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Biomedical subjects

M De Vos

Publications and source records attributed to M De Vos.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Preterm premature rupture of membranes in a patient with the hypermobility type of the Ehlers-Danlos syndrome. A case report.

OBJECTIVES: This report wants to focus on the risk of severe prematurity in patients with the hypermobility type of the Ehlers-Danlos syndrome (EDS), a heritable disorder of connective tissue. Although various obstetrical complications have been reported in patients with EDS, most reports specifically comment on the severe complications in patients with the vascular type of EDS, including uterine and arterial rupture. Pregnancy outcome in patients presenting the hypermobility type of EDS is poorly documented. CASE: A 33-year-old nullipara was referred for preconceptual genetic counseling with a history of easy bruising, generalized joint hypermobility and chronic arthralgia and myalgia. The diagnosis of the hypermobility type of EDS was confirmed on clinical examination. During her first pregnancy, she underwent a prophylactic McDonald cerclage at 14 weeks' gestation. Premature rupture of membranes occurred at 23 weeks' gestation. A female infant was delivered at 26 weeks and died 3 h after birth. Electron-microscopic examination showed collagen fibre abnormalities in the fetus' skin, which were compatible with the diagnosis of EDS. CONCLUSIONS: Patients with the hypermobility type of EDS can have an increased risk for pregnancy complications, including prematurity due to cervical incompetence and to premature rupture of membranes. We therefore demand the clinician's alertness for possible signs of this underdiagnosed type of EDS and recommend the collaboration between the obstetrician and the medical geneticist in the obstetrical management of these patients.

Adult↗
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Biliary complications of large Echinococcus granulosus cysts: report of 2 cases and review of the literature.

Hydatid cysts are often incidentally found and remain clinically silent. However complications can occur. We present 2 patients who developed biliary complications due to a large hydatid cyst. In the first patient compression on the intrahepatic bile ducts and cystic duct by the cyst, caused cholangitis and cholecystitis. Moreover the cyst had ruptured into the right intrahepatic bile ducts. A sphincterotomy was performed with extraction of hydatid sand. A pericystectomy was necessary because of infectious deterioration of the patient. Albendazole was continued for 8 weeks after surgery. The second case presented with jaundice and weight-loss since 1 month. A large hydatid cyst caused compression on the bile duct bifurcation with proximal bile duct dilatation. A cystectomy was performed 2 weeks after albendazole therapy initiation, which was continued for 8 weeks after surgery. Follow-up of both surgical interventions was unremarkable. Although Echinococcus granulosus in not prevalent in Belgium, we must be aware of this pathology in patients coming from high endemic regions.

Adult↗
PubMedDate not supplied

Infectious complications of acute pancreatitis.

Disease severity in patients with acute pancreatitis varies from mild disease with minimal morbidity, to severe disease in which a whole spectrum of local and systemic complications may occur. Infectious complications frequently arise, and especially infection of pancreatic necrosis is an important risk factor for mortality. Several strategies have been devised to reduce this risk, and the use of prophylactic therapy, e.g. selective digestive decontamination, can be considered in patients with documented necrosis fo the pancreas. Pancreatic abscesses and infected pseudocysts arise later in the course of disease, and should be considered as separate entities, due to differences in therapy and outcome of these patients. When infection occurs, source control using either surgical or percutaneous drainage techniques, is essential to avoid systemic complications.

Abscess↗
PubMedDate not supplied

Severe bleeding following endoscopic variceal ligation: should EVL be avoided in Child C patients?

In the last decade there has been an evolution in the treatment of bleeding oesophageal varices. Endoscopic variceal ligation (EVL) is one of those new techniques that not only has shown to be more effective than sclerotherapy, but also causes less side effects, resulting in less episodes of rebleeding and improving survival. We describe severe bleeding in 3 patients after EVL, occurring between 5 and 10 days after the initial ligation. Two Child C patients could not be resuscitated and died shortly after this event. Severely impaired clotting function as a result of the liver disease and the greater size of the ulcers induced by EVL may contribute to this dramatic complication. Severe bleeding due to postligation ulceration may lead to death, which occurred in 2 of our Child C patients. Since more and more endoscopists are using EVL in the treatment of oesophageal variceal bleeding, they should be aware of the possible complications caused by this rather new technique.

Contraindications↗
PubMedDate not supplied

Gut mucosal T cell lines from ankylosing spondylitis patients are enriched with alphaEbeta7 integrin.

OBJECTIVE: An intriguing link between gut and synovial inflammation exists in patients with spondyloarthropathy (SpA), illustrated by the high frequency of microscopically inflammatory gut lesions observed in these patients. We hypothesise that aberrant homing of mucosal T cells might play a role in the induction/perpetuation of arthritis in SpA. Here, we analyse the expression of the homing molecules alpha4beta7 and alphaEbeta7 on mucosal T cells from patients with ankylosing spondylitis (AS) and controls, in view of the critical role of these receptors in the homing of mucosal lymphocytes. METHODS: Colonic biopsy specimens were obtained from patients with AS (n = 23) and controls (n = 30). Biopsy specimens were immunostained, treated for extraction of intraepithelial lymphocytes (IEL) and lamina propria lymphocytes (LPL) or cultured in the presence of IL-2. The expression of the beta7 integrins was investigated. RESULTS: In situ no differences were observed in alphaEbeta7 and alpha4beta7 integrin expression in isolated IEL and LPL, whether determined by flow cytometry or by immunohistochemical staining. In gut mucosal T cell lines, alphaEbeta7 expression was significantly higher in the mucosa of patients with AS compared with controls. Alpha4beta7 was highly expressed on T cells in both groups studied. Mucosal T cells either expressed only the alpha4beta7 integrin or co-expressed the alpha4beta7 and alphaEbeta7 integrins. Almost none of them expressed only the alphaEbeta7 integrin. CONCLUSION: In gut mucosal T cell lines from patients with AS an increased expression of alphaEbeta7 was observed.

Adolescent↗
PubMedDate not supplied

Liver transplantation and mental retardation.

Mental retardation has been a controversial relative contraindication to organ transplantation. We present a case report of a 54 year old man with alcoholic cirrhosis and mental retardation who was sent for evaluation for liver transplantation. We discuss the ethical considerations of transplantation in the mental retarded patient.

Belgium↗
PubMedDate not supplied

Observational survey of NSAID-related upper gastro-intestinal adverse events in Belgium.

OBJECTIVES: To evaluate the impact of NSAID use on current routine upper GI endoscopy (UGIE) and to compare the lesions found in NSAID users and non-users. METHODS: Participating gastroenterologists consecutively documented outpatients with and without suspicion of bleeding, referred for upper gastrointestinal endoscopy. Patient characteristics, presence of risk factors, NSAID use and endoscopic findings were reported on standard data collection forms. MAIN RESULTS: A total of 2685 non-bleeding and 159 bleeding patients were enrolled within a time period of 2 months. NSAID therapy was present in 20% of the non-bleeding patients and at least 9% of referrals for endoscopy were directly related to suspected NSAID adverse events. Nearly half of acute bleeding patients (42%) were NSAID users, including aspirin for cardioprevention. Warning digestive symptoms prior to acute bleeding were frequently absent (56%). Oesophagitis was the main endoscopic diagnosis (51% of patients). Gastroduodenal (GD) ulcer was significantly more frequent in NSAID users, whereas oesophagitis and bleeding oesophageal varices were more frequent among non-users. Analysis of odds ratio's demonstrated NSAID use to significantly increase the risk for gastric ulcer in the whole patient group (OR = 2.73; 95% confidence interval (CI): 1.98-3.77; p < 0.001) and, in addition, for duodenal ulcer in the elderly (> 65 y) subgroup (OR = 2.91; 95% CI: 1.52-5.59; p < 0.05). CONCLUSIONS: This survey confirms the high incidence of GD ulcers in NSAID users and the risk for serious gastrointestinal complications, often occurring without warning symptoms. It underlines the impact of NSAID use on the routine endoscopy load, the necessity of careful selection of patients for NSAID prescriptions and the need for gastropreventive measures, particularly in elderly patients and patients associating multiple risk factors.

Adult↗
PubMedDate not supplied

Standard and innovative therapy of inflammatory bowel diseases.

During last years, treatment of IBD evolved from a non-specific suppression of the mucosal immunological response to a more specific intervention in the immunocascade. While corticosteroids and aminosalicylates remain the mainstay of treatment, more potent immunosuppressors like azathioprine, methotrexate and cyclosporine are used in corticodependent or resistant patients. Safety profiles of these drugs become better established. The successful introduction of biological therapies such as a chimeric monoclonal antibody against TNFalpha, opened a new field of research and possibilities. New humanized agents interfering at several levels in the production of cytokines are in development. Moreover, other pathways are focused like signal transduction, adhesion of cells to tissue, modulation of tissue architecture, bacterial flora .... Challenges for the next future remain the development of more effective and safe drugs, the identification of target populations for every drug, the study of the influence of biological therapies on natural history of the disease and finally the definite cure of the patient. An updated review from current and future treatment modalities is given.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Influence of posture on haemodynamics, sodium and hormonal homeostasis in cirrhotic patients with and without ascites.

BACKGROUND/AIMS: Previous studies in preascitic cirrhosis demonstrated sodium retention during upright posture and sodium hyperexcretion during bed-rest. In patients with ascites, sodium excretion and creatinine clearance decreased during upright posture. Head-down tilting (HDT) accentuated the natriuretic effect of bed-rest in short term studies. The aim of this study was to evaluate the effects of prolonged change in posture on sodium homeostasis and on haemodynamics in cirrhotic patients. METHODS: Eighteen cirrhotic patients (9 with, 9 without ascites), were studied during 12 h upright, supine and HDT position (-10 degrees). During each position, 12 h urine collections were performed and blood samples were obtained before and after change in position. Non-invasive systemic hemodynamic measurements were performed. RESULTS: There was no significant difference between HDT and supine position in both ascitic and preascitic groups for urinary volume, fractional sodium excretion, creatinine clearance, urinary and plasma hormones and hemodynamics. Urinary volume (in supine and HDT) and fractional sodium excretion (in supine) were significantly higher and urinary noradrenaline and plasma renin (in supine and HDT) significantly lower in the preascitic group compared with the ascitic patients. Cardiac output and heart rate decreased after 12 h supine and HDT, suggesting a deactivation of sympatic nervous system and catecholamines. CONCLUSION: Our results demonstrate that prolonged HDT had no advantage over normal bed-rest in both patient groups. Possibly, a short-term beneficial effect of HDT was lost after several hours.

Adult↗
PubMedDate not supplied

Treatment of acute diarrhoea: update of guidelines based on a critical interuniversity assessment of medications and current practices.

Further to a thorough analysis of the problem of acute diarrhoea and the therapeutic options, recommendations were defined following a multidisciplinary approach. These guidelines take into account the reality of frequent self-medication. They further differ as a function of age (children, primarily treated by ORS and for whom self-medication is not advised versus adults who can self-medicate), symptoms (uncomplicated diarrhoea versus dysentery) and location where the diarrhoea is contracted (at home or when travelling).

Acute Disease↗
PubMedDate not supplied

Metastatic follicular dendritic cell sarcoma of the stomach: a case report and review of the literature.

Follicular dendritic cell (FDC) sarcomas are rare tumours, typically seen in lymph nodes. However, in about one third of the reported cases, a FDC sarcoma presents as an extranodal mass. Involvement of the gastrointestinal tract is extremely rare, and only 3 cases have been described to date. We report on a 40-year-old female patient with a follicular dendritic cell sarcoma located in the stomach and the presence of a metastasis in the liver at the time of diagnosis. Severe asthenia, nausea, back pain and loss of weight were the presenting symptoms. A CT scan of the abdomen and an upper gastrointestinal endoscopy revealed a tumour mass in the stomach. The diagnosis of a FDC sarcoma was made on histological and immunohistochemical findings. We report the second case of a FDC sarcoma presenting in the stomach. Due to its rarity, a FDC sarcoma seldom enters the differential diagnosis of spindle cells neoplasms of the gastrointestinal tract. Complete surgical resection is the treatment of choice for FDC sarcoma.

Adult↗
PubMedDate not supplied

Report on the Belgian consensus meeting on colorectal cancer screening.

Screening and prevention of colorectal cancer must be a public health priority. It is the most frequent malignancy in Europe, the second leading cause of cancer death, including Belgium where more than 6000 new cases occur per year. Various screening modalities, from non invasive to invasive are available and currently in use and they are all cost-effective in comparison with no screening. The decision as to which screening test to use should be made by the patient and clinician. Consensus documents prepared by the Belgian scientific community appear in this issue of Acta Gastroenterologica Belgica, summarizing the scientific evidence in favour as well as the limitations of fecal occult blood tests, flexible sigmoidoscopy, videocolonoscopy and virtual colonoscopy.

Belgium↗
PubMedDate not supplied

Ileal mucosal mononuclear cells in patients with seronegative spondylarthropathy.

In order to study local immunoregulatory mechanisms in patients with seronegative spondylarthropathy and histological evidence of asymptomatic intestinal inflammation, we determined mononuclear cells in distal ileal mucosa with an indirect immunoperoxidase technique using a panel of monoclonal antibodies. The number of intraepithelial lymphocytes in inflamed mucosa was not significantly increased. They carried mainly the suppressor-cytotoxic CD8 marker (greater than 80%), less frequently the helper T cell marker CD4 and lacked the pan T epitope CD3 in greater than 50%. There were no intraepithelial B cells or natural killer cells. The lamina propria lymphocytes were T and B cells, the former being more numerous. Helper T cells were more frequent than suppressor-cytotoxic T cells. There were no alterations in the proportion of T cells in inflamed mucosa. Natural killer cells were scarce. They occurred in small numbers in a minority of cases with gut inflammation and spondylarthropathy and rarely in inflammatory bowel disease. It is concluded that although there is an increase of lamina propria monocytes, there is no immunoregulatory imbalance in the ileal mucosa of patients with seronegative spondylarthropathy.

Adolescent↗
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Subclinical involvement of the gut in undifferentiated spondylarthropathies.

In order to evaluate the frequency of subclinical gut involvement in the seronegative spondylarthropathies, ileocolonoscopy with biopsies of the colon, ileocecal valve and ileum were performed on 211 patients with ankylosing spondylitis (AS), reactive arthritis (ReA) and undifferentiated spondylarthropathies. Inflammatory gut lesions were detected in a large number of these patients. It was concluded that the group of undifferentiated spondylarthropathies could be split into fairly equal subgroups: one subgroup suffering from subclinical inflammatory bowel disease associated with peripheral joint symptoms, a second subgroup presenting a form of enterogenic ReA, and a third subgroup in which no relation with the gut could be demonstrated. Ankylosing spondylitis, which has to be considered as a form of undifferentiated seronegative spondylarthropathy, could be subdivided into the same subgroups. These findings confirm the existence of subclinical gut involvement in patients with seronegative spondylarthropathies.

Arthritis↗