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Leuven, Belgium

Van De Velde M.,UZ Leuven | Van De Velde M.,Catholic University of Leuven
Current Opinion in Anaesthesiology | Year: 2015

Purpose of review Remifentanil is a relatively new but commonly used opioid alternative in the management of labor pain relief. The present article evaluates efficacy and safety of patient-controlled intravenous analgesia (PCIA) with remifentanil in the management of labor pain relief. Recent findings Remifentanil PCIA provides analgesia that is superior to nitrous oxide or other opioids such as meperidine, but is less effective when compared with epidural analgesia. Recent evidence suggests it produces significant respiratory depression making routine use as first line analgesia strategy virtually impossible. Summary Remifentanil PCIA is a valuable analgesic strategy whenever regional analgesia is contraindicated. Using it as first line strategy seems to be contraindicated because of significant respiratory side-effects to the mother. Whenever used advanced and continuous monitoring using capnography, saturation monitoring and one-to-one midwifery care are mandatory! © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Coppens G.,UZ Leuven
Bulletin de la Société belge d'ophtalmologie | Year: 2010

Risks that glaucoma medications pose to the fetus and neonate must be balanced against the risk of vision loss in the mother. There is no high level evidence for harmful effects on the fetus and neonate of medications used to treat glaucoma. All topical and systemic glaucoma medication should be avoided during the first trimester of pregnancy. Systemic carbonic anhydrase inhibitors, topical prostaglandin analogues and antimetabolites during surgery should be avoided absolutely. Some topical medications are deemed compatible with lactation by the American Academy of Pediatrics, however, caution should still be practiced.

Coppens G.,UZ Leuven
Bulletin de la Société belge d'ophtalmologie | Year: 2010

PURPOSE: To report corneal toxicity of Mitomycin C application during filtering glaucoma surgery in two patients. CASE REPORTS: An elderly woman, 81 years of age, developed diffuse corneal epitheliopathy with subepithelial stromal oedema seven weeks after a trabeculectomy with Mitomycin C application. Another patient, a 76-year-old man, first developed a central epithelium defect and stromal oedema in the second postoperative week after a similar procedure. Later the corneal stroma melted, what resulted in perforation in the second postoperative month. RESULTS: Intraoperative Mitomycin C application during trabeculectomy induced serious corneal complications several weeks after the surgery. CONCLUSIONS: Although infrequent, serious corneal complications may arise following the intraoperative use of Mitomycin C in filtering surgery for glaucoma. The possible contributing factors to the development of the corneal toxicity will be discussed.

Tombal B.,Catholic University of Louvain | Borre M.,Aarhus University Hospital | Rathenborg P.,Herlev Hospital | Werbrouck P.,AZ Groeninge Kortrijk | And 11 more authors.
The Lancet Oncology | Year: 2014

Background: The androgen receptor inhibitor enzalutamide is approved for the treatment of metastatic castration-resistant prostate cancer that has progressed on docetaxel. Our aim was to assess the activity and safety of enzalutamide monotherapy in men with hormone-naive prostate cancer. Methods: This trial is an ongoing open-label, single-arm, phase 2 study, done across 12 European sites. Men aged over 18 years, with hormone-naive prostate cancer for whom hormone therapy was indicated, and who had non-castration levels of testosterone and prostate-specific antigen (PSA) of 2 ng/mL or greater at screening, and an Eastern Cooperative Oncology Group score of 0, received oral enzalutamide 160 mg/day. The primary outcome was the proportion of patients with an 80% or greater decline in PSA at week 25. All analyses included all patients who had received at least one dose of the study drug. This study is registered with ClinicalTrials.gov, number NCT01302041. Findings: 67 men were enrolled into the study. 62 patients (92·5%, 95% CI 86·2-98·8) had a decline in PSA of 80% or greater at week 25. The most commonly reported treatment-emergent adverse events up to week 25 were gynaecomastia (n=24), fatigue (n=23), nipple pain (n=13), and hot flush (n=12), all of which were of mild to moderate severity. Nine patients had a treatment-emergent adverse event of grade 3 or higher, most of which were reported in one patient each, except for pneumonia (grade 3, two patients) and hypertension (grade 3, four patients). Five patients reported serious adverse events, none of which were deemed to be treatment related. Interpretation: Our findings suggest that enzalutamide monotherapy in men with hormone-naive prostate cancer of varying severity provides a level of disease suppression, and was generally well tolerated. These findings provide a rationale for further investigation of clinical response and outcomes with enzalutamide in non-castrate men with prostate cancer. Funding: Astellas Pharma Inc, Medivation Inc. © 2014 Elsevier Ltd.

Haller J.A.,Wills Eye Hospital | Stalmans P.,UZ Leuven | Benz M.S.,Retina Consultants of Houston | Gandorfer A.,Klinikum der LMU | And 3 more authors.
Ophthalmology | Year: 2015

Purpose: To evaluate the efficacy of a single intravitreal injection of ocriplasmin 125 μg across relevant subpopulations of patients with symptomatic vitreomacular adhesion (VMA)/vitreomacular traction (VMT), including when associated with macular hole. Design: Two multicenter, randomized, placebo-controlled, double-masked, 6-month studies. Participants: A total of 652 randomized patients (464 receiving ocriplasmin; 188 receiving placebo). Methods: A single intravitreal injection of ocriplasmin 125 μg or placebo in the study eye. Main Outcome Measures: Prespecified subgroup analyses were conducted to evaluate the effects on the proportion of patients with nonsurgical resolution of focal VMA at day 28, nonsurgical full-thickness macular hole (FTMH) closure at month 6, and categoric improvement in best-corrected visual acuity (BCVA) at month 6. Results: Resolution of VMA at day 28 was achieved more often in younger patients (<65 years), eyes without epiretinal membrane, eyes with FTMH, phakic eyes, and eyes with a focal VMA ≤1500 μm. Eyes with FTMH width ≤250 μm were more likely to achieve nonsurgical FTMH closure. Categoric ≥2-line and ≥3-line improvement in BCVA occurred more often in younger patients (<65 years) and in patients with a lower baseline BCVA (<65 letters). Treatment differences in favor of ocriplasmin were generally observed across each subgroup of sub-populations studied. Conclusions: Subgroup analyses confirmed the positive effect of ocriplasmin across relevant subpopulations. © 2015 by the American Academy of Ophthalmology.

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