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D De Ridder

Publications and source records attributed to D De Ridder.

At least 19 recordsLinked to original sources
PubMed2006

Repetitive transcranial magnetic stimulation (rTMS): a new therapeutic approach in subjective tinnitus?

Subjective (non-recordable) tinnitus is the conscious perception of a phantom sound, and a very frequent, sometimes disabling, condition. Even if subjective tinnitus is often related to peripheral hearing loss, neurophysiological and functional imaging studies provide increasing evidence for an involvement both auditory and non-auditory central nervous pathways in the generation of tinnitus and related distress. Repetitive transcranial magnetic stimulation (rTMS) has been proposed to relieve tinnitus by reducing auditory cortex hyperexcitability associated with this condition. This paper will review the first clinical results reported in auditory cortex rTMS studies, with special reference to the pathophysiology of tinnitus processing and the mechanisms of action of rTMS. Although rTMS appears to be a very promising tool for the diagnosis and the treatment of tinnitus patients, available knowledge is still very limited at the moment. Further basic research and clinical studies are needed in order to optimize the parameters of stimulation (stimulus frequency, cortical target definition) and to validate the application of this technique in the management of patients with disabling tinnitus.

Chronic Disease↗
PubMed2006

The effect of imatinib mesylate on the contractility of isolated rabbit myometrial strips.

BACKGROUND: C-kit receptor expressing interstitial cells generate and coordinate the electrical signals that control peristalsis in the gut. However, the function of interstitial cells in the myometrium is not known. METHODS: (1) Sections of rabbit myometrium were subjected to immunohistochemical staining for the c-kit receptor. (2) Spontaneously contracting myometrial strips from New Zealand White rabbits near term were mounted in an organ bath and attached to a tension-recording device. The effect of increased concentrations of the c-kit receptor antagonist imatinib mesylate on these contractions was observed. The main outcome measures were the change in frequency, amplitude and duration of contraction. RESULTS: (1) Multipolar cells expressing c-kit were identified in the fibromuscular septum confirming the presence of interstitial cells in rabbit myometrium. (2) Imatinib decreased the amplitude of contractions by approximately 20% at 100 microM. No effect was seen at lower concentrations. No effect of imatinib on frequency or duration of contractions was observed at any of the concentrations studied. CONCLUSIONS: In isolated rabbit myometrium, acute inhibition of the c-kit receptor by imatinib mesylate affects only the amplitude of spontaneous contractions at concentrations, the equivalent of x10-100 the normal therapeutic concentration.

Animals↗
PubMed2006

The use of flupirtine in treatment of tinnitus.

CONCLUSION: Flupirtine, a functional NMDA antagonist, does not seem to be efficacious in the treatment of tinnitus. OBJECTIVES: The purpose of this study was to investigate whether flupirtine has any beneficial effect on tinnitus perception. PATIENTS AND METHODS: Twenty-four patients were selected (6 female and 18 male patients) with continuous subjective tinnitus. Eight patients suffered left-sided tinnitus, 4 right-sided tinnitus and 12 bilateral tinnitus. We assessed the burden of the tinnitus by loudness visual analogue scale (VAS) and tinnitus questionnaire (TQ) according to Hallam et al., and Hiller and Goebel. All patients were treated with a 2 x 100 mg daily dosage of oral flupirtine for 3 weeks in an open prospective design. RESULTS: There was no statistical effect on VAS and TQ of the treatment with flupirtine. Only one patient (4.2%) experienced a positive effect on the tinnitus but discontinued the treatment because of amnesia and concentration disorders.

Adult↗
PubMed2006

Overactive bladder: The importance of new guidance.

Overactive bladder (OAB) affects an estimated 49 million people in Europe, but only a minority receive appropriate treatment. Others are bothered by unacceptable levels of symptoms that severely impair their quality of life and represent a significant financial burden to themselves and to their healthcare providers. Recently updated guidelines from the International Consultation on Incontinence (ICI) and the European Association of Urology (EAU) take account of important new developments in the management of bladder problems in both primary and secondary care. However, local implementation of previous guidance has been variable, with many patients with OAB and other bladder problems failing to gain full benefit from current clinical and scientific understanding of these conditions. The recent expansion of the range of treatments available for OAB and stress urinary incontinence makes it especially important that physicians become aware of the differential diagnosis of these conditions - the questions they need to ask, and the investigations which will help determine the most appropriate course of action.

Algorithms↗
PubMed2005

Frequency specific hearing improvement in microvascular decompression of the cochlear nerve.

BACKGROUND: Microvascular compressions of the cochlear nerve can lead to hearing loss. Due to the tonotopic organization of the cochlear nerve any focal compression of the cochlear nerve will result in a frequency specific hearing loss. Decompressing the cochlear nerve could result in a frequency specific hearing improvement, without improving overall hearing. METHOD: Thirty one patients underwent microvascular decompression operations of the vestibulocochlear nerve for vertigo or tinnitus. Preoperative audiograms were substracted from postoperative audiograms obtained 2 years after microvascular decompression. The frequencies of maximal hearing improvement postoperatively were determined. FINDINGS: Of the 31 patients studied, 19 had improvements of 5 dB or more at one or more frequencies postoperatively, and 15 patients had improvements of 10 dB or more. Three patients had improvements of 25 dB or more postoperatively. The postoperative hearing improvement was frequency-specific and related to the anatomical location of the vascular contact on the auditory nerve. The improvement of hearing becomes diluted when the difference between pre- and postoperative hearing thresholds are averaged over all audiometric frequencies. We therefore present results for each frequency that was tested. CONCLUSIONS: Microvascular decompression of the cochlear nerve can improve hearing in selected patients. The improvement seems too small to justify decompressive surgery for the sole purpose of hearing improvement, but it could be considered if associated short vertigo spells, ipsilateral tinnitus, otalgia and cryptogenic hemifacial spasm are present. Decompression should be performed early, before BAEP changes become noticeable. 3D-MRI could become a valuable tool for selecting good surgical candidates.

Adult↗
PubMed2005

Conservative bladder management in advanced multiple sclerosis.

Anticholinergics and intermittent catheterization are the cornerstones of bladder management in early multiple sclerosis (MS). In advanced MS however, bladder management is based more on tradition than on evidence. Nurses seem to deal with catheter problems and chronic incontinence. Despite the abundant use of indwelling catheters, there is a lack for guidelines on catheter-induced problems. The psychosexual and social impact of bladder problems in advanced MS is often neglected. The international multidisciplinary special interest group on sexual, urological and bowel dysfunction in MS (SUBDIMS) as a special interest group of the Rehabilitation in Multiple Sclerosis (RIMS) was confronted with a high variability in practice and a lack of guidelines. A literature review was prepared during three multidisciplinary expert meetings. This review will be the basis of further initiatives to improve the urological treatment of patients with advanced MS.

Evidence-Based Medicine↗
PubMed2004

Does the location of a vascular loop in the cerebellopontine angle explain pulsatile and non-pulsatile tinnitus?

The purpose was to investigate patients with unexplained pulsatile and non-pulsatile tinnitus by means of MR imaging of the cerebellopontine angle (CPA) and to correlate the clinical subtype of tinnitus with the location of a blood vessel (in the internal auditory canal or at the cisternal part of the VIIIth cranial nerve). Clinical presentation of tinnitus and perceptive hearing loss were correlated. In 47 patients with unexplained tinnitus, an MR examination of the CPA was performed. Virtual endoscopy reconstructions were obtained using a 3D axial thin-section high-resolution heavily T2-weighted gradient echo constructive interference in steady state (CISS) data-set. High-resolution T2-weighted CISS images showed a significantly higher number of vascular loops in the internal auditory canal in patients with arterial pulsatile tinnitus compared to patients with non-pulsatile tinnitus (P<0.00001). Virtual endoscopy images were used to investigate vascular contacts at the cisternal part of the VIIIth cranial nerve in patients with low pitch and high pitch non-pulsatile tinnitus. A significantly different distribution of the vascular contacts (P=0.0320) was found. Furthermore, a correlation between the clinical presentation of non-pulsatile tinnitus (high pitch and low pitch) and the perceptive hearing loss was found (P=0.0235). High-resolution heavily T2-weighted CISS images and virtual endoscopy of the CPA can be used to evaluate whether a vascular contact is present in the internal auditory canal or at the cisternal part of the VIIIth cranial nerve and whether the location of the vascular contact correlates with the clinical subtype of tinnitus. Our findings suggest that there is a tonotopical structure of the cisternal part of the VIIIth cranial nerve. A correlation between the clinical presentation of tinnitus and hearing loss was found.

Adolescent↗
PubMed2004

Solifenacin appears effective and well tolerated in patients with symptomatic idiopathic detrusor overactivity in a placebo- and tolterodine-controlled phase 2 dose-finding study.

OBJECTIVES: To evaluate the dose-response relationship and safety/tolerability of solifenacin succinate (YM905) in the treatment of overactive bladder (OAB), and to compare its efficacy and safety/tolerability with tolterodine 2 mg twice daily. PATIENTS AND METHODS: This multicentre study included a 2-week single-blind placebo run-in, a 4-week double-blind placebo-controlled active treatment phase, and a 2-week follow-up. Men and women with an OAB and urodynamic evidence of detrusor overactivity were randomized to placebo or solifenacin 2.5, 5, 10 or 20 mg once daily, or tolterodine 2 mg twice daily. RESULTS: Of 265 patients enrolled, 225 were randomized and 192 completed the study. Solifenacin 5, 10 and 20 mg produced statistically significant (P < 0.05) improvements in voids/24 h vs placebo, whereas tolterodine did not; the mean change with tolterodine was between those with solifenacin 2.5 and 5 mg. The outcome was similar for the mean change from baseline to endpoint in mean volume voided/void. For incontinence and urgency episodes/24 h the solifenacin dose groups showed numerically superior changes vs placebo; the mean effects with tolterodine were generally smaller than with solifenacin. Most of the efficacy effect of solifenacin was evident at 2 weeks. Quality-of-life outcomes supported the efficacy results. Solifenacin 5 and 10 mg were well tolerated; there were no serious treatment-related adverse events. The incidence of dry mouth was 14% for solifenacin 5 and 10 mg, 2.6% for placebo and 24% for tolterodine. CONCLUSION: In this study, the 5- and 10-mg doses of solifenacin appeared to be the most clinically effective for treating OAB, considering the balance between efficacy, quality of life and tolerability. From the results of this study solifenacin 5 and 10 mg were selected for further evaluation in large-scale phase 3 studies.

Adolescent↗
PubMed2003

Image guided surgery for petrous apex lesions.

OBJECTIVES: To evaluate whether computer-assisted frameless stereotactic navigation in the temporal bone provides sufficient clinical application accuracy and thus a useful tool in temporal bone surgery. METHODS: Two patients with petrous apex cholesterol granuloma were operated on by an epidural middle fossa approach using a Stealth/Medtronic trade mark neuronavigation system. Based on literature data optimal skin fiducial placement and registration methods were used. Intra-operative accuracy was checked using three precise anatomical landmarks. Drilling of the petrous apex bone was guided by neuronavigation. Postoperative Computed Tomography (CT) images were fused with the preoperative CT and planning. RESULTS: The application of image-guidance in temporal bone surgery causes no additional burden to the patient nor prolongs the operating time. The accuracy measured at the anatomical landmarks was under 2,0 mm. This is confirmed by evaluation of bone removal through image fusion of pre- and postoperative CT-scan. CONCLUSIONS: The clinical application of a neuronavigation system during petrous apex surgery can be regarded as useful. Using all available data on registration methods it seems possible to obtain intra-operative application accuracies of <2,0 mm. Additional cadaver work is being performed to support these data.

Adult↗
PubMed2003

Potency after unilateral nerve sparing surgery: a report on functional and oncological results of unilateral nerve sparing surgery.

The objective of the study was to evaluate unilateral nerve sparing prostate surgery. Patient files of men who underwent unilateral nerve sparing radical prostatectomy were analyzed retrospectively after a minimum follow-up period of 18 months. Of 46 patients who received unilateral nerve sparing surgery, 14 (30.4%) regained full potency after surgery. In 92.9% of these patients, recovery occurred within a period of 18 months. Age is the single most important factor in the recuperation of potency after unilateral nerve sparing surgery. Most of the patients (84.8%) reported the ability to achieve orgasm. Of eight patients with positive section margins, two had positive section margins at the spared side only. Unilateral nerve sparing surgery remains a feasible treatment option for prostate cancer.

Adult↗
PubMed2000

Effect of pelvic-floor re-education on duration and degree of incontinence after radical prostatectomy: a randomised controlled trial.

BACKGROUND: Urinary incontinence is a common long-term complication after radical prostatectomy. Spontaneous recovery of normal urinary control after surgery can take 1-2 years. We aimed to investigate whether there was any beneficial effect of pelvic-floor re-education for patients with urinary incontinence as a result of radical prostatectomy. METHODS: 102 consecutive incontinent patients who had had radical retropubic prostatectomy for clinically localised prostate cancer and who could comply with the ambulatory treatment schedule in our hospital were randomised, after catheter removal, into a treatment group (n=50) and a control group (n=52). Patients in the treatment group took part in a pelvic-floor re-education programme for as long as they were incontinent, and for a maximum of 1 year. The control group received placebo therapy. The primary endpoint was continence rate at 3 months. Incontinence was assessed objectively with the 1 h and 24 h pad tests and subjectively by the visual analogue scale. The groups were analysed on an intention-to-treat basis by ANOVA and chi2-test. FINDINGS: In the treatment group continence was achieved after 3 months in 43 (88%) of 48 patients. In the control group, continence returned after 3 months in 29 (56%) of 52 patients. At 1 year, the difference in proportion between treatment and control group was 14% (95% CI 2-27). In the treatment group improvement in both duration (log-rank test, p=0.0001) and degree of incontinence (Wald test, p=0.0010) was significantly better than in the control group. INTERPRETATION: Pelvic-floor re-education should be considered as a first-line option in curing incontinence after radical prostatectomy.

Biofeedback, Psychology↗
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

Evaluation of the use of Urocath-Gel catheters for intermittent self-catheterization by male patients using conventional catheters for a long time.

STUDY DESIGN: Prospective study of intermittent self-catheterization (CIC) with change from conventional catheter to low-friction Urocath-Gel catheter. OBJECTIVES: To evaluate if such catheters are well accepted and to evaluate their practical use. METHODS: Thirty-nine male patients, between 19 and 74 years old, performing clean intermittent self-catheterization with conventional catheters for a neuropathic bladder for many years were included in this study after written informed consent. Exclusion criteria were clinical urinary tract infection, acute infection of urethra, prostate or epididymis, untreated urethral strictures and false passages or severe urethral bleeding occurring within the last month. During 1 month they changed to the use of the Urocath-Gel catheter. Complications were noted. Satisfaction was evaluated by a visual analogue scale and by questioning. RESULTS: Four patients did not complete the study, two for side effects, two for difficulties with the catheterization technique. Time needed for CIC was not different with both techniques. Difficult introduction or difficult retreat of the catheter were not different in frequency. Impossibility to introduce the catheter was less frequent. Urethritis and urethral bleeding were less frequent than during the use of conventional catheters. Satisfaction was better with the low friction catheters. Negative satisfaction was mainly related to the availability and the use of water to lubricate the catheter, difficulty of manipulation and fear for cost. CONCLUSION: The hydrophilic catheter Urocath-Gel proved as easy to use as conventional catheters but was better tolerated. Satisfaction was better especially in patients who experienced problems with conventional catheters. Some patients were unsatisfied for reasons of practical use or for economical reasons.

Adult↗
PubMed1999

Pelvic floor descent in females: comparative study of colpocystodefecography and dynamic fast MR imaging.

The purpose of this study was to compare fast dynamic magnetic resonance imaging (MRI) with colpocystodefecography (CCD) in the evaluation of pelvic floor descent in women. Thirty-five women with clinical evidence of pelvic floor descent were studied. A fast single-shot MR sequence was performed in the supine position during pelvic floor relaxation and during maximal pelvic strain. On the same day, a dynamic CCD was performed with the patient seated on a stool-chair. The degree of descent of the bladder, vagina, and anorectal junction was evaluated as the vertical distance between the pubococcygeal line and the bladder base, the vaginal vault, and the anorectal junction, respectively. A bulge of more than 3 cm measured as the distance between the extended line of the anterior border of the anal canal and the tip of the rectocele was interpreted as a rectocele. MRI was compared with CCD during maximal pelvic strain (CCD 1) and during voiding and defecation (CCD II). CCD was considered as the gold standard. Compared with clinical examination, CCD I showed a larger number of involved compartments, except for the middle compartment. CCD II was superior to clinical examination in all cases. In comparison with CCD I and especially CCD II, MRI had a lower sensitivity, especially for the anterior and middle compartment. Even four enteroceles seen on CCD II were not detected by MRI. When CCD I and CCD II were compared, a cystocele, a vaginal vault prolapse, an enterocele, and a rectocele were more readily seen on CCD II than with CCD I. When compared with CCD, supine dynamic MRI is unreliable, especially in the anterior and middle compartment. Even in the detection of enteroceles CCD was superior to MRI. In general, the best results with MRI can be expected for evaluation of the rectum.

Adult↗
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↗