1
|
Smeets MM, Vandenbossche P, Duijst WL, Mook WNV, Leers MPG. Validation of a new method for saliva cortisol testing to assess stress in first responders. Emerg Med J 2021; 38:297-302. [PMID: 33574024 DOI: 10.1136/emermed-2019-209205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/09/2020] [Accepted: 01/07/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Acute or chronic stress can lead to physical and mental disorders. Measuring cortisol can objectify the degree of stress. Cortisol is traditionally measured in serum, but recently the relevant fraction of free cortisol can be reliably measured in saliva, using the very sensitive liquid chromatography tandem mass spectrometry (LC-MS/MS) method. The use of saliva is non-invasive and allows easy serial testing around stressful events. The main objective of this study is to investigate whether serial saliva cortisol determinations using the LC-MS/MS method can be used to assess the stress response that first responders may experience during moments of acute professional deployment in their daily work. METHODS Healthy first responders (police officers, firefighters, rapid response team, ambulance personnel, first aid and emergency medical personnel) were recruited to participate in a Euregional high-reliability simulation training ('Be Aware'-scenario training, 19 April 2018). At three time points, simultaneous venous blood samples and saliva samples were obtained. These time points were 1 hour before, immediately after and 10 hours after the simulation training. The correlation between changes in saliva cortisol measured by LC-MS/MS and serum cortisol at all three time points was determined. Results were compared with spectators not directly participating in the simulation. RESULTS 70 subjects participated in the simulation. There was a strong correlation between the changes in saliva and blood cortisol at the three time points. A significant increase in blood and saliva cortisol was shown 1 hour after the experienced stress moments. The levels had almost completely returned to baseline in all healthy volunteers 10 hours later. Cortisol in spectators was unaffected. CONCLUSION Serial saliva cortisol measurements using LC-MS/MS is a reliable and fast non-invasive functional stress assay, which can be easily collected in daily practice and used for investigation and monitoring of stress response in front line responders.
Collapse
Affiliation(s)
- Math Mj Smeets
- Clinical Chemistry & Hematology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Piet Vandenbossche
- School of Business & Economics, Maastricht University, Maastricht, The Netherlands.,Faculty of Social Sciences, University of Antwerpen, Antwerpen, Belgium
| | - Wilma Ljm Duijst
- Department of Criminal Law and Criminology, Maastricht University, Maastricht, The Netherlands.,Deptartment of Forensic Sciences, GGD IJsselland, Zwolle, The Netherlands
| | - Walther Nka van Mook
- Department of Intensive Care Medicine, Academisch Ziekenhuis Maastricht, Maastricht, The Netherlands.,School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Mathie P G Leers
- Clinical Chemistry & Hematology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| |
Collapse
|
2
|
Alexandrescu V, Hubermont G, Philips Y, Guillaumie B, Ngongang C, Coessens V, Vandenbossche P, Coulon M, Ledent G, Donnay JC. Combined Primary Subintimal and Endoluminal Angioplasty for Ischaemic Inferior-limb Ulcers in Diabetic Patients: 5-year Practice in a Multidisciplinary ‘Diabetic-Foot’ Service. Eur J Vasc Endovasc Surg 2009; 37:448-56. [DOI: 10.1016/j.ejvs.2008.12.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 12/14/2008] [Indexed: 11/17/2022]
|
3
|
Alexandrescu V, Ngongang C, Coulon M, Vandenbossche P. Large non-anastomotic false aneurysm on dacron aortobifemoral prosthesis solved by endovascular exclusion. Acta Chir Belg 2008; 108:747-9. [PMID: 19241931 DOI: 10.1080/00015458.2008.11680329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aortic and iliac pseudo-aneurysms are infrequent but challenging complications after open surgical graft reconstructions, mostly having para-anastomotic localisations. The true corporeal peri-prosthetic false aneurysms are, up until now, very rarely documented presentations. We report the clinical case of an 8.8 cm diameter non-anastomotic and aseptic pseudo-aneurysm developed on aorto-bifemoral Dacron prosthesis in a symptomatic and high surgical risk patient. Considering the clinical presentation and the anatomical features, a chronic tear of the posterior prosthetic wall by prominent aortic remnant calcifications was evoked as the possible aetiology. An endovascular exclusion, using a tapered aorto-uni-iliac endograft coupled to a femoro-femoral bypass revascularisation, was technically successful. Despite scarce published clinical data focusing on the optimal treatment dedicated to this category of false aneurysm, this approach is thought to be beneficial in selected cases of high-risk surgical patients.
Collapse
Affiliation(s)
- V. Alexandrescu
- Department of Vascular Surgery, Princesse Paola Hospital, Marche-en-Famenne and Sainte-Thérèse Hospital, Bastogne, Belgium
| | - Chr. Ngongang
- Department of Vascular Surgery, Princesse Paola Hospital, Marche-en-Famenne and Sainte-Thérèse Hospital, Bastogne, Belgium
| | - M. Coulon
- Department of Radiology Princesse Paola Hospital, Marche-en-Famenne, Belgium
| | - P. Vandenbossche
- Department of Emergency Care, Princesse Paola Hospital, Marche-en-Famenne, Belgium
| |
Collapse
|
4
|
Vanpee D, Swine C, Vandenbossche P, Gillet JB. Epidemiological profile of geriatric patients admitted to the emergency department of a university hospital localized in a rural area. Eur J Emerg Med 2001; 8:301-4. [PMID: 11785598 DOI: 10.1097/00063110-200112000-00010] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The number of geriatric patients admitted to the accident and emergency department is growing. These patients also present increasing functional dependence and a large panel of associated diseases and associated problems. For the purpose of describing this phenomenon, we prospectively studied the epidemiology of patients 75 years and older entering the emergency department of a university hospital localized in a rural area. From January 1996 up to January 1997, 1298 patients aged 75 years or older were admitted to the emergency department. This age group represented 12.3% of all the patients admitted during the period. The gender distribution was almost equal: 56% were female and 44% male. Most of them (75%) were referred by their general practitioner although 15% came spontaneously. The most common complaints were, in decreasing order: general condition impairment (21.5%), dyspnoea (15%), falls and traumas (15%), abdominal problems (13%), thoracic pain (9%), syncope, dizziness (7%) and stroke (5.5%). Hospitalization was necessary in 69% of cases. Among the patients coming spontaneously a larger proportion (55%) were sent back home compared with only 25% of those referred by their general practitioner.
Collapse
Affiliation(s)
- D Vanpee
- Emergency Unit, Université Catholique de Louvain, Mont-Godinne University Hospital, Yvoir, Belgium
| | | | | | | |
Collapse
|
5
|
Abstract
AIM By a prospective study, authors tried to analyse the quality of management of the pediatric patient admitted in the emergency department. POPULATION AND METHODS One hundred admission files were prospectively analysed for characteristics of age (mean age: 70 months), effectiveness of measurement of physiological parameters, evaluation of appropriateness of nursing management according to recorded parameters, length of stay in the emergency department according to the need for hospitalization, blood tests, X-rays and the seniority of the attending medical staff. RESULTS Parameters were not, or only incompletely, recorded in 65 files. . Although all were recorded in the remaining 35 files, subsequent management was inadequate in seven cases. Mean length of stay in the emergency department was 116 minutes, influenced by the need for hospitalization (145 minutes compared to 102 minutes for the non-hospitalized children), timing of admission (mean: 125 minutes from 8 am to 6 pm, compared to 94 minutes from 6 pm to 8 am), need for blood tests, X-rays or both (mean: 122, 107 and 170 minutes respectively, compared to 55 minutes when no complementary exam was asked) and seniority of attending medical staff (mean: 65 minutes for permanent staff compared to 116 minutes for fellows). CONCLUSIONS Measurement of physiological parameters must be standard practise in the management of pediatric patients admitted to the emergency department and must lead to appropriate management without undue delay. In order to reach this goal, emergency departments should be more adequately staffed with nurses and senior doctors specifically trained in the care of the pediatric patient. Blood tests and X-rays should be more readily available.
Collapse
Affiliation(s)
- E Bodart
- Service de pédiatrie, cliniques universitaires UCL de Mont-Godinne, Belgique
| | | | | | | | | |
Collapse
|
6
|
Affiliation(s)
- E Bodart
- Department of Paediatrics, Catholic University of Louvain at Mont-Godinne, Yvoir, Belgium
| | | | | | | | | |
Collapse
|
7
|
Rosiere A, Michel LA, de Canniere L, Vandenbossche P, Joucken K. Surgery as a 'last resort' option for active variceal bleeding further complicated by iatrogenic oesophageal perforation. Br J Surg 1997; 84:858-9. [PMID: 9189109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- A Rosiere
- Surgical Services, University of Louvain Medical School, Mont-Godinne University Hospital, Yvoir, Belgium
| | | | | | | | | |
Collapse
|
8
|
Rosiere A, Michel LA, De Canniere L, Vandenbossche P, Joucken K. Surgery as a ‘last resort’ option for active variceal bleeding further complicated by iatrogenic oesophageal perforation. Br J Surg 1997. [DOI: 10.1046/j.1365-2168.1997.02683.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
9
|
Michel LA, Lacrosse M, Decannière L, Rosière A, Vandenbossche P, Trigaux JP. Spiral computed tomography with three-dimensional reconstructions for severe blunt abdominal traumas: a useful complementary tool? Eur J Emerg Med 1997; 4:87-93. [PMID: 9228449 DOI: 10.1097/00063110-199706000-00006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Spiral computed tomography (CT) has proved to be a valuable tool by providing three-dimensional (3D) images of the studied structures. We hypothesized that a more realistic depiction of lesions by 3D CT could be of interest for surgeons who are treating blunt abdominal traumas and lead to less inappropriate triage. A good working relationship between surgeons and radiologists allowed us to perform a 3D CT examination in six patients. In the first patient, the 3D CT accurately demonstrated spleen fragmentation without devascularized fragment. The second patient had complete devascularization of the spleen upper pole. Conservative treatment was pursued for both patients. For the third patient, 3D CT helped us to differentiate peritoneal-perisplenic fluid from subcapsular fluid. The fourth patient had minor spleen injury associated with severe lacerations of the left kidney. 3D CT showed a complete separation of the kidney lower pole. A delayed partial lower nephrectomy was performed. The fifth patient presented a fragmented spleen and transient massive haematuria related to a well-contained laceration of the kidney upper pole that were amenable to nonoperative management. The sixth patient was emergency operated for active bleeding from a fragmented spleen. 3D CT performed 2 months after spleen repair allowed the assessment of the amount of devascularized tissue, as well as the status of the upper abdomen arteries. For haemodynamically stable patients, 3D CT could be a helpful addition to conventional axial CT for quantifying blunt abdominal traumas, for making the choice between nonoperative and operative treatment, but also between emergency and delayed surgical strategy.
Collapse
Affiliation(s)
- L A Michel
- University of Louvain School of Medicine at Mont-Godinne University Hospital, Yvoir, Belgium
| | | | | | | | | | | |
Collapse
|
10
|
de Cannière L, Michel LA, Lorge F, Rosière A, Vandenbossche P. Direct carbon dioxide insufflation of the retroperitoneum under laparoscopic control for renal and adrenal surgery. Eur J Surg 1997; 163:339-44. [PMID: 9195166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Assessment of the videoscopic approach to the retroperitoneal space in the vicinity of the kidney and the adrenal gland. DESIGN Open study. SETTING University hospital, Belgium. SUBJECTS 10 patients who underwent 11 operations (adrenalectomy, n = 3, nephrectomy, n = 5, partial nephrectomy, n = 2, and renal cystectomy, n = 1). INTERVENTIONS Direct CO2 insufflation of the retroperitoneal space in order to obtain a convenient retroperitoneal working space for renal and adrenal surgery. OUTCOME MEASURES Feasibility, morbidity and mortality. RESULTS 8 patients were operated on exclusively by the retroperitoneoscopic approach; 2 required the retroperitoneal and transperitoneal routes to be combined to complete an adrenalectomy. No patients required blood transfusion and no patient died. Median postoperative stay was 3 days. CONCLUSION The CO2 insufflation technique of the retroperitoneum is safe and reproducible. Nevertheless, far from excluding each other, both approaches-laparoscopic and retroperitoneoscopic-are complementary in difficult cases, particularly for adrenal endoscopic surgery and for larger renal lesions.
Collapse
Affiliation(s)
- L de Cannière
- Surgical Service, University of Louvain Medical School, Mont-Godinne University Hospital, Yvoir, Belgium
| | | | | | | | | |
Collapse
|
11
|
Michel LA, Lacrosse M, Decannière L, Lorge F, Rosière A, Vandenbossche P, Trigaux JP. Blunt renal traumas: contribution of spiral CT with three dimensional reconstruction to the surgical decision process? Int Surg 1996; 81:377-81. [PMID: 9127799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Spiral CT has proved to be a valuable tool by providing various kinds of three-dimensional (3D) images of the studied structures. Such 3D images, which offer a more realistic depiction of the lesions, could be of interest for surgeons who are attempting to treat conservatively blunt abdominal traumas and lead to less inappropriate triage between conservative and operative management particularly for renal trauma. A good working relationship between surgeons and radiologists allowed us to perform an early follow-up 3D spiral CT on a commercially available spiral CT scanner. In the first adult patient, the 3D CT demonstrated minor spleen injury associated with severe lacerations of the left kidney with complete separation of the kidney lower pole. A delayed partial lower nephrectomy was performed. For the second 12-year-old patient presenting with severe spleen trauma and macroscopic hematuria, the 3D CT accurately documented the spleen and renal lesions that were safely amenable to nonoperative treatment. For hemodynamically stable patients, 3D CT is a potentially helpful addition to conventional axial CT for quantifying blunt renal traumas and for making the strategic choice between nonoperative, emergency or delayed surgical treatment.
Collapse
Affiliation(s)
- L A Michel
- Service of Surgery, University of Louvain School of Medicine, Mont-Godinne University Hospital, Yvoir, Belgium
| | | | | | | | | | | | | |
Collapse
|
12
|
Frippiat F, Donckier J, Vandenbossche P, Stoffel M, Boland B, Lambert M. Splenic infarction: report of three cases of atherosclerotic embolization originating in the aorta and retrospective study of 64 cases. Acta Clin Belg 1996; 51:395-402. [PMID: 8997756 DOI: 10.1080/22953337.1996.11718537] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The authors report 3 cases of thromboembolic splenic infarction due to atherosclerosis of the thoracic aorta and the splenic artery. On this occasion, a retrospective analysis of 64 splenic infarcts showed that, in contrast to the literature, the leading aetiology in our series consisted of haematologic disorders (50%), followed by cardiovascular diseases (29%) and by digestive disorders (20%). Mean age was 58 +/- 17 years and 50% of the patients were aged below 60 years. Hospital mortality rate was high (34%) but not directly related to splenic infarction, suggesting that splenic infarction often occurs in the setting of severe underlying diseases. Splenic infarct is part of the differential diagnosis of the left upper quadrant pain and can also mimic renal disorders. Laboratory values may show an inflammatory syndrome and an increase in serum lactate deshydrogenase. Diagnosis is often made by CT scan and can be confirmed by a selective spleen scintigraphy. Transoesophageal echocardiography is essential in the detection of cardiac and thoracic aorta embolic material.
Collapse
Affiliation(s)
- F Frippiat
- Service de Médecine Interne Générale et Endocrinologie, Cliniques de Mont-Godinne, Bruxelles
| | | | | | | | | | | |
Collapse
|
13
|
Abstract
A prospective study was carried out to assess the incidence and type of complications after non-therapeutic operations for penetrating trauma. A total of 372 operations were performed on 368 patients with penetrating injuries to the abdomen (240 procedures), chest (49), neck (48) and extremities (35). There were 46 negative or non-therapeutic operations. The incidence of major complications directly related to anaesthesia or operation in this group of patients was 4 percent (two patients). The operation might have contributed to a further three major complications. The mean hospital stay for patients undergoing uncomplicated non-therapeutic operation was 4.1 days; for those with complications it was 21.2 days. It is concluded that non-therapeutic operations for penetrating trauma carry a significant morbidity rate. A policy of selective conservatism is advocated.
Collapse
Affiliation(s)
- D Demetriades
- Department of Surgery, Baragwanath Hospital, University of Witwatersrand, Johannesburg, South Africa
| | | | | | | | | |
Collapse
|