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Biomedical subjects

W Vincken

Publications and source records attributed to W Vincken.

At least 73 records · Page 4Linked to original sources
PubMed1995

Tuberculous pleural effusion following coronary artery bypass graft.

We present two patients with moderate left ventricular dysfunction, who developed a pleural effusion after coronary artery bypass grafting (CABG). The effusion was proven to be an exsudate of tuberculous origin. This illustrates that not all pleural exsudates developing after CABG are due to a post-pericardiotomy syndrome. Therefore microbiological examination of pleural fluid and if necessary pleural biopsy should be performed in all patients with an unresolving pleural effusion following CABG.

Aged↗
PubMed1995

Cardiopulmonary exercise testing following bilateral thoracoscopic sympathicolysis in patients with essential hyperhidrosis.

BACKGROUND: Essential hyperhidrosis is characterised by an overactivity of the sympathetic fibres passing through the upper dorsal sympathetic ganglia D2-D3. Anatomical interruption at the D2-D3 level is a highly effective treatment for essential hyperhidrosis but also causes (partial) cardiac denervation and, after surgical sympathicolysis, important impairment of cardiopulmonary exercise function has been observed. The purpose of this study was to compare the results of cardiopulmonary exercise testing between patients with essential hyperhidrosis and a normal control population, and to examine the effects of thoracoscopic D2-D3 sympathicolysis on cardiopulmonary exercise capacity in patients with essential hyperhidrosis. METHODS: maximal, symptom limited incremental exercise tests were performed in 26 patients with severe essential hyperhidrosis one week before and one month after D2-D3 thoracoscopic sympathicolysis, and in 14 age and sex matched healthy volunteers. D2-D3 thoracoscopic sympathicolysis was performed using a simplified one stage bilateral procedure. RESULTS: Palmar hyperhidrosis was relieved in every patient, confirming the D2-D3 denervation. A higher peak heart rate (7%) was seen in the patient group than in the normal subjects, but ll other cardiovascular, metabolic, and respiratory parameters were similar. After D2-D3 thoracoscopic sympathicolysis, heart rate at rest (13%) and at peak exercise (7%) were reduced, together with an increase in oxygen pulse. All other parameters remained unchanged. CONCLUSIONS: Sympathetic overactivity relevant to cardiovascular function in essential hyperhidrosis is evident only during sympathetic stimulation. D2-D3 thoracoscopic sympathicolysis causes a small and asymptomatic reduction in maximal and resting heart rate and is not associated with a decrease in exercise capacity, in contrast with the detrimental effects on exercise capacity of open surgical sympathectomy.

Adult↗
PubMed1995

Three cases of bronchial stump aspergillosis: unusual clinical presentations and beneficial effect of oral itraconazole.

Bronchial stump aspergillosis (BSA), i.e. Aspergillus infection of bronchial granulation tissue surrounding endobronchial suture threads, is a very rare variant of localized suppurative bronchial Aspergillus infection. The majority of reported cases have occurred within one year after lung surgery. We present three more patients, in whom BSA occurred very late (4.5, 6 and 7 yrs) after pulmonary resection. Other unusual features were: complete absence of symptoms in one patient, and simultaneous occurrence of aspergilloma in another. Removal of the endobronchial suture probably constitutes the key therapy for BSA. In all three of our patients oral itraconazole resulted in clinical, histological and microbiological improvement. In conclusion, BSA should be considered in the differential diagnosis of haemoptysis occurring up to 7 yrs after lung surgery, although an asymptomatic presentation is possible. Furthermore, BSA can be associated with other clinical presentations of Aspergillus infection, e.g. aspergilloma. Finally, long-term oral itraconazole therapy may represent a valid alternative when removal of the suture is not feasible.

Administration, Oral↗
PubMed1995

Non-small-cell lung cancer with multiple paraneoplastic syndromes.

We describe the case of a patient with multiple paraneoplastic syndromes, six in total, associated with a non-small-cell cancer of the lung. In this single patient we found hypertrophic pulmonary osteoarthropathy, hyperkeratosis of palms and soles, erythema annulare centrifugum, syndrome of inappropriate secretion of antidiuretic hormone (SIADH), and ectopic andrenocorticotrophic hormone (ACTH) and calcitonin production.

ACTH Syndrome, Ectopic↗
PubMed1995

Asthma medications and disease exacerbations: an epidemiological study as a method for asthma surveillance.

Recent experimental and epidemiological studies have suggested that outcomes of asthma are significantly influenced by treatment patterns. This study was conducted in order to investigate the links between treatment patterns in asthmatics and occurrence of disease exacerbations. We performed a nested case-control study in a cohort of 680 asthmatics identified between 1986 and 1991 in a drug dispensing database. After validation in a pilot study, the intermittent use of oral corticosteroids was used as a proxy for asthma exacerbations. Cases with an exacerbation (n=133) were pair-wise matched with controls. The type of medications used for the usual treatment of asthma were examined in relation to the risk of asthma exacerbation. The use of oral xanthines and inhaled fenoterol but not of inhaled salbutamol, corticosteroids, cromoglycate and ipratropium bromide was associated with an increased probability of asthma exacerbation. Within the cohort, the proportion of subjects dispensed inhaled corticosteroids rose from 12 to 27% between 1986 and 1991. The proportion of subjects using inhaled bronchodilators without inhaled corticosteroids also decreased over this period of time. The identification of markers of asthma exacerbations made it possible to link the probability of adverse outcome risk for such exacerbations with treatment patterns. This method could be useful in further development of asthma surveillance using drug dispensing databases.

Adolescent↗
PubMed1994

Upper airway obstruction due to inoperable intrathoracic goitre treated by tracheal endoprosthesis.

Thyroidectomy is the treatment of choice in patients with thyroid enlargement complicated by compression or displacement of the trachea because of the risk of complete airway obstruction due to sudden enlargement of the goitre by, for example, haemorrhage. In patients who are medically inoperable an endoscopically inserted tracheal endoprosthesis may provide longstanding airway patency, as reported here.

Aged↗
PubMed1994

Successful management of recurrent pneumothorax in cystic fibrosis by localized apical thoracoscopic talc poudrage.

Thoracoscopic talc poudrage of the entire pleural surface constitutes successful treatment of recurrent pneumothorax in cystic fibrosis (CF); however, subsequent lung transplantation is seriously jeopardized due to the development of extensive pleural adhesions. We describe a 27-year-old patient with CF with recurrent right-sided pneumothorax, refractory to chest tube drainage and to chemical (tetracycline) pleurodesis, who was successfully treated with a localized, apical thoracoscopic talc poudrage, thereby preserving the possibility of subsequent lung transplantation.

Adult↗
PubMed1993

The association of bronchiolitis obliterans organizing pneumonia, systemic lupus erythematosus, and Hunner's cystitis.

An 83-year-old woman with histologically confirmed Hunner's cystitis presented with persistent fever, progressive dyspnea, and pulmonary patchy infiltrates. A transbronchial biopsy specimen revealed bronchiolitis obliterans organizing pneumonia. She progressively had development of renal insufficiency, due to systemic lupus erythematosus, proved by renal biopsy specimen. She recovered under corticosteroid treatment, but irreversible renal failure made long-term hemodialysis necessary.

Aged↗
PubMed1992

Pulmonary arterial hypertension in sepsis and the adult respiratory distress syndrome.

Pulmonary arterial hypertension, defined as a mean pulmonary artery pressure exceeding 20 mmHg has been observed both in experimental animal and human sepsis, even before development of the adult respiratory distress syndrome. In this article we review several mechanisms that have been invoked for the pulmonary arterial hypertension associated with sepsis (and the adult respiratory distress syndrome): obstruction of the pulmonary microcirculation with microthrombi composed of platelets and leukocytes, and active pulmonary vasoconstriction induced by the autonomous nervous system, hypoxia or vasoactive humoral factors ("mediators"). Some of these mediators, in particular serotonin and arachidonic acid metabolites have been the subject of substantial research and therapeutic manipulation. Since pulmonary arterial hypertension imposes an increased afterload to the right ventricle and because right ventricular dysfunction appears to be a major determinant of the outcome of sepsis, the study of the mechanisms involved in pulmonary arterial hypertension may lead to improved management of sepsis and septic shock.

Humans↗
PubMed1992

Metabolic effects of inhaled fenoterol in normal subjects.

Although the hypokalemic effect of inhaled beta 2-adrenergic agonists has been well documented, little is known as to their effect on plasma magnesium. We therefore examined in ten healthy young volunteers the effect of the inhalation of 2 mg of nebulized fenoterol on plasma potassium (Kpl), plasma magnesium (Mgpl), and intraerythrocytic magnesium (MgIE) levels, as well as on plasma insulin and C peptide concentrations, measured before and serially up to 110 min after fenoterol inhalation. In all subjects, fenoterol inhalation caused a reversible reduction in Kpl (range, 0.2 to 1.1 mEq/L), which was progressive, reaching a statistically significant nadir 30 to 60 min following fenoterol inhalation (largest dip in Kpl, 0.55 +/- 0.29 mEq/L; p < 0.05). The nadir in Kpl levels was preceded by a peak in plasma insulin levels in all subjects. No significant changes in Mgpl or MgIE were observed in any of the subjects. We conclude that fenoterol inhaled at a dosage used in clinical practice significantly reduces Kpl but not Mgpl nor MgIE levels in healthy subjects, indicating a lower sensitivity of Mg++ ions to beta 2-adrenergic stimulation than K+ ions. Beta 2-adrenergic-induced insulin secretion probably contributes to the hypokalemic effect of inhaled fenoterol.

Administration, Inhalation↗
PubMed1992

Intraventricular rifampicin in severe tuberculous meningo-encephalitis.

We present a patient acutely ill from severe tuberculous meningo-encephalitis, in whom acute hepatic and renal failure, due to intercurrent septic shock, precluded the administration of full systemic dosage of antituberculous drugs. Daily direct intraventricular administration of 5 mg rifampicin, via a subcutaneous Ommaya reservoir connected to a catheter placed in the right lateral cerebral ventricle, resulted in rapid improvement without neurological sequelae. Intraventricular rifampicin administration for 50 consecutive days was well-tolerated without local or systemic side-effects. In well-selected patients with severe tuberculous meningo-encephalitis, intraventricular rifampicin may safely and highly effectively be added to systemic antituberculous therapy.

Acute Kidney Injury↗
PubMed1990

Transient left heart failure in amniotic fluid embolism.

We report a patient with amniotic fluid embolism (AFE) in whom the occurrence of late onset, severe pulmonary oedema was due to isolated left ventricular (LV) failure. Following institution of diuretics and inotropic support, the situation promptly improved and follow-up haemodynamic assessment showed complete recovery of LV function. This report indicates that reversible LV failure may occur late after AFE and emphasises the usefulness of pulmonary artery catheterisation for proper assessment and guidance of therapy of pulmonary oedema in AFE.

Adult↗