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Vergouwen M.D.I.,University Utrecht | Algra A.,University Utrecht | Pfefferkorn T.,Ludwig Maximilians University of Munich | Weimar C.,University of Duisburg - Essen | And 4 more authors.
Stroke | Year: 2012

Background and Purpose-The frequent use of a longer time window for recanalization therapy in patients with basilar artery occlusion (BAO) in daily practice is not supported by any scientific evidence. We investigated the relationship between time to recanalization therapy and functional outcome in BAO with data from the BasilarArtery International Cooperation Study (BASICS). Methods-BASICS is a prospective multicenter registry of patients (n=619) with radiologically confirmed BAO. We analyzed patients receiving intravenous thrombolysis or intra-arterial treatment. Patients were divided into 4 groups based on the interval between estimated time of BAO and start of recanalization therapy: ≤3 hours (n=134), >3 to ≤6 hours (n=151), >6 to ≤9 hours (n=56), and >9 hours (n=68). Primary outcome measure was poor functional outcome (modified Rankin scale score 4-6) after 1 month. We calculated adjusted risk ratios with 95% CIs using Poisson regression analyses with the ≤3 hours group as the reference group. Results-Patients had an increased risk of poor functional outcome as time to recanalization therapy became longer (≤3 hours: 62%; >3 to ≤6 hours: 67% [adjusted risk ratio, 1.06; 0.91-1.25]; >6 to ≤9 hours: 77% [adjusted risk ratio, 1.26; 1.06-1.51]; >9 hours: 85% [adjusted risk ratio, 1.47; 1.26-1.72]). Conclusions-Early recanalization therapy in patients with BAO is associated with a more favorable outcome with a significant increased chance of a poor outcome when recanalization therapy is started >6 hours after estimated time of BAO. © 2012 American Heart Association, Inc. Source

Roskams T.,University Hospitals of Leuven
Clinics in Liver Disease | Year: 2011

A better understanding of signaling pathways in HCC pathogenesis has led to targeted therapies against HCC. Identification of liver cancer stem cell markers and their related pathways is one of the most important goals of liver cancer research. New therapies should ideally target cancer stem cells and not normal stem/progenitor cells, because the latter are very important in regeneration and repair. Individualized HCC therapy will require better definition of patient subgroups that benefit most or should be protected from therapy failure and unwanted side effects. Tumor tissue acquisition should be mandatory, reversing the practice that was established years ago when targeted HCC therapy was but a pope dream. © 2011 Elsevier Inc. Source

Kim N.H.,University of California at San Diego | Delcroix M.,University Hospitals of Leuven | Jenkins D.P.,Cardiothoracic Surgery | Channick R.,Massachusetts General Hospital | And 7 more authors.
Journal of the American College of Cardiology | Year: 2013

Since the last World Symposium on Pulmonary Hypertension in 2008, we have witnessed numerous and exciting developments in chronic thromboembolic pulmonary hypertension (CTEPH). Emerging clinical data and advances in technology have led to reinforcing and updated guidance on diagnostic approaches to pulmonary hypertension, guidelines that we hope will lead to better recognition and more timely diagnosis of CTEPH. We have new data on treatment practices across international boundaries as well as long-term outcomes for CTEPH patients treated with or without pulmonary endarterectomy. Furthermore, we have expanded data on alternative treatment options for select CTEPH patients, including data from multiple clinical trials of medical therapy, including 1 recent pivotal trial, and compelling case series of percutaneous pulmonary angioplasty. Lastly, we have garnered more experience, and on a larger international scale, with pulmonary endarterectomy, which is the treatment of choice for operable CTEPH. This report overviews and highlights these important interval developments as deliberated among our task force of CTEPH experts and presented at the 2013 World Symposium on Pulmonary Hypertension in Nice, France. © 2013 by the American College of Cardiology Foundation. Published by Elsevier Inc. Source

Pilaete K.,University Hospitals of Leuven
European Archives of Oto-Rhino-Laryngology | Year: 2014

Drug-induced sleep endoscopy (DISE) is a new tool in the work-up of patients with sleep-disordered breathing (SDB). We assessed the impact of DISE on the treatment plan of snoring patients. This is a single institution prospective longitudinal clinical trial. The setting is a private teaching hospital. A consecutive series of 100 snoring patients prospectively underwent a standardised questionnaire, clinical examination, rhinomanometry, allergy skin prick testing, DISE and polysomnography. Management plan before and after DISE evaluation was compared. In 61 patients (excluding 16 patients sent for continuous positive airway pressure, three patients refused sleep endoscopy and 20 were lost to follow-up), we compared the treatment plans. DISE showed single level airway collapse in 13 and multilevel collapse in 48 patients. The site of flutter did not add additional information as compared to the pattern and the location of the collapse. After DISE, the initial management plan changed in 41 % of patients irrespective of the type of initial management plan. The only somewhat accurate initial treatment plan was uvulopalatopharyngoplasty (unchanged in 11/13 patients). Excluding moderate to severe obstructive sleep apnea patients DISE is an indispensable tool in treatment decision in all SDB patients. We suggest to simplify the protocol for DISE reporting. © 2013 Springer-Verlag Berlin Heidelberg. Source

Degreef I.,University Hospitals of Leuven | De Smet L.,University Hospital Pellenberg
Acta Orthopaedica Belgica | Year: 2010

Dupuytren's disease has been the subject of numerous epidemiological surveys attempting to expand our knowledge on its origin and spread. In Flanders, although numerous studies on surgical outcome have been reported, information on prevalence of Dupuytren's disease is lacking. Therefore, Flanders' population in a non-hospital environment was studied by a clinical evaluation performed by a single hand specialist. Five different market places spread geographically in the 5 Flemish provinces of Belgium were visited to examine the hands of randomly chosen individuals over 50 years old visiting the market. In all, 500 people were examined ; Dupuytren's disease was found to be present in 32% of the population. Nodules without finger contractures (stage 1) were seen in 24% of the population, in comparable proportions in males (28%) and females (20%). However, finger contractures (stage 2) were seen in 8%, significantly more often in males (11%) than in females (4%). The prevalence of stage 1 is somewhat lower in individuals over 80 years old. In men, the incidence of stage 2 was found to increase with age. These findings were compared with literature data on the prevalence of Dupuytren's disease in other countries and populations. It appears that, similar to northern Europe, Dupuytren's disease is also a common disease in Flanders. © 2010, Acta Orthopædica Belgica. Source

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