Search

Item does not contain fulltext BACKGROUND: Yeasts and molds now rank among the most common pathogens in intensive care units. Whereas the incidence of Candida infections peaked in the late 1970s, aspergillosis is still increasing. METHOD: Review of the pertinent English-language literature. RESULTS: Most factors promoting an invasive fungal infection are difficult to avoid because they are connected directly to treatment of the underlying disease. Antifungal treatment is often commenced on an empiric basis, whereas it might be preferable to adopt a strategy based on a diagnostic procedure able to demonstrate or exclude fungal disease. Polyenes have been the drugs of choice, but voriconazole is the new standard for aspergillosis. For invasive candidiasis, fluconazole is a more convenient option, with the new echinocandins or voriconazole as alternatives. CONCLUSIONS: The incidence of invasive fungal infection is increasing, but so too are the choices of agents for therapy. For reasons of efficacy and safety, therapy with an echinocandin or azole antifungal agent is supplanting the use of polyenes.

Item does not contain fulltext

Contains fulltext : 57206.pdf (Publisher’s version ) (Closed access)

Item does not contain fulltext Invasive fungal infections are an increasing complication for patients with cancer. These infections still are difficult to diagnose and to treat and thus still have a high fatality rate. New strategies should include evaluation of new diagnosis tools and large-scale assessment of these new methods will need multidisciplinary collaboration. High-quality clinical trials dedicated to establish 'state-of-the-art' prevention and treatment are also directly needed. Created in 1991, the EORTC Invasive Fungal Infection Group has faced several of these challenges and significantly improved the knowledge and management of these infections in Europe.

Item does not contain fulltext

Contains fulltext : 21970___.PDF (Publisher’s version ) (Open Access)

Item does not contain fulltext

Contains fulltext : 4734.pdf (Publisher’s version ) (Open Access)

Item does not contain fulltext The coagulation-fibrinolytic profile during cardiopulmonary bypass (CPB) has been widely documented. However, less information is available on the possible persistence of these alterations when autotransfusion is used in management of perioperative blood loss. This study was designed to explore the influence of autotransfusion management on intravascular fibrin degradation and postoperative transfusions. Thirty patients, undergoing elective primary isolated coronary bypass grafting, were randomly allocated either to a control group (group A; n=15) or an intervention group (group B; n=15) in which mediastinal and residual CPB blood was collected and processed by a continuous autotransfusion system before re-infusion. Intravascular fibrin degradation as indicated by D-dimer generation was measured at five specific intervals and corrected for hemodilution. In addition, chest tube drainage and need for homologous blood were monitored. D-dimer generation increased significantly during CPB in group A, from 312 to 633 vs. 291 to 356 ng/mL in group B (p = .001). The unprocessed residual blood (group A) revealed an unequivocal D-dimer elevation, 4131 +/- 1063 vs. 279 +/- 103 ng/mL for the processed residual in group B (p < .001). Consequently, in the first post-CPB period, the intravascular fibrin degradation was significantly elevated in group A compared with group B (p = .001). Twenty hours postoperatively, no significant difference in D-dimer levels was detected between both groups. However, a significant intra-group D-dimer elevation pre- vs. postoperative was noticed from 312 to 828 ng/mL in group A and from 291 to 588 ng/mL in group B (p < .01 for both). Postoperative chest tube drainage was higher in the patients from group A, which also had the highest postoperative D-dimer levels. Patients in group A perceived a higher need for transfusions of red cells suspensions postoperatively. These data clearly indicate that autotransfusion management during and after CPB suppresses early postoperative fibrin degradation. Keywords: cardiopulmonary bypass, cardiotomy suction, coronary surgery, autotransfusion, fibrin degradation.

Item does not contain fulltext

Item does not contain fulltext

Contains fulltext : 47961.pdf (Publisher’s version ) (Closed access) Invasive aspergillosis remains an important cause of morbidity and mortality in patients with prolonged and severe immune suppression such as following haematopoietic stem-cell transplantation. Consensus definitions, which allow categorisation of patients based on diagnostic criteria, are an important improvement in uniform registration of invasive mycoses in clinical trials. Prospective monitoring of high-risk patients for the circulating aspergillus cell-wall component galactomannan, results in earlier diagnosis in two-thirds of patients when compared with conventional diagnostic methods. High-resolution CT (HRCT) enables the lesions characteristic of invasive mycoses to be detected earlier and better than by chest radiograph. In addition, invasive mycoses cause characteristic lesions on the HRCT scan including the halo-sign and the air-crescent sign. The pre-emptive management strategy which combines monitoring of patients for surrogate markers with a HRCT scan appears to be a promising approach to the early identification and treatment of patients with invasive aspergillosis.

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext INTRODUCTION: Transfusion guidelines may result in unwanted delay in infusion schemes, as simultaneous infusion of blood components and drug solutions is universally prohibited. The aim of this study was to measure possible damage to red cells by drug solutions, as manifested by haemolysis, using a dynamic model that resembles the clinical setting. METHODS: Stored filtered and irradiated RBC concentrates and drug solutions were co-infused in an in vitro dynamic model. Also, incubation in a static model was performed. The haemolytic potency of the drug solutions was measured by determining free haemoglobin (fHb) levels. RESULTS AND DISCUSSION: Neither in the dynamic tests nor in the static tests did fHb levels exceed the maximally acceptable standard for filtered RBC concentrates according to Dutch specification guidelines. In the static test model, fHb levels were slightly elevated compared with those of control samples, as well as those in the dynamic test model. CONCLUSION: A novel in vitro dynamic infusion system appears to represent a useful technique to calculate possible damage to RBCs resulting from co-infused drug solutions. Co-infusion of the drug solutions tested with filtered and irradiated RBC concentrates did not produce fHb levels above the levels accepted by the Dutch national guidelines. Apart from haemolysis, other parameters reflecting RBC damage should be investigated in future studies.

Item does not contain fulltext False-positive tests for Aspergillus galactomannan have been reported in neutropenic patients. We failed to detect any circulating antigen during the 2 weeks following allogeneic haematopoietic stem cell transplantation of 12 patients who had severe mucositis but were unable to eat.

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Contains fulltext : 120764.pdf (Publisher’s version ) (Open Access)

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext 3 p.

Contains fulltext : 23696___.PDF (Publisher’s version ) (Open Access) rights: (c)RU Radboud Universiteit Nijmegen, 1996

Item does not contain fulltext

Contains fulltext : 20632___.PDF (Publisher’s version ) (Open Access)

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Item does not contain fulltext

Contains fulltext : mmubn000001_026634295.pdf (Publisher’s version ) (Open Access) Promotor : C. Haanen 79 p.

Contains fulltext : 30950_reguofal.pdf (Publisher’s version ) (Open Access) Contains fulltext : 53670.pdf (Publisher’s version ) (Open Access) RU Radboud Universiteit Nijmegen, 19 december 2007 Promotor : Pauw, B.E. de Co-promotores : Joosten, I., Hilbrands, L.B. 192 p.

Contains fulltext : 51787.pdf (Publisher’s version ) (Open Access) RU Radboud Universiteit Nijmegen, 24 mei 2007 Promotor : Pauw, B.E. de Co-promotores : Joosten, I., Hilbrands, L.B. 159 p.

Contains fulltext : 26945_mucobaina.pdf (Publisher’s version ) (Open Access) The intensive chemotherapy with or without radiation therapy used to prepare for a haematopoietic stem cell transplant (HSCT) is unfortunately complicated by damage to the mucosa of the digestive tract. The resultant, mucosal barrier injury (MBI) causes painful ulcerations, which are readily apparent in mouth and are known as mucositis. This makes eating and drinking difficult at a time when patients need optimal nutrition. Moreover until very recently there were no specific remedies of proven value. Patients had to rely on pain relief and other palliative measures to alleviate the symptoms of mucositis. MBI is a dynamic and complex pathobiological process consisting of 4 phases; an inflammatory-, epithelial-, ulcerative/infective- and a healing phase. Initially, small intestinal epithelial cells secrete pro-inflammatory cytokines after exposure to cytotoxic therapy. This phase is mediated by nuclear factor-kappa B activation. Curcumin is able to inhibit this process, resulting in partial amelioration of villous atrophy providing a potentially new approach preventing MBI. MBI was measured among more than 100 HSCT recipients by scoring oral mucositis, determining gut toxicity (nausea, vomiting, diarrhoea and cramps) and by undertaking a permeability test consisting of four sugars (D-xylose, 3-O-methyl-D-glucose, L-rhamnose and lactulose). These features of MBI were significantly correlated with each other but each tool measured a different aspect of MBI. Gut integrity and absorption were still abnormal 3 to 4 weeks after transplant. Novel use was also made of serum citrulline to determine intestinal MBI since the amino acid is a marker of small bowel enterocyte mass. The results showed citrulline to be a more sensitive and specific marker of gut MBI than the other tools. A prospective, randomised, double-blinded, placebo-controlled study with glutamine-dipeptide supplementation failed to ameliorate MBI in HSCT recipients. However it became clear that a significant increase in the levels of inflammatory response markers (IL-8, LBP and CRP) was seen in patients mirroring the pattern of MBI. These markers were already significantly elevated before the onset of fever or bacteraemia during profound neutropenia suggesting that the degree of MBI rather than bacteraemia determines the intensity of this inflammatory response. Hence, aiming either to down-regulate the inflammatory response or at restoring the barrier by stimulating epithelial cell functioning may be more fruitful in protecting HSCT recipients from infectious complications than antimicrobial therapy. RU Radboud Universiteit Nijmegen, 27 juni 2005 Promotor : Pauw, B.E. de Co-promotores : Donnelly, J.P., Schattenberg, A.V.M.B. 186 p.