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Biomedical subjects

D Knockaert

Publications and source records attributed to D Knockaert.

At least 19 recordsLinked to original sources
PubMed2006

Repetitive 18-fluorodeoxyglucose positron emission tomography in isolated polymyalgia rheumatica: a prospective study in 35 patients.

OBJECTIVE: To study fluorodeoxyglucose (FDG) deposition in different vascular beds and in the large joints of patients with isolated polymyalgia rheumatica (PMR), and to investigate whether there is a relation between FDG-positron emission tomography (PET) results and risk of relapse. METHODS: All consecutive patients with isolated PMR underwent a FDG-PET scan before treatment with steroids was started and--if logistics allowed--at 3 and 6 months. PET scans were scored at seven different vascular areas and a total vascular score (TVS) was calculated, ranging from 0 to 21. FDG uptake in the shoulders, the hips and the processi spinosi of the vertebrae was scored as 0 (no uptake), 1 (moderate uptake) or 2 (intense uptake). RESULTS: Thirty-five patients entered the study. At diagnosis, vascular FDG uptake was noted in 11 patients (31%), predominantly at the subclavian arteries. Mean TVS was low. FDG uptake in the shoulders was noted in 94% of patients, in the hips in 89% and in the processi spinosi of the vertebrae in 51%. The intensity of FDG uptake in the large vessels or in the shoulders, hips or processi spinosi did not correlate with the risk of relapse. CONCLUSIONS: Only one in three patients has an (moderately) increased vascular FDG uptake, especially in the subclavian arteries. The vast majority has inflammation of shoulders and hips, and half of them have increased FDG-uptake at the processi spinosi. Results of FDG-PET scans in patients with PMR did not correlate with their risk of relapse.

Aged↗
PubMed2001

Clinical value of [(18)F]fluoro-deoxyglucose positron emission tomography for patients with fever of unknown origin.

We describe the diagnostic contribution of [(18)F]fluoro-deoxyglucose (FDG) positron emission tomography (PET) scan in 58 consecutive cases of fever of unknown origin (FUO) and compare this new approach with gallium scintigraphy. This investigation was performed from March 1996 through October 1998 at Gasthuisberg University Hospital in Leuven, Belgium. A final diagnosis was established for 38 patients (64%). Forty-six FDG-PET scans (79%) were abnormal; 24 of these abnormal scans (41% of the total number of scans) were considered helpful in diagnosis, and 22 (38% of the total number) were considered noncontributory to the diagnosis. In a subgroup of 40 patients (69%), both FDG-PET and gallium scintigraphy were performed. FDG-PET scan and gallium scintigraphy were normal in 23% and 33% of these cases, respectively; helpful in diagnosis in 35% and 25%, respectively; and noncontributory in 42% each. All foci of abnormal gallium accumulation were also detected by use of an FDG-PET scan. We conclude that FDG-PET is a valuable second-step technique in patients with FUO because it yielded diagnostic information in 41% of the patients in whom the probability of a definite diagnosis was only 64%. FDG-PET scan compares favorably with gallium scintigraphy for this indication. Because of the quick results (within hours instead of days), FDG-PET scan may replace gallium scintigraphy as a radiopharmaceutical for the evaluation of patients with FUO.

Citrates↗
PubMed2001

Chest pain in general practice or in the hospital emergency department: is it the same?

OBJECTIVE: The aim of the present study was to provide a description of the impact of setting on the diagnostic case mix that is identified in consecutive patients presenting with chest pain. METHODS: A cross-sectional study was carried out of patients presenting with chest pain according to setting: general practice, self-referred, referred or arriving by ambulance at the hospital emergency department (ED). GPs from 25 general practices situated in the Flemish part of Belgium were recruited, and the hospital involved was a major teaching hospital in the same area. A total of 320 patients in general practice and 580 patients in the hospital ED were studied. The difference in prevalence rates for the major diagnostic categories was the main outcome measure. RESULTS: Gastrointestinal disorders, musculoskeletal problems and psychopathology are identified more frequently in general practice; and serious lung diseases and cardiovascular diseases in the hospital ED. Within the hospital, there is a strong trend towards increasing frequency of serious cardiovascular diseases including unstable angina (P = 0.01) from self-referred to referred patients and those rushed in by ambulance. The opposite trend was identified for respiratory (P = 0.02) and musculoskeletal (P = 0.07) diseases. The diagnostic case mix in self-referred patients tends to be more similar to the other groups of hospital patients than to patients in general practice. CONCLUSIONS: There is a large difference between the diagnostic case mix presented in general practice compared with the ED and among referral-related subgroups within the hospital emergency department.

Adult↗
PubMed1999

Giant cell arteritis can be associated with T4-lymphocytic alveolitis.

We describe three patients with histologically proven giant cell arteritis who presented with respiratory complaints. In one patient, dry cough and dyspnoea dominated the clinical picture. In the other two patients, a diagnosis of giant cell arteritis was readily suspected by the presence of typical complaints, although both patients spontaneously mentioned a persistent cough and dyspnoea, respectively. Radiographs of the chest were normal. Lung function tests, including a carbon monoxide (CO)-diffusion capacity measurement, were always normal. Broncho-alveolar lavage fluid examination showed a normal cell count but an increased number of lymphocytes (16-61%) with a predominance of T4-lymphocytes (65.5-84.5%). We conclude that respiratory complaints and T4-lymphocytic alveolitis can be associated with giant cell arteritis.

Aged↗
PubMed1999

New arguments for a vasculitic nature of polymyalgia rheumatica using positron emission tomography.

OBJECTIVE: To study the possible contribution of fluorodeoxyglucose (FDG)-positron emission tomography (PET) in the diagnosis of giant cell arteritis and polymyalgia rheumatica. METHODS: A consecutive case series consisting of five patients with polymyalgia rheumatica, six patients with temporal arteritis and 23 age-matched patients with other inflammatory conditions were evaluated with FDG-PET. Studies were performed before therapy with steroids was started. RESULTS: A total of 4/6 patients with giant cell arteritis and 4/5 patients with polymyalgia had increased FDG uptake in their thoracic vessels, compared to 1/23 controls (P < 0.001). Increased vascular FDG uptake in the upper legs was seen in 8/11 patients with giant cell arteritis or polymyalgia compared to 8/23 control patients (P < 0.05), and in the lower legs in 6/11 patients compared to 6/23 controls (P = not significant). CONCLUSIONS: FDG-PET scan is the first non-invasive technique which may indicate large-vessel vasculitis and which can show its extension throughout the body. It strongly suggests that polymyalgia rheumatica is a form of vasculitis.

Aged↗
PubMed1997

Coronary involvement in the Churg-Strauss syndrome.

The Churg-Strauss syndrome (CSS) is a rare systemic disease characterised by vasculitis and peripheral eosinophilia in patients with an atopic constitution. Cardiac involvement is an important cause of morbidity and mortality yet coronary involvement is very rarely documented. We report the case of a 38 year old man presenting with fulminant heart failure. Coronary arteriography demonstrated extensive focal vasculopathy consistent with vasculitis. The diagnosis of CSS was established based upon the classical diagnostic criteria and corticosteroid treatment resulted in a spectacular remission of disease activity.

Adult↗
PubMed1995

Linear IgA dermatosis: a new cause of fever of unknown origin.

We describe a 60-year-old patient who presented with prolonged fever, weight loss, adenopathies and malaise. Two months later, an aphthous stomatitis and pharyngitis developed, together with ulcerations bilaterally in the groin. Two separate skin biopsies revealed the diagnosis of linear IgA dermatosis. This entity, which is well known to dermatologists but not to internists, should be added to the extensive list of disorders than can provoke the syndrome of fever of unknown origin.

Autoimmune Diseases↗
PubMed1994

Cauda equina syndrome complicating ankylosing spondylitis: role of computed tomography and magnetic resonance imaging.

We present two cases of cauda equina syndrome in ankylosing spondylitis. Cauda equina syndrome is a rare complication of ankylosing spondylitis, the pathogenesis of which is not well understood. The onset is insidious with pain and sensory symptoms; sphincter disturbances are common. After a period of increasing neurological symptoms, the condition tends to stabilize. The degree of nerve involvement is variable and can be accurately defined by electromyography. The diagnosis has to be confirmed by computed tomography (CT) or magnetic resonance imaging (MRI); myelography must be avoided. There is no specific treatment, except for pain control. The different clinical presentations and the role of new imaging techniques, CT and MRI, are demonstrated.

Cauda Equina↗
PubMed1994

Kaposi's sarcoma presenting as generalized lymphedema.

We present a HIV-1 seropositive patient with generalized lymphedema, due to a rare lymphangiomatous variant of Kaposi's sarcoma, successfully treated with interferon-alpha. The clinical presentation and treatment possibilities of Kaposi's sarcoma are reviewed.

Blotting, Western↗
PubMed1994

Yersiniosis: the clinical spectrum.

Although pathogenic Yersinia have been described several decades ago, human Yersinia infections remain enigmatic. The high prevalence in Europe and the variety of manifestations should be known to most clinicians. Both Yersinia enterocolitica and Y. pseudotuberculosis may cause similar clinical pictures. The clinical spectrum encompasses both intestinal and extraintestinal infectious syndromes and reactive or postinfectious immunological manifestations. The limited value of the currently available serodiagnostic techniques and the broad clinical spectrum make reactive yersiniosis a difficult diagnosis. Yersiniosis must be considered in the differential diagnosis of rheumatic and collagen vascular diseases. In selected indications the use of newer diagnostic tools such as immunoblotting and indirect immunofluorescence may increase the diagnostic yield in idiopathic reactive manifestations or recurrent or persisting infections of unknown origin. Recently, fluoroquinolones have emerged as promising drug when therapy is indicated.

Arthritis, Reactive↗
PubMed1991

Occult tuberculous postpneumonectomy space empyema four years after lung resection.

We describe a patient in whom a tuberculous postpneumonectomy empyema developed 4 years after resection for lung cancer. The clinical presentation was dominated by non-specific constitutional symptoms, without any chest complaints. A computed tomographic scan of the chest suggested inflammation in the postpneumonectomy space. Ultimately Mycobacterium tuberculosis was cultured from material aspirated by needle thoracocentesis. To our knowledge this is the first report of a tuberculous postpneumonectomy empyema complicating resection for cancer.

Aged↗
PubMed1990

Endometriosis of the cecum and appendix: two case reports.

Two cases of endometriosis of the cecal area are reported. In one case, the endometriosis was located in the appendix causing intussusception into the cecum. Both cases were associated with localizations of endometriosis in the rectosigmoid.

Adult↗
PubMed1989

Pulmonary migration following periurethral polytetrafluoroethylene injection for urinary incontinence.

We report a case of clinically significant migration of polytetrafluoroethylene (Teflon) paste particles to the lungs after periurethral injection. These particles were identified by standard and polarized light microscopy. Since the long-term effects in humans are not sufficiently known, we strongly warn against the use of polytetrafluoroethylene paste in children or young adults with a normal life expectancy.

Adult↗
PubMed1986

Mercury intoxication after topical application of a metallic mercury ointment.

Two cases of mercury poisoning with predominantly dermatological symptoms are reported. The mercury intoxication was caused by the application of an over-the-counter metallic mercury ointment. The calculations of mercury excretion suggest strongly that cutaneous absorption could have been a significant route of entry.

Administration, Topical↗