AZ Groeninge

Kortrijk, Belgium

AZ Groeninge

Kortrijk, Belgium
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Brusselle G.G.,Ghent University | VanderStichele C.,Ghent University | Jordens P.,OLV Ziekenhuis | Deman R.,AZ Groeninge | And 14 more authors.
Thorax | Year: 2013

Background: Patients with severe asthma are at increased risk of exacerbations and lower respiratory tract infections (LRTI). Severe asthma is heterogeneous, encompassing eosinophilic and non-eosinophilic (mainly neutrophilic) phenotypes. Patients with neutropilic airway diseases may benefit from macrolides. Methods: We performed a randomised double-blind placebo-controlled trial in subjects with exacerbationprone severe asthma. Subjects received low-dose azithromycin (n=55) or placebo (n=54) as add-on treatment to combination therapy of inhaled corticosteroids and long-acting β2 agonists for 6 months. The primary outcome was the rate of severe exacerbations and LRTI requiring treatment with antibiotics during the 26-week treatment phase. Secondary efficacy outcomes included lung function and scores on the Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ). Results: The rate of primary endpoints (PEPs) during 6 months was not significantly different between the two treatment groups: 0.75 PEPs (95% CI 0.55 to 1.01) per subject in the azithromycin group versus 0.81 PEPs (95% CI 0.61 to 1.09) in the placebo group (p=0.682). In a predefined subgroup analysis according to the inflammatory phenotype, azithromycin was associated with a significantly lower PEP rate than placebo in subjects with noneosinophilic severe asthma (blood eosinophilia ≤200/ml): 0.44 PEPs (95% CI 0.25 to 0.78) versus 1.03 PEPs (95% CI 0.72 to 1.48) (p=0.013). Azithromycin significantly improved the AQLQ score but there were no significant between-group differences in the ACQ score or lung function. Azithromycin was well tolerated, but was associated with increased oropharyngeal carriage of macrolide-resistant streptococci. Conclusions Azithromycin did not reduce the rate of severe exacerbations and LRTI in patients with severe asthma. However, the significant reduction in the PEP rate in azithromycin-treated patients with non-eosinophilic severe asthma warrants further study. number NCT00760838.

Van der Bracht H.,Ghent University | Van der Bracht H.,University Hospitals Leuven | Van der Bracht H.,Stellenbosch University | Bellemans J.,University Hospitals Leuven | And 4 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2014

Purpose: To analyze anatomical risk factors and surgical technique dependent variables, which determine the risk for femoral notch impingement in anatomically correct placed tibial tunnels for anterior cruciate ligament (ACL) surgery. Methods: Twenty fresh frozen adult human knee specimens under the age of 65 years were used. Digital templates mimicking a tibial tunnel aperture at the tibia plateau were designed for different tibial tunnel diameters and different drill-guide angles. The centres of these templates were placed over the geometric centre of the native tibial ACL footprint. The distances between the anterior borders of the templates and the anterior borders of the footprints (graft free zone) were measured and compared. Furthermore, anatomic risk factors for femoral notch impingement were determined. Results: The graft free zone was statistically significantly longer for larger drill-guide angles compared to smaller drill-guide angles (p < 0.00001). Furthermore, 8 mm diameter tibial tunnels had a statistically significant larger graft free zone compared to 10-mm-diameter tibial tunnels (p < 0.00001). For the 10 mm diameter tibial tunnels with drill-guide angle of 45°, 9 out of 20 knees (45 %) were "at risk" for notching and 4 out of 20 knees (20 %) had "definite" notching. For 10-mm tunnels with drill-guide angle of 45°, a risk for notching was associated with smaller tibial ACL footprint (p < 0.05). Conclusion: If a perfect centrally positioned tibial tunnel is drilled, a real risk for femoral notch impingement exists depending on the size of the tibial ACL footprint and surgery-related factors. Therefore, in anatomical tibial tunnel placement in single bundle ACL reconstruction surgery, particular attention should be paid to size of the tunnel and drill-guide angle to minimize the risk of femoral notch impingement. © 2013 Springer-Verlag Berlin Heidelberg.

Dekeyser M.,AZ Groeninge | D'Hondt M.,AZ Groeninge
Tijdschrift voor Geneeskunde | Year: 2016

Hepatic adenomas are rare, benign hepatic tumours. Hepatocellular adenoma (HCA) is more frequently diagnosed in female patients. Rarely a HCA transforms into a hepatocellular carcinoma (HCC). Risk factors for malignant transformation are male sex, HCA with a β-catenin mutation and the size of the tumour. In the Western world there is a female predominance of HCA, but malignant transformation occurs more in male patients. Complications such as bleeding and malignant transformation, rarely occur in tumours smaller than 5 cm. β-catenin mutation contributes in the Wntsignaling pathway and the cadherin-catenin complex. Therefore, a β-catenin mutation is a risk factor for malignant transformation. To differentiate HCA from HCC imaging techniques and histopathological examination are required. With imaging a tentative diagnosis can be obtained, but microscopical examination is needed. Indications for resection are HCA's more than 5 cm and symptomatic adenomas.

Sathekge M.M.,University of Pretoria | Maes A.,AZ Groeninge | Pottel H.,Catholic University of Leuven | Stoltz A.,University of Pretoria | van de Wiele C.,Ghent University
South African Medical Journal | Year: 2010

Objective: Fluorodeoxyglucose (FDG)-positron emission tomography (PET) is an accurate non-invasive imaging test for differentiating benign from malignant solitary pulmonary nodules (SPNs). We aimed to assess its diagnostic accuracy for differentiating benign from malignant SPNs in a tuberculosis (TB)-endemic area. Methods: Thirty patients, 22 men and 8 women, mean age 60 years, underwent dual time point FDG-PET/computed tomography (CT) imaging, followed by histological examination of the SPN. Maximum standard uptake values (SUVmax) with the greatest uptake in the lesion were calculated for two time points (SUV1 and SUV2), and the percentage change over time per lesion was calculated (%DSUV). Routine histological findings served as the gold standard. Results: Histological examination showed that 14 lesions were malignant and 16 benign, 12 of which were TB. SUVmax for benign and malignant lesions were 11.02 (standard deviation (SD) 6.6) v. 10.86 (SD 8.9); however, when tuberculomas were excluded from the analysis, a significant difference in mean SUV1max values between benign and malignant lesions was observed (p=0.0059). Using an SUVmax cut-off value of 2.5, a sensitivity of 85.7% and a specificity of 25% was obtained. Omitting the TB patients from analysis resulted in a sensitivity of 85.7% and a specificity of 100%. Mean %DSUV of benign lesions did not differ significantly from mean %DSUV of malignant lesions (17.1% (SD 16.3%) v. 19.4% (SD 23.7%)). Using a cut-off of %DSUV >10% as indicative of malignancy, a sensitivity of 85.7% and a specificity of 50% was obtained. Omitting the TB patients from the analysis yielded a sensitivity of 85.7% and a specificity of 75%. Conclusion: Our findings suggest that FDG-PET cannot distinguish malignancy from tuberculoma and therefore cannot reliably be used to reduce futile biopsy/thoracotomy.

Van De Wiele C.,Ghent University | Kruse V.,Ghent University | Smeets P.,Ghent University | Sathekge M.,University of Pretoria | And 2 more authors.
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2013

Data available in patients suffering from squamous cell carcinoma of the head and neck, lung carcinoma, oesophageal carcinoma and gynaecological malignancies suggest that metabolic tumour volume and to a lesser extent total lesion glycolysis have the potential to become valuable in the imaging of human solid tumours as prognostic biomarkers for short- to intermediate-term survival outcomes, adding value to clinical staging, for assessment of response to treatment with neoadjuvant and concurrent chemotherapy, and for treatment optimization; for example, based on early treatment response assessment using changes in metabolic tumour volume over time, it might be possible to select patients who require a more aggressive treatment to improve their outcome. Prospective studies enrolling consecutive patients, adopting standardized protocols for FDG PET acquisition and processing, adjusting for potential confounders in the analysis (tumour size and origin) and determining the optimal methodology for determination of these novel markers are mandatory. © 2012 Springer-Verlag Berlin Heidelberg.

Van De Wiele C.,Ghent University | Maes A.,AZ Groeninge | Maes A.,University Hospital Leuven | Brugman E.,AZ Groeninge | And 4 more authors.
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2012

Available literature on the differences in circulation and microcirculation of normal liver and liver metastases as well as in rheology of the different radiolabelled microspheres [99mTc-labelled macroaggregates of albumin (MAA), 90Y-TheraSpheres and 90Y-SIR-spheres] used in selective internal radiation therapy (SIRT) are reviewed and implications thereof on the practice of SIRT discussed. As a result of axial accumulation and skimming, large microspheres are preferentially deposited in regions of high flow, whereas smaller microspheres are preferentially diverted to regions of low flow. As flow to normal liver tissue is considerably variable between segments and also within one segment, microspheres will be delivered heterogeneously within the microvasculature of normal liver tissue. This non-uniformity in microsphere distribution in normal liver tissue has a significant "liver-sparing" effect on the dose distribution of 90Y-labelled microspheres. Arterial flow to liver metastases is most pronounced in the hypervascular rim of metastases, followed by the smaller metastases and finally by the central hypoperfused region of the larger metastases. Because of the wide variability in size of labelled MAAs and because of the skimming effect, existing differences in flow between metastatic lesions of variable size are likely exaggerated on 99mTc-MAA scintigraphy when compared to 90Y-TheraSpheres and 90Y-SIR-spheres (smaller variability in size and probably also in specific activity). Ideally, labelled MAAs would contain a size range similar to that of 90Y-SIR- spheres or 90Y-TheraSpheres. Furthermore, the optimal number of MAA particles to inject for the pretreatment planning scintigraphy warrants further exploration as it was shown that concentrated suspensions of microspheres produce more optimal tumour to normal liver distribution ratios. Finally, available data suggest that the flow-based heterogeneous distribution of microspheres to metastatic lesions of variable size might be optimized, that is rendered more homogeneous, through the combined use of angiotensin II and degradable starch microspheres. © Springer-Verlag 2012.

Desmet M.,AZ Groeninge | Vanneste B.,Catholic University of Leuven | Reynvoet M.,AZ Groeninge | Van Cauwelaert J.,AZ Groeninge | And 4 more authors.
Anaesthesia | Year: 2015

Summary We recruited patients scheduled for shoulder rotator cuff repair or subacromial decompression under general anaesthesia and interscalene brachial plexus blockade (30 ml ropivacaine 0.5%). We allocated 240 participants into four groups of 60 that were given pre-operative saline 0.9% or dexamethasone 1.25 mg, 2.5 mg or 10 mg, intravenously. We recorded outcomes for 48 h. The median (IQR [range]) time to first postoperative analgesic request after saline was 12.2 (11.0-14.1 [1.8-48]) h, which was extended by intravenous dexamethasone 2.5 mg and 10 mg to 17.4 (14.9-21.5 [7.2-48]) h, p < 0.0001, and 20.1 (17.2-24.3 [1.3-48]) h, p < 0.0001, respectively, but not by dexamethasone 1.25 mg, 14.0 (12.1-17.7 [2.1-48]) h, p = 0.05. Postoperative analgesia was given sooner after rotator cuff repair than subacromial decompression, hazard ratio (95% CI) 2.2 (1.6-3.0), p < 0.0001, but later in older participants, hazard ratio (95% CI) 0.98 (0.97-0.99) per year, p < 0.0001. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

Desmet M.,AZ Groeninge | Braems H.,Catholic University of Leuven | Reynvoet M.,AZ Groeninge | Plasschaert S.,AZ Groeninge | And 5 more authors.
British Journal of Anaesthesia | Year: 2013

BackgroundInterscalene brachial plexus block (ISB) provides excellent, but time-limited analgesia. Dexamethasone added to local anaesthetics prolongs the duration of a single-shot ISB. However, systemic glucocorticoids also improve postoperative analgesia. The hypothesis was tested that perineural and i.v. dexamethasone would have an equivalent effect on prolonging analgesic duration of an ISB.MethodsWe performed a prospective, double blind, randomized, placebo-controlled study. Patients presenting for arthroscopic shoulder surgery with an ISB were randomized into three groups: ropivacaine 0.5% (R); ropivacaine 0.5% and dexamethasone 10 mg (RD); and ropivacaine 0.5% with i.v. dexamethasone 10 mg (RDiv). The primary outcome was the duration of analgesia, defined as the time between performance of the block and the first analgesic request. Standard hypothesis tests (t-test, Mann-Whitney U-test) were used to compare treatment groups. The primary outcome was analysed by Kaplan-Meier survival analysis with a log-rank test and Cox's proportional hazards regression.ResultsOne hundred and fifty patients were included after obtaining ethical committee approval and patient informed consent. The median time of a sensory block was equivalent for perineural and i.v. dexamethasone: 1405 min (IQR 1015-1710) and 1275 min (IQR 1095-2035) for RD and RDiv, respectively. There was a significant difference between the ropivacaine group: 757 min (IQR 635-910) and the dexamethasone groups (P<0.0001).ConclusionsI.V. dexamethasone is equivalent to perineural dexamethasone in prolonging the analgesic duration of a single-shot ISB with ropivacaine. As dexamethasone is not licensed for perineural use, clinicians should consider i.v. administration of dexamethasone to achieve an increased duration of ISB. © The Author [2013]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.

Swinnen G.,AZ Groeninge | Maes A.,AZ Groeninge | Pottel H.,Catholic University of Leuven | Vanneste A.,AZ Groeninge | And 3 more authors.
European Urology | Year: 2010

Background: Locoregional lymph node metastasis is an important prognostic factor in patients with bladder cancer. Multimodal treatment, depending on preoperative stage, may improve survival. The standard imaging modalities for staging (computed tomography [CT] or magnetic resonance imaging [MRI]) have an accuracy range of 70-90% for lymph node staging. A more accurate preoperative diagnostic test could improve survival rates even more. Objective: To determine whether the use of 2-deoxy-2 [F] fluoro-D-glucose (FDG) positron emission tomography (PET) in combination with CT (FDG-PET/CT) can increase the reliability of preoperative lymph node staging in patients with nonmetastatic invasive bladder cancer (T2 or higher, M0) or recurrent high-risk superficial disease (T1G3 with or without Tis, M0). Design, setting, and participants: Fifty-one patients underwent a preoperative FDG-PET/CT between April 2004 and December 2007. Independent of the result for lymph node status, all patients underwent a radical cystectomy and an extended lymphadenectomy. The FDG-PET/CT and CT results were compared with the definitive pathologic results. Measurements: Among the 51 patients, 13 patients had metastatically involved locoregional lymph nodes, diagnosed on histopathology. In six patients, these nodes demonstrated increased FDG uptake on PET. In seven patients, PET/CT did not diagnose the positive lymph nodes. PET/CT was false positive in one patient. Results and limitations: For the diagnosis of node-positive disease, the accuracy, the sensitivity, and the specificity of FDG-PET/CT were 84%, 46%, and 97%, respectively. When analysing the results of CT alone, there was accuracy of 80%, sensitivity of 46%, and specificity of 92%. The use of FDG-PET/CT is hampered by technical limitations. Conclusions: We found no advantage for combined FDG-PET/CT over CT alone for lymph node staging of invasive bladder cancer or recurrent high-risk superficial disease. © 2009 European Association of Urology.

Lerut P.,AZ Groeninge | Nuytens F.,AZ Groeninge | D'Hondt M.,AZ Groeninge
Annals of Surgical Oncology | Year: 2016

Background: The management of patients with simultaneously diagnosed colorectal liver and lung metastases (SLLM) remains controversial. A recent study based on an analysis of the LiverMetSurvey demonstrated that patients with SLLM suitable for resection of all metastases have a survival similar to that of patients who undergo removal of isolated liver metastases.1 Simultaneous transdiaphragmatic resection of peripheral lung lesions and liver resection by laparotomy has been described previously.2 To the authors’ knowledge, no previous reports on a similar minimally invasive approach have been published. In April 2015, the authors started performing combined minimally invasive transdiaphragmatic resections of peripheral colorectal lung metastases in patients undergoing laparoscopic liver resections. This video aims to demonstrate the authors’ first experience with this minimally invasive approach. Methods: This report describes a combined minimally invasive transdiaphragmatic resection of peripheral colorectal lung metastasis in a patient undergoing a laparoscopic liver resection. General anesthesia was induced with placement of a double-lumen endotracheal tube to achieve single-lung ventilation. Once laparoscopic liver resection was completed, the left lung containing the metastatic lesion was deflated. The left hemidiaphragm was carefully divided using a 10-cm incision around the central tendon to avoid damage to the phrenic nerve. The lung metastasis was localized using intraoperative ultrasound, and the lesion was resected using endoscopic 60-mm vascular staplers. A thoracic tube was placed, and the diaphragm was closed with a running nonabsorbable suture. Results: The operative time was 180 min, and the blood loss was 100 ml. The postoperative course was uneventful. The patient was discharged on postoperative day 4. Pathology confirmed two colorectal metastases. Tumor-free margins of 5 mm for the liver and 7 mm for the lung were achieved. Conclusions: Simultaneous transdiaphragmatic resection of peripheral lung lesions is feasible for patients undergoing laparoscopic liver resection. The low invasiveness of the described technique could facilitate an aggressive operative approach to SLLM. © 2016 Society of Surgical Oncology

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