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Biomedical subjects

L Baert

Publications and source records attributed to L Baert.

At least 37 records · Page 2Linked to original sources
PubMed2000

Patient satisfaction and complications following sacral nerve stimulation for urinary retention, urge incontinence and perineal pain: a multicenter evaluation.

The aim of the study was to determine the success rate, the complications, the failures and the solutions found in troublesome cases. A retrospective study was performed in three university centers in Belgium. Between March 1994 and April 1998, a quadripolar electrode and a pulse generator were implanted in 53 patients (8 men, 45 women, 43 +/- 12 years, mean follow-up 24 +/- 8 months, range 13-39 months). During the first few months, 45 (85%) of the 53 patients had an objective response. Eight late failures occurred, with a mean failure delay of 9 +/- 5 months. We performed 15 revisions in 12 patients. Major complications were pain and current-related troubles. The outcome was significantly better (P = 0.001) in post-stress incontinence surgery patients. Device-related pain was found more frequently in patients with dysuria and/or retention or perineal pain, and the test stimulation was less reliable (P = 0.025) in patients with a psychiatric history. Sacral nerve stimulation is efficient in treating patients with refractory lower urinary tract symptoms and/or perineal pain.

Adult↗
PubMed2000

Schlieren photography study of energy absorption by uric acid nuclei.

Previous studies using microfocus x-ray radiography on concentric laminated uric acid calculi following in vitro extracorporeal shock-wave lithotripsy (ESWL) has demonstrated the enlargement of the matrix layers. The Schlieren technique was used to verify the hypothesis that the incident energy would be concentrated in the matrix layers by total internal reflection. Because of the rough surface of the stone, the ultrasonic beam (4 MHz) was incident at various angles. At the critical Rayleigh angle (45.9 degrees +/- 0.5 degrees ), the reflected beam consisted of a spectacularly reflected lobe and a reradiated leaky Rayleigh wave. Different critical Lamb angles, theta(L), of 30.8 degrees, 38.1 degrees and 50.8 degrees (experimental uncertainty 0.5 degrees ) were also determined. Depending on the angle of incidence on the stone surface, a Rayleigh wave can be produced and/or one or more layers, as a whole, are set into vibration (Lamb excitation), with the result that shell-like fragments consisting of one or more layers, break off the stones at sites of weaker bonding, as has been noted in previous in vitro lithotripsy experiments by our group.

Absorption↗
PubMed2000

Brachytherapy with iridium-192 for bladder cancer.

OBJECTIVE: Patients with invasive bladder cancer often need radical cystectomy with its implications on quality of life. Bladder preservation combining surgery and radiotherapy could maintain quality of life without compromising tumor control. STUDY DESIGN: Twenty-eight selected patients with different stages of invasive bladder cancer were treated with preoperative external beam radiotherapy in a dosage depending on the tumor stage. Subsequently they underwent surgical exploration with or without partial cystectomy and insertion of source carrier tubes for afterloading with iridium-192. A close follow-up consisted of 3-monthly urine cytology, cystoscopy and yearly CT scan. RESULTS: Sixteen patients (57%) are alive with no evidence of disease. Five patients (18%) have died of non-cancer-related causes without evidence of recurrent tumor. Tumor progression was seen in 7 patients (25%). CONCLUSIONS: Interstitial radiation can result in long-term complete remission in patients with small solitary invasive bladder tumors. The afterloading technique is safe and effective. The selection of patients is the most relevant key to success.

Adult↗
PubMed2000

Radical prostatectomy can provide a cure for well-selected clinical stage T3 prostate cancer.

OBJECTIVE: Radical prostatectomy is commonly believed not to achieve the eradication of locally advanced disease. This retrospective study aimed to elucidate the role of radical prostatectomy in this condition. METHODS: A retrospective study of 158 patients surgically treated for clinical stage T3N0M0 prostate cancer was undertaken. Thirty patients had postoperative hormonal treatment, rendering prostate-specific antigen (PSA) follow-up unreliable, and were considered to be progressive at 1 month. Eighteen other patients received postoperative radiotherapy. One hundred and ten patients had radical prostatectomy only. PSA-relapse-free survival was analyzed. The mean follow-up time was 30 months. RESULTS: Seventy-nine percent of the resected specimens were pathologically T3 (pT3), and about 25% were pT3c. Thirteen percent were pT2 and 8% were pT4. Ninety-five specimens (60%) had positive surgical margins. There was poor accordance between the biopsy Gleason score and that of the specimen. A multivariate analysis showed that seminal vesicle and nodal invasion, margin status and a PSA level above 10 ng/ml were independent prognostic factors. In 47 cT3a patients with PSA <10 ng/ml, the PSA-free survival rate exceeded 70% at 24 months and the 5-year estimated PSA-free survival rate was more than 60%. CONCLUSIONS: Radical prostatectomy has a place in the treatment of clinical stage T3 prostate cancer patients with a PSA value lower than 10 ng/ml. There is a need to definitively rule out nodal or seminal vesicle invasion in order to select those patients that can benefit from surgery.

Aged↗
PubMed2000

Fluorescence detection of flat bladder carcinoma in situ after intravesical instillation of hypericin.

PURPOSE: We determined the sensitivity and specificity of detecting flat bladder carcinoma in situ through fluorescent detection after intravesical hypericin instillations. MATERIALS AND METHODS: The study included 40 patients, of whom 26 presented with macroscopic visible tumor, 9 had a positive cytology without visible tumor and 5 underwent cystoscopy after bacillus Calmette-Guerin instillations (4) or radiotherapy (1). We instilled 40 ml. of a 8 microM. solution of hypericin intravesically for at least 2 hours. Fluorescence excitation with blue light was effective up to 16 hours after termination of the instillation. RESULTS: All visible papillary tumors showed red fluorescence. In addition, 134 flat fluorescent areas were detected. Analysis of 281 biopsies from flat bladder wall indicated 93% sensitivity and 98.5% specificity for detecting carcinoma in situ. Visible lesions resulting from radiotherapy, chemotherapy or immunotherapy did not show any fluorescent signs and, therefore, did not induce false-positive readings. There were no signs of photobleaching during inspection and resection. CONCLUSIONS: We report a simple yet comprehensive endoscopic method for early detection of bladder cancer, including carcinoma in situ. Hypericin induced fluorescence has a high sensitivity and specificity for detection of bladder transitional cell carcinoma, papillary and flat carcinoma in situ. When carcinoma in situ is suspected, this technique is highly recommended.

Administration, Intravesical↗
PubMed1999

Inflammatory abdominal aortic aneurysm and bilateral complete ureteral obstruction: treatment by endovascular graft and bilateral ureteric stenting.

Inflammatory abdominal aortic aneurysms may present a challenge to the surgeon, especially because of associated retroperitoneal fibrosis and possible ureteral complications. We present a case of inflammatory abdominal aortic aneurysm with bilateral ureteral entrapment and complete anuria, successfully treated by endovascular grafting and temporary ureteral stenting.

Aortic Aneurysm, Abdominal↗
PubMed1999

Metallothioneins in human kidneys and associated tumors.

Human kidneys and their associated tumors (nonneoplastic kidney tissues from patients with a transitional cell carcinoma or an adenocarcinoma and the adenocarcinomas themselves) were evaluated for their Zn, Cd, and Cu contents as well as for their metallothionein (MT) level. The total Cd content was correlated with the MT content, and both values were significantly decreased in the adenocarcinomas in comparison with the other tissues. After extraction and separation by anion-exchange chromatography, MT-0 was identified in the nonneoplastic tissues from both the adenocarcinomas as well as the transitional cell carcinomas. Since until now MT-0 protein was only found in human fetal liver and in Zn-stimulated human monocytes, a possible role for this isoform as an oncofetal marker is hypothesized. Separation of the isoforms of MT by reversed-phase high-performance liquid chromatography and sequence analysis showed besides MT-1e and MT-1l the isoform-MT-1g, which is not expressed in the healthy kidney, and MT-1k, an isoform which is not yet demonstrated in renal tissues. We conclude that the expression profile of the MT isoforms in the kidney changes due to the presence of a tumor.

Adenocarcinoma↗
PubMed1999

Clinical application of the Bardex IC Foley catheter.

OBJECTIVES: We performed two randomized prospective studies with the silver-coated Bardex IC catheter in order to evaluate the incidence of bacteriuria during short- and medium-term catheterization after urological procedures. METHODS: During catheterization only consecutive suprapubic urine samples were taken and cultured. After removal of the catheter the patient was allowed one wash-out void, and before the second micturition a suprapubic puncture was performed to collect a culture specimen. RESULTS: In the first trial, after radical prostatectomy 18 patients with the Bardex IC catheter were compared to 17 patients with a silicon catheter after the same procedure. There was no significant difference in bacteriuria after 14 days (50.0 vs. 53.3%). In the second part of the study 180 patients were evaluated 101 with latex and 79 with Bardex IC catheters. The median catheterization time was 5 days. The results show a significant delay in the onset of bacteriuria when a silver alloy catheter is used (p < 0.003). On day 5 only 6.3% had bacteriuria in the Bardex IC group versus 11.9% in the latex group. CONCLUSION: We conclude that, after urological procedures, short-term catheterization with the Bardex IC catheter is superior to the classical latex catheter.

Adult↗
PubMed1999

Nitric oxide synthase expression in neurogenic bladder disease: a pilot study.

Neurogenic bladders are susceptible to bladder cancer development, especially in the case of chronic indwelling catheters. The classic carcinogenesis theory involves the formation of carcinogenic nitrosamines by bacteria due to chronic infection. We designed a pilot study to evaluate the expression of the of Nitric Oxide Synthase (NOS) isoforms in bladder tissue to study the role of the endogenous formation of NO (Nitric Oxide) in neurogenic bladders. Immunohistochemistry was performed on bladder biopsies from neurogenic, normal, and obstructed bladders. The neurogenic bladder had a higher expression of endothelial NOS (eNOS), but especially of neuronal NOS (nNOS). Besides, this extra-neuronal expression of nNOS by urothelium and interstitial cells was observed. This study proves the important role of endogenous formation of NO by suburothelial nerves but also by urothelium and interstitial cells. This overexpression could possibly be a factor in the higher incidence of bladder cancer in neurogenic bladders. On the other hand, it shows the plasticity of the NO pathways in these cases and raises important research questions concerning the physiological role of these changes.

Biopsy↗
PubMed1999

Pelvic floor rehabilitation in multiple sclerosis.

Although primarily used for treatment of stress incontinence, pelvic floor rehabilitation has been reported to have some value in the treatment of detrusor instability and urgency. In neurogenic bladder dysfunction due to Multiple Sclerosis, many authors have suggested the possible use of pelvic floor rehabilitation as a treatment modality. Therefore, we designed an open prospective trial to look at the possible role of pelvic floor rehabilitation in voiding dysfunction due to MS, concentrating upon the clinical and neurological parameters in relation to the outcome. A new scoring system for pelvic floor dysfunction is introduced. Thirty female patients were evaluated. In 25, the strength of the pelvic floor was significantly improved after one month (p < 0.001). In all patients but one the endurance score improved significantly (p < 0.001) as did the exhaustibility score (p = 0.01). The relaxation score on the other hand did not show any significant evolution despite intensive training. Cystometric findings after one month did not significantly differ from the initial cystometric findings. There was a significant increase in the mean functional bladder capacity as read from the voiding charts from 173.8 cc +/- 53.9 cc to 208.5 cc +/- 57.6 cc (p = 0.005). Also the mean urinary frequency decreased significantly from 12.7 +/- 3.6 to 9.1 +/- 2.6 (p < 0.01) as did the mean number of daily incontinent episodes from 2.8 +/- 1.3 to 1.5 +/- 1.5 (p < 0.01). Pelvic floor rehabiltation has a place in the treatment of MS patients with a low Kurtzke score and without pelvic floor spasticity.

Adult↗
PubMed1998

Radical prostatectomy and postoperative irradiation in patients with pathological stage C (T3) carcinoma of the prostate.

PURPOSE: Adenocarcinoma of the prostate is the most common human cancer of internal organs. Radical surgery is regarded by many to be the treatment of choice for capsule confined disease. Since accurate preoperative assessment of tumor stage is difficult to define, many patients are subsequently found to have pathological stage C (T3) disease. These patients should be considered for adjuvant radiotherapy. METHODS AND MATERIALS: A group of 201 PS C (T3) unselected patients, treated with radical prostatectomy and limited pelvic lymphadenectomy, received postoperative irradiation to the prostate bed. This radiotherapy was given between 42-90 days after surgery and consisted of a median dose of 48 Gy. Patient survival, disease free survival, time to clinical and chemical relapse and the incidence of local and systemic relapse were analyzed. The influence of multiple parameters on the treatment outcome including patient age, treatment period, clinical stage, pathological stage, Gleason's score, prostate specific antigen (PSA), radiotherapy techniques and radiation dose were examined using univariate and multivariate analysis. Follow-up ranged from 3 to 15 years, with a median of 5 years. RESULTS: The overall 5- and 10-year actuarial survival was 92% and 83% (median > 10 years), respectively and the 5- and 10-year disease-free survival (clinical and PSA) was 67% and 53% (median > 10 years), respectively. A total of 61 (30%) patients had a recurrence, including 23 (11%) patients who had clinical and 38 (19%) who had PSA recurrence. Of the 23 patients with clinical recurrence, 10 (5%) had local recurrence, including two patients who had local and systemic recurrence. Pathological stage and Gleason's score were independently predictive of recurrence (each with p < 0.001 after controlling for the other). Patients in the worst prognostic category with pathological stage C3 and Gleason's score 8-10 were predicted to be at 7.2 times the risk of recurrence, compared to stage C1 or C2 and Gleason's score 2-7 patients. Preoperative PSA level (> 25 ng/ml) was also an important independent factor predicting tumor recurrence, p = 0.05. All other investigated parameters were not significant in predicting tumor recurrence. This treatment program was very well tolerated by the study patients, with seven (3.5%) recorded with major and 18 (9%) with minor surgical complications, while 65% of patients had minor and clinically insignificant radiation complications. CONCLUSION: Surgery followed by moderate dose radiotherapy in patients with PS C (T3) prostatic carcinoma was well tolerated and resulted in excellent overall and disease free survival, with a low incidence of local recurrence. New treatment strategies need to be developed for patients with C3 tumors and those with high (8-10) Gleason's score and those with high (> 25 ng/ml) PSA level at diagnosis.

Aged↗
PubMed1998

Clinical assessment of pelvic floor dysfunction in multiple sclerosis: urodynamic and neurological correlates.

We present a study on the clinical assessment of pelvic floor dysfunction in 30 female patients with proven multiple sclerosis (MS). A scoring system for pelvic floor muscle testing by digital vaginal palpation is proposed. The concept of pelvic floor spasticity in MS is introduced. The relationship of our findings with the neurological findings and urodynamic data is presented. Pelvic floor spasticity correlates well with the presence of detrusor-external sphincter dyssynergia and with more severe spinal cord disease.

Female↗
PubMed1998

Partial nephrectomy for renal cell carcinoma can achieve long-term tumor control.

PURPOSE: Partial nephrectomy is becoming more widely accepted as alternative treatment for small renal cell carcinoma. To analyze its value in tumor control and its complication rate a retrospective study was done. MATERIALS AND METHODS: A total of 76 patients underwent kidney sparing surgery, which was required in 25 and in the presence of a normal contralateral kidney in 51. Tumor size varied between 0.9 and 15 cm. Simple enucleation was done in 4 and partial nephrectomy in all other cases. The patients were followed every 3 months during year 1, every 4 months during years 2 and 3, and every 6 months during years 4 and 5 postoperatively. Mean followup is 75 months. RESULTS: Eight patients had postoperative complications, most often hemorrhage. None of the patients had local recurrence, although in 3 systemic disease developed. CONCLUSIONS: Nephron sparing surgery is more challenging than radical nephrectomy and, therefore, can be more complicated. The selection of suitable candidates is the key to success. Many patients can benefit from nephron sparing surgery for small easily resectable renal cell carcinoma even in presence of a normal contralateral kidney. Randomized trials are needed to establish the definitive role of this approach in kidney cancer treatment.

Aged↗