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Kingman M.,Southwestern Medical Center | Hinzmann B.,Bayer AG | Vachiery J.-L.,Cliniques Universitaires Of Bruxelles
BMJ Open | Year: 2014

Objectives: To better understand the patient's perspective of pulmonary hypertension (PH), including the impact of living with PH, disease management and treatment. Design: This qualitative ethnographic study collected observational video footage, supplemented by field notes and patient diaries to assess the impact of PH on the patient's life. Setting: Patients were observed and filmed in their home for up to 6 h, capturing the environment, interactions and activities of everyday life. Participants: Patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic PH who were receiving PAH-specific medication were recruited through healthcare professionals (HCPs) and patient associations in seven countries across four continents. Sampling was purposive and subgroup analysis was not intended. Results: Overall, 39 patients with PH were enrolled. Many patients had a poor understanding of PH and found their 'invisible' disease difficult to explain to others. An important finding was the secrecy surrounding PH. Feelings of insecurity and isolation were regularly reported, and many patients admitted to hiding their symptoms. The marked improvement in symptoms after therapy initiation made assessment of disease progression more difficult as patients compared their quality of life (QoL) against pretreatment levels. Extensive planning and adherence to daily routines were required in patients' everyday life. Conclusions: Ethnography was used for the first time, in several countries, to evaluate the patient's perception of living with PH. This approach revealed key findings that would not typically be uncovered using other qualitative techniques, including the secrecy surrounding PH, the difficulties in describing the disease and the challenges in assessing disease progression. A more tailored dissemination of information from HCPs and development of a simple and understandable PH definition may be beneficial in alleviating the secrecy reported by patients. A greater appreciation of how patients perceive their disease and QoL has the potential to improve PH management.

PubMed | Hannover Medical School, University of Genoa, University of Bologna, University Paris - Sud and 3 more.
Type: | Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation | Year: 2016

The VOLibris Tracking (VOLT) Study was an open-label, prospective, observational, multicenter, post-marketing registry program designed to more fully characterize the safety profile of ambrisentan for the treatment of pulmonary arterial hypertension (PAH). The key outcome was the incidence of aminotransferase elevations >3 the upper limit of normal (ULN).In total, 999 patients from 115 centers in 15 countries, who were prescribed ambrisentan for the treatment of PAH (Functional Class II and III) between 30 June 2008 and 13 May 2011, were enrolled. Of these, 238 had PAH associated with connective tissue disease (PAH-CTD) and 220 had no prior PAH-specific therapy. Routine clinical monitoring data were collected by physicians.The incidence of both alanine and aspartate aminotransferase events (>3 ULN) was 0.02 per patient-year (95% confidence interval 0.015 to 0.027). Similar results were reported for the PAH-CTD and PAH-specific-therapy-naive subgroups. Overall, 514 (52%) patients reported treatment-emergent adverse events of special interest, most commonly edema/fluid retention (249, or 25%) and anemia (143, or 14%).Data from the VOLT study indicate no new ambrisentan-related safety signals. Ambrisentan was not associated with increases in liver function test abnormalities above the assumed background incidence of 1.5% per year, and the observed safety profile of ambrisentan was consistent with previously published data.

Forfia P.R.,University of Pennsylvania | Vachiry J.-L.,Cliniques Universitaires Of Bruxelles
American Journal of Cardiology | Year: 2012

In the context of pulmonary arterial hypertension (PAH), echocardiographic assessment of right ventricular (RV) function is key to determining disease severity and prognosis. Using Doppler echocardiography (ECHO) there are numerous ways that RV function can be measured, either directly or indirectly, to capture the triad of changes in RV geometry, right-to-left interaction, and RV systolic dysfunction in response to high pulmonary vascular resistance states, such as PAH. To fully evaluate and characterize the nature and extent of the impact of PAH on the RV in an individual patient, it is critical to assess a combination of these direct and indirect measures of RV function. In order to predict changes in status and have prognostic significance, the variables used must be easy to measure, reproducible, and clinically relevant. This review assesses the relative value of different ECHO parameters and looks at what the future holds for ECHO imaging of the right heart in PAH. © 2012 Elsevier Inc.

PubMed | S Luca Hospital and Cliniques Universitaires Of Bruxelles
Type: Review | Journal: Current heart failure reports | Year: 2016

Heart failure (HF) is a clinical syndrome frequently associated with airway obstruction, either as a respiratory comorbidity or as a direct consequence of HF pathophysiology. Recognizing the relative contribution of an underlying airway disease as opposed to airway obstruction due to volume overload and left atrial pressure elevation is of importance for the appropriate management of patients affected by HF. This review focuses on les liaisons dangereuses between the heart and the lungs, outlying recent advances linking in a vicious circle of chronic obstructive lung disease (COPD) and obstructive sleep apnea (OSA) on one side and HF on the other side. It also discusses the role of pivotal diagnostic tools such as pulmonary function tests and cardiopulmonary exercise test to determine the contribution of HF and COPD to symptoms and clinical status. Treatment implications are discussed as well.

Burny F.,Cliniques Universitaires Of Bruxelles | Burny W.,Cliniques Universitaires Of Bruxelles | Donkerwolcke M.,Cliniques Universitaires Of Bruxelles | Behrens M.,Stryker Inc.
International Orthopaedics | Year: 2012

Purpose: We designed a sensor that measures the bending moments at the articulations and the torque of the rod of a Hoffmann II® external fixation. We considered the effect of the callus formation in the stabilisation of a "fracture-fixation system." Methods: Four Hoffmann II® frame configurations were mechanically tested. Two carbon fibre tubes represent the bone fragments (length 180 mm, outer diameter 25 mm, inner diameter 19 mm). The callus is represented by the interposition of springs of different rigidity (10-405 N/mm) in the fracture gap between the tubes. Results: The deformation of the frame is in inverse proportion to the stiffness of the callus; the slope of the curve drops rapidly during early development of the callus, to reach a plateau after some 50 % of recovery of the normal mechanical characteristics of the bone. This simulation supports the theoretical approach, i.e. The external frame resists larger stresses at the start of the fracture healing. Over a callus stiffness of some 200 N/mm the pattern of the curves remains similar, regardless of the frame configuration. Conclusion: An optimisation of the frame is possible, adapted to the actual mechanical situation of the callus. A monitoring system is deemed reliable after making sure that the elementary components behave the same way in the clinical condition as in the laboratory. In an experimental set up we confirmed its reliability in a clinical-like situation. © 2012 Springer-Verlag Berlin Heidelberg.

Farber C.M.,Immunodeficiency Treatment Unit | Van Der Biest-Cardinal C.,Cliniques Universitaires Of Bruxelles
Acta Clinica Belgica | Year: 2011

New applications are always being developed for immunoglobulins; new recommendations are regularly published. We wished to know the indications used in a large hospital. A hundred and thirty-six adult patients were prescribed immunoglobulins from January to December 2008. Three preparations in intravenous immunoglobulins were available (one liquid, 2 freeze-dried). Fourteen charts were rejected for clerical errors. A hundred and twenty two charts were available for statistical study. Thirty-six patients were on immunoglobulins for antibody deficiency, 19 were followed in haematology for chronic lymphoid leukaemia or multiple myeloma, 19 were treated after lung transplantation, 17 had received a kidney transplant, 1 after heart transplantation: these indications were substitution. Twenty for Guillain Barré and chronic demyelinating polyneuropathy, 10 in immune thrombocytopenic purpura: this was for immunomodulation. Recommendations were followed by the prescribers; charts were reviewed in March and November 2009. Side-effects were rare. (0.6%) (1).

PubMed | Ospedale S Luca Irccs Instituto Auxologico Italiano, University of Milan Bicocca and Cliniques Universitaires Of Bruxelles
Type: | Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation | Year: 2017

Excessive exercise-induced hyperventilation and high prevalence of exercise oscillatory breathing (EOB) are present in patients with post-capillary pulmonary hypertension (PH) complicating left heart disease (LHD). Patients with pre-capillary PH have even higher hyperventilation but no EOB. We sought to determine the impact of a pre-capillary component of PH on ventilatory response to exercise in patients with PH and left heart disease.We retrospectively compared patients with idiopathic or heritable pulmonary arterial hypertension (PAH, n = 29), isolated post-capillary PH (IpcPH, n = 29), and combined post- and pre-capillary PH (CpcPH, n = 12). Diastolic pressure gradient (DPG = diastolic pulmonary artery pressure - pulmonary wedge pressure) was used to distinguish IpcPH (DPG <7 mm Hg) from CpcPH (DPG 7 mm Hg).Pulmonary vascular resistance (PVR) was higher in PAH, intermediate in CpcPH, and low in IpcPH. All patients with CpcPH but 1 had PVR >3 Wood unit. Exercise-induced hyperventilation (high minute ventilation over carbon dioxide production, low end-tidal carbon dioxide) was marked in PAH, intermediate in CpcPH, and low in IpcPH (p < 0.001) and correlated with DPG and PVR. Prevalence of EOB decreased from IpcPH to CpcPH to PAH (p < 0.001).Patients with CpcPH may have worse hemodynamics than patients with IpcPH and distinct alterations of ventilatory control, consistent with more exercise-induced hyperventilation and less EOB. This might be explained at least in part by the presence and extent of pulmonary vascular disease.

Sobczak S.,Free University of Colombia | Rotsaert P.,Cliniques Universitaires Of Bruxelles | Vancabeke M.,Cliniques Universitaires Of Bruxelles | Van Sint Jan S.,Free University of Colombia | And 2 more authors.
Clinical Biomechanics | Year: 2011

Background: Many studies show good clinical results after proximal row carpectomy. Some biomechanical consequences are documented, but to our knowledge muscle moment arm variations have not previously been quantified. Methods: In five fresh-frozen wrist, kinematics and tendon excursions were measured using a 3D electrogoniometer and Linear Variable Differential Transformers (SOLARTRON Inc., AMETEK Advanced Measurement Technology, Inc, 801 South Illinois Avenue, Oak Ridge, TN 37831-2011, USA), respectively, in three conditions: intact wrist, after posterior capsulotomy and after proximal row carpectomy. Mean pivot point, defined as the point whose sum of the squared distances to the helical axes is minimum, wrist range of motion and mean moment arms were measured during dorso-palmar flexion, radioulnar deviation and circumduction movements. Findings: No alteration of the range of motion was observed. On the other hand, the mean pivot point shifted proximally (6.8-9.1 mm) after proximal row carpectomy (p < 0.05) for all motions tested and most muscle moment arms decreased significantly after proximal row carpectomy. Interpretation: The results of this study allow a better understanding of the biomechanical effects of this procedure. The important moment arm reduction and pivot point displacement suggest modifications of joint biomechanical parameters which could influence the functional outcome of PRC. © 2011 Elsevier Ltd.

Cordonnier M.,Cliniques Universitaires Of Bruxelles | Van Nechel C.,Cliniques Universitaires Of Bruxelles
Acta Neurologica Belgica | Year: 2013

There are five possible ocular signs or complaints of a life or sight threatening neuro-ophthalmological condition: diplopia, isolated anisocoria, transient visual loss, severe pain in head or neck (with or without photophobia) and oscillopsia/nystagmus. In this review, the ocular signs and symptoms of neuro-ophthalmological emergencies are described together with their practical work-up and the risks associated with missing the diagnosis. Concerning diplopia, the associated signs pointing to a possible threatening condition are emphasized. Six focus points resuming core messages are displayed throughout this review. © 2013 Belgian Neurological Society.

PubMed | Cliniques Universitaires Of Bruxelles
Type: Journal Article | Journal: Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie | Year: 2016

Intravesical instillations of BCG represent an established treatment of high-risk non-muscle-invasive bladder cancer but also carry considerable toxicity. The aim of this work was to identify adverse effects, their impact on the treatment and the possible involvement of the BCG strain used.To evaluate adverse events in terms of incidence, severity and moment of occurrence, we performed a retrospective analysis of all patients treated with BCG in our institution from 1998 to 2012.One hundred and forty-six patients were retained for analysis, 140 (95.9%) finished their first induction cycle. Thirty patients (20.6%) had to stop the treatment because of BCG-related adverse events, 80% of which happened during the first 3 BCG cycles (12 instillations). The strain used may have had a significant impact: 16 out of 42 patients (38.1%) treated with Connaught (Immucyst) and 14 out of 104 patients (13.5%) treated with Tice (Oncotice) had to stop treatment because of BCG related adverse events (P=0.0019) with an odds ratio of 2.83 (IC 95%: 1.52-5.23).BCG-related adverse events generally occur at the beginning of the treatment and therefore do not limit the use of BCG maintenance therapy. Good instillation practice and, in our series, the shift from Connaught to Tice strain enabled to significantly reduce BCG-related adverse events through time. The potential implication of the BCG strain used should be evaluated in prospective trials.

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