University Hospital of Leuven

of Leuven, Belgium

University Hospital of Leuven

of Leuven, Belgium
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Boeckxstaens G.E.,University Hospital of Leuven
Clinical Gastroenterology and Hepatology | Year: 2014

Background & Aims: The gastric acid pocket is believed to be the reservoir from which acid reflux events originate. Little is known about how changes in position, size, and acidity of the acid pocket contribute to the therapeutic effect of proton pump inhibitors (PPIs) in patients with gastroesophageal reflux disease (GERD). Methods: Thirty-six patients with GERD (18 not taking PPIs, 18 taking PPIs; 19 men; age, 55 ± 2.1 y) were analyzed by concurrent high-resolution manometry and pH-impedance monitoring after a standardized meal. The acid pocket was visualized using scintigraphy after intravenous administration of 99mtechnetium-pertechnetate. The size of the acid pocket was measured and its position was determined, relative to the diaphragm, using radionuclide markers on a high-resolution manometry catheter. At the end of the study, the acid pocket was aspirated, and its pH level was measured. Results: The number of reflux episodes was comparable between patients on and off PPIs, but the number of acid reflux episodes was reduced significantly in patients on PPIs. In patients on PPIs, the acid pocket was smaller and more frequently located below the diaphragm. The mean pH of the acid pocket was significantly lower in patients not taking PPIs (n= 6) than in those who were (n= 16) (0.9; range, 0.7-1.2 vs 4.0; range, 1.6-5.9; P < .001). The pH of acid pockets correlated significantly with the lowest pH values measured for refluxate (r= 0.72; P < .01). Conclusions: Based on analyses of acid pockets in patients with GERD, the acid pocket appears to be a reservoir from which reflux occurs when patients are receiving PPIs. PPIs might affect the size, acidity, or position of the acid pocket, which contributes to the efficacy in patients with GERD. © 2014 AGA Institute.

Roscigno M.,Ospedali Riuniti di Bergamo | Heidenreich A.,RWTH Aachen | Lotan Y.,Southwestern Medical Center | Margulis V.,Southwestern Medical Center | And 3 more authors.
European Urology | Year: 2011

Context: The role of lymph node dissection (LND) in patients treated with radical nephroureterectomy (RNU) for upper tract urothelial cancer (UTUC) is still controversial. Objective: To analyze the impact of lymph node invasion on the outcome of patients, the staging, and the possible therapeutic role of LND in UTUC. Evidence acquisition: A Medline search was conducted to identify original articles, review articles, and editorials addressing the role of LND in UTUC. Keywords included upper tract urothelial neoplasms, lymphadenectomy, lymph node excision, lymphatic metastases, nephroureterectomy, imaging, and survival. Evidence synthesis: Regional nodes are frequently involved in UTUC and represent the most common metastatic site. Regional nodal status is a significant predictor of patient outcomes, especially in invasive disease. Therefore, select patients treated with RNU at high risk for regional nodal metastases should undergo LND to improve disease staging, which would identify those who could benefit from adjuvant systemic therapy. Several retrospective studies suggested the potential therapeutic role of LND in UTUC. An accurate LND could remove some nodal micrometastases not identified on routine pathologic examination, thus improving local control and cancer-specific survival. Radical surgery and LND might be curative in a subpopulation with limited nodal disease, as described in bladder cancer. A clear knowledge of the limits of LND and a template of LND for UTUC are still needed. Conclusions: An extended LND can provide better disease staging and may be curative in patients with limited nodal disease. However, current evidence is based on retrospective studies, which limits the ability to standardize either the indication or the extent of LND. Prospective trials are required to determine the impact of LND on survival in patients with UTUC and identify patients for a risk-adapted approach such as close follow-up or adjuvant chemotherapy. © 2011 European Association of Urology.

Boyle M.P.,Johns Hopkins University | De Boeck K.,University Hospital of Leuven
The Lancet Respiratory Medicine | Year: 2013

Cystic fibrosis is caused by dysfunction or deficiency of the cystic fibrosis transmembrane conductance regulator (CFTR) protein, an epithelial chloride channel that has a key role in maintaining homoeostasis of the airway surface liquid layer in the lungs. More than 1900 CFTR mutations that might result in a disease phenotype have been identified; these can be grouped into classes on the basis of their effect on CFTR protein production, trafficking, function, and stability. In the past 2 years, landmark clinical trials have shown that correction of CFTR function leads to substantial clinical benefit for individuals with cystic fibrosis. These findings are ushering in a new era of cystic fibrosis treatments designed to correct the underlying CFTR defect caused by different mutation classes. With analysis of continuing trials and available patient registries, here we assess mutation types and the number and geographical distribution of patients who are likely to benefit from CFTR-correcting treatment. © 2013 Elsevier Ltd.

Bourgeois P.,University Hospital of Leuven | Morren M.-A.,University Hospital of Leuven
Pediatric Dermatology | Year: 2015

Frey's syndrome is characterized by sweating and flushing in the temporal and preauricular areas after a salivary stimulus. It is caused by damage to the auriculotemporal nerve, hence the alternative name of auriculotemporal syndrome. We report the case of a 2-year-old girl presenting with postprandial unilateral flushing that developed after a herpes zoster infection. © 2015 Wiley Periodicals, Inc.

Proesmans M.,University Hospital of Leuven | Vermeulen F.,University Hospital of Leuven | Boulanger L.,University Hospital of Leuven | Verhaegen J.,University Hospital of Leuven | De Boeck K.,University Hospital of Leuven
Journal of Cystic Fibrosis | Year: 2013

In patients with cystic fibrosis (CF), treatment of new Pseudomonas aeruginosa (Pa) infection postpones the occurrence of chronic infection, but the best eradication regimen is unknown Aim of the study: Compare 2 Pa eradication regimens in children with new Pa infection. Methods: Children with CF (0-18years) and a new isolation of Pa from sputum, cough swab or BAL were randomized to treatment with tobramycin inhalation solution for 28days (TIS) or inhaled sodiumcolistimethate (2×2millU/day) plus oral ciprofloxacin (30mg/kg/day) for 3months (CC). Airway cultures were taken for 6 consecutive months, then every 3months. The primary outcome was Pa eradication at the end of treatment. Secondary outcome parameters were: time to Pa relapse from end of treatment, total and Pa specific IgG, FEV1, BMI and Pa status at 2year follow-up. Results: 58 patients with new Pa isolation were randomized. Their median age was 9years (IQR 4.7-13.1) and their median FEV1 98% predicted (IQR 87-107). Eighteen treatments concerned the first Pa isolation 'ever' (TIS: 8; CC: 10). For the remaining, median time since previous Pa was 19months (IQR 9-41). Eradication at end of treatment was similar for both treatments: 26/29 CC and 23/29 in TOBI treated patients (p=0.47). Median time to recurrence of Pa was 9months (95% CI 0.0-19.0) for CC and 5months (95% CI 1.7-8.3) for TIS (p=0.608). After 1year, the 2 groups did not differ in change in total and Pa specific IgG, FEV1 and BMI. After 2years, 10% of patients had chronic Pa infection. Conclusion: In children with CF and new Pa infection, inhalation of TIS (28. days) or CC (3. months) resulted in similar eradication success at the end of treatment (80 and 90% respectively) and similar clinical evolution during the first 2. years of follow-up. © 2012 European Cystic Fibrosis Society.

Hallemans A.,University of Antwerp | Ortibus E.,University Hospital of Leuven | Meire F.,Hopital University Des Enfants Reine Fabiola | Aerts P.,University of Antwerp | Aerts P.,Ghent University
Gait and Posture | Year: 2010

The objective of this study was to demonstrate specific differences in gait patterns between those with and without a visual impairment. We performed a biomechanical analysis of the gait pattern of young adults (27±13 years old) with a visual impairment (n=10) in an uncluttered environment and compared it to the gait pattern of age matched controls (n=20). Normally sighted adults were tested in a full vision and no vision condition. Differences are found in gait between both groups and both situations. Adults with a visual impairment walked with a shorter stride length (1.14±0.21m), less trunk flexion (4.55±5.14°) and an earlier plantar foot contact at heel strike (1.83±3.49°) than sighted individuals (1.39±0.08m; 11.07±4.01°; 5.10±3.53°). When sighted individuals were blindfolded (no vision condition) they showed similar gait adaptations as well as a slower walking speed (0.84±0.28ms-1), a lower cadence (96.88±13.71stepsmin-1) and limited movements of the hip (38.24±6.27°) and the ankle in the saggital plane (-5.60±5.07°) compared to a full vision condition (1.27±0.13ms-1; 110.55±7.09stepsmin-1; 45.32±4.57°; -16.51±6.59°).Results showed that even in an uncluttered environment vision is important for locomotion control. The differences between those with and without a visual impairment, and between the full vision and no vision conditions, may reflect a more cautious walking strategy and adaptive changes employed to use the foot to probe the ground for haptic exploration. © 2010 Elsevier B.V.

Birch I.,University of West London | Deschamps K.,University Hospital of Leuven
Journal of the American Podiatric Medical Association | Year: 2011

Background: The considerable variation in subtalar joint structure and function shown by studies indicates the importance of developing a noninvasive in vivo technique for assessing subtalar joint movement. This article reports the in vitro testing of the CODA MPX30, an active infrared marker motion analysis system. This work represents the first stage in the development of a noninvasive in vivo method for measuring subtalar joint motion during walking. Methods: The in vitro repeatability of the CODA MPX30 system's measurements of marker position, simple and intermarker set angles, was tested. Angular orientations of markers representing the position of the talus and the calcaneus were measured using a purpose-designed marker placement model. Results: Marker location measurements were shown to vary by less than 1.0 mm in all of the planes. The measurement of a 90° angle was also found to be repeatable in all of the planes, although measurements made in the yz plane were shown to be consistently inaccurate (mean, 92.47°). Estimation of segmental orientation was found to be repeatable. Estimations of marker set orientations were shown to increase in variability after a coordinate transform was performed (maximum SD, 1.14°). Conclusions: The CODA MPX30 was shown to produce repeatable estimations of marker position. Levels of variation in segmental orientation estimates were shown to increase subsequent to coordinate transforms. The combination of the CODA MPX30 and an appropriate marker placement model offers the basis of an in vivo measurement strategy of subtalar joint movement, an important development in the understanding of the function of the joint during gait. © 2011 by the American Podiatric Medical Association.

La Gerche A.,University of Melbourne | La Gerche A.,Catholic University of Leuven | La Gerche A.,University Hospital of Leuven | Burns A.T.,St Vincents Hospital | And 5 more authors.
Journal of the American Society of Echocardiography | Year: 2012

Background: The significance of reduced right ventricular (RV) deformation reported in endurance athletes (EAs) is unclear, highlighting the ambiguities between physiologic RV remodeling and pathology. The aim of this study was to test the hypothesis that RV functional reserve would be normal in EAs despite reduced deformation measures at rest. Methods: Forty EAs and 15 nonathletes (NAs) performed maximal incremental exercise with simultaneous echocardiographic measures of RV function. Two-dimensional (2D) and color-coded Doppler acquisitions were used to quantify peak systolic strain and strain rate (SRs) for the basal, mid, and apical RV free wall. A second surrogate of contractility, the RV end-systolic pressure-area relationship, was calculated from the tricuspid regurgitant velocity and the RV end-systolic area. Changes in multiple measures obtained throughout exercise were used to assess the affect of exercise on RV contractility. Results: Compared with NAs at rest, basal RV strain and SRs were reduced in EAs, with good agreement between 2D and Doppler methods. During exercise, there was a strong linear correlation between heart rate and global SRs (r = -0.74 and r = -0.84 for Doppler and 2D methods, respectively, P <.0001), which was similar for EAs and NAs (P =.21 and P =.97 for differences in mean regression slopes by Doppler and 2D echocardiography, respectively). Exercise-induced increases in the RV end-systolic pressure-area relationship were also similar for EAs and NAs (P =.42). There was a strong correlation between RV global SRs and the RV end-systolic pressure-area relationship during exercise (r = 0.71, P <.0001). Conclusions: Comparable RV contractile reserve for EAs and NAs suggests that the lower resting values of RV in EAs may represent physiologic changes rather than subclinical myocardial damage. © 2012 by the American Society of Echocardiography.

Duytschaever G.,Ghent University | Huys G.,Ghent University | Bekaert M.,Ghent University | Boulanger L.,University Hospital of Leuven | And 2 more authors.
Journal of Cystic Fibrosis | Year: 2013

Background: Recurrent antimicrobial interventions and disease-related intestinal dysfunction are suspected to contribute to the dysbiosis of the gastrointestinal microbial ecosystem in patients with cystic fibrosis (CF). The present study set out to detect and identify microbial discriminants in the gut microbiota composition that are associated with CF-related intestinal dysbiosis. Methods: An in-depth description of CF-associated gut dysbiosis was obtained by screening denaturing gradient gel electrophoresis (DGGE) fingerprints for potentially discriminating bacterial species, and quantification by means of real-time PCR analyses using group-specific primers. Results: A total of 8 DGGE band-classes assigned to the genus Bifidobacterium (n = 3), and members of Clostridium clusters XIVa (n = 3) and IV (n = 2), were significantly (p < 0.05) underrepresented in samples of patients with CF. Real-time PCR analyses confirmed a significantly lower abundance and temporal stability of bifidobacteria and Clostridium cluster XIVa in the fecal microbiota of patients with CF. Conclusion: This study is the first to report specific microbial determinants of dysbiosis in patients with CF. © 2012 European Cystic Fibrosis Society.

De Boeck K.,University Hospital of Leuven | Vermeulen F.,University Hospital of Leuven | Meyts I.,University Hospital of Leuven | Hutsebaut L.,Landsbond Van de Christelijke Mutualiteiten | And 2 more authors.
Pediatrics | Year: 2011

BACKGROUND: In children, antibiotics as well as asthma drugs are frequently prescribed. We investigated the effects of the codispensing of antibiotics and asthma drugs to children. METHODS: Using a health insurance database, we examined dispensing and codispensing of antibiotics and asthma drugs for the period of a 1 year in 892 841 Belgian children aged <18 years. RESULTS: For a 1-year period, an antibiotic was dispensed to 44.21% of children: 73.05% aged <3 years; 49.62% aged 3 to 7 years; and 34.21% aged 8 to <18 years. An asthma drug was dispensed to 16.04% of children: 44.81% aged <3 years; 17.90% aged 3 to 7 years; and 7.64% aged 8 to <18 years. Overall, an antibiotic was dispensed without an asthma drug to 38.62% of children versus with an asthma drug to 73.50% of children (P<.0001). More frequent dispensing of antibiotics to children who received an asthma drug (odds ratio: 1.90; 95% confidence interval: 1.89-1.91) occurred in all age categories (P<.0001). In 35.64% of children with an asthma drug dispensed, an antibiotic was dispensed on the same day. CONCLUSIONS: In all age groups, dispensing of antibiotics is more likely in children who have an asthma drug dispensed in the same year. In all age groups, codispensing of antibiotics and asthma drugs is a common practice. Efforts to decrease antibiotic use in children could be improved by focusing on children who are being treated with asthma drugs. Copyright © 2011 by the American Academy of Pediatrics.

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