding use of contrast enhanced computed tomography (CT) in patients with acute abdomen may change the spectrum of renal infarction. METHODS: Twenty-seven consecutive patients presenting to a single university hospital with nontraumatic CT-documented acute renal infarction were studied and stratified according to the presence or absence of cardiac disease, either obvious at presentation or detected during work-up. RESULTS: Eleven patients (41%) had obvious cardiac disease, including atrial fibrillation in all but one. Sixteen patients (59%) had no discernible structural or arrhythmic cardiac disease and were classified as idiopathic group. Patients in the idiopathic group were significantly younger (median age in years [interquartile range]: 48 [41-53] versus 75 [53-82] years, P = .003) and, besides smoking, had fewer traditional cardiovascular risk factors. CONCLUSION: Acute renal infarction may occur in individuals of middle age without risk factors for cardioembolism. In patients with renal colic without lithiasis the diagnosis of renal infarction should be considered especially if serum lactate dehydrogenase is elevated, even in the absence of atrial fibrillation.

Acute Disease↗
PubMed2006

Extremely elevated C-reactive protein.

BACKGROUND: C-reactive protein (CRP) is a widely used inflammatory marker. Yet, the clinical significance and outcome of extremely elevated CRP levels are poorly characterized. METHODS: We collected all patients seen at a university hospital in 2004 with at least one CRP level above 500 mg/l and retrospectively analyzed their electronic files, focusing on patient characteristics, clinical diagnosis, microbiology and vital outcome. RESULTS: CRP was above 500 mg/l in 130 patients with a median age of 62 years. Patient characteristics, settings, etiologies of inflammation, comorbidities and microbiology varied widely. Infections, mainly bacterial, accounted for 88% of episodes. Outcome was fatal in 36% of all patients and in 61% of patients with active malignancies. CONCLUSION: A wide variety of infections, especially bacterial, that are generally readily identified account for the majority of instances of extreme CRP elevation. Mortality is high, certainly in oncological patients.

Journal Article↗
PubMed2005

The diagnostic spectrum of unintentional weight loss.

Significant and documented involuntary weight loss in adults frequently poses a diagnostic challenge to the clinician. We summarize published series on the etiologies and the outcomes of involuntary weight loss and use these data to formulate a proposal for a diagnostic work-up. Simple, non-invasive screening tests, embarking from thorough history-taking and clinical examination, are advocated first. Additional testing should be directed towards areas of concern raised by this initial evaluation. If a well-thought-out baseline examination is reassuring and fails to provide further clues, a strategy of watchful waiting with close clinical follow-up is preferred to a blind pursuit of additional, more invasive, or expensive investigations.

Journal Article↗
PubMed2004

Contribution of (18)fluoro-deoxyglucose positron emission tomography to the work-up of patients with fever of unknown origin.

Background: Recent studies have suggested that (18)fluoro-deoxyglucose (FDG) positron emission tomography (PET) may be useful in the work-up of patients with fever of unknown origin (FUO), but its exact diagnostic yield has not been established. Methods: From January 1999 through December 2001, 74 (67%) of 110 prospectively collected patients who fulfilled the revised criteria of classic FUO underwent a FDG-PET scan. The diagnostic yield of this technique was assessed after diagnostic work-up and follow-up. Abnormal FDG-PET scans that pointed to the final diagnosis were categorized as helpful; all other scans were considered noncontributory. Results: A final diagnosis was established in 39 (53%) of the 74 patients who underwent FDG-PET. Fifty-three (72%) of the 74 FDG-PET scans were abnormal; 19 scans (36% of the abnormal scans or 26% of the total number of scans) were helpful. In the 39 patients with a final diagnosis, 49% of the scans were helpful. A diagnosis was established in 31 (58%) of the 53 patients with an abnormal scan and in 8 (38%) of the 21 patients with a normal scan (P=0.2). Baseline clinical variables (age and sex, as well as periodicity, duration, and height of the fever) and inflammatory parameters (erythrocyte sedimentation rate, C-reactive protein, and hemoglobin) did not predict the usefulness of FDG-PET. Conclusions: FDG-PET contributed positively to the diagnosis in a quarter of our patients with classical FUO. This number is lower than that found in previous studies. Yet, against the background of the wide array of heterogeneous disorders that make up the FUO spectrum and the low number of final diagnoses established (in only 53% of cases), the diagnostic yield of FDG-PET is encouraging. Therefore, the use of FDG-PET should be considered whenever a baseline work-up fails to reveal the cause of a prolonged, febrile illness.

Journal Article↗
PubMed2004

Survival after a lethal dose of arsenic trioxide.

A case of a 27-year-old woman who ingested 9000 mg arsenic trioxide (As2O3) is reported. Classical symptoms of an acute arsenicum (As) poisoning such as gastrointestinal cramps, vomiting, diarrhea, ECG changes and disturbed liver function tests were observed. The absorption of the ingested As was minimalized by a continuous gastric irrigation with highly concentrated NaHCO3 and intestinal cleansing with NaHCO3 and polyethyleneglycol was performed. Forced diuresis, BAL (2,3-dimercaptopropanol) and DMSA (meso-2,3-dimercaptosuccinic acid) were started and therapy to enhance the formation of methylated As derivatives, which are potentially less toxic and which can be excreted more easily, was then administered. The patient survived this massive dose of ingested inorganic As with only polyneuropathy one year later.

Adult↗
PubMed2003

From prolonged febrile illness to fever of unknown origin: the challenge continues.

BACKGROUND: Epidemiological changes and the ongoing expansion of the diagnostic armamentarium warrant a regular update of the spectrum of diseases that present as prolonged febrile illnesses. METHODS: We prospectively collected a series of 290 immunocompetent patients referred to our university hospital between 1990 and 1999 with a febrile illness (temperature >38.3 degrees C) of uncertain cause, lasting at least 3 weeks. Patients were categorized in 4 groups according to the timing of diagnosis: early diagnosis (within 3 in-hospital days or 3 outpatient visits), intermediate diagnosis (between days 4 and 7), late diagnosis (after day 7), and no diagnosis during index contact or follow-up. RESULTS: A final diagnosis was established early in 67 patients (23.1%), intermediate in 38 (13.1%), and late in 87 (30.0%). In the remaining 98 (33.8%), no diagnosis was made. The cause of the fever remained obscure in 50 (47.6%) of 105 patients with episodic fever vs 48 (25.9%) of 185 patients with continuous fever (P<.001). Among the 192 patients with a final diagnosis, noninfectious inflammatory diseases represented the most prevalent diagnostic category (35.4%), surpassing infections (29.7%), miscellaneous causes (19.8%), and malignancies (15.1%). Fourteen disorders accounted for over 59% of diagnoses, whether diagnosis was reached early, intermediate, or late. Hematological malignancies made up 11.5% of diagnoses, but were responsible for 14 (58.3%) of the 24 fatalities related to the febrile illness. Of the 80 patients discharged alive without diagnosis and for whom follow-up was available, 3 died, but the deaths were considered to be unrelated to the feverish illness. CONCLUSIONS: Prolonged febrile illnesses remain a diagnostic challenge. Despite the technological progress of the late 20th century, the origin of the fever remains elusive in many patients, especially in those with episodic fevers. Noninfectious inflammatory diseases emerge as the most prevalent diagnostic category.

Adult↗
PubMed2003

Pain during bone marrow aspiration: prevalence and prevention.

The prevalence, intensity, determinants and prevention of pain during bone marrow aspiration (BMA) in adults are not well defined. In the first part of this prospective study (observational phase), 132 adult hematological patients undergoing BMA after local anesthesia scored the procedural pain by means of a visual analogue scale (VAS). Moderate to severe pain was defined as a VAS score exceeding 30 mm. Eighty-six percent reported procedural pain. The VAS score (mean+/-SEM) was 27.2+/-2.1 mm. Thirty-six percent of patients graded the pain as moderate to severe. In a linear regression analysis, VAS score correlated positively with the duration of the procedure (P=0.029) and negatively with the age of the patient (P=0.006). In the second part of the study (interventional phase), 100 patients were randomized to 50 mg tramadol or placebo, given orally at least one hour before BMA. VAS scores during aspiration were significantly lower in tramadol recipients versus placebo recipients (16.5+/-3.0 mm and 28.8+/-3.4 mm, respectively, P=0.003). Pretreatment with tramadol reduced the percentage of patients with at least moderate pain from 40% to 20% (P=0.029). Four tramadol and 3 placebo recipients reported side effects (dizziness or sedation). In conclusion, notwithstanding local anesthesia, the great majority of adult hematological patients experience transient pain during BMA that is of at least moderate intensity in over a third. Pretreatment with tramadol lowers pain intensity significantly and is well tolerated.

Adolescent↗