Han S.N.,University Hospitals Leuven |
Lotgerink A.,Jessa Hospital |
Gziri M.M.,University Hospitals Leuven |
Van Calsteren K.,University Hospitals Leuven |
And 2 more authors.
BMC Medicine | Year: 2012
Background: Recent insights provide support for the treatment of cancer during pregnancy, a coincidence that poses both mother and fetus at risk. Our aim was to critically review studies on the physiologic variations during pregnancy, the most common tumor markers used in diagnosis and follow-up of gynecological cancers.Methods: We conducted a systematic review of six tumor markers during normal pregnancy: carbohydrate antigen (CA) 15-3 (breast cancer); squamous cell carcinoma antigen (cervical cancer); and CA 125, anti-Müllerian hormone, inhibin B and lactate dehydrogenase (ovarian cancer).Results: For CA 15-3, 3.3% to 20.0% of all measurements were above the cut-off (maximum 56 U/mL in the third trimester). Squamous cell carcinoma antigen values were above cut-off in 3.1% and 10.5% of the measurements (maximum 4.3 μg/L in the third trimester). Up to 35% of CA 125 levels were above cut-off: levels were highest in the first trimester, with a maximum value up to 550 U/mL. Inhibin B, anti-Müllerian hormone and lactate dehydrogenase levels were not elevated in maternal serum during normal pregnancy.Conclusion: During normal pregnancy, tumor markers including CA 15.3, squamous cell carcinoma antigen and CA 125 can be elevated; inhibin B, anti-Müllerian hormone and lactate dehydrogenase levels remain below normal cut-off values. Knowledge of physiological variations during pregnancy can be clinically important when managing gynecological cancers in pregnant patients. © 2012 Han et al; licensee BioMed Central Ltd.
Albersen M.,University Hospitals Leuven |
Linsen L.,Hasselt University |
Tinel H.,Bayer AG |
Sandner P.,Bayer AG |
Van Renterghem K.,Jessa Hospital
Journal of Sexual Medicine | Year: 2013
Introduction.: Overall efficacy rates of phosphodiesterase type 5 inhibitors (PDE5-i) for erectile dysfunction (ED) are 60-70%. PDE5-i treatment failures currently have to resort to invasive treatment options for restoration of erectile function. Aims.: To assess changes in the nitric oxide (NO)/cyclic guanosine monophosphate (cGMP)/protein kinase (PKG) pathway in human corpus cavernosum (HCC) of PDE5-i nonresponders compared with healthy controls. To evaluate the effects of BAY 60-4552, a stimulator of soluble guanylate cyclase (sGC), and vardenafil on relaxation of HCC strips from PDE5-i nonresponders. Main Outcome Measures.: mRNA expression, morphological localization of the NO/cGMP/PKG pathway, and relaxant capacity of both compounds alone or combined. Analysis of variance, t-test or Mann-Whitney test based upon number of groups and normality of data. Methods.: HCC tissues were harvested after consent from individuals undergoing penile prosthesis implantation (patients) and potent patients undergoing transurethral surgery (healthy controls, needle biopsy). HCC tissues of patients were compared with those of healthy controls for the expression of mRNA coding for PDE5A, eNOS, PKGα1, PKG2, sGCα1, sGCα2, sGCβ1, sGCβ2, α-smooth muscle actin (aSMA) and β-actin by quantitative polymerase chain reaction (qPCR). The respective proteins were localized using immunofluorescence. Tissue strips of patients were precontracted with phenylepinephrine followed by incubation with 1μM of either vardenafil or BAY 60-4552, or both simultaneously. Results.: The main targets in the NO/cGMP/sGC pathway were downregulated in PDE5-i nonresponders. The pathway was morphologically located to HCC smooth muscle, of which the overall content was preserved in ED patients based on aSMA expression. BAY 60-4552 and vardenafil have synergistic effects on relaxation of HCC of PDE5-i nonresponders. The main limitation is the small amount of control tissue precluding functional testing on these samples. Conclusion.: Despite downregulation of the NO/cGMP/PKG pathway, combining BAY 60-4552 with vardenafil significantly enhanced relaxation HCC strips of PDE5-i nonresponders. © 2013 International Society for Sexual Medicine.
Bervoets L.,Hasselt University |
Massa G.,Jessa Hospital
Pediatric Obesity | Year: 2014
Background: Studies have reported that children who are obese are becoming more severely obese. Objective: We aimed to classify obese children based on age- and gender-specific centile curves passing through body mass index (BMI) 30, 35 and 40 at age 18 as 'class I', 'class II' or severe, and 'class III' or morbid obesity. Methods: In addition to the International Obesity Task Force BMI cut-offs corresponding to BMI 30 and 35, we calculated the BMI cut-offs corresponding to BMI 40 using the LMS method proposed by Cole and Lobstein. We classified 217 obese children according to these criteria. Results: Fifty-six (25.8%) children had class III obesity, 73 (33.6%) class II obesity and 88 (40.6%) class I obesity. Class III obese children had a higher waist circumference, systolic blood pressure and fasting insulinaemia compared with less obese children. Conclusion: It is clinically important to classify obese children in different classes of obesity severity. © 2014 The Authors Pediatric Obesity © 2014 International Association for the Study of Obesity.
Willems E.,University Hospital Leuven |
Verhaegen J.,University Hospital Leuven |
Magerman K.,Jessa Hospital |
Nys S.,Jessa Hospital |
Cartuyvels R.,Jessa Hospital
International Journal of Antimicrobial Agents | Year: 2013
The purpose of this manuscript was to review recent literature and guidelines regarding phenotypic detection of emerging β-lactamases [extended-spectrum β-lactamases (ESBLs), AmpC β-lactamases and carbapenemases] in Gram-negative bacilli (GNB) in order to formulate recommendations on best practice to screen for them. We conclude that chromogenic ESBL screening agar plates are suitable to screen for ESBL-producing Enterobacteriaceae directly from clinical samples. Furthermore, ceftazidime (CAZ) and ceftriaxone or cefotaxime (CTX) are the indicator antimicrobial agents of choice for ESBL detection in GNB. In non-inducible Enterobacteriaceae, the combined double-disk synergy test (CDDST) with at least CTX and CAZ and additionally cefepime as indicators is the preferred ESBL confirmation assay. The two most suitable ESBL confirmation strategies in AmpC co-producing Enterobacteriaceae are adapted CDDSTs: (i) with addition of 3-aminophenylboronic acid to CTX and CAZ disks; and (ii) with addition of cloxacillin (CLOX) to Mueller-Hinton agar. Reduced cefoxitin susceptibility and decreased susceptibility to cefotetan are regarded as suitable screening tests for plasmid-mediated and derepressed AmpC production. A CLOX-based CDDST with CTX and CAZ as indicators is considered to be the best AmpC confirmation assay. Finally, in Enterobacteriaceae isolates we suggest to screen for carbapenemases with a 0.5 μg/mL meropenem screening breakpoint. For class A carbapenemase confirmation, the home-prepared as well as the commercially available boronic acid-based CDDST can be considered. For metallo-β-lactamase confirmation, ethylene diamine tetra-acetic-acid-based home-prepared assays are recommended. The most suitable method (CDDST or DDST) and indicator antimicrobial agent(s) vary depending on the bacterial genus. © 2012 Elsevier B.V. and the International Society of Chemotherapy.
Willems E.,University Hospital Leuven |
Cartuyvels R.,Jessa Hospital |
Magerman K.,Jessa Hospital |
Verhaegen J.,University Hospital Leuven
Diagnostic Microbiology and Infectious Disease | Year: 2013
Rapid detection of extended-spectrum β-lactamase (ESBL)-producing Gram-negative bacilli in surveillance samples of high-risk patients allows early optimization of antimicrobial therapy and timely introduction of infection control procedures. This study evaluated the BLSE (AES Chemunex), chromID ESBL (bioMérieux), and Brilliance ESBL agar (Oxoid) for rapid detection of ESBL-producing Enterobacteriaceae from surveillance samples. A total of 139 perineal and nose samples were processed. Isolated bacterial strains were identified by mass spectrometry. ESBL confirmation was performed by phenotypical and molecular tests. Overall, 16 ESBL-producing Enterobacteriaceae were recovered. The sensitivities after 24 h of incubation were comparable (BLSE, 87.5%; Brilliance ESBL, 87.5%; and chromID, 81.3%). The specificity of chromogenic media (80.7-82.1%) was significantly higher compared to BLSE (60.8%). All 3 media are reliable to screen for ESBL-producing Enterobacteriaceae from surveillance samples. Yet, the main advantages of chromogenic media over BLSE reside in their chromogenic character and higher specificity, reducing the total number of isolates that require further identification and ESBL confirmation testing. © 2013 Elsevier Inc.
Hansen D.,Hasselt University |
Dendale P.,Jessa Hospital
Journal of Cardiopulmonary Rehabilitation and Prevention | Year: 2014
PURPOSE: Type 2 diabetes mellitus (T2DM) is associated with chronotropic incompetence (CI), which may lead to a worse prognosis. It remains uncertain whether CI in T2DM patients is related to patient characteristics that are modifiable by exercise interventions. METHODS: From 33 male T2DM patients and 18 healthy subjects not taking β-blockers, calcium-antagonists, and/or diuretics, a fasting blood sample was collected, followed by an oral glucose tolerance test, maximal cardiopulmonary exercise test, and body composition analysis. Chronotropic incompetence was defined as the inability to achieve a maximal chronotropic response index (maxCRI) ≥ 0.80 during exercise testing. By univariate correlations and multivariate regression analysis, relationships between exercise tolerance, body composition, glycemic control, and maxCRI were examined. RESULTS: MaxCRI was significantly lower in T2DM patients (0.85 ± 0.17) vs healthy controls (1.02 ± 0.17, P <.01): Chronotropic incompetence was prevalent in 14 T2DM patients (42%) and 1 healthy subject (6%, P <.05). Significant (P <.05) univariate correlations between maxCRI and body mass index (r =-0.59), blood high-density lipoprotein cholesterol (r = 0.34), HbA1c (r =-0.33) and insulin level (r =-0.48), HOMA-IR index (r =-0.45), trunk adipose tissue mass (r =-0.45), waist circumference (r =-0.58), peak cycling power output (r = 0.42), and oxygen uptake (r = 0.33) were found (P <.05). Independent significant relations were found between maxCRI and waist circumference (P <.01) and peak cycling power output (P <.05). CONCLUSIONS: Chronotropic incompetence in male T2DM patients is independently related to exercise tolerance and adipose tissue mass. These data provide further insight into the etiology of CI in male T2DM patients and show that exercise interventions might impact predictors of CI. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams &Wilkins.
Knol J.J.,Jessa Hospital |
D'Hondt M.,Groeninge Hospital |
Souverijns G.,Jessa Hospital |
Heald B.,Colorectal Research Unit |
Vangertruyden G.,Jessa Hospital
Techniques in Coloproctology | Year: 2015
Background: Laparoscopic total mesorectal excision (TME) for low rectal cancer can be technically challenging. This report describes our initial experience with a hybrid laparoscopic and transanal endoscopic technique for TME in low rectal cancer.Methods: Between December 2012 and October 2013, we identified patients with rectal cancer < 5 cm from the anorectal junction (ARJ) who underwent laparoscopic-assisted TME with a transanal minimally invasive surgery (TAMIS) technique. A standardized stepwise approach was used in all patients. Resection specimens were examined for completeness and measurement of margins. Preoperative magnetic resonance imaging (MRI) characteristics and short-term postoperative outcomes were examined. All values are mean ± standard deviation.Results: Ten patients (8 males; median age: 60.5 (range 36–70) years) were included. On initial MRI, all tumors were T2 or T3, mean tumor height from the ARJ was 28.9 ± 12.2 mm, mean circumferential resection margin was 5.3 ± 3.1 mm, and the mean angle between the anal canal and the levator ani was 83.9° ± 9.7°. All patients had had preoperative chemoradiotherapy, TME via TAMIS, and distal anastomosis. There were no intraoperative complications, anastomotic leaks, or 30-day mortality. The pathologic quality of all mesorectal specimens was excellent. The distal resection margin was 19.4 ± 10.4 mm, the mean circumferential resection margin was 13.8 ± 5.1 mm, and the median lymph node harvest was 10.5 (range 5–15) nodes.Conclusions: A combined laparoscopic and transanal approach can achieve a safe and oncologically complete TME dissection for low rectal tumors. This approach may improve clinical outcomes in these technically difficult cases, but larger prospective studies are needed. © 2015, Springer-Verlag Italia Srl.
Dilling-Boer D.,Jessa Hospital |
Vanduynhoven P.,Jessa Hospital
Journal of Cardiovascular Electrophysiology | Year: 2015
Asymptomatic Coronary Occlusion and Right Ventricular Outflow Tract Tachycardia Ablation Introduction Radiofrequency ablation has become a standard procedure in the treatment of ventricular arrhythmias. The success rate varies according to the etiology and the presence or absence of underlying structural heart disease, while complication rates are relatively low. Methods To describe the damage in neighboring structures during the ablation in certain locations. Results We present a patient who underwent a radiofrequency ablation of sustained monomorphic ventricular tachycadia at the inferior and anterior part of the right ventricular outflow tract, at the insertion of the right ventricle to the left ventricle. Extensive ablation resulted in an asymptomatic occlusion of the mid segment of the left descending coronary artery. Conclusion Creation of deeper and broader lesions with current catheter technologies can result in damage of the adjacent endo- and epicardial structures. Careful evaluation of the area of interest prior to and after the ablation should therefore be mandatory. © 2015 Wiley Periodicals, Inc.
Hansen D.,Jessa Hospital
Sports medicine (Auckland, N.Z.) | Year: 2012
In subjects with obesity, the implementation of long-term exercise intervention increases lean tissue mass and lowers adipose tissue mass. However, data indicate a blunted lipolytic response, and/or skeletal muscle protein synthesis, when subjects with obesity are exposed to acute endurance or resistance exercise, respectively. Therefore, subjects with obesity seem to display a suboptimal physiological response to acute exercise stimuli. It might be hypothesized that hormonal disturbances contribute, at least in part, to these abnormal physiological reactions in the obese. This review discusses the impact of acute endurance and resistance exercise on endocrine hormones directly related to lipolysis and/or skeletal muscle protein synthesis (insulin, [nor]epinephrine, cortisol, growth hormone, testosterone, triiodothyronine, atrial natriuretic peptide, insulin-like growth factor-1), as well as the impact of long-term endurance and resistance exercise intervention on these hormonal responses to acute endurance and resistance exercise. In the obese, some endocrinological disturbances during acute endurance and resistance exercise have been identified: a blunted blood growth hormone, atrial natriuretic peptide and epinephrine release, and greater cortisol and insulin release. These hormonal disturbances might contribute to a suppressed lipolytic response, and/or suppressed skeletal muscle protein synthesis, as a result of acute endurance or resistance exercise, respectively. In subjects with obesity, the impact of acute endurance and resistance exercise on other endocrine hormones (norepinephrine, testosterone, triiodothyronine, insulin-like growth factor-1) remains elusive. Furthermore, whether long-term endurance and resistance exercise intervention might reverse these hormonal disturbances during acute endurance and resistance exercise in these individuals remains unknown.
Boonen E.,Catholic University of Leuven |
Vervenne H.,Catholic University of Leuven |
Meersseman P.,Catholic University of Leuven |
Andrew R.,University of Edinburgh |
And 10 more authors.
New England Journal of Medicine | Year: 2013
Background: Critical illness is often accompanied by hypercortisolemia, which has been attributed to stress-induced activation of the hypothalamic-pituitary-adrenal axis. However, low corticotropin levels have also been reported in critically ill patients, which may be due to reduced cortisol metabolism. Methods: In a total of 158 patients in the intensive care unit and 64 matched controls, we tested five aspects of cortisol metabolism: daily levels of corticotropin and cortisol; plasma cortisol clearance, metabolism, and production during infusion of deuteriumlabeled steroid hormones as tracers; plasma clearance of 100 mg of hydrocortisone; levels of urinary cortisol metabolites; and levels of messenger RNA and protein in liver and adipose tissue, to assess major cortisol-metabolizing enzymes. Results: Total and free circulating cortisol levels were consistently higher in the patients than in controls, whereas corticotropin levels were lower (P<0.001 for both comparisons). Cortisol production was 83% higher in the patients (P = 0.02). There was a reduction of more than 50% in cortisol clearance during tracer infusion and after the administration of 100 mg of hydrocortisone in the patients (P≤0.03 for both comparisons). All these factors accounted for an increase by a factor of 3.5 in plasma cortisol levels in the patients, as compared with controls (P<0.001). Impaired cortisol clearance also correlated with a lower cortisol response to corticotropin stimulation. Reduced cortisol metabolism was associated with reduced inactivation of cortisol in the liver and kidney, as suggested by urinary steroid ratios, tracer kinetics, and assessment of liver-biopsy samples (P≤0.004 for all comparisons). Conclusions: During critical illness, reduced cortisol breakdown, related to suppressed expression and activity of cortisol-metabolizing enzymes, contributed to hypercortisolemia and hence corticotropin suppression. The diagnostic and therapeutic implications for critically ill patients are unknown. (Funded by the Belgian Fund for Scientific Research and others; ClinicalTrials.gov numbers, NCT00512122 and NCT00115479; and Current Controlled Trials numbers, ISRCTN49433936, ISRCTN49306926, and ISRCTN08083905.) Copyright © 2013 Massachusetts Medical Society.