Sint-Niklaas, Belgium
Sint-Niklaas, Belgium

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Scheerlinck T.,Universitair Ziekenhuis Brussel Brussel | Delport H.,AZ Nikolaas | Kiewitt T.,BioMet
Journal of Bone and Joint Surgery - Series A | Year: 2010

Background: The cement mantle within a hip resurfacing head is important for implant survival. Too much cement leads to thermal bone necrosis, whereas not enough cement might cause mechanical failure and particle-induced osteolysis. We evaluated the impact of different cementing techniques on the quality of the cement mantle in hip resurfacing. Methods: Sixty bovine condyles were prepared to fit a size-46 ReCap (Biomet) implant and divided into five groups of twelve specimens each. In two of the groups, a polymeric replica was filled halfway with low-viscosity cement; suction was employed in one of those groups and not used in the other. Medium-viscosity cement was used in the remaining three groups: it was spread out within the implant in one group, it was packed on the bone in another, and a combination of those techniques was used in the third. Half of the sixty specimens had six anchoring holes. The specimens underwent computed tomography and were analyzed with custom-made segmentation software. Results: The cementing technique and anchoring holes influenced the cement quantity within the implant and the thickness of the cement mantle; suction and bone density did not. Both filling techniques involving the use of low-viscosity cement resulted in excessive cement within the implant (filling index, 47.30% to 60.66%) and large cement defects at the base. The combined technique also resulted in large cement quantities (filling index, 46.62% to 54.12%) but fewer cement defects at the base. The filling technique involving the use of medium-viscosity cement decreased the cement quantity (filling index, 43.31% to 45.68%), but cement packing was the best technique (filling index, 29.20% to 31.05%), resulting in the thinnest, most homogeneous cement mantle. However, distal cement defects remained, and the prevalence of proximal cement-implant interfacial gaps was about 10%. Conclusions: The results of this experimental study cannot be extrapolated directly to the in vivo situation, and they apply only to implants with an inner geometry similar to that of the size-46 ReCap resurfacing head and to the cement brands that we used. None of the cementing techniques was "perfect." Both of the filling techniques involving use of low-viscosity cement and the combined technique resulted in excessive cement proximally. The filling technique involving use of medium-viscosity cement was promising, but the cement-packing technique offered the best opportunity to control the quality of the cement mantle. However, the presence of interfacial gaps raised new questions. We suggest that the use of anchoring holes in cancellous bone should be considered with caution in order to avoid overfilling with cement. Clinical Relevance: This study should help the clinician to choose an optimal cementing technique for hip resurfacing. Copyright © 2010 by The Journal of Bone and Joint Surgery, Incorporated.


Zachee B.,AZ Nikolaas | Berghe L.V.,Sint Lukas Hospital Bruges
Acta Orthopaedica Belgica | Year: 2016

Results and clinical outcome of a prospective multicenter clinical study involving 100 patients undergoing a lumbar interbody fusion procedure using an unilateral approach to the spine to introduce a new surgical technique as a viable and less invasive alternative to standard posterior (PLIF) or transforaminal (TLIF) lumbar interbody fusion techniques: For certain indications clinical data show that unilateral lumbar interbody fusion (ULIF) offers the surgeon a considerable time advantage compared to standard lumbar interbody fusion techniques. © 2016, Acta Orthopædica Belgica.


Riekhoff A.G.M.,University of Antwerp | Jadoul C.,AZ Nikolaas | Mercelis R.,University of Antwerp | Cras P.,University of Antwerp | Ceulemans B.P.G.M.,University of Antwerp
European Journal of Paediatric Neurology | Year: 2012

Background: Chronic inflammatory demyelinating polyneuroradiculopathy (CIDP) is an autoimmune disease of the peripheral nervous system, causing demyelination and even axonal degeneration. In children, abnormal gait as a first sign of muscle weakness is a frequent reason to seek medical attention. Diagnosis is made on the basis of clinical characteristics, electromyography and nerve conduction studies, and elevated protein in cerebrospinal fluid. Aims: We present three new cases of CIDP. The literature was reviewed in order to obtain more information on presentation, outcome and treatment strategies world-wide. Results: The course of disease can be relapsing-remitting or chronic-progressive. From case series it is known that first-line immunotherapy (intravenously administered immunoglobulin, corticosteroids or plasmapheresis) is initially of benefit in most children with CIDP. There is little evidence, however, on second-line therapies as azathioprine, cyclosporine A, mycophenolate mofetil, methothrexate, cyclophosphamide and IFN alpha. Although the outcome of children with CIDP is generally regarded to be good, disease related disability can be severe. Conclusion: Childhood CIDP is rare. In general and in comparison to adults, children tend to have a more acute progressive onset, with more severe symptoms. Showing a higher tendency towards a relapsing-remitting course, children often show a better and faster improvement after therapy, and a more favorable outcome. Swift recognition of CIDP and empiric start of treatment are considered important to avoid potentially irreversible axonal damage and associated disability. Response to first-line therapies is usually favorable, however recommendations regarding the choice of second-line therapy can only be made on the basis of current practice described in case reports. Safety and efficacy data are insufficient. The cases described show that trial and error are often involved in finding an optimal treatment strategy, especially in those patients refractory to first-line treatment or with a prolonged course. Clinical experience with immunomodulatory treatment is paramount when treating children with CIDP. © 2011 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.


Intestinal obstruction is a common complication in patients with advanced abdominal or pelvic cancer. The synthetic somatostatin analogue octreotide can help relieve nausea, vomiting and pain in patients with inoperable obstruction. Here, we report a case of recurrent intestinal obstruction in a patient with adenocarcinoma. Although the obstruction was resolved after 3 days of treatment with octreotide, new episodes of obstruction occurred, resulting in a delay of the chemotherapy treatment. After 3 episodes of obstruction, we initiated treatment with a longer-acting somatostatin analogue, lanreotide Autogel® 120 mg, administered once every 4 weeks. The treatment with lanreotide Autogel is being continued, allowing for continuation of the chemotherapy without further episodes of intestinal subocclusion or obstruction. Until November 2013, the patient received eighteen 4-weekly injections of lanreotide Autogel and did not report side effects. This case report demonstrates the successful treatment of intestinal obstruction with lanreotide Autogel in a patient with adenocarcinoma. © 2014 S. Karger AG, Basel.


Van Buyten J.-P.,AZ Nikolaas | Linderoth B.,Karolinska University Hospital
European Journal of Pain Supplements | Year: 2011

In the mid of the 20th century various types of facial pains, not clearly originating from the teeth or the eyes, were often misdiagnosed as trigeminal neuralgia and treated with lesional techniques. Pains from the rest of the head were simply classified as " headache" and treated with the pharmaceutical means available at that time. For migraine there was often no effective therapy.Headache is a common reasons for patients to seek medical care. Migraine is the most common form of disabling primary headache that has been estimated to be the most costly neurological disorder in the European Community at more than €27 billion per year. While considerable developments have been made in understanding and treating primary headaches there remains a group of patients with difficult to treat headache problems. Facial pain is another complex pain problem and especially severe neuropathic facial pain with considerable deafferentation has been labelled " la bête noire" of pain surgery. Many of these headache and facial pain problems are refractory to pharmacotherapy. Interventional pain management using electrical stimulation techniques can be the solution for a selected portion of these patients. In this article we describe and discuss a " treatment ladder" from minimally invasive to more interventional stimulation techniques according to the diagnosis of the pain syndrome under consideration. For each type of procedure, indications, technique and complications are discussed based on the experience of the authors and a review of the literature. © 2011.


Verelst P.,AZ Nikolaas | Van Zundert A.,Catharina Hospital | Van Zundert A.,Ghent University | Van Zundert A.,Maastricht University
Regional Anesthesia and Pain Medicine | Year: 2013

Shoulder surgery is associated with significant postoperative pain in many patients. The use of an interscalene nerve block offers good analgesia but is associated with a high incidence of an ipsilateral phrenic nerve block. Several strategies to avoid this adverse effect have been studied. Possible strategies are (1) using very low volumes of local anesthetics, (2) targeting the brachial plexus at a lower level in the neck, (3) applying a suprascapular nerve block, and (4) applying the combination of a suprascapular and an axillary nerve block. Using systemic analgesics is a less favorable strategy because this may result in less potent analgesia and may cause more adverse effects, including respiratory depression and nausea. Copyright © 2012 American Society of Regional Anesthesia and Pain Medicine.


Van Buyten J.-P.,AZ Nikolaas | Linderoth B.,Karolinska University Hospital
European Journal of Pain Supplements | Year: 2010

Approximately 30% of patients experience persistent or recurrent low back and/or pain projecting into the legs following technically adequate lumbosacral surgery. Such pain conditions are often alluded to as the failed back surgery syndrome (FBSS). FBSS represents a significant clinical and economic concern. The treatment of FBSS presents a challenge to physicians, as conservative therapies and spinal reoperations are often unsuccessful - if not a significant cause (besides fibrosis) of the persistent pain syndrome is found at the post-operative examinations. Neuropathic pain radiating into the leg(s) is often the main component of this persistent and disabling syndrome. In this case, spinal cord stimulation (SCS) has been shown to be a successful therapeutic option. Studies have demonstrated that up to 60% of implanted patients experience 50% or more pain relief following SCS. Moreover, SCS has been shown to improve both quality of life and functional status in a significant number of patients. In order to address the challenge of managing both chronic back and leg pain, a multidisciplinary group of physicians experienced in pain management and spinal surgery assembled to discuss and formulate a treatment strategy for FBSS, based on a systematic review of the literature that focused on the role of SCS. The outcome of these discussions however remained unpublished why an update, taking into account also the moderns technologies has been performed.The development of new treatment algorithms should allow, easier, more rational and effective management of this common and clinically - as well as economically - important problem. © 2010 European Federation of International Association for the Study of Pain Chapters.


Van Buyten J.-P.,AZ Nikolaas | Al-Kaisy A.,Guys And St Thomas Hospital | Smet I.,AZ Nikolaas | Palmisani S.,Guys And St Thomas Hospital | Smith T.,Guys And St Thomas Hospital
Neuromodulation | Year: 2013

Objective The objective of this prospective, open-label, multicenter European clinical trial was to quantify the efficacy and safety of a spinal cord stimulation (SCS) system that utilizes high-frequency (up to 10 kHz) waveforms, which do not produce paresthesia, for the treatment of chronic, intractable pain of the back and/or limbs. Material and Methods Eighty-three patients, with significant back pain, were recruited for a trial of high-frequency stimulation through two percutaneous eight-contact epidural leads. Patients' pain ratings, disability, sleep disturbances, and satisfaction, as well as complication rates, were assessed for up to six months. Results After a trial period, 88% (72 out of 82) of patients reported a significant improvement in visual analog scale (VAS) scores and underwent permanent implantation of the high-frequency SCS system. Mean back pain VAS of 8.4 was reduced to 2.7 at six months (p< 0.001). Mean leg pain VAS of 5.4 was reduced to 1.4 at six months (p< 0.001). Seventy-four percent of patients had greater than 50% back pain relief at six months. There were significant improvements in Oswestry disability score and sleep, and reductions in pain medication use. Adverse events observed were those seen with conventional SCS therapy - lead migration, wound infection, and pain around implant site. Conclusions In a cohort of patients with difficult-to-treat chronic back pain, high-frequency SCS provided significant and sustained low back pain and leg pain relief to more than 70% of treated subjects. Notably, this was achieved without paresthesia. Patients also experienced significant improvement in disability and sleep. Overall, the results confirm a favorable safety and efficacy profile of the high-frequency SCS system. © 2012 International Neuromodulation Society.


Goeminne P.C.,Catholic University of Leuven | De Wit E.H.,AZ Nikolaas | Burtin C.,Catholic University of Leuven | Valcke Y.,AZ Nikolaas
Appetite | Year: 2012

Aim: A new system of meal distribution called Meals on Wheels, allowing food ordering at mealtime and providing guidance by trained nutritional assistants, might show benefit in offering nutritional support. This study investigates whether Meals on Wheels improves total food intake per day and yielded improved appreciation of food quality and increased access to food and mealtimes. Methods: In a prospective cohort trial where control and intervention groups were taken from all patients hospitalized at the respiratory disease department, age, sex, BMI, admission weight, height, reason for admission and discharge weight were noted, as was food intake, supplements, waste per meal and daily total. For food appreciation the questionnaire developed by Naithani et al. was used. The study included 83 patients in the control group and 106 patients in the Meals on Wheels group. Results: Mean total daily food intake was 236. g higher in patients in the Meals on Wheels than in controls. There was higher intake of oral nutritional supplements in the Meals on Wheels group compared to controls, resulting in significantly less oral nutritional supplements wasted. There was also significantly less waste in the Meals on Wheels group. For food access and appreciation, patients appreciated Meals on Wheels more than the old system in terms of choice, hunger, food quality and organization. Conclusions: Meals on Wheels resulted in higher food intake during each meal, less waste and better use of oral nutritional supplements. Patients appreciated Meals on Wheels more than the old system in terms of choice, hunger, food quality and organization. © 2012 Elsevier Ltd.


Background: Arthrodesis is considered to be the reference treatment for degenerative disc disease (DDD), if the symptoms are refractory to conservative management. The drawback of arthrodesis is, besides a percentage of non-union, the reduced mobility that might generate an increased load and risk for degeneration of the adjacent levels. Total disc replacement (TDR) implants may overcome this problem. The long-term clinical effect and radiographic evaluation of motion preservation after implantation, however, have been subject to several nonconclusive studies. This study evaluated the long-term clinical and radiographic results and the safety of TDR with the Maverick prosthesis for surgical treatment of monosegmental DDD. Methods: TDR was performed in 50 consecutive patients with monosegmental DDD using the Maverick device. Patients were followed prospectively for disability, quality of life, pain intensity and frequency, as well as working status and return to sports, during 48 months. Motion preservation was assessed on neutral and dynamic radiographs at 48 months. Results: The disability, pain intensity and frequency, and quality of life improved significantly at the 6-week follow-up, which was maintained over the full 48 months following Maverick implantation. Preoperatively, 80% of the patients stopped working and 86% halted sports activities. Four years after surgery, 85% of patients were again working and 79% took up their normal sports activities. Radiographic assessment showed that motion at the index level is maintained 48 months after TDR. No major complications were encountered. Conclusion: In this study, TDR with the Maverick prosthesis at one lumbar segment reduced pain and disability and improved quality of life as well as the general condition. Motion was preserved at the operated level, 48 months after surgery. The long-term effect on adjacent levels needs further follow-up. © 2012 Elsevier Inc. All rights reserved.

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