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De Ridder F, Braspenning R, Ordonez JS, Klarenbeek G, Lauwers P, Ledeganck KJ, Delbeke D, De Block C. Early feasibility study with an implantable near-infrared spectroscopy sensor for glucose, ketones, lactate and ethanol. PLoS One 2024; 19:e0301041. [PMID: 38701088 PMCID: PMC11068174 DOI: 10.1371/journal.pone.0301041] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 02/18/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVE To evaluate the safety and performance of an implantable near-infrared (NIR) spectroscopy sensor for multi-metabolite monitoring of glucose, ketones, lactate, and ethanol. RESEARCH DESIGN AND METHODS This is an early feasibility study (GLOW, NCT04782934) including 7 participants (4 with type 1 diabetes (T1D), 3 healthy volunteers) in whom the YANG NIR spectroscopy sensor (Indigo) was implanted for 28 days. Metabolic challenges were used to vary glucose levels (40-400 mg/dL, 2.2-22.2 mmol/L) and/or induce increases in ketones (ketone drink, up to 3.5 mM), lactate (exercise bike, up to 13 mM) and ethanol (4-8 alcoholic beverages, 40-80g). NIR spectra for glucose, ketones, lactate, and ethanol levels analyzed with partial least squares regression were compared with blood values for glucose (Biosen EKF), ketones and lactate (GlucoMen LX Plus), and breath ethanol levels (ACE II Breathalyzer). The effect of potential confounders on glucose measurements (paracetamol, aspartame, acetylsalicylic acid, ibuprofen, sorbitol, caffeine, fructose, vitamin C) was investigated in T1D participants. RESULTS The implanted YANG sensor was safe and well tolerated and did not cause any infectious or wound healing complications. Six out 7 sensors remained fully operational over the entire study period. Glucose measurements were sufficiently accurate (overall mean absolute (relative) difference MARD of 7.4%, MAD 8.8 mg/dl) without significant impact of confounders. MAD values were 0.12 mM for ketones, 0.16 mM for lactate, and 0.18 mM for ethanol. CONCLUSIONS The first implantable multi-biomarker sensor was shown to be well tolerated and produce accurate measurements of glucose, ketones, lactate, and ethanol. TRIAL REGISTRATION Clinical trial identifier: NCT04782934.
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Affiliation(s)
- Francesca De Ridder
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine & Health Science, Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Rie Braspenning
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Antwerp, Belgium
| | | | | | - Patrick Lauwers
- Department of Vascular & Thoracic Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Kristien J. Ledeganck
- Faculty of Medicine & Health Science, Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | | | - Christophe De Block
- Department of Endocrinology-Diabetology-Metabolism, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine & Health Science, Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
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Lauwers P, Wouters K, Vanoverloop J, Avalosse H, Hendriks JMH, Nobels F, Dirinck E. The impact of diabetes on mortality rates after lower extremity amputation. Diabet Med 2024; 41:e15152. [PMID: 37227722 DOI: 10.1111/dme.15152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To assess the impact of diabetes, amputation level, sex and age on mortality rates after lower extremity amputation (LEA) in Belgium, and to assess temporal trends in one-year survival rates from 2009 to 2018. METHODS Nationwide data on individuals who underwent minor and major LEA from 2009 to 2018 were collected. Kaplan-Meier survival curves were constructed. A Cox regression model with time-varying coefficients was used to estimate the likelihood of mortality after LEA in individuals with or without diabetes. Matched amputation-free individuals with or without diabetes were used for comparison. Time trends were analysed. RESULTS Amputations 41,304 were performed: 13,247 major and 28,057 minor. Five-year mortality rates in individuals with diabetes were 52% and 69% after minor and major LEA, respectively (individuals without diabetes: 45% and 63%, respectively). In the first six postoperative months, no differences in mortality rates were found between individuals with or without diabetes. Later, hazard ratios (HRs) for mortality in individuals with diabetes (compared with no diabetes) after minor LEA ranged from 1.38 to 1.52, and after major LEA from 1.35 to 1.46 (all p ≤ 0.005). Among individuals without LEA, HRs for mortality in diabetes (versus no diabetes) were systematically higher compared to the HRs for mortality in diabetes (versus no diabetes) after minor and major LEA. One-year survival rates did not change for individuals with diabetes. CONCLUSIONS In the first six postoperative months, mortality rates after LEA were not different between individuals with or without diabetes; later, diabetes was significantly associated with increased mortality. However, as HRs for mortality were higher in amputation-free individuals, diabetes impacts mortality less in the minor and major amputation groups relative to the comparison group of individuals without LEA.
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Affiliation(s)
- Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Kristien Wouters
- Antwerp University Hospital, Clinical Trial Center (CTC), CRC Antwerp, Edegem, Belgium
| | - Johan Vanoverloop
- IMA/AIM (Intermutualistisch Agentschap/Agence Intermutualiste), Brussels, Belgium
| | - Hervé Avalosse
- IMA/AIM (Intermutualistisch Agentschap/Agence Intermutualiste), Brussels, Belgium
- Landsbond der Christelijke Mutualiteiten/Alliance Nationale des Mutualités Chrétiennes, Brussels, Belgium
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Frank Nobels
- Department of Endocrinology, Onze Lieve Vrouw Ziekenhuis Aalst, Aalst, Belgium
| | - Eveline Dirinck
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Edegem, Belgium
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Lauwers P, Hendriks JMH, Wouters K, Vanoverloop J, Avalosse H, Dirinck E, Nobels F. Impact of diabetes on medical costs in the pre- and postoperative year of lower extremity amputations in Belgium. Diabetes Res Clin Pract 2024; 207:111072. [PMID: 38142745 DOI: 10.1016/j.diabres.2023.111072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/10/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
AIMS To compare the medical costs of individuals undergoing lower extremity amputation (LEA) in Belgium with those of amputation-free individuals. METHODS Belgian citizens undergoing LEAs in 2014 were identified. The median costs per capita in euros for the 12 months preceding and following minor and major LEAs were compared with those of matched amputation-free individuals. RESULTS A total of 3324 Belgian citizens underwent LEAs (2295 minor, 1029 major), 2130 of them had diabetes. The comparison group included 31,716 individuals. Amputation was associated with high medical costs (individuals with diabetes: major LEA €49,735, minor LEA €24,243, no LEA €2,877 in the year preceding amputation; €45,740, €21,445 and €2,284, respectively, in the post-amputation year). Significantly higher costs were observed in the individuals with (versus without) diabetes in all groups. This difference diminished with higher amputation levels. Individuals undergoing multiple LEAs generated higher costs (individuals with diabetes: €39,313-€89,563 when LEAs preceded index amputation; €46,629-€92,877 when LEAs followed index amputation). Individuals dying in the year after a major LEA generated remarkably lower costs. CONCLUSIONS LEA-related medical costs were high. Diabetes significantly impacted costs, but differences in costs diminished with higher amputation levels. Individuals with multiple amputations generated the highest costs.
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Affiliation(s)
- Patrick Lauwers
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Drie Eikenstraat 655, B-2650 Edegem, Belgium; University of Antwerp, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Universiteitsplein 1, B-2610 Wilrijk, Belgium.
| | - Jeroen M H Hendriks
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Drie Eikenstraat 655, B-2650 Edegem, Belgium; University of Antwerp, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Universiteitsplein 1, B-2610 Wilrijk, Belgium
| | - Kristien Wouters
- Antwerp University Hospital, Clinical Trial Centre (CTC), CRC Antwerp, Drie Eikenstraat 655, B-2650 Edegem, Belgium
| | - Johan Vanoverloop
- Intermutualistisch Agentschap/Agence Intermutualiste (IMA/AIM), Bolwerklaan 21 B 7, B-1210 Brussels, Belgium
| | - Hervé Avalosse
- Intermutualistisch Agentschap/Agence Intermutualiste (IMA/AIM), Bolwerklaan 21 B 7, B-1210 Brussels, Belgium; Landsbond der Christelijke Mutualiteiten/Alliance Nationale des Mutualités Chrétiennes, Haachtsesteenweg 579 B 40, B-1031 Brussels, Belgium
| | - Eveline Dirinck
- Antwerp University Hospital, Department of Endocrinology, Diabetology and Metabolism, Drie Eikenstraat 655, B-2650 Edegem, Belgium; University of Antwerp, Laboratory of Experimental Medicine and Paediatrics (LEMP), Universiteitsplein 1, B-2610 Wilrijk, Belgium
| | - Frank Nobels
- Onze Lieve Vrouw Ziekenhuis Aalst, Department of Endocrinology, Moorselbaan 164, B-9300 Aalst, Belgium
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Berzenji L, Wen W, Verleden S, Claes E, Yogeswaran SK, Lauwers P, Van Schil P, Hendriks JMH. Minimally Invasive Surgery in Non-Small Cell Lung Cancer: Where Do We Stand? Cancers (Basel) 2023; 15:4281. [PMID: 37686557 PMCID: PMC10487098 DOI: 10.3390/cancers15174281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/04/2023] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
In the last two decades, robotic-assisted thoracoscopic surgery (RATS) has gained popularity as a minimally invasive surgical (MIS) alternative to multi- and uniportal video-assisted thoracoscopic surgery (VATS). With this approach, the surgeon obviates the known drawbacks of conventional MIS, such as the reduced in-depth perception, hand-eye coordination, and freedom of motion of the instruments. Previous studies have shown that a robotic approach for operable lung cancer has treatment outcomes comparable to other MIS techniques such as multi-and uniportal VATS, but with less blood loss, a lower conversion rate to open surgery, better lymph node dissection rates, and improved ergonomics for the surgeon. The thoracic surgeon of the future is expected to perform more complex procedures. More patients will enter a multimodal treatment scheme making surgery more difficult due to severe inflammation. Furthermore, due to lung cancer screening programs, the number of patients presenting with operable smaller lung nodules in the periphery of the lung will increase. This, combined with the fact that segmentectomy is becoming an increasingly popular treatment for small peripheral lung lesions, indicates that the future thoracic surgeons need to have profound knowledge of segmental resections. New imaging techniques will help them to locate these lesions and to achieve a complete oncologic resection. Current robotic techniques exist to help the thoracic surgeon overcome these challenges. In this review, an update of the latest MIS approaches and nodule detection techniques will be given.
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Affiliation(s)
- Lawek Berzenji
- Department of Thoracic and Vascular Surgery, University of Antwerp, 2610 Wilrijk, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Laboratory of Thoracic and Vascular Surgery, 2650 Edegem, Belgium
| | - Wen Wen
- Department of Thoracic and Vascular Surgery, University of Antwerp, 2610 Wilrijk, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Laboratory of Thoracic and Vascular Surgery, 2650 Edegem, Belgium
| | - Stijn Verleden
- Department of Thoracic and Vascular Surgery, University of Antwerp, 2610 Wilrijk, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Laboratory of Thoracic and Vascular Surgery, 2650 Edegem, Belgium
| | - Erik Claes
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Laboratory of Thoracic and Vascular Surgery, 2650 Edegem, Belgium
| | - Suresh Krishan Yogeswaran
- Department of Thoracic and Vascular Surgery, University of Antwerp, 2610 Wilrijk, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Laboratory of Thoracic and Vascular Surgery, 2650 Edegem, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, University of Antwerp, 2610 Wilrijk, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Laboratory of Thoracic and Vascular Surgery, 2650 Edegem, Belgium
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, University of Antwerp, 2610 Wilrijk, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Laboratory of Thoracic and Vascular Surgery, 2650 Edegem, Belgium
| | - Jeroen M. H. Hendriks
- Department of Thoracic and Vascular Surgery, University of Antwerp, 2610 Wilrijk, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Laboratory of Thoracic and Vascular Surgery, 2650 Edegem, Belgium
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium
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Vanherwegen AS, Lauwers P, Lavens A, Doggen K, Dirinck E. Sex differences in diabetic foot ulcer severity and outcome in Belgium. PLoS One 2023; 18:e0281886. [PMID: 36795662 PMCID: PMC9934352 DOI: 10.1371/journal.pone.0281886] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Sex differences are increasingly recognized to play an important role in the epidemiology, treatment and outcomes of many diseases. This study aims to describe differences between sexes in patient characteristics, ulcer severity and outcome after 6 months in individuals with a diabetic foot ulcer (DFU). METHODS A total of 1,771 patients with moderate to severe DFU participated in a national prospective, multicenter cohort study. Data were collected on demographics, medical history, current DFU and outcome. For data analysis, a Generalized Estimating Equation model and an adjusted Cox proportional hazards regression were used. RESULTS The vast majority of patients included were male (72%). Ulcers in men were deeper, more frequently displaying probe to bone, and more frequently deeply infected. Twice as many men presented with systemic infection as women. Men demonstrated a higher prevalence of previous lower limb revascularization, while women presented more frequently with renal insufficiency. Smoking was more common in men than in women. No differences in presentation delay were observed. In the Cox regression analysis, women had a 26% higher chance of healing without major amputation as a first event (hazard ratio 1.258 (95% confidence interval 1.048-1.509)). CONCLUSIONS Men presented with more severe DFU than women, although no increase in presentation delay was observed. Moreover, female sex was significantly associated with a higher probability of ulcer healing as a first event. Among many possible contributing factors, a worse vascular state associated with a higher rate of (previous) smoking in men stands out.
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Affiliation(s)
| | - Patrick Lauwers
- Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Astrid Lavens
- Health Services Research, Sciensano, Brussels, Belgium
| | - Kris Doggen
- Health Services Research, Sciensano, Brussels, Belgium
| | - Eveline Dirinck
- Endocrinology, Diabetology and Metabolism, University Hospital Antwerp, Edegem, Belgium
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Deben C, De La Hoz EC, Compte ML, Van Schil P, Hendriks JMH, Lauwers P, Yogeswaran SK, Lardon F, Pauwels P, Van Laere S, Bogaerts A, Smits E, Vanlanduit S, Lin A. OrBITS: label-free and time-lapse monitoring of patient derived organoids for advanced drug screening. Cell Oncol 2022; 46:299-314. [PMID: 36508089 DOI: 10.1007/s13402-022-00750-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Patient-derived organoids are invaluable for fundamental and translational cancer research and holds great promise for personalized medicine. However, the shortage of available analysis methods, which are often single-time point, severely impede the potential and routine use of organoids for basic research, clinical practise, and pharmaceutical and industrial applications.
Methods
Here, we developed a high-throughput compatible and automated live-cell image analysis software that allows for kinetic monitoring of organoids, named Organoid Brightfield Identification-based Therapy Screening (OrBITS), by combining computer vision with a convolutional network machine learning approach. The OrBITS deep learning analysis approach was validated against current standard assays for kinetic imaging and automated analysis of organoids. A drug screen of standard-of-care lung and pancreatic cancer treatments was also performed with the OrBITS platform and compared to the gold standard, CellTiter-Glo 3D assay. Finally, the optimal parameters and drug response metrics were identified to improve patient stratification.
Results
OrBITS allowed for the detection and tracking of organoids in routine extracellular matrix domes, advanced Gri3D®-96 well plates, and high-throughput 384-well microplates, solely based on brightfield imaging. The obtained organoid Count, Mean Area, and Total Area had a strong correlation with the nuclear staining, Hoechst, following pairwise comparison over a broad range of sizes. By incorporating a fluorescent cell death marker, intra-well normalization for organoid death could be achieved, which was tested with a 10-point titration of cisplatin and validated against the current gold standard ATP-assay, CellTiter-Glo 3D. Using this approach with OrBITS, screening of chemotherapeutics and targeted therapies revealed further insight into the mechanistic action of the drugs, a feature not achievable with the CellTiter-Glo 3D assay. Finally, we advise the use of the growth rate-based normalised drug response metric to improve accuracy and consistency of organoid drug response quantification.
Conclusion
Our findings validate that OrBITS, as a scalable, automated live-cell image analysis software, would facilitate the use of patient-derived organoids for drug development and therapy screening. The developed wet-lab workflow and software also has broad application potential, from providing a launching point for further brightfield-based assay development to be used for fundamental research, to guiding clinical decisions for personalized medicine.
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Affiliation(s)
- Christophe Deben
- Center for Oncological Research (CORE), Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium.
| | | | - Maxim Le Compte
- Center for Oncological Research (CORE), Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | | | - Filip Lardon
- Center for Oncological Research (CORE), Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium
| | - Patrick Pauwels
- Center for Oncological Research (CORE), Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium
- Department of Pathology, Antwerp University Hospital, Edegem, Belgium
| | - Steven Van Laere
- Center for Oncological Research (CORE), Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium
| | - Annemie Bogaerts
- Plasma Lab for Applications in Sustainability and Medicine ANTwerp (PLASMANT), University of Antwerp, 2610, Wilrijk, Belgium
| | - Evelien Smits
- Center for Oncological Research (CORE), Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium
- Center for Cell Therapy and Regenerative Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Steve Vanlanduit
- Industrial Vision Lab, University of Antwerp, Groenenborgerlaan 171, 2020, Antwerp, Belgium
| | - Abraham Lin
- Center for Oncological Research (CORE), Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, Wilrijk, Belgium
- Plasma Lab for Applications in Sustainability and Medicine ANTwerp (PLASMANT), University of Antwerp, 2610, Wilrijk, Belgium
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Lauwers P, Wouters K, Vanoverloop J, Avalosse H, Hendriks J, Nobels F, Dirinck E. Temporal trends in major, minor and recurrent lower extremity amputations in people with and without diabetes in Belgium from 2009 to 2018. Diabetes Res Clin Pract 2022; 189:109972. [PMID: 35760154 DOI: 10.1016/j.diabres.2022.109972] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
AIMS This study assessed temporal trends in the incidence of lower extremity amputations (LEA) in Belgium from 2009 to 2018, and subsequent secondary amputation rates. METHODS Nationwide data on LEA were collected. Sex- and age-adjusted annual incidence rates were calculated. Time trends were analysed in negative binomial models. The incidence of secondary interventions, defined as either any ipsilateral reamputation or any contralateral amputation, was studied with death as competing risk. RESULTS 41 304 amputations were performed (13 247 major, 28 057 minor). In individuals with diabetes, the amputation rate (first amputation per patient per year) decreased from 143.6/100.000 person-years to 109.7 (IRR 0.97 per year, 95 %CI 0.96-0.98, p < 0.001). The incidence of major LEAs decreased from 56.2 to 30.7 (IRR 0.93, 95 %CI 0.91-0.94, p < 0.001); the incidence of minor amputations showed a non-significant declining trend in women (54.3 to 45.0/100 000 person years, IRR 0.97 per year, 95 %CI 0.96-0.99), while this remained stable in men with diabetes (149.2 to 135.3/100 000 person years, IRR 1.00 per year, 95 %CI 0.98-1.01). In individuals without diabetes, the incidence of major amputation didn't change significantly, whereas minor amputation incidence increased (8.0 to 10.6, IRR 1.04, 95 %CI 1.03-1.05, p < 0.001). In individuals with diabetes, one-year secondary intervention rates were high (31.3% after minor, 18.4% after major LEA); the incidence of secondary amputations didn't change. CONCLUSIONS A significant decline in the incidence rate of major LEA was observed in people with diabetes. This decline was not accompanied by a significant rise in minor LEA. The incidence of secondary interventions remained stable.
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Affiliation(s)
- Patrick Lauwers
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Drie Eikenstraat 655, B 2650 Edegem, Belgium.
| | - Kristien Wouters
- Antwerp University Hospital, Clinical Trial Center (CTC), CRC Antwerp, Drie Eikenstraat 655, B 2650 Edegem, Belgium
| | - Johan Vanoverloop
- IMA/AIM (Intermutualistisch Agentschap/Agence Intermutualiste), Bolwerklaan 21 B 7, 1210 Brussels, Belgium
| | - Hervé Avalosse
- IMA/AIM (Intermutualistisch Agentschap/Agence Intermutualiste), Bolwerklaan 21 B 7, 1210 Brussels, Belgium; Landsbond der Christelijke Mutualiteiten/Alliance Nationale des Mutualités Chrétiennes, Haachtsesteenweg 579 B 40, B 1031 Brussels, Belgium
| | - Jeroen Hendriks
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Drie Eikenstraat 655, B 2650 Edegem, Belgium
| | - Frank Nobels
- Onze Lieve Vrouw Ziekenhuis Aalst, Department of Endocrinology, Moorselbaan 164, B 9300 Aalst, Belgium
| | - Eveline Dirinck
- Antwerp University Hospital, Department of Endocrinology, Diabetology and Metabolism, Drie Eikenstraat 655, B 2650 Edegem, Belgium
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Verplancke V, Dams K, Raman P, Ruttens D, Thiessen S, Baar I, Jacobs R, Lauwers P, Yogeswaran K, Verleden S, Hendriks J, Kwakkel-van Erp J. Use of High Dose Corticosteroids Reversed COVID-19 Associated ARDS in a Patient Listed for Lung Transplantation. J Heart Lung Transplant 2022. [PMCID: PMC8988704 DOI: 10.1016/j.healun.2022.01.1363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction In acute respiratory distress syndrome (ARDS) patients with irreversible lung damage, lung transplantation from a ventilator and/or extracorporeal membrane oxygenation support (ECMO) is feasible. Recently, selection criteria for lung transplant candidates with a COVID-19 associated ARDS have been published. Here, we report the efficacy of high dose corticosteroids as ultimate salvage therapy, despite Meduri scheme attempts, in a patient listed for transplantation. Case Report A 50-year-old female with a medical history of Multiple Sclerosis (relapsing-remitting type under treatment with anti-alpha4 -integrin therapy), was tested positive for COVID-19. She deteriorated and was admitted to the hospital. High flow oxygen and dexamethasone (six milligram daily), were started but unfortunately, she developed a severe ARDS with need for mechanical ventilation and ECMO support. Corticosteroids according to the Meduri scheme and ciprofloxacin were started. Weaning trials were initiated but failed and CT-thorax showed consolidation and presumed fibrosis. After 37 days on ECMO, she was evaluated and listed for bilateral lung transplantation. A corticosteroid pulse therapy of 1000 mg of methylprednisolone IV for three days during antibiotic coverage with piperacillin/tazobactam was started and within three days the clinical condition of the patient improved and she could be weaned from ECMO (51 days of ECMO) and delisted from the lung transplantation waiting list. Nowadays, patient does not require oxygen, is at home and revalidating. Summary Here, we report the efficacy of a regimen with high dose corticosteroids as ultimate salvage therapy, despite Meduri scheme attempts, in a patient listed for transplantation. Corticosteroids are beneficial for immunomodulation and may reduce hyperinflammation. Our trial with administration of high dose corticosteroids pulse therapy in COVID-19 ARDS patients refractory to corticosteroids according to “classical schemes” has been successful and is informative. Further studies, will hopefully further elucidate responders and non-responders to high dose corticosteroid pulse therapy and preferably answer the question if prophylactic use of antibiotics and antifungals (in view of possible complications such as pulmonary aspergillosis and mucormycosis) is prudent in this vulnerable group.
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Lauwers P, Dirinck E, Van Bouwel S, Verrijken A, Van Dessel K, Van Gils C, Sels M, Peiffer F, Van Schil P, De Block C, Hendriks J. Malnutrition and its relation with diabetic foot ulcer severity and outcome: a review. Acta Clin Belg 2022; 77:79-85. [PMID: 32727304 DOI: 10.1080/17843286.2020.1800315] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Malnutrition has a detrimental effect on wound healing; hence, it might influence the outcome in people with a diabetic foot ulcer (DFU).The aim of this manuscript is to overview studies that describe the prevalence of malnutrition in DFU patients and assess the relation between malnutrition, DFU severity, and outcome. METHODS A literature review was performed. Malnutrition had to be defined by anthropometry and/or validated screening and assessment tools. RESULTS Five papers were included: one RCT, three prospective cohort studies and one retrospective observational study. A substantial number of patients were at risk for malnutrition (49%-70%) or were malnourished (15%-62%). In one study, nutritional status was related to DFU severity. Three authors demonstrated a negative influence of malnutrition on outcome. Two studies examined the prevalence of malnutrition after six months, but did not detect a decline in malnutrition rates. CONCLUSIONS Despite a large heterogeneity, all papers indicated that malnutrition is highly prevalent among DFU patients. Notwithstanding the lack of unequivocal evidence, malnutrition might have a negative influence on DFU outcome. Therefore, clinicians should pay attention to the nutritional status of people with a DFU.Abbreviations: BMI: Body Mass Index; DFU: Diabetic Foot Ulcer; DM: Diabetes Mellitus; GNRI: Geriatric Nutritional Risk Index; HbA1c: Glycated Hemoglobin; IWGDF: International Working Group on the Diabetic Foot; LEA: Lower Extremity Amputation; MNA: Mini Nutritional Assessment; MNA-SF: Mini Nutritional Assessment-Short Form; MUST: Malnutrition Universal Screening Tool; NRS-2002: Nutritional Risk Screening-2002; PAD: Peripheral Arterial Disease; RCT: randomized controlled trial; SGA: Subjective Global Assessment.
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Affiliation(s)
- Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Eveline Dirinck
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital (UZA), Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics (LEMP), Division of Endocrinology, University of Antwerp, Antwerp, Belgium
| | - Saskia Van Bouwel
- Department of Orthopedic Surgery, Antwerp University Hospital (UZA), Edegem, Belgium
| | - An Verrijken
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital (UZA), Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics (LEMP), Division of Endocrinology, University of Antwerp, Antwerp, Belgium
| | - Kristof Van Dessel
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital (UZA), Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics (LEMP), Division of Endocrinology, University of Antwerp, Antwerp, Belgium
| | - Carolien Van Gils
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Michaël Sels
- Department of Clinical Nutrition and Dietetics, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Frida Peiffer
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital (UZA), Edegem, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Antwerp, Belgium
| | - Christophe De Block
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital (UZA), Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics (LEMP), Division of Endocrinology, University of Antwerp, Antwerp, Belgium
| | - Jeroen Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital (UZA), Edegem, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Antwerp, Belgium
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10
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Timmers M, Dirinck E, Lauwers P, Wuyts W, De Block C. ABCC8 variants in MODY12: Review of the literature and report of a case with severe complications. Diabetes Metab Res Rev 2021; 37:e3459. [PMID: 34014594 DOI: 10.1002/dmrr.3459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/31/2021] [Accepted: 04/13/2021] [Indexed: 11/10/2022]
Abstract
More than 1000 variants of the ATP-binding cassette transporter subfamily C member 8 (ABCC8) gene have been reported in neonatal diabetes mellitus. Up to now only 55 ABCC8 variants were associated with Maturity-Onset Diabetes of the Young 12 (MODY12). We present a c.3544C>T p.(Arg1182Trp) ABCC8 variant in a 35-year-old women who had pronounced microvascular diabetic complications and a charcot arthropathy necessitating a lower limb amputation. The unusual severity of the disease course prompted us to perform a systematic review of all genetic variants in MODY12. The present mutation has mostly been associated with neonatal diabetes and in only three papers reporting a MODY12. The 55 MODY12 variants show a large clinical heterogeneity, even in relatives with the same mutation, ranging from mild impaired glucose tolerance to severe insulin-dependent diabetes mellitus. HbA1c at diagnosis ranged from 5% to 14% and age at diagnosis ranged from 2 to 53 years. However, several case reports lack documentation of diabetic complications. Hence, more detailed reports remain necessary to improve insight in MODY12 pathophysiology and outcome. In this article current data regarding therapeutic management are provided, and key points to consider for the individual patient affected by MODY12 are presented.
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Affiliation(s)
- Marijke Timmers
- Department of Endocrinology, Diabetology, and Metabolism, Antwerp University Hospital, Edegem, Belgium
| | - Eveline Dirinck
- Department of Endocrinology, Diabetology, and Metabolism, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Patrick Lauwers
- Department of Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Wim Wuyts
- Department of Medical Genetics, Antwerp University Hospital, Edegem, Belgium
| | - Christophe De Block
- Department of Endocrinology, Diabetology, and Metabolism, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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11
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Diebels I, Hendriks JMH, Van Meerbeeck JP, Lauwers P, Janssens A, Yogeswaran SK, Van Schil PEY. Evaluation of mediastinoscopy in mediastinal lymph node staging for non-small-cell lung cancer. Interact Cardiovasc Thorac Surg 2021; 32:270-275. [PMID: 33257953 DOI: 10.1093/icvts/ivaa263] [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: 05/23/2020] [Revised: 08/12/2020] [Accepted: 09/17/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The purpose of this study was to assess the quality of video-assisted cervical mediastinoscopy (VACM) in the staging of non-small-cell lung cancer (NSCLC) at the Antwerp University Hospital with a focus on test effectiveness indicators, morbidity and unforeseen pN2 results. METHODS All consecutive VACM workups of cases of NSCLC performed between January 2010 and December 2015 were included to assess overall test quality and effectiveness. Quality assurance was performed in accordance with the recommendations of the European Society of Gastrointestinal Endoscopy and European Society of Thoracic Surgeons (ESTS) where appropriate. RESULTS A total of 168 video-assisted cervical mediastinoscopies were included. A total of 91.7% of the procedures were performed in accordance with the ESTS guideline. An unforeseen pN2 staging was identified in 10 anatomical lung resections (8.6%). Statistical analysis showed no significant association between VACM performed in accordance with the ESTS guideline and the presence of pN2 positive lymph nodes [χ2 (1) = 0.61; P = 0.57] and no association between VACM performed in accordance with the ESTS guideline and overall futile thoracotomy [χ2 (1) = 0.76; P = 0.50]. Calculations revealed a sensitivity of 81.8 [95% confidence interval (CI) 69.1-90.9], specificity of 100%, positive predictive value of 100%, negative predictive value of 91.9% (95% CI 86.6-95.2) and diagnostic accuracy of 94.1% (95% CI 89.33-97.11). CONCLUSIONS Overall, 91.7% of the VACM were performed in accordance with the ESTS guideline. This process resulted in a sensitivity of 81.8%, a negative predictive value of 91.9% and an unforeseen pN2 rate of 8.6%.
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Affiliation(s)
- Ian Diebels
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Jan P Van Meerbeeck
- Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Annelies Janssens
- Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Suresh K Yogeswaran
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Paul E Y Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp, Belgium
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12
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Berzenji L, Debaenst S, Hendriks JMH, Yogeswaran SK, Lauwers P, Van Schil PE. The role of the surgeon in the management of oligometastatic non-small cell lung cancer: a literature review. Transl Lung Cancer Res 2021; 10:3409-3419. [PMID: 34430376 PMCID: PMC8350094 DOI: 10.21037/tlcr-21-58] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/23/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE In this review, we aim to summarize the most recent data on the surgical management of oligometastatic non-small cell lung cancer (NSCLC). BACKGROUND Approximately 60-70% of all patients with NSCLC initially present with advanced stages of cancer at time of diagnosis. These patients are generally treated with chemotherapy, radiation therapy, or a combination of these modalities. Patients with late-stage disease are usually not considered to be amenable for curative-intent treatments due to poor prognoses. Despite advances in systemic therapies, 5-year overall survival rates in these patients remain poor. However, technological advances in imaging modalities and new imaging strategies have substantially increased tumor detection rates and have resulted in a shift towards earlier diagnosis of NSCLC, possibly in stages in which metastatic disease is limited and still treatable. Studies in recent years have shown that there is a distinct group of patients with metastatic lesions at one or a few sites, often referred to as oligometastatic disease, that may have better survival outcomes compared to patients with more disseminated diseases. Furthermore, it is suggested that these patients may benefit from a combination of systemic treatment and local treatment aimed at the metastatic site(s). However, the role of surgery in this setting remains a controversial subject, with many unanswered questions. METHODS The PubMed/MEDLINE database and the Cochrane database were searched to find relevant articles regarding oligometastatic NSCLC. Specifically, articles regarding definitions of oligometastatic disease, oligometastatic tumor biology, diagnosis, and the treatment of oligometastatic disease were identified. CONCLUSIONS Oligometastatic NSCLC represents a wide spectrum of diseases and encompasses a heterogeneous patient population. Current data suggests that local ablative treatment of oligometastatic lesions with surgery or stereotactic body radiation therapy may result in improved overall survival and progression-free survival rates. However, more data from multi-center prospective trials are necessary to shed light on which therapeutic modalities are most suitable for the treatment of oligometastatic NSCLC. Integration of clinical and molecular staging data is necessary to allow for more personalized treatment approaches.
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Affiliation(s)
- Lawek Berzenji
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Sophie Debaenst
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | | | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
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13
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Abstract
Colorectal cancer (CRC) is one of the leading causes of cancer-related deaths worldwide. It is estimated that 50% of all patients with CRC develop metastases, most commonly in the liver and the lung. Lung metastases are seen in approximately 10–15% of all patients with CRC. A large number of these patients with metastatic CRC can only receive palliative treatment due to invasion of other organs and disseminated disease. However, a subset of these patients present with potentially resectable metastases. Pulmonary metastasectomy is considered to be a potentially curative treatment for selected patients with resectable metastatic CRC. Current data suggest that patients that undergo pulmonary metastasectomy have 5-year survival rates of approximately 40%. However, the majority of data published regarding lung metastasectomy is based on small, retrospective case series. Due to this lack of prospective data, it is still unclear which subset of patients will benefit most from curative-intent surgery. Furthermore, there is also controversy regarding which prognostic and genetic factors are related to survival outcomes and whether there is a difference between open and thoracoscopic approaches in terms of overall and disease-free survival. In this review, we aim to summarize the latest data on prognostic factors and survival outcomes after pulmonary metastasectomy in patients with metastatic CRC.
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Affiliation(s)
- Paul Beckers
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Lawek Berzenji
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Suresh K Yogeswaran
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Giada Bilotta
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Nikol Shkarpa
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Jeroen Hendriks
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
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14
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Verplancke V, Sabbe A, Dumoulin X, Janssens E, Hendriks J, Yogeswaran S, Lauwers P, Lamote K, Kwakkel- van Erp J. The Smell of Lung Transplantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.453] [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: 11/25/2022] Open
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15
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Gielis JF, Geelhoed R, Yogeswaran SK, Lauwers P, Van Schil P, Hendriks JMH. Evaluation of Temporal Artery Duplex Ultrasound for Diagnosis of Temporal Arteritis. J Surg Res 2021; 261:320-325. [PMID: 33485088 DOI: 10.1016/j.jss.2020.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/12/2020] [Revised: 10/10/2020] [Accepted: 12/16/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Temporal arteritis or giant cell arteritis is a form of systemic inflammatory vasculitis closely associated with polymyalgia rheumatica. It may have serious systemic, neurologic, and ophthalmic consequences as it may lead to impaired vision and blindness. Definitive diagnosis is made after histopathologic analysis of a superficial temporal artery (TA) biopsy, which requires a small surgical procedure often under local anesthesia. We investigated whether a noninvasive technique such as duplex ultrasound of the TA could replace histopathological analysis. METHODS Eighty-one patients referred to our department for TA biopsy were first screened with a duplex ultrasound for a surrounding halo and/or occlusion of the TA. Presence of visual disturbances and unilateral pain (headache and/or tongue/jaw claudication) was noted before TA biopsy. Pathological analysis was considered the gold standard. Correlation between duplex findings, symptoms, and pathology was determined by Spearman's Rho test. The predictive value of a halo and TA occlusion on duplex were determined by ROC curve analysis. RESULTS A halo or TA occlusion was found in 16.0% and 3.7% of patients, respectively. Unilateral pain was reported in 96% of cases while 82% complained of visual disturbances. Correlation coefficients for halo and occlusion were 0.471 and 0.404, respectively (P < 0.0001), suggesting a moderate correlation between duplex and biopsy. There was no significant correlation between visual impairment or pain and histologic findings. The ROC curve analysis showed a sensitivity of 53.3% and 20.0%, and specificity of 91.9% and 100% for presence of a halo and occlusion of the TA on duplex, respectively. CONCLUSIONS Arterial duplex is a moderately sensitive but highly specific test for exclusion of temporal arteritis. We observed a moderate correlation between these findings on duplex and histopathological analysis as a gold standard. Arterial duplex may serve as a valuable diagnostic addition to prevent unnecessary surgical procedures and can even substitute biopsy in patients where surgery is not an option.
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Affiliation(s)
- Jan F Gielis
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium.
| | - Renate Geelhoed
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Suresh K Yogeswaran
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
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16
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Bosiers M, Deloose K, Callaert J, Verbist J, Hendriks J, Lauwers P, Schroë H, Lansink W, Scheinert D, Schmidt A, Zeller T, Beschorner U, Noory E, Torsello G, Austermann M, Wauters J. Stent-grafts are the best way to treat complex in-stent restenosis lesions in the superficial femoral artery: 24-month results from a multicenter randomized trial. J Cardiovasc Surg (Torino) 2020; 61:617-625. [PMID: 33231029 DOI: 10.23736/s0021-9509.20.11382-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This clinical trial aims to evaluate the outcome (up to 24-months) of the treatment of in-stent restenotic or reoccluded lesions in the femoropopliteal arteries, by comparing the treatment of the GORE<sup>®</sup> VIABAHN<sup>®</sup> Endoprosthesis with PROPATEN Bioactive Surface (W. L. Gore & Associates, Flagstaff, AZ, USA) with a standard PTA treatment. The primary effectiveness endpoint of the study is the primary patency at 12 months, defined as no evidence of restenosis or occlusion within the originally treated lesion based on color-flow duplex ultrasound (PSVR≤2.5) and without target lesion revascularization (TLR) within 12 months. The primary safety endpoint is the proportion of subjects who experience serious device-related adverse events within 30 days postprocedure. METHODS A total of 83 patients meeting inclusion and exclusion criteria have been enrolled in this prospective, randomized, multicenter, controlled study in 7 sites between June 2010 and February 2012. Patients with an in-stent restenosis lesion in the femoropopliteal region and a Rutherford classification from 2 to 5 could be enrolled. After screening, the patient was randomized to either treatment with the GORE<sup>®</sup> VIABAHN<sup>®</sup> Endoprosthesis with PROPATEN Bioactive Surface or treatment with a standard PTA balloon. After the index procedure, follow-up visits at 1 month, 6 months, 12 months and 24 months were required. A color flow Doppler ultrasound was performed on all follow-up visits and a quantitative vascular angiography at the 12-month follow-up visit. RESULTS In the VIABAHN<sup>®</sup> group, 39 patients (74.4% male; mean age 67.69±9.77 years) were enrolled and in the PTA group, 44 patients (72.7% male; mean age 68.98±9.71 years) were enrolled, which is comparable for both treatment groups. In the VIABAHN<sup>®</sup> group, 34 (87.2%) patients presented with claudication (Rutherford 2 and 3) and 5 (12.8%) patients had critical limb ischemia (Rutherford 4 and 5). In the PTA group, 36 (81.8%) patients were claudicants (Rutherford 2 and 3) and 8 (18.2%) presented with critical limb ischemia (Rutherford 4 and 5). The 12-month primary patency rates were 74.8% for the VIABAHN<sup>®</sup> group and 28.0% for the PTA group (P<0.001). No patients were reported to have device-related serious adverse events within 30 days postprocedure. The primary patency rate for the 24-month follow-up was 58.40% in the Viabahn group and 11.60% in the PTA group (P<0.001). CONCLUSIONS The treatment of femoropopliteal in-stent restenosis with a VIABAHN<sup>®</sup> Endoprosthesis shows significantly better results than the treatment with a standard PTA balloon. This demonstrates that the use of the VIABAHN<sup>®</sup> Endoprosthesis is a very promising tool for the treatment of complex in-stent restenosis.
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Affiliation(s)
- Marc Bosiers
- Department of Vascular Surgery, AZ Sint-Blasius, Dendermonde, Belgium -
| | - Koen Deloose
- Department of Vascular Surgery, AZ Sint-Blasius, Dendermonde, Belgium
| | - Joren Callaert
- Department of Vascular Surgery, AZ Sint-Blasius, Dendermonde, Belgium
| | - Jürgen Verbist
- Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium
| | - Jeroen Hendriks
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, University Hospital Antwerp, Edegem, Belgium
| | - Herman Schroë
- Department of Thoracic and Vascular Surgery, Vascular Center ZOL, Genk, Belgium
| | - Wouter Lansink
- Department of Thoracic and Vascular Surgery, Vascular Center ZOL, Genk, Belgium
| | - Dierk Scheinert
- Department of Angiology, Leipzig Heart Center, Leipzig, Germany
| | - Andrej Schmidt
- Department of Angiology, Leipzig Heart Center, Leipzig, Germany
| | - Thomas Zeller
- Department of Angiology, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Germany
| | - Ulrich Beschorner
- Department of Angiology, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Germany
| | - Elias Noory
- Department of Angiology, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Germany
| | - Giovanni Torsello
- Department of Vascular Surgery, St. Franziskus Hospital and University Hospital of Münster, Münster, Germany
| | - Martin Austermann
- Department of Vascular Surgery, St. Franziskus Hospital and University Hospital of Münster, Münster, Germany
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Jimidar N, Lauwers P, Govaerts E, Claeys M. The clicking chest: what exactly did Hamman hear? A case report of a left-sided pneumothorax. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 33442622 PMCID: PMC7793154 DOI: 10.1093/ehjcr/ytaa331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/14/2020] [Accepted: 08/28/2020] [Indexed: 12/04/2022]
Abstract
Background Hamman’s sign is a rare phenomenon. Louis Hamman described this pathognomonic clicking chest noise in association with pneumomediastinum in 1937. This typical noise can also be present in left-sided pneumothorax. Clinical cases already mention this pericardial knock in 1918 in gunshot wounds of the left chest and in 1928 in cases of spontaneous left-sided pneumothorax. However, the sound itself has only rarely been recorded. Case summary We describe a case of a young man with no significant medical history who was referred to the hospital with chest pain and audible clicks, documented with his smartphone. Imaging studies including chest radiograph and computed tomography scan revealed a left-sided pneumothorax. The patient underwent semi-urgent insertion of a thorax drain. His clinical outcome was excellent. Discussion In recent years only a few case reports describe Hamman’s sign, as it is rare and happens only transiently. This case report includes the audible clicks recorded by the patient with his smartphone. We stress the importance of thoracic clicking sounds as key symptom in the differential diagnosis of left-sided pneumothorax, pneumomediastinum, and valvular pathology such as mitral valve prolapse.
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Affiliation(s)
- Nadeem Jimidar
- Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Patrick Lauwers
- Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | | | - Marc Claeys
- Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
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Hendrikx B, Lauwers P, Broeckx G, Snoeckx A, Van Schil P. Cholesterol granuloma mimicking an anterior mediastinal tumor - a case report. Acta Chir Belg 2020; 122:260-261. [PMID: 32857013 DOI: 10.1080/00015458.2020.1816672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There are many different types of mediastinal masses, which makes it challenging to diagnose them. Furthermore, the clinical presentation can range from asymptomatic to life-threatening. We present the case of a 68-year-old male with an incidental finding of a tumor located in the anterior mediastinum. A computed tomography (CT) of the thorax and an 18-Fluorodeoxyglucose positron emission tomography (PET) suggested a thymoma, which is the most common primary tumor of the anterior mediastinum. The patient was scheduled for a robotic-assisted thoracoscopy (RATS) thymectomy. Both this procedure and the postoperative course were uneventful. The pathology report showed multiple cholesterol granulomas in the mediastinal fat. Furthermore, no malignancy (e.g. a thymoma) could be found. A cholesterol granuloma mimicking an anterior mediastinal tumor is extremely rare.
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Affiliation(s)
- Bart Hendrikx
- Department of Thoracic- and Vascular surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Patrick Lauwers
- Department of Thoracic- and Vascular surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Glenn Broeckx
- Department of Pathology, Antwerp University Hospital, Antwerp, Belgium
| | - Annemie Snoeckx
- Department of Radiology, Antwerp University Hospital, Antwerp, Belgium
| | - Paul Van Schil
- Department of Thoracic- and Vascular surgery, Antwerp University Hospital, Antwerp, Belgium
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Deloose K, Bosiers M, Peeters P, Verbist J, Maene L, Beelen R, Keirse K, Hendriks J, Lauwers P, Wauters J, Verschueren M. Combining the Passeo-18 Lux Drug-Coated Balloon and the Pulsar-18 Bare Metal Stent: 12- and 24-Month Outcomes of the BIOLUX 4EVER Investigator-Initiated Trial. J Endovasc Ther 2020; 27:936-945. [PMID: 32873131 DOI: 10.1177/1526602820952413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report the outcomes after treating stenotic or occluded femoropopliteal lesions with a drug-coated balloon (DCB) followed by the implantation of a thin-strut self-expanding bare metal stent in the BIOLUX 4EVER trial (ClinicalTrials.gov identifier NCT02211664). MATERIALS AND METHODS The prospective, multicenter, physician-initiated BIOLUX 4-EVER trial was conducted at 5 centers in Belgium and enrolled 120 patients (mean age 70.9±10.5 years; 79 men) with symptomatic stenotic or occluded de novo femoropopliteal lesions. A fifth of the patients had diabetes mellitus and nearly half had previous peripheral artery interventions. The lesions were a mean 83.3±49.5 mm long with a mean reference vessel diameter of 5.26±0.59 mm. Lesions were treated with a Passeo-18 Lux DCB followed by the implantation of a Pulsar-18 bare metal stent. Follow-up visits were conducted at 1, 6, 12, and 24 months postprocedure; the main outcome was primary patency at 12 months. RESULTS Technical success was obtained in all patients. Primary patency was observed in 89.9% of patients (95% CI 84.0% to 95.8%) at 12 months and in 83.5% at 24 months (95% CI 89.9% to 97.3%), and freedom from target lesion revascularization was 93.6% (95% CI 89.9% to 97.3%) and 86.1% (95% CI 79.9% to 92.3%), respectively. Ten patients died throughout the course of the trial (90.7% survival at 24 months), all of noncardiovascular causes. The ankle-brachial index improved from 0.68±0.09 at baseline to 0.93±0.11 and 0.93±0.12 at 12- and 24-month follow-up visits (p<0.001). An improvement of at least 1 Rutherford category was observed in 91 of 94 patients (96.8%) at 12 months and 78 of 83 patients (93.4%) at 24 months (p<0.001). CONCLUSION The combination of a Passeo-18 Lux DCB followed by a Pulsar-18 stent implantation produced safe and effective outcomes in the treatment of femoropopliteal lesions at up to 24 months. Adding paclitaxel to the bare nitinol stent platform by predilating with a Passeo-18 Lux DCB seems to increase efficacy at 1 and 2 years compared with the use of bare metal stents only, which were investigated in the precursor 4-EVER study.
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Affiliation(s)
- Koen Deloose
- Department of Vascular Surgery, AZ Sint-Blasius, Dendermonde, Belgium
| | - Marc Bosiers
- Department of Vascular Surgery, AZ Sint-Blasius, Dendermonde, Belgium
| | - Patrick Peeters
- Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium
| | - Jürgen Verbist
- Department of Cardiovascular and Thoracic Surgery, Imelda Hospital, Bonheiden, Belgium
| | - Lieven Maene
- Department of Cardiovascular and Thoracic Surgery, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Roel Beelen
- Department of Cardiovascular and Thoracic Surgery, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Koen Keirse
- Department of Vascular Surgery, R.Z. Heilig-Hart, Tienen, Belgium
| | - Jeroen Hendriks
- Department Thoracic and Vascular Surgery, UZA, Edegem, Belgium
| | - Patrick Lauwers
- Department Thoracic and Vascular Surgery, UZA, Edegem, Belgium
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Abstract
OPINION STATEMENT Robotic-assisted videothoracoscopic surgery (R-VATS) has become increasingly popular and widely used since its introduction and is nowadays considered a standard treatment approach in many centres for the treatment of non-small cell lung cancer. R-VATS was initially developed to overcome the drawbacks of VATS by offering surgeons more flexibility and three-dimensional optics during thoracoscopic surgery. The effectiveness of R-VATS lobectomy regarding oncological outcomes, morbidity, mortality, and postoperative quality of life (QoL) has been shown in an increasing number of studies. More recently, these results have also been corroborated for sublobar resections, more specifically for segmentectomy. However, no well-powered, multicentre randomized trials have been performed to demonstrate the superiority of R-VATS compared with open surgery or conventional types of VATS (total VATS, uniportal VATS, etc.). The majority of the evidence currently available is based on non-randomized studies, and many studies report conflicting results when comparing R-VATS and conventional VATS. Moreover, there is a lack of data regarding the cost and the cost-efficiency of robotic surgery compared with VATS and open surgery. Current evidence suggests that R-VATS costs are higher than VATS and that a deficit can only be prevented when up to 150-300 thoracic surgery procedures are performed annually. Finally, robotic-assisted laparoscopic surgery showed better ergonomics and reduced musculoskeletal disorders compared with non-robotic laparoscopic surgery.
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Affiliation(s)
- Lawek Berzenji
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Antwerp University, Level 2, Route 146, Wilrijkstraat 10, B-2650, Edegem (Antwerp), Belgium
| | - Krishan Yogeswaran
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Antwerp University, Level 2, Route 146, Wilrijkstraat 10, B-2650, Edegem (Antwerp), Belgium
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Antwerp University, Level 2, Route 146, Wilrijkstraat 10, B-2650, Edegem (Antwerp), Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Antwerp University, Level 2, Route 146, Wilrijkstraat 10, B-2650, Edegem (Antwerp), Belgium
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Antwerp University, Level 2, Route 146, Wilrijkstraat 10, B-2650, Edegem (Antwerp), Belgium.
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Hendriks JMH, Yogeswaran SK, Berzenji L, Goedemé J, Lauwers P, Van Schil P. Robotic-assisted thoracoscopic lobectomy of the right middle lobe. Multimed Man Cardiothorac Surg 2020; 2020. [PMID: 32520453 DOI: 10.1510/mmcts.2020.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Robotic-assisted thoracoscopic surgery has increased in popularity during the past two decades because it offers 3-dimensional optics, increased instrument and wrist flexibility compared to classical video-assisted thoracoscopic surgery, and, for patients, improved quality of life and shorter hospital stays compared to open surgery. In this video tutorial, we demonstrate a robotic-assisted thoracoscopic surgery lobectomy in a patient with a tumor in the right middle lobe. The patient had an excellent recovery with no perioperative or postoperative complications.
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Affiliation(s)
- Jeroen M. H. Hendriks
- Dept of Thoracic and Vascular Surgery, University Hospital Antwerp & Antwerp University, Antwerp, Belgium
| | - Suresh Krishan Yogeswaran
- Dept of Thoracic and Vascular Surgery, University Hospital Antwerp & Antwerp University, Antwerp, Belgium
| | - Lawek Berzenji
- Dept of Thoracic and Vascular Surgery, University Hospital Antwerp & Antwerp University, Antwerp, Belgium
| | - Johannes Goedemé
- Dept of Thoracic and Vascular Surgery, KLINA, Brasschaat, Belgium
| | - Patrick Lauwers
- Dept of Thoracic and Vascular Surgery, University Hospital Antwerp & Antwerp University, Antwerp, Belgium
| | - Paul Van Schil
- Dept of Thoracic and Vascular Surgery, University Hospital Antwerp & Antwerp University, Antwerp, Belgium
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22
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Hendriks JM, Dubois M, Lauwers P, de Vleeschauwer P, Vanbetsbrugge M, Deleersnijder R, Wustenberghs K, Robijn J, Jacobs B, Willaert W, Vandekerkhof J, Keirse K, Gabriëls K, Hoppenbrouwers M, Haesen D. Endovascular treatment of atherosclerotic lesions in the superficial femoral artery and proximal popliteal artery using the sinus-SuperFlex-635 stent: twelve-month results from the HERO Registry. J Cardiovasc Surg (Torino) 2020; 61:84-92. [PMID: 32079379 DOI: 10.23736/s0021-9509.19.11028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the safety and performance of the sinus-SuperFlex-635 self-expandable nitinol stent (Optimed GmbH) for the treatment of steno-occlusive lesions in the superficial femoral artery (SFA) and proximal popliteal artery (PPA). METHODS The prospective, multicenter, observational HERO study recruited 117 eligible patients (83 men; mean age 69.4±9.7y) from 7 centers in Belgium. RESULTS A total of 129 stents were successfully deployed in 121 lesions in 117 patients (100%). The patients presented with symptomatic ≥50% stenosis or chronic total occlusion (CTO) (30.6%). Mean lesion length was 71.4±56.3 mm. Moderate to severe calcification was present in 82.6% of the lesions. Acute lesion success (<30% residual stenosis) was achieved in 96.0%. There were no in-hospital serious adverse events. Duplex ultrasound-driven primary patency at 12 months was recorded in 84 of 107 (78.5%) lesions. The overall target lesion revascularization (TLR) rate was 8.4% at 12 months; the target extremity revascularization (TER) rate was 4.7%. Clinical assessment at 12 months demonstrated improvement by at least 1 Rutherford class, without the need for TLR (i.e. primary sustained clinical improvement) in 83.9% of patients and with the need for TLR in 90.6% of patients (i.e. secondary sustained clinical improvement). CONCLUSIONS Based on the high primary patency, low stent fracture rate and significant clinical improvement, combined with refined stent design and long stent availability, the sinus-SuperFlex-635 self-expandable nitinol stent proves its value in the treatment of complex femoropopliteal lesions.
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Affiliation(s)
- Jeroen M Hendriks
- Department of Thorax and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium -
| | - Marc Dubois
- Department of Thorax and Vascular Surgery, Heilig-Hartziekenhuis Lier, Antwerp, Belgium
| | - Patrick Lauwers
- Department of Thorax and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | | | - Michiel Vanbetsbrugge
- Department of Thorax and Vascular Surgery, GZA Sint-Augustinus Wilrijk, Antwerp, Belgium
| | - Roderik Deleersnijder
- Department of Thorax and Vascular Surgery, GZA Sint-Augustinus Wilrijk, Antwerp, Belgium
| | - Karen Wustenberghs
- Department of Thorax and Vascular Surgery, GZA Sint-Augustinus Wilrijk, Antwerp, Belgium
| | - Jorn Robijn
- Department of Vascular and Thorax Surgery, General Hospital Jan Portaels Vilvoorde, Flemish Brabant, Belgium
| | - Bart Jacobs
- Department of Vascular Surgery, General Hospital Maria Middelares Gent, East Flanders, Belgium
| | - Willem Willaert
- Department of Vascular Surgery, General Hospital Maria Middelares Gent, East Flanders, Belgium
| | - Jos Vandekerkhof
- Department of Vascular Surgery, Jessa Hospital Hasselt, Limburg, Belgium
| | - Koen Keirse
- Department of Vascular Surgery, Regional Hospital Tienen, Flemish Brabant, Belgium
| | | | - Mieke Hoppenbrouwers
- Department of Thorax and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
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Berzenji L, Hendriks J, Lauwers P, Yogeswaran S, Van Schil P. P2.18-02 Pneumonectomy and Lung Cancer: A Treacherous Combination. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1956] [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: 11/30/2022]
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24
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Van Regenmortel N, Hendrickx S, Roelant E, Baar I, Dams K, Van Vlimmeren K, Embrecht B, Wittock A, Hendriks JM, Lauwers P, Van Schil PE, Van Craenenbroeck AH, Verbrugghe W, Malbrain MLNG, Van den Wyngaert T, Jorens PG. 154 compared to 54 mmol per liter of sodium in intravenous maintenance fluid therapy for adult patients undergoing major thoracic surgery (TOPMAST): a single-center randomized controlled double-blind trial. Intensive Care Med 2019; 45:1422-1432. [PMID: 31576437 PMCID: PMC6773673 DOI: 10.1007/s00134-019-05772-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/29/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE To determine the effects of the sodium content of maintenance fluid therapy on cumulative fluid balance and electrolyte disorders. METHODS We performed a randomized controlled trial of adults undergoing major thoracic surgery, randomly assigned (1:1) to receive maintenance fluids containing 154 mmol/L (Na154) or 54 mmol/L (Na54) of sodium from the start of surgery until their discharge from the ICU, the occurrence of a serious adverse event or the third postoperative day at the latest. Investigators, caregivers and patients were blinded to the treatment. Primary outcome was cumulative fluid balance. Electrolyte disturbances were assessed as secondary endpoints, different adverse events and physiological markers as safety and exploratory endpoints. FINDINGS We randomly assigned 70 patients; primary outcome data were available for 33 and 34 patients in the Na54 and Na154 treatment arms, respectively. Estimated cumulative fluid balance at 72 h was 1369 mL (95% CI 601-2137) more positive in the Na154 arm (p < 0.001), despite comparable non-study fluid sources. Hyponatremia < 135 mmol/L was encountered in four patients (11.8%) under Na54 compared to none under Na154 (p = 0.04), but there was no significantly more hyponatremia < 130 mmol/L (1 versus 0; p = 0.31). There was more hyperchloremia > 109 mmol/L under Na154 (24/35 patients, 68.6%) than under Na54 (4/34 patients, 11.8%) (p < 0.001). The treating clinicians discontinued the study due to clinical or radiographic fluid overload in six patients receiving Na154 compared to one patient under Na54 (excess risk 14.2%; 95% CI - 0.2-30.4%, p = 0.05). CONCLUSIONS In adult surgical patients, sodium-rich maintenance solutions were associated with a more positive cumulative fluid balance and hyperchloremia; hypotonic fluids were associated with mild and asymptomatic hyponatremia.
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Affiliation(s)
- Niels Van Regenmortel
- Department of Intensive Care Medicine, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium.
- Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen Campus Stuivenberg, Lange Beeldekensstraat 267, 2060, Antwerp, Belgium.
| | - Steven Hendrickx
- Department of Anesthesiology, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
| | - Ella Roelant
- Clinical Trial Center (CTC), Clinical Research Center Antwerp, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
- StatUa, Center for Statistics, University of Antwerp, Prinsstraat 13, 2000, Antwerp, Belgium
| | - Ingrid Baar
- Department of Intensive Care Medicine, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
| | - Karolien Dams
- Department of Intensive Care Medicine, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
| | - Karen Van Vlimmeren
- Department of Anesthesiology, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
| | - Bart Embrecht
- Department of Anesthesiology, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
| | - Anouk Wittock
- Department of Anesthesiology, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
| | - Jeroen M Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Amaryllis H Van Craenenbroeck
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
- Department of Nephrology, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
| | - Walter Verbrugghe
- Department of Intensive Care Medicine, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
| | - Manu L N G Malbrain
- Department of Intensive Care Medicine, University Hospital Brussels (UZB), Laarbeeklaan 101, Jette, 1090, Brussels, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Jette, 1090, Brussels, Belgium
| | - Tim Van den Wyngaert
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
- Department of Nuclear Medicine, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
| | - Philippe G Jorens
- Department of Intensive Care Medicine, Antwerp University Hospital, Wilrijkstraat 10, Edegem, 2650, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
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Beckers PAJ, Mercelis R, Heyman S, Verheuen L, Lauwers P, Hendriks JM, Van Schil PE. Myasthenia gravis appearing after thymectomy heralding recurrent thymoma. Acta Chir Belg 2019; 119:195-197. [PMID: 29768973 DOI: 10.1080/00015458.2018.1438556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Thirty to fifty percent of thymoma patients develop myasthenia gravis (MG). In 1.5-28% of cases, MG appears many years after removal of a thymoma. PATIENTS AND METHODS We present a case report of a 72-year-old female who presented with MG four months after total thymectomy. RESULTS A 72-year-old female patient presents with MG four months after total thymectomy. Imaging revealed a PET-positive nodule anterior to the superior vena cava. By median sternotomy, the nodule was removed at our hospital. Pathology confirmed a recurrent B2/B3 thymoma with R0 resection. No adjuvant therapy was given. Large population studies show the appearance of new-onset MG associated with recurrent thymoma in 3% of cases. CONCLUSIONS New-onset MG postthymectomy heralds recurrent disease in 3% of cases. Thorough screening is needed in such patients.
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Affiliation(s)
- Paul A. J. Beckers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Rudy Mercelis
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
| | - Stijn Heyman
- Department of General Surgery, Antwerp Hospital Network (ZNA), Antwerp, Belgium
| | - Lies Verheuen
- Department of Pathology, Antwerp University Hospital, Edegem, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Jeroen M. Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Paul E. Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
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Domen A, Berzenji L, Hendriks JMH, Yogeswaran SK, Lauwers P, Van Meerbeeck JP, Van Schil PE. Extrapleural pneumonectomy: still indicated? Transl Lung Cancer Res 2018; 7:550-555. [PMID: 30450293 DOI: 10.21037/tlcr.2018.07.07] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The optimal treatment of malignant pleural mesothelioma (MPM) has not yet been established and is still under investigation. Surgery is one of the pillars in the multimodality approach with the purpose of removing as much as visible tumor as possible and to relieve symptoms. To date, two major surgical procedures are available for removal or debulking of MPM that is considered to be resectable: [extended (e)] pleurectomy/decortication (P/D) and extrapleural pneumonectomy (EPP). Historically, EPP was regarded as the only way to achieve a macroscopic complete resection. However, in the last years, there is a shift in literature towards (e)P/D as the preferred surgical procedure whenever possible as several retrospective studies and meta-analyses showed a similar or lower long-term survival and higher perioperative mortality and postoperative morbidity in patients who been treated with EPP. On the other hand, no randomized-controlled trials regarding surgical treatment with (e)P/D or EPP exist and therefore level A evidence favoring one surgical procedure is lacking. In this review we provide a nuanced and well-considered answer to the question whether EPP is still indicated in the surgical treatment of MPM.
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Affiliation(s)
- Andreas Domen
- Department of Thoracic and Vascular surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - Lawek Berzenji
- Department of Thoracic and Vascular surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | | | - Patrick Lauwers
- Department of Thoracic and Vascular surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - Jan P Van Meerbeeck
- Division of Thoracic Oncology, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
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27
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Claessen H, Avalosse H, Guillaume J, Narres M, Kvitkina T, Arend W, Morbach S, Lauwers P, Nobels F, Boly J, Van Hul C, Doggen K, Dumont I, Felix P, Van Acker K, Icks A. Decreasing rates of major lower-extremity amputation in people with diabetes but not in those without: a nationwide study in Belgium. Diabetologia 2018; 61:1966-1977. [PMID: 29909501 PMCID: PMC6096627 DOI: 10.1007/s00125-018-4655-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 05/08/2018] [Indexed: 12/26/2022]
Abstract
AIMS/HYPOTHESIS The reduction of major lower-extremity amputations (LEAs) is one of the main goals in diabetes care. Our aim was to estimate annual LEA rates in individuals with and without diabetes in Belgium, and corresponding time trends. METHODS Data for 2009-2013 were provided by the Belgian national health insurance funds, covering more than 99% of the Belgian population (about 11 million people). We estimated the age-sex standardised annual amputation rate (first per year) in the populations with and without diabetes for major and minor LEAs, and the corresponding relative risks. To test for time trends, Poisson regression models were fitted. RESULTS A total of 5438 individuals (52.1% with diabetes) underwent a major LEA, 2884 people with above- and 3070 with below-the-knee major amputations. A significant decline in the major amputation rate was observed in people with diabetes (2009: 42.3; 2013: 29.9 per 100,000 person-years, 8% annual reduction, p < 0.001), which was particularly evident for major amputations above the knee. The annual major amputation rate remained stable in individuals without diabetes (2009: 6.1 per 100,000 person-years; 2013: 6.0 per 100,000 person-years, p = 0.324) and thus the relative risk reduced from 6.9 to 5.0 (p < 0.001). A significant but weaker decrease was observed for minor amputation in individuals with and without diabetes (5% and 3% annual reduction, respectively, p < 0.001). CONCLUSIONS/INTERPRETATION In this nationwide study, the risk of undergoing a major LEA in Belgium gradually declined for individuals with diabetes between 2009 and 2013. However, continued efforts should be made to further reduce the number of unnecessary amputations.
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Affiliation(s)
- Heiner Claessen
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Herve Avalosse
- IMA/AIM (InterMutualistisch Agentschap/Agence Intermutualiste), Brussels, Belgium
- Landsbond der Christelijke Mutualiteiten/Alliance Nationale des Mutualités Chrétiennes, Brussels, Belgium
| | - Joeri Guillaume
- IMA/AIM (InterMutualistisch Agentschap/Agence Intermutualiste), Brussels, Belgium
- Nationaal Verbond der Socialistische Mutualiteiten/Union Nationale des Mutualités Socialistes, Brussels, Belgium
| | - Maria Narres
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Tatjana Kvitkina
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Werner Arend
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Stephan Morbach
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Diabetes and Angiology, Marienkrankenhaus, Soest, Germany
| | - Patrick Lauwers
- Diabetes Liga, Ghent, Belgium
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Frank Nobels
- Nationaal Verbond der Socialistische Mutualiteiten/Union Nationale des Mutualités Socialistes, Brussels, Belgium
- Department of Endocrinology, Onze Lieve Vrouw Ziekenhuis Aalst, Aalst, Belgium
| | - Jacques Boly
- Landsbond der Christelijke Mutualiteiten/Alliance Nationale des Mutualités Chrétiennes, Brussels, Belgium
| | - Chris Van Hul
- Landsbond van Onafhankelijke Ziekenfondsen/Union des Mutualités Libres, Anderlecht, Belgium
| | - Kris Doggen
- Scientific Institute of Public Health, Brussels, Belgium
| | - Isabelle Dumont
- Association Belge du Diabète, Brussels, Belgium
- Centre Multidisciplinaire du Pied Diabetique, Ransart, Belgium
| | - Patricia Felix
- Association Belge du Diabète, Brussels, Belgium
- Department of Endocrinology, CHR de la Citadelle, Liège, Belgium
| | - Kristien Van Acker
- D-Foot International (International Working Group on the Diabetic Foot- Implementation), Department of Diabetology and Endocrinology, CSF, Chimay, Belgium
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Center (DDZ), Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Hendrickx S, Van Vlimmeren K, Baar I, Verbrugghe W, Dams K, Van Cromphaut S, Roelant E, Embrecht B, Wittock A, Mertens P, Hendriks JM, Lauwers P, Van Schil PE, Van Craenenbroeck AH, Van den Wyngaert T, Jorens P, Van Regenmortel N. Introducing TOPMAST, the first double-blind randomized clinical trial specifically dedicated to perioperative maintenance fluid therapy in adults. Anaesthesiol Intensive Ther 2017; 49:366-372. [PMID: 29170998 DOI: 10.5603/ait.a2017.0070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 10/17/2017] [Accepted: 11/23/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although prescribed to every patient undergoing surgery, maintenance fluid therapy is a poorly researched part of perioperative fluid therapy. The tonicity of the chosen solutions, could be an important cause of morbidity, with hyponatremia being a potential side effect of hypotonic solutions, where isotonic solution could lead to fluid overload. METHODS The TOPMAST-trial is an ongoing prospective single-center double-blind randomized trial comparing an isotonic and a hypotonic maintenance fluid strategy during and after surgery in patients undergoing different types of major thoracic surgery. Patients receive NaCl 0.9% in glucose 5% with an added 40 mmol L-1 of potassium chloride or a premixed solution containing 54 mmol L-1 sodium, 55 mmol L-1 chloride and 26 mmol of potassium at a rate of 27 mL per kg of body weight per day. The primary hypothesis is that isotonic maintenance solutions cause a more positive perioperative fluid balance than hypotonic fluids. Different secondary safety endpoints will be explored, especially the effect of the study treatments on the occurrence electrolyte disturbances (e.g. hyponatremia, hyperchloremia) and a set of clinical endpoints. Efficacy endpoints include the need for resuscitation fluids and assessment of renal and hormonal adaptive mechanisms. An anticipated 68 patients will be included between March 2017 and January 2018. DISCUSSION The study will provide the most comprehensive evaluation of clinically important outcomes associated with the choice of perioperative maintenance fluid therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Niels Van Regenmortel
- Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen, Campus Stuivenberg, Antwerp, Belgium.
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Van Schil PE, Berzenji L, Yogeswaran SK, Hendriks JM, Lauwers P. Surgical Management of Stage IIIA Non-Small Cell Lung Cancer. Front Oncol 2017; 7:249. [PMID: 29124039 PMCID: PMC5662551 DOI: 10.3389/fonc.2017.00249] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 10/06/2017] [Indexed: 12/12/2022] Open
Abstract
According to the eighth edition of the tumor–node–metastasis classification, stage III non-small cell lung cancer is subdivided into stages IIIA, IIIB, and IIIC. They represent a heterogeneous group of bronchogenic carcinomas with locoregional involvement by extension of the primary tumor and/or ipsilateral or contralateral lymph node involvement. Surgical indications have not been definitely established but, in general, long-term survival is only obtained in those patients in whom a complete resection is obtained. This mini-review mainly focusses on stage IIIA disease comprising patients with locoregionally advanced lung cancers. Different subcategories of N2 involvement exist, which range from unexpected N2 disease after thorough preoperative staging or “surprise” N2, to bulky N2 involvement, mostly treated by chemoradiation, and finally, the intermediate category of potentially resectable N2 disease treated with a combined modality regimen. After induction therapy for preoperative N2 involvement, best surgical results are obtained with proven mediastinal downstaging when a lobectomy is feasible to obtain a microscopic complete resection. However, no definite, universally accepted guidelines exist. A relatively new entity is salvage surgery applied for recurrent disease after full-dose chemoradiation when no other therapeutic options exist. Equally, only a small subset of patients with T4N0-1 disease qualify for surgical resection after thorough discussion within a multidisciplinary tumor board on the condition that a complete resection is feasible. Targeted therapies and immunotherapy have recently become part of our therapeutic armamentarium, and it might be expected that they will be incorporated in current regimens after careful evaluation in randomized clinical trials.
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Affiliation(s)
- Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Lawek Berzenji
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Suresh K Yogeswaran
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Jeroen M Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
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Snoeckx A, Dendooven A, Carp L, Desbuquoit D, Spinhoven MJ, Lauwers P, Van Schil PE, van Meerbeeck JP, Parizel PM. Wolf in Sheep’s Clothing: Primary Lung Cancer Mimicking Benign Entities. Lung Cancer 2017; 112:109-117. [DOI: 10.1016/j.lungcan.2017.07.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 07/24/2017] [Accepted: 07/31/2017] [Indexed: 12/12/2022]
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Domen A, De Laet C, Vanderbruggen W, Gielis J, Hendriks JMH, Lauwers P, Janssens A, Hiddinga B, Van Meerbeeck JP, Van Schil PE. Malignant pleural mesothelioma: single-institution experience of 101 patients over a 15-year period. Acta Chir Belg 2017; 117:157-163. [PMID: 28399779 DOI: 10.1080/00015458.2016.1272253] [Citation(s) in RCA: 2] [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] [Indexed: 10/19/2022]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is a rare but aggressive neoplasm that typically originates from the mesothelial surfaces of the pleural cavity. Exposure to asbestos is the principal etiological agent of MPM. The disease is characterized by difficult stage classification and limited consensus on therapeutic approach. We have evaluated the experience with MPM in the Antwerp University Hospital over the past 15 years. METHODS A database was created with all patients diagnosed with or treated for a MPM between 2001 and 2015. A total of 101 patients were included on which different survival analyses were performed combined with a reproduction of demographic, clinical, histologic and therapeutic data, and these were compared to literature data. RESULTS Vast majority of our 101 patients were male (80%) with a median age of 66 years at diagnosis with predominantly epitheloid histology (81%). Overall median survival was 18.3 months and overall 1-, 2- and 5-year survival rates were 68%, 37% and 7%, respectively. Kaplan-Meier analysis showed a non-significant difference in survival between the several best (b) TNM-stages (p = .356). A significant difference in survival was observed in patients undergoing surgery versus no surgery (p = .008), between the different histological types (p < .0001) and treatment with chemotherapy alone versus chemotherapy with surgery (p < .0001). Smoking at diagnosis and epitheloid histology have been identified as significant prognostic factors in the multivariate Cox regression model (HR 3.13 and 0.53, respectively). CONCLUSION Descriptive and survival analysis of our patient database confirmed the limitations of the current staging system and were concordant with literature regarding MPM.
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Affiliation(s)
- Andreas Domen
- Department of Thoracic and Vascular surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Christophe De Laet
- Department of Thoracic and Vascular surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Wies Vanderbruggen
- Department of Thoracic and Vascular surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Jan Gielis
- Department of Thoracic and Vascular surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Jeroen M. H. Hendriks
- Department of Thoracic and Vascular surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Annelies Janssens
- Division of Thoracic Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Birgitta Hiddinga
- Division of Thoracic Oncology, Antwerp University Hospital, Antwerp, Belgium
| | | | - Paul E. Van Schil
- Department of Thoracic and Vascular surgery, Antwerp University Hospital, Antwerp, Belgium
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Van Schil PE, Yogeswaran K, Hendriks JM, Lauwers P, Faivre-Finn C. Advances in the use of surgery and multimodality treatment for N2 non-small cell lung cancer. Expert Rev Anticancer Ther 2017; 17:555-561. [PMID: 28403675 DOI: 10.1080/14737140.2017.1319766] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Stage IIIA-N2 non-small cell lung cancer (NSCLC) represents a heterogeneous group of bronchogenic carcinomas with locoregional involvement. Different categories of N2 disease exist, ranging from unexpectedly encountered N2 involvement after detailed preoperative staging or 'surprise' N2, to potentially resectable disease treated within a combined modality setting, and finally, bulky N2 involvement treated by chemoradiation. Areas covered: Large randomised controlled trials and meta-analyses on stage IIIA-N2 NSCLC have been published but their implications for treatment remain a matter of debate. No definite recommendations can be provided as diagnostic and therapeutic algorithms vary according to local, national or international guidelines. Expert commentary: From the literature, it is clear that patients with stage IIIA-N2 NSCLC should be treated by combined modality therapy including chemotherapy, radiotherapy and surgery. The relative contribution of each modality has not been firmly established. For patients undergoing induction therapy, adequate restaging is important as only down-staged patients will clearly benefit from surgical resection. Each patient should be discussed within a multidisciplinary team to determine the best diagnostic and therapeutic approach according to the specific local expertise. In the near future, it might be expected that targeted therapies and immunotherapy will be incorporated as possible therapeutic options.
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Affiliation(s)
- Paul E Van Schil
- a Department of Thoracic and Vascular Surgery , Antwerp University Hospital , Edegem (Antwerp) , Belgium
| | - Krishan Yogeswaran
- a Department of Thoracic and Vascular Surgery , Antwerp University Hospital , Edegem (Antwerp) , Belgium
| | - Jeroen M Hendriks
- a Department of Thoracic and Vascular Surgery , Antwerp University Hospital , Edegem (Antwerp) , Belgium
| | - Patrick Lauwers
- a Department of Thoracic and Vascular Surgery , Antwerp University Hospital , Edegem (Antwerp) , Belgium
| | - Corinne Faivre-Finn
- b Division of Molecular and Clinical Cancer Sciences , University of Manchester , Manchester , UK
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Abstract
Salvage surgery is a relatively new entity in thoracic surgery and oncology. Salvage resection after radiotherapy refers to surgery as only remaining therapeutic option in patients who were treated with high-dose stereotactic radiotherapy (SRT) for early-stage lung cancer or full-dose chemoradiation for locally advanced lung cancer. Indications include locally progressive tumors, recurrent local or locoregional disease, or specific complications after radiotherapy such as lung abscesses or infected, necrotic cavities. Small, retrospective series demonstrate that salvage surgery after high-dose radiotherapy is feasible and may yield good long-term results. A clear distinction should be made between salvage surgery after SRT for early-stage lung cancer and salvage procedures after full-dose chemoradiation for lung cancers with locoregional extension into the mediastinum. Salvage surgery after SRT may be rather straightforward and in specific cases even feasible by a minimally invasive approach. In contrast, surgery after a full dose of chemoradiation delivered several months or years earlier, can be quite challenging and the dissection of the pulmonary artery and mediastinal lymph nodes technically demanding. Due to the more central irradiation an intrapericardial dissection is often required. To prevent a bronchopleural fistula protection of the bronchial stump with well-vascularized flaps is recommended. Each individual patient in whom salvage surgery is considered, should be discussed thoroughly within a multidisciplinary board, detailed cardiopulmonary functional evaluation is required, and the operation should be performed by an experienced team including a thoracic surgeon, anaesthesiologist and intensive care physician. At the present time only retrospective series are available. Carefully designed prospective studies are necessary to more precisely define indications and results of salvage surgery not only after SRT for peripherally localized lesions but also following full-dose chemoradiation for locoregionally advanced disease.
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Affiliation(s)
- Annemie Van Breussegem
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Jeroen M Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
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Snoeckx A, Desbuquoit D, Spinhoven M, Janssens A, Lauwers P, De Waele M, De Pooter C, Pauwels P, Van Meerbeeck J, Parizel P. P1.03-078 Size Matters...but Don't Underestimate the Power of Morphology. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.750] [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: 10/20/2022]
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Savelev A, Moscicki R, Mata Caballero R, Jacobs J, Popa OA, Siliste RN, Rivin AE, Rud SD, Climent V, Feliu E, Vicedo A, Saavedra J, Lopez Pais J, Molina L, Gorriz J, Hernandez Jimenez V, Perea J, Forteza A, Esteban C, Alonso Martin J, Van Berendoncks AM, Van Herck JL, Vergauwen W, Spinhoven MJ, Lauwers P, Tjalma WA, Dorobantu L, Chioncel O, Stiru O, Herlea V, Bulescu C, Lacau S, Iliescu V, Ginghina C, Ciudin R, Ciomag R, Homentcovschi C, Saguna C, Spataru D. Clinical Cases: Masses, tumors and source of embolism82A case of right atrial diverticulum initially diagnosed in 58 years old female patient83Unusual cardiac mass84A very rare cardiac mass in the right atrium85A rare cause of syncope: intravenous leiomyomatosis with cardiac extension86Left ventricular myxoma- a rare finding87Mediastinal masses and a left atrial tumor: are they related? -the role of multimodal imaging in the diagnosis and the management of the patient. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew231] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lauwers P, De Greef K, Van den Brande F, Hendriks J, De Maeseneer M, Van Schil P. Aortic Graft Infection from Appendicitis. A Case Report. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2004.11679593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- P. Lauwers
- University Hospital of Antwerp, Department of Thoracic and Vascular Surgery, Edegem, Belgium
| | - K. De Greef
- University Hospital of Antwerp, Department of Thoracic and Vascular Surgery, Edegem, Belgium
| | - F. Van den Brande
- University Hospital of Antwerp, Department of Thoracic and Vascular Surgery, Edegem, Belgium
| | - J. Hendriks
- University Hospital of Antwerp, Department of Thoracic and Vascular Surgery, Edegem, Belgium
| | - M. De Maeseneer
- University Hospital of Antwerp, Department of Thoracic and Vascular Surgery, Edegem, Belgium
| | - P. Van Schil
- University Hospital of Antwerp, Department of Thoracic and Vascular Surgery, Edegem, Belgium
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van Dorp M, Gilbers M, Lauwers P, Van Schil PE, Hendriks JMH. Local Anesthesia for Percutaneous Thoracic Endovascular Aortic Repair. Aorta (Stamford) 2016; 4:78-82. [PMID: 28097183 DOI: 10.12945/j.aorta.2016.16.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/12/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Thoracic endovascular aortic repair (TEVAR) requires large-bore vascular access due to the considerable diameters of the endoprosthesis and delivery device. The preclose technique preceding endograft delivery has opened the door for an evolved access strategy. In addition, treatment under local anesthesia offers the advantage of optimal neuromonitoring. The goal of this study was to analyze the efficacy and safety of percutaneous TEVAR under local anesthesia. METHODS All patients undergoing TEVAR in an elective setting at the Antwerp University Hospital between June 2012 and June 2015 were prospectively entered into an endovascular database. This database was queried for demographics, procedural details, and access-related complications. All patients underwent a percutaneous approach with the Perclose Proglide under local anesthesia. RESULTS This review identified 34 patients in whom 37 percutaneous TEVAR procedures were completed under local anesthesia. All patients experienced adequate analgesia, and no conversions to general anesthesia were implemented. The mean size of the arteriotomy was 23.8 ± 1.3 French (F). The number of Proglide deployments was 80, with an 8% rate of failure on deployment. There were no conversions to surgical cutdown, and adequate hemostasis was obtained in all procedures. The incidence of postprocedural access-related complications was 3%. CONCLUSION Local anesthesia for percutaneous TEVAR can be performed safely and effectively. The percutaneous approach facilitates local anesthesia, which provides the added benefit of early recognition of neurologic complications while maintaining a low risk of access-related complications despite the need for large-bore vascular access.
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Affiliation(s)
- Martijn van Dorp
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - Martijn Gilbers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
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Sente T, Van Berendoncks AM, Jonckheere AI, Rodenburg RJ, Lauwers P, Van Hoof V, Wouters A, Lardon F, Hoymans VY, Vrints CJ. Primary skeletal muscle myoblasts from chronic heart failure patients exhibit loss of anti-inflammatory and proliferative activity. BMC Cardiovasc Disord 2016; 16:107. [PMID: 27228977 PMCID: PMC4880810 DOI: 10.1186/s12872-016-0278-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 05/13/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Peripheral skeletal muscle wasting is a common finding with adverse effects in chronic heart failure (HF). Whereas its clinical relevance is beyond doubt, the underlying pathophysiological mechanisms are not yet fully elucidated. We aimed to introduce and characterize the primary culture of skeletal muscle cells from individual HF patients as a supportive model to study this muscle loss. METHODS AND RESULTS Primary myoblast and myotubes cultures were successfully propagated from the m. vastus lateralis of 6 HF patients with reduced ejection fraction (HFrEF; LVEF <45 %) and 6 age and gender-matched healthy donors. HFrEF cultures were not different from healthy donors in terms of morphology, such as myoblast size, shape and actin microfilament. Differentiation and fusion indexes were identical between groups. Myoblast proliferation in logarithmic growth phase, however, was attenuated in the HFrEF group (p = 0.032). In addition, HFrEF myoblasts are characterized by a reduced TNFR2 expression and IL-6 secretion (p = 0.017 and p = 0.016; respectively). CONCLUSION Biopsy derived primary skeletal muscle myoblasts of HFrEF patients produce similar morphological and myogenic differentiation responses as myoblasts of healthy donors, though demonstrate loss of anti-inflammatory and proliferative activity.
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Affiliation(s)
- Tahnee Sente
- Laboratory of Cellular and Molecular Cardiology, Antwerp University Hospital, Edegem, Belgium. .,Department of Translational Pathophysiological Research, Cardiovascular Diseases, University of Antwerp, Wilrijk, Belgium.
| | | | - An I Jonckheere
- Department of Pediatric Neurology, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Richard J Rodenburg
- Department of Pediatrics, Nijmegen Center for Mitochondrial Disorders, Translational Metabolic Laboratory, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Viviane Van Hoof
- Department of Biochemistry, Antwerp University Hospital, Edegem, Belgium
| | - An Wouters
- Center for Oncological Research (CORE) Antwerp, University of Antwerp, Wilrijk, Belgium
| | - Filip Lardon
- Center for Oncological Research (CORE) Antwerp, University of Antwerp, Wilrijk, Belgium
| | - Vicky Y Hoymans
- Laboratory of Cellular and Molecular Cardiology, Antwerp University Hospital, Edegem, Belgium.,Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - Christiaan J Vrints
- Laboratory of Cellular and Molecular Cardiology, Antwerp University Hospital, Edegem, Belgium.,Department of Translational Pathophysiological Research, Cardiovascular Diseases, University of Antwerp, Wilrijk, Belgium.,Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
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Laet CD, Domen A, Cheung KJ, Meulemans E, Lauwers P, Hendriks JM, Schil1 PEV. Malignant Pleural Mesothelioma: Rationale for a New TNM Classification. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2014.11681020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- C. De Laet
- Equally contributing authors
- Department of Thoracic and Vascular surgery and
| | | | - K. J. Cheung
- Multidisciplinary Oncology Centre Antwerp (MOCA), Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - E. Meulemans
- Multidisciplinary Oncology Centre Antwerp (MOCA), Antwerp University Hospital, Edegem (Antwerp), Belgium
| | - P. Lauwers
- Department of Thoracic and Vascular surgery and
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Vermeulen T, Hendriks J, Baeten M, Lauwers P, Van Schil P. Endarterectomy Combined with Retrograde Stenting for Tandem Lesions of the Carotid Artery. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2011.11680760] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- T. Vermeulen
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - J.M.H. Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - M. Baeten
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - P. Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - P. Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
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Abstract
Surgical resection remains the standard of care for functionally operable early-stage non-small-cell lung cancer (NSCLC) and resectable stage IIIA disease. The role of invasive staging and restaging techniques is currently being debated, but they provide the largest biopsy samples which allow for precise mediastinal staging. Different types of operative procedures are currently available to the thoracic surgeon, and some of these interventions can be performed by video-assisted thoracic surgery (VATS) with the same oncological results as those by open thoracotomy. The principal aim of surgical treatment for NSCLC is to obtain a complete resection which has been precisely defined by a working group of the International Association for the Study of Lung Cancer (IASLC). Intraoperative staging of lung cancer is of utmost importance to decide on the extent of resection according to the intraoperative tumour (T) and nodal (N) status. Systematic nodal dissection is generally advocated to evaluate the hilar and mediastinal lymph nodes which are subdivided into seven zones according to the most recent 7th tumour-node-metastasis (TNM) classification. Lymph-node involvement not only determines prognosis but also the administration of adjuvant therapy. In 2011, a new multidisciplinary adenocarcinoma classification was published introducing the concepts of adenocarcinoma in situ and minimally invasive adenocarcinoma. This classification has profound surgical implications. The role of limited or sublobar resection, comprising anatomical segmentectomy and wide wedge resection, is reconsidered for early-stage lesions which are more frequently encountered with the recently introduced large screening programmes. Numerous retrospective non-randomised studies suggest that sublobar resection may be an acceptable surgical treatment for early lung cancers, also when performed by VATS. More tailored, personalised therapy has recently been introduced. Quality-of-life parameters and surgical quality indicators become increasingly important to determine the short-term and long-term impact of a surgical procedure. International databases currently collect extensive surgical data, allowing more precise calculation of mortality and morbidity according to predefined risk factors. Centralisation of care has been shown to improve results. Evidence-based guidelines should be further developed to provide optimal staging and therapeutic algorithms.
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Affiliation(s)
- Paul E Van Schil
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Edegem, Antwerp, Belgium
| | - Bram Balduyck
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Edegem, Antwerp, Belgium
| | - Michèle De Waele
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Edegem, Antwerp, Belgium
| | - Jeroen M Hendriks
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Edegem, Antwerp, Belgium
| | - Marjan Hertoghs
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Edegem, Antwerp, Belgium
| | - Patrick Lauwers
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Edegem, Antwerp, Belgium
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Vermeersch N, Hendriks J, Lauwers P, Salgado R, Van Schil P. Aortic Dissection Limited to Abdominal Aorta: an Underrecognized Entity? Acta Chir Belg 2015; 115:293-8. [PMID: 26324032 DOI: 10.1080/00015458.2015.11681115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Aortic dissection limited to the abdominal aorta is a rare clinical entity with non-specific clinical features. Optimal treatment, as well as natural history and progression of the disease, remain unclear. In 1992 we -reported 5 cases of isolated abdominal aortic dissection (IAAD) and in the present paper we update our series with 5 additional patients. A concise literature review is also provided. METHODS Between 1992 and 2014, we diagnosed 5 patients with IAAD (4 men, mean age 60.6 years, range 45-77). No patient presented with acute onset of symptoms. One patient was diagnosed with a periumbilical bruit, and diagnosis was made with magnetic resonance (MR)-angiography. Other diagnoses were incidental findings on computed tomographic (CT) scanning. Dissection was located infrarenally in four cases and at the celiac trunk in one case. RESULTS All cases were treated conservatively with hypertension control and close follow-up. Follow-up period ranged from 10 months to 20 years and was performed yearly by CT- or MR-angiography and blood pressure monitoring. All patients remained symptom-free, all dissection lengths remained stable. Slowly increasing post-dissection aneurysmal dilatation was encountered in two patients. We combined results of these five new patients with five previously diagnosed and reported patients at our center. Treatment was surgical in only one out of 10 patients. There was no disease-related mortality during follow-up. CONCLUSIONS Based on our case series, IAAD remains a rare clinical condition with relative benign clinical course. Treatment was almost exclusively conservative. Recent publications state IAAD might be underrecognized and under-diagnosed compared to thoracic aortic dissections.
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van Dorp M, Ruyssers M, Amajoud Z, Lauwers P, Schil PEV, Hendriks JMH. Preclose Percutaneous Endurant™ Endografting with the Proglide™ Device: a Safe and Feasible Combination. Acta Chir Belg 2015; 115:219-23. [PMID: 26158254 DOI: 10.1080/00015458.2015.11681100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Endovascular repair of abdominal aortic aneurysms has been revolutionized over the last two decades. Opening the doors for a percutaneous approach by avoiding surgical exposure of the vascular access site. The goal of this report is to analyze the feasibility and efficacy of using Perclose Proglide™ through a preclose technique in a percutaneous approach to Endurant™ endografting for Asymptomatisch infrarenal aortic aneurysms in an elective setting. METHODS Between April 2011 and April 2014, 45 consecutive patients underwent percutaneous endovascular aortic aneurysm repair (PEVAR) for an asymptomatic infrarenal aortic aneurysm. Closure of percutaneous access sites was ensured with Perclose Proglide in a "preclose" technique. Data were collected in a prospective maintained database with a follow-up period of one month. Patient demographics, aneurysmal characteristics, procedural details and complications were recorded. RESULTS A total of 170 Proglide devices were used to close 85 access sites. Adequate hemostasis was obtained in 96.5 percent (82 of 85 access sites). Conversion to a femoral cutdown was necessary in 2.4% (2 of 85 access sites). The mean hospitalization was 2.6 days and 86.7 percent of patients were discharged within 2 days. The incidence of post-procedural access-related complications was 2.2%. CONCLUSIONS PEVAR using the Perclose Proglide in preclosing 14Fr to 20Fr access sites for Endurant endografting in the treatment of asymptomatic infrarenal aortic aneurysms is feasible and effective. Moreover, the percutaneous approach allows for procedures to be performed under local anesthesia, while providing a low risk for access-related complications and a relatively short hospitalization.
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Van Schil PE, Hendriks JM, Lauwers P. Focus on treatment complications and optimal management surgery. Transl Lung Cancer Res 2015; 3:181-6. [PMID: 25806298 DOI: 10.3978/j.issn.2218-6751.2014.06.07] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/19/2014] [Indexed: 11/14/2022]
Abstract
Thoracic surgery comprises major procedures which may be challenging, not only from a technical point of view but also regarding anesthetic and postoperative management. Complications are common occurrences which are also related to the comorbidity of the patients. After major lung resections pulmonary and pleural complications are often encountered. In this overview more surgically related complications are discussed, focusing on postpneumonectomy pulmonary edema, thromboembolic disease including pulmonary embolism, prolonged air leak, lobar torsion, persistent pleural space, empyema and bronchopleural fistula. Prevention, timely recognition, and early adequate treatment are key points as complications initially considered to be minor, may suddenly turn into life-threatening events. To this end multidisciplinary cooperation is necessary. Preoperative smoking cessation, adequate pain control, attention to nutritional status, incentive spirometry and early mobilization are important factors to reduce the incidence of postoperative complications.
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Affiliation(s)
- Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Belgium
| | - Jeroen M Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Belgium
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Bosiers M, Deloose K, Callaert J, Verbist J, Hendriks J, Lauwers P, Schroë H, Lansink W, Scheinert D, Schmidt A, Zeller T, Beschorner U, Noory E, Torsello G, Austermann M, Peeters P. Superiority of Stent-Grafts for In-Stent Restenosis in the Superficial Femoral Artery. J Endovasc Ther 2015; 22:1-10. [DOI: 10.1177/1526602814564385] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To evaluate the short- and midterm outcomes of the Viabahn endoprosthesis with Propaten Bioactive Surface vs. standard balloon angioplasty for treatment of in-stent restenosis in the superficial femoral artery. Methods: Between June 2010 and February 2012, 83 patients with superficial femoral artery in-stent and Rutherford category 2 to 5 ischemia were enrolled at 7 sites participating in this prospective randomized controlled study (RELINE; ClinicalTrials.gov; identifier NCT01108861). The patients were randomized to treatment with either the heparin-bonded Viabahn endoprosthesis (n=39: 29 men; mean age 67.7±9.8 years) or a standard angioplasty balloon (n=44: 32 men; mean age 69.0±9.7 years). The primary effectiveness outcome was primary patency at 12 months, defined as no restenosis/occlusion within the target lesion based on duplex ultrasound and no target lesion revascularization. The primary safety endpoint was the incidence of serious device-related adverse events within 30 days of the procedure. Results: All patients randomized to receive dilation or the Viabahn stent-graft were treated according to their assignment. The technical success was 100% for the Viabahn group and 81.8% for the angioplasty group (p=0.002) owing to 9 patients requiring a bailout procedure after unsuccessful angioplasty. The 12-month primary patency rates were 74.8% for the Viabahn group and 28.0% for the angioplasty group (p<0.001). Excluding the 9 angioplasty patients who received bailout stenting, the primary patency for optimal balloon angioplasty was 37.0% (p<0.001). Three patients experienced device-related adverse events within 30 days: occlusion of the target lesion (Viabahn group), peripheral embolization (angioplasty group), and reocclusion of the target lesion (angioplasty group). Conclusion: In this study, the treatment of femoropopliteal in-stent restenosis with a Viabahn endoprosthesis showed significantly better results than treatment with a standard balloon at 1 year.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Thomas Zeller
- Universitäts-Herzzentrum Freiburg, Bad Krozingen, Germany
| | | | - Elias Noory
- Universitäts-Herzzentrum Freiburg, Bad Krozingen, Germany
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Van Brussel I, Ammi R, Rombouts M, Cools N, Vercauteren SR, De Roover D, Hendriks JMH, Lauwers P, Van Schil PE, Schrijvers DM. Fluorescent activated cell sorting: an effective approach to study dendritic cell subsets in human atherosclerotic plaques. J Immunol Methods 2014; 417:76-85. [PMID: 25527343 DOI: 10.1016/j.jim.2014.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/12/2014] [Accepted: 12/12/2014] [Indexed: 12/24/2022]
Abstract
Different immune cell types are present within atherosclerotic plaques. Dendritic cells (DC) are of special interest, since they are considered as the 'center of the immuniverse'. Identifying inflammatory DC subtypes within plaques is important for a better understanding of the lesion pathogenesis and pinpoints their contribution to the atherosclerotic process. We have developed a flow cytometry-based method to characterize and isolate different DC subsets (i.e. CD11b(+), Clec9A(+) and CD16(+) conventional (c)DC and CD123(+) plasmacytoid (p)DC) in human atherosclerotic plaques. We revealed a predominance of pro-inflammatory CD11b(+) DC in advanced human lesions, whereas atheroprotective Clec9A(+) DC were almost absent. CD123(+) pDC and CD16(+) DC were also detectable in plaques. Remarkably, plaques from distinct anatomical locations exhibited different cellular compositions: femoral plaques contained less CD11b(+) and Clec9A(+) DC than carotid plaques. Twice as many monocytes/macrophages were observed compared to DC. Moreover, relative amounts of T cells/B cells/NK cells were 6 times as high as DC numbers. For the first time, fluorescent activated cell sorting analysis of DC subsets in human plaques indicated a predominance of CD11b(+) cDC, in comparison with other DC subsets. Isolation of the different subsets will facilitate detailed functional analysis and may have significant implications for tailoring appropriate therapy.
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Affiliation(s)
- Ilse Van Brussel
- Lab of Physiopharmacology, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium.
| | - Rachid Ammi
- Lab of Physiopharmacology, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium
| | - Miche Rombouts
- Lab of Physiopharmacology, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium
| | - Nathalie Cools
- Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium
| | - Sven R Vercauteren
- Department of Thoracic and Vascular Surgery, ZNA Middelheim (Ziekenhuis Netwerk Antwerpen), Lindendreef 1, B-2020 Antwerp, Belgium
| | - Dominique De Roover
- Department of Thoracic and Vascular Surgery, ZNA Middelheim (Ziekenhuis Netwerk Antwerpen), Lindendreef 1, B-2020 Antwerp, Belgium
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital (UZA), Wilrijkstraat 10, B-2650 Edegem, Antwerp, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital (UZA), Wilrijkstraat 10, B-2650 Edegem, Antwerp, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital (UZA), Wilrijkstraat 10, B-2650 Edegem, Antwerp, Belgium
| | - Dorien M Schrijvers
- Lab of Physiopharmacology, University of Antwerp, Universiteitsplein 1, B-2610 Antwerp, Belgium
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Bosiers M, Deloose K, Callaert J, Keirse K, Verbist J, Hendriks J, Lauwers P, D'Archambeau O, Scheinert D, Torsello G, Peeters P. 4-French-compatible endovascular material is safe and effective in the treatment of femoropopliteal occlusive disease: results of the 4-EVER trial. J Endovasc Ther 2014; 20:746-56. [PMID: 24325689 DOI: 10.1583/13-4437mr.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To report the 1-year results of a prospective multicenter trial to evaluate the safety and efficacy of treating symptomatic femoropopliteal occlusive disease using 4-F-compatible materials and no closure device. METHODS The non-randomized 4-EVER trial (4-F endovascular treatment approach to infrainguinal disease) was conducted at 5 European hospitals (ClinicalTrials.gov identifier NCT01413139). The protocol mandated the use of only 4-F sheaths, self-expanding nitinol stents (Astron Pulsar or Pulsar-18 stent), and balloons from a single manufacturer. Between June 2010 and June 2011, 120 symptomatic patients (82 men; mean age 71±9.7 years, range 47-90), primarily claudicants, treated for 120 femoropopliteal lesions (>90% TASC A/B) were enrolled. The mean lesion length was 71.0±45.9 mm. Follow-up evaluations were scheduled on day 1 and at 1, 6, 12, and 24 months. A duplex ultrasound was performed on all follow-up visits to determine vessel patency (primary outcome measure at 1 year), and biplanar radiography was performed at 12 and 24 months to assess stent fracture. RESULTS Stents were successfully implanted in all patients: an Astron Pulsar stent in 70 (58.3%) lesions and a Pulsar-18 stent in 46 (38.3%); 4 (3.3%) patients had both stents implanted for flow-limiting dissection after predilation. No closure devices were used; the mean manual compression time was 8.1 minutes (2-15). Four (3.3%) patients developed significant hematoma at the puncture site, but none required surgical repair. The overall 12-month primary patency rate was 81.4%: 85.2% for the Astron Pulsar and 73.4% for the Pulsar-18 (p=0.236). Freedom from target lesion revascularization at 12 months for the entire cohort was 89.3%. CONCLUSION Compared to published historical data for superficial femoral artery type A/B lesion stenting using 6-F devices, the 4-F devices applied in this trial showed similar patency at 12 months, fewer access site complications, and shorter manual compression times, supporting the supposition that 4-F endovascular treatment is safe and effective.
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Affiliation(s)
- Marc Bosiers
- 1 Department of Vascular Surgery, A.Z. Sint-Blasius, Dendermonde, Belgium
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Doggen K, Van Acker K, Beele H, Dumont I, Félix P, Lauwers P, Lavens A, Matricali GA, Randon C, Weber E, Van Casteren V, Nobels F. Implementation of a quality improvement initiative in Belgian diabetic foot clinics: feasibility and initial results. Diabetes Metab Res Rev 2014; 30:435-43. [PMID: 24446240 DOI: 10.1002/dmrr.2524] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/24/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND This article aims to describe the implementation and initial results of an audit-feedback quality improvement initiative in Belgian diabetic foot clinics. METHODS Using self-developed software and questionnaires, diabetic foot clinics collected data in 2005, 2008 and 2011, covering characteristics, history and ulcer severity, management and outcome of the first 52 patients presenting with a Wagner grade ≥ 2 diabetic foot ulcer or acute neuropathic osteoarthropathy that year. Quality improvement was encouraged by meetings and by anonymous benchmarking of diabetic foot clinics. RESULTS The first audit-feedback cycle was a pilot study. Subsequent audits, with a modified methodology, had increasing rates of participation and data completeness. Over 85% of diabetic foot clinics participated and 3372 unique patients were sampled between 2005 and 2011 (3312 with a diabetic foot ulcer and 111 with acute neuropathic osteoarthropathy). Median age was 70 years, median diabetes duration was 14 years and 64% were men. Of all diabetic foot ulcers, 51% were plantar and 29% were both ischaemic and deeply infected. Ulcer healing rate at 6 months significantly increased from 49% to 54% between 2008 and 2011. Management of diabetic foot ulcers varied between diabetic foot clinics: 88% of plantar mid-foot ulcers were off-loaded (P10-P90: 64-100%), and 42% of ischaemic limbs were revascularized (P10-P90: 22-69%) in 2011. CONCLUSIONS A unique, nationwide quality improvement initiative was established among diabetic foot clinics, covering ulcer healing, lower limb amputation and many other aspects of diabetic foot care. Data completeness increased, thanks in part to questionnaire revision. Benchmarking remains challenging, given the many possible indicators and limited sample size. The optimized questionnaire allows future quality of care monitoring in diabetic foot clinics.
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De Laet C, Domen A, Cheung KJ, Meulemans E, Lauwers P, Hendriks JM, Van Schil PE. Malignant Pleural Mesothelioma : Rationale for a New TNM Classification. Acta Chir Belg 2014; 114:245-249. [PMID: 26021419] [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: 06/04/2023]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is a rare but aggressive thoracic malignancy with a poor prognosis. In this regard, a well-defined staging system is of utmost importance in order to correctly diagnose and assign an appropriate treatment to the patient. METHODS The current TNM-staging system (7th edition) enables to either clinically or pathologically stage the severity of the disease according to extension of the tumor (T), number of nodes (N) and presence of metastases (M). Patients with stage I-III are considered for surgery, while palliative treatment is indicated for stage IV patients according to the current classification. RESULTS Despite its widespread use, the validity of this staging system is questioned due to the low prevalence, histological variety and retrospective nature of the previous study design. In addition, the role of specific treatment modalities including surgery, has yet to be determined, especially for treatment of early-stage disease. In this regard, the International Association for the Study of Lung Cancer (IASLC) initiated the multi-centre, prospective "Mesothelioma Staging Project" in order to address limitations of the 7th edition and to optimize the staging system in accordance to current needs. CONCLUSIONS An improved staging system will contribute to the design of prospective multi-institutional clinical trials investigating novel treatment strategies for mesothelioma. In this way comparison of outcome between different medical centres also becomes feasible.
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Affiliation(s)
- C De Laet
- Department of Thoracic and Vascular surgery, Antwerp University Hospital, Edegem (Antwerp), Belgium
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Abstract
In the last 5 years, the current management of stage I non-small-cell lung cancer has been challenged due to novel surgical approaches and advances in radiation technology. The outcome after a sublobar resection is promising, especially for tumors less than 2 cm. Other treatment opportunities are available for high risk patients with comorbidity and impaired pulmonary function. Stereotactic ablative body radiotherapy is a good alternative treatment to surgery, especially in elderly and comorbid patients. However, randomized evidence comparing sublobar resection and stereotactic radiotherapy is presently lacking. The most recent development in radiotherapy is hadron therapy with a presumed reduced toxicity because of its peculiar physical and biological effects. Promising thermal and microwave ablative techniques are in development and have specific niche indications.
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Affiliation(s)
- Svitlana Tarasevych
- Department of Thoracic Oncology, Multidisciplinary Oncology Center Antwerp University Hospital, Antwerp, Belgium
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