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Dooms C.,University Hospitals Leuven | Seijo L.,Clinica Universitaria de Navarra | Gasparini S.,Azienda Ospedaliero Universitaria Riuniti | Trisolini R.,Maggiore Hospital | And 2 more authors.
European Respiratory Review | Year: 2010

Since the introduction of the flexible fibreoptic bronchoscope in the late 1960s there have been relatively few technological advances for three decades, aside from the development of a white light video bronchoscope with a miniature charge-coupled device built in its tip replacing the fibreoptics. White light flexible videobronchoscopy with its ancillary devices (forceps biopsy, bronchial brushing, bronchoalveolar lavage, bronchial washings and transbronchial needle aspiration) has long been the only established diagnostic bronchoscopic technique. With the advances in microtechnology over the past two decades, recent technical developments such as autofluorescence bronchoscopy and endoscopic ultrasound allow better evaluation of endobronchial, mediastinal and parenchymal lesions. © ERS 2010.


Krassas G.E.,Panagia General Hospital | Poppe K.,University Hospital Brugmann | Glinoer D.,University Hospital Saint Pierre
Endocrine Reviews | Year: 2010

Via its interaction in several pathways, normal thyroid function is important to maintain normal reproduction. In both genders, changes in SHBG and sex steroids are a consistent feature associated with hyperand hypothyroidism and were already reported many years ago. Male reproduction is adversely affected by both thyrotoxicosis and hypothyroidism. Erectile abnormalities have been reported. Thyrotoxicosis induces abnormalities in sperm motility, whereas hypothyroidism is associated with abnormalities in sperm morphology; the latter normalize when euthyroidism is reached. In females, thyrotoxicosis and hypothyroidism can cause menstrual disturbances. Thyrotoxicosis is associated mainly with hypomenorrhea and polymenorrhea, whereas hypothyroidism is associated mainly with oligomenorrhea. Thyroid dysfunction has also been linked to reduced fertility. Controlled ovarian hyperstimulation leads to important increases in estradiol, which in turn may have an adverse effect on thyroid hormones and TSH. When autoimmune thyroid disease is present, the impact of controlled ovarian hyperstimulation may become more severe, depending on preexisting thyroid abnormalities. Autoimmune thyroid disease is present in 5-20% of unselected pregnant women. Isolated hypothyroxinemia has been described in approximately 2% of pregnancies, without serum TSH elevation and in the absence of thyroid autoantibodies. Overt hypothyroidism has been associated with increased rates of spontaneous abortion, premature delivery and/or low birth weight, fetal distress in labor, and perhaps gestation-induced hypertension and placental abruption. The links between such obstetrical complications and subclinical hypothyroidism are less evident. Thyrotoxicosis during pregnancy is due to Graves' disease and gestational transient thyrotoxicosis. All antithyroid drugs cross the placenta and may potentially affect fetal thyroid function. Copyright © 2010 by The Endocrine Society.


PubMed | University Hospitals Leuven, Vrije Universiteit Brussel, University Hospital Vesale, Ghent University and 6 more.
Type: Journal Article | Journal: Respiratory medicine | Year: 2015

Pharmaceutical companies offer an increasing number of inhaler devices, whether or not together with new substances, for maintenance treatment of patients with COPD or asthma. However, well-designed studies to support these developments are scarce.The aim of this research was to evaluate how far new developments of inhaler devices are scientifically supported and translate into improvements of patient preferences and/or clinical outcomes.A systematic literature review was performed to retrieve randomised controlled trials in patients with COPD or asthma that studied the in-company evolution of inhaler devices. Results were tabulated and discussed.A total of 30 studies were found comparing Respimat() vs. HandiHaler(), Diskus()(Accuhaler()) vs. Diskhaler()(Rotadisk()) or pMDI, Ellipta() vs. Diskus()(Accuhaler()), Nexthaler() vs. pMDI, or Breezhaler() vs. Aerolizer(). These studies show that developments of inhaler devices may improve patient satisfaction but do not lead to demonstrable improvements in clinical efficacy. Current changes of devices are most commonly parallelled by changes in administration frequency towards once daily treatment. The only well-documented effect was found for the Respimat() Soft Mist Inhaler, which realises a more than 3-fold lowering of the once-daily tiotropium dose through increased performance of the inhaler device. There are however, no data on clinical efficacy or safety comparing the two devices at the same dosage.Future developments of inhaler devices should all require well-designed studies to demonstrate patient benefit.


Degueldre M.,University Hospital Saint Pierre | Vandromme J.,University Hospital Saint Pierre | De Wind A.,Free University of Brussels | Feoli F.,Free University of Brussels
European Journal of Cancer Prevention | Year: 2016

Confocal laser endomicroscopy (CLE) enables in-vivo, real-time, imaging of tissues with a micron-scale resolution through a fiber optic probe. CLE could be a valuable tool for the detection and characterization of suspicious (dysplastic) areas on the uterine cervix in a minimally invasive manner. This study evaluates the technical feasibility and safety of CLE on the cervix. The study also aims to create a preliminary iconography of normal and dysplastic squamous and columnar cervical epithelium. In-vivo CLE was performed on nine patients scheduled for a cervical loop electric excision procedure for high-grade superficial intraepithelial lesions. The CLE images were compared with standard hematoxylin and eosin analysis of loop electric excision procedure specimens. The histopathological diagnosis on the surgical specimen was established as per standard of care. CLE images were then reviewed by pathologists to point out specific histopathological features. pCLE of the exocervix and the transformation zone was performed successfully on seven out of nine patients. Uninterpretable images were obtained in two other cases: one using the AlveoFlex and one using the GastroFlex UHD after the application of acetic acid 2%. A total of 82.5% of the sequences recorded with the GastroFlex were suitable for interpretation. No adverse event or complications occurred. CLE enables proper in-vivo imaging of healthy and dysplastic cervical tissue. Images correlate well with the histopathological features established through traditional histology. Future blinded prospective analysis will determine the reliability of the realtime diagnosis and its potential use in the assessment and treatment of cervical lesions. © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Demeester R.,University Hospital Saint Pierre | Demeester R.,Institute of Tropical Medicine | Claus M.,University Hospital Saint Pierre | Hildebrand M.,IRIS South Hospital | And 2 more authors.
Journal of Travel Medicine | Year: 2010

Background. Mediterranean spotted fever (MSF) is a tick-borne infection caused by Rickettsia conorii conorii mainly endemic in the Mediterranean Basin. Although usually considered as a benign disease, severe forms of MSF have been sporadically reported. Methods. We report on three patients who developed severe MSF complications after a stay in Morocco. Literature was reviewed to assess the frequency and pattern of MSF complications in the largest reported case series in endemic countries. Results. Each of our three patients diagnosed with MSF presented with a different complicated course: one with meningoencephalitis, one with lung embolism and one with septic shock and multi organ failure. In published series, rate of complications (defined as severe organ involvement) ranged from 1% to 20%. However, study designs and settings were highly variable and did not allow for relevant comparisons. Meningoencephalitis and shock with multi organ failure were the most frequently observed complications. Mortality of severe course was up to 20% in some series. Conclusion. Severe organ involvement is not infrequent in patients with Mediterranean spotted fever and fatal outcome is regularly reported. Because presentations of complicated course may be extremely diverse, a high index of suspicion is required in febrile patients with potential exposure, in particular if skin rash and/or eschar are found. Early appropriate antibiotherapy is crucial to improve outcome. © 2010 International Society of Travel Medicine.


Demeester R.,University Hospital Saint Pierre | Demeester R.,Institute of Tropical Medicine | Bottieau E.,Institute of Tropical Medicine | Van Esbroeck M.,Institute of Tropical Medicine | And 3 more authors.
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2010

We report a case of hantavirus infection (nephropathia epidemica) diagnosed in a Belgian backpacker returning from a trekking expedition in Ecuador, after likely heavy exposure to rodents. Because of epidemiological inconsistency, molecular investigation was performed and revealed a Puumala infection acquired during very limited exposure in Belgium upon return. © 2009 Springer-Verlag.


PubMed | University Hospital Saint Pierre, Pfizer, University Hospitals of Leuven and University of Antwerp
Type: | Journal: BMC family practice | Year: 2015

Serious lower respiratory tract infections (SLRTIs), especially Streptococcus pneumoniae (SP)-related pneumonia cause considerable morbidity and mortality. Chest imaging, sputum and blood culture are not routinely obtained by general practitioners (GPs). Antibiotic therapy is usually started empirically. The BinaxNOW and Urine Antigen Detection (UAD) assays have been developed respectively to detect a common antigen from all pneumococcal strains and the 13 pneumococcal serotypes present in the vaccine Prevenar 13 (PCV13).OPUS-B was a multicentre, prospective, case-control, observational study of patients with SLRTI in primary care in Belgium, conducted during two winter seasons (2011-2013). A urine sample was collected at baseline for the urine assays. GPs were blinded to the results. All patients with a positive BinaxNOW test and twice as much randomly selected BinaxNOW negative patients were followed up. Recorded data included: socio-demographics, medical history, vaccination history, clinical symptoms, CRB-65 score, treatments, hospitalization, blood cultures, healthcare use, EQ-5D score. The objectives were to evaluate the percentage of SP SLRTI within the total number of SLRTIs, to assess the percentage of SP serotypes and to compare the burden of disease between pneumococcal and non-pneumococcal SLRTIs.There were 26 patients with a BinaxNOW positive test and 518 patients with a BinaxNOW negative test. The proportion of pneumococcal SLRTI was 4.8 % (95 % CI: 3.1 %-7.2 %). Sixty-eight percent of positive cases showed serotypes represented in PCV13. In the BinaxNOW-positive patients, women were more numerous, there was less exposure to young children, seasonal influenza vaccination was less frequent, COPD was more frequent, the body temperature and the number of breaths per minute were higher, the systolic blood pressure was lower, the frequency of sputum, infiltrate, chest pain, muscle ache, confusion/disorientation, diarrhoea, pneumonia and exacerbations of COPD was more frequent, EQ-5D index and VAS scale were lower, the number of visits to the GP, of working days lost and of days patients needed assistance were higher.SP was responsible for approximately 5 % of SLRTIs observed in primary care in Belgium. Pneumococcal infection was associated with a significant increase in morbidity. Sixty-eight percent of serotypes causing SLRTI were potentially preventable by PCV13.


PubMed | University Hospital Saint Pierre, 3 Institute dImmunologie and 1 Service of Endocrinology and Metabolic Diseases
Type: Journal Article | Journal: Thyroid : official journal of the American Thyroid Association | Year: 2015

The aim of this review was to delineate the characteristics of antineutrophil cytoplasmic antibody (ANCA)-associated small-vessel vasculitis associated with antithyroid drugs (ATD). A PubMed search was made for English language articles using the search terms antithyroid drugs AND ANCA OR ANCA-associated vasculitis.The literature includes approximately 260 case reports of ANCA-associated small-vessel vasculitis related to ATD, with 75% of these associated with thiouracil derivatives (propylthiouracil [PTU]) and 25% with methyl-mercapto-imidazole derivatives (MMI/TMZ). The prevalence of ANCA-positive cases caused by ATD varied between 4% and 64% with PTU (median 30%), and 0% and 16% with MMI/TMZ (median 6%). Young age and the duration of ATD therapy were the main factors contributing to the emergence of ANCA positivity. Before ATD therapy initiation, the prevalence of ANCA-positive patients was 0-13%. During ATD administration, 20% of patients were found to be positive for ANCA. Only 15% of ANCA-positive patients treated with ATD exhibited clinical evidence of vasculitis, corresponding to 3% of all patients who received ATD. Clinical manifestations of ANCA-associated vasculitis related to ATD were extremely heterogeneous. When vasculitis occurred, ATD withdrawal was usually followed by rapid clinical improvement and a favorable prognosis.ANCA screening is not systematically recommended for individuals on ATD therapy, particularly given the decreasing use of PTU in favor of TMZ/MMI. Particular attention should be given to the pediatric population with Graves disease who receive ATD, as well as patients treated with thiouracil derivatives and those on long-term ATD therapy.


Mirica D.C.,University Hospital Saint Pierre | Jahjah L.,University Hospital Saint Pierre | Vandenbossche J.-L.,University Hospital Saint Pierre
European Heart Journal Cardiovascular Imaging | Year: 2012

We describe a unique case of a 37-year-old patient who was diagnosed with human immunodeficiency virus/tuberculosis co-infection due to a cardiac involvement that consisted in atrial fibrillation as a consequence of a compression of the left atrium by a giant necrotic lymphadenopathy and a pericardial effusion. All rights reserved. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2012.


Mirica D.C.,University Hospital Saint Pierre
European heart journal cardiovascular Imaging | Year: 2012

We describe a unique case of a 37-year-old patient who was diagnosed with human immunodeficiency virus/tuberculosis co-infection due to a cardiac involvement that consisted in atrial fibrillation as a consequence of a compression of the left atrium by a giant necrotic lymphadenopathy and a pericardial effusion.

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