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Biomedical subjects

F Penninckx

Publications and source records attributed to F Penninckx.

At least 19 recordsLinked to original sources
PubMed1996

A cost comparison of disposable vs reusable instruments in laparoscopic cholecystectomy.

BACKGROUND: This paper compares the costs of disposable and reusable instruments in laparoscopic cholecystectomy. METHODS: The instrument set considered includes those instruments that are available in both a reusable and disposable form. A market study within the Belgian market was performed in order to compare purchase prices. In addition, costs of cleaning, sterilization, wrapping, maintenance, repair, and disposal of waste were calculated. The effects of reusables and disposables were examined by means of a literature overview. RESULTS: It was calculated that the instrument cost per procedure of a full disposable set is 7.4-27.7 times higher than the cost per procedure with reusables. In comparison with disposables, modular systems ("semidisposable") and mixed use of disposables and reusables reduce costs, but still the cost per procedure remains higher than with reusables. A sensitivity analysis confirmed that these conclusions are robust to the model assumptions. In addition, the available evidence in the literature suggests that reusables do not compromise patient or staff safety. CONCLUSIONS: If reusables are used instead of disposables when performing a laparoscopic cholecystectomy, considerable savings can be achieved without compromising patient and staff safety.

Belgium↗
PubMed1996

Complications of CO2-laser endoscopic excision of deep endometriosis.

The complications during and following endoscopic excision of deep endometriosis were analysed. The data of 225 excisions performed in 212 women had been collected prospectively into a database immediately following surgery and during the follow-up visit. The data confirmed the association of severe pelvic pain and deep endometriosis, severe pelvic being the only indication for surgery in 67, 78 and 76% of women with type I (n = 99), type II (n = 55) and type III (n = 71) lesions respectively. They confirmed that type II and type III were the largest lesions and that they were found predominantly in revised American Fertility Society (AFS) class II. The duration of surgery decreased with expertise (P < 0.01), but increased when deeper or larger lesions were excised (P < 0.0001) and when cystic ovarian endometriosis was also present (P < 0.001). Excision was clinically judged to be complete in 94, 96 and 85% of women with type I, II or III lesions respectively. In order to achieve this, part of the bowel wall had to be resected in 6.3% and part of the posterior vaginal fornix in 13.6% of cases. This risk was associated mainly in type II or III lesions and with larger lesions (P = 0.001). This was not considered as a complication, since all lesions could be repaired endoscopically and since follow-up was uneventful. Complications were one ureter lesion and seven late bowel perforations with periotonitis. Our data did not permit the evaluation as to whether medical pretreatment could improve completeness of surgery or decrease the risk. They revealed, however, that in six of seven women with type III lesions--in whom excision was judged to be complete--no pretreatment had been given and that luteinizing hormone releasing hormone (LHRH) agonist treatment decreased the volume of type II lesions (P = 0.04). In conclusion, complete endoscopic excision could be performed in over 90% of women with deep endometriosis, but required bowel surgery in over 6% of cases. Ureter lesions were rare, but postoperative bowel perforations with periotonitis occurred in 2-3% of cases. Medical pretreatment is advocated since LHRH agonist treatment was shown to shrink the deep endometriotic lesion.

Adult↗
PubMed1996

Comparative study of classical, colorimetric and immunologic staining methods for the assessment of tumor cell viability.

The trypan blue exclusion test, the MTT test and an immunostaining test for apoptosis were performed before and after incubation of SW620 human colonic carcinoma cells with different cytotoxic agents (CTAs) in order to assess tumor cell viability and CTA efficacy in vitro. A modified MTT test using light microscopy was also performed. A good correlation was found between the trypan blue assay and the MTT test, as determined by spectrophotometry. There was no 'overestimation' of cell viability as measured by the trypan blue test. The monitoring of formazan formation by light microscopy was feasible, but not very reliable since it did not show a good correlation with findings determined by spectrophotometry. The apoptosis test failed to show good correlation with other tests. Distilled water had no relevant cytotoxic effect, while chlorhexidine cetrimide (HAC 3.5%), chloramine 0.5% and polyvinylpyrrolidone iodine (PVP-I) > or = 0.05% damaged a large majority of cells. PVP-I at a concentration of > or = 5% was found to be the most effective CTA.

Antineoplastic Agents↗
PubMed1996

Technique and early results of videoscopic lumbar sympathectomy.

The authors describe their technique of videoscopic (VS) lumbar sympathectomy (LSE), compared to the open LSE. From 1992 to 1994, 21 open and 19 VS LSE were performed. The indication was reflex sympathetic dystrophy in 17 and arterial insufficiency in 23 patients. In the open LSE the mean duration of anaesthesia was 80 min (55-115) and of surgery 37 min (25-65). The length of the chain removed varied from 1 to 3 ganglia (6-7 cm). Complications were noted in 5 patients: 1 pneumonia, 2 superficial wound problems and 2 cases of postsympathectomy neuralgia. Hospital stay of patients with RSD varied from 2 to 5 days. Of the 19 attempts to perform a VS LSE 4 had to be converted to the open technique. The duration of anesthesia was 150 min (90-280) and of surgery 92 min (45-240). Lengths of chain removed varied from 1 to several ganglia (6-7 cm). A pneumoperitoneum was present in 10 procedures, but a Veress needle was placed in only 4 of these. Complications were present in 9 patients: 1 important subcutaneous emphysema, 1 severe costal pain, 2 neuralgia, 1 temporary psoas dysfunction, 1 haemorrhage from a lumbar vein with conversion to the open technique and 3 minor superficial wound problems. The hospital stay ranged from 2 to 5 days. This study suggests that the VS LSE has no benefit over the open technique as far as the operative and early results are concerned. Whether this technique avoids some of the late disadvantages of a lumbotomy remains to be seen.

Adolescent↗
PubMed1996

Exfoliated tumour cells and locally recurrent colorectal cancer.

The presence of intraluminal viable exfoliated tumour cells has been demonstrated in patients with colorectal cancer. Several non-randomised studies found a significant reduction of the recurrence rate after the intraoperative luminal instillation of cytotoxic agents, as compared with "historical" patient series. Antiseptic solutions, e.g. sodium hypochlorite and povidone-iodine, were reported to be "cancericidal" for exfoliated cancer cells in vitro. A survey held among Belgian surgeons practising colorectal cancer surgery revealed that 78% of them never use any agent during surgery. Only a minority performs pre-resectional luminal instillation-mostly to treat the distal (low) anastomotic level: 14% in patients with rectal cancer and 7% in patients with colon cancer. About 8% of the surgeons only perform peritoneal/pelvic lavage at the end of the procedure. This is in strong contrast with surgical practice in the UK. It seems reasonable to advocate intra-operative pre-resectional bowel washouts with cytotoxic agents besides other measures to avoid recurrence, e.g. the no touch isolation technique with early division of the vascular supply, wide excision of the mesenterium, avoidance of iatrogenic tumour perforation, "en bloc" resection if adjacent organs are invaded, adjuvant radio- and chemotherapy.

Administration, Topical↗
PubMed1995

Controlled trial of metronidazole treatment for prevention of Crohn's recurrence after ileal resection.

BACKGROUND/AIMS: New lesions recur within weeks to months after ileal resection and ileocolonic anastomosis for Crohn's ileitis. A double-blind controlled trial was performed using metronidazole to prevent recurrence after ileal resection. METHODS: Sixty patients who underwent curative ileal resection and primary anastomosis were included within 1 week after surgery. Thirty patients received metronidazole (20 mg/kg body wt) daily for 3 months, and 30 patients received placebo. Treatment was then discontinued. Nine patients dropped out during treatment, 7 in the metronidazole group and 2 in the placebo arm. RESULTS: At 12 weeks, 21 of 28 patients (75%) in the placebo group had recurrent lesions in the neoterminal ileum as compared with 12 of 23 patients (52%) in the metronidazole group (P = 0.09). The incidence of severe endoscopic recurrence was significantly reduced by metronidazole (3 of 23; 13%) as compared with placebo (12 of 28; 43%; P = 0.02). Patients in the metronidazole arm had more frequent side effects. Metronidazole therapy statistically reduced the clinical recurrence rates at 1 year (4% vs. 25%). Reductions at 2 years (26% vs. 43%) and 3 years (30% vs. 50%) were not significant. CONCLUSIONS: Metronidazole therapy for 3 months decreases the severity of early recurrence of Crohn's disease in the neoterminal ileum after resection and seems to delay symptomatic recurrence.

Adult↗
PubMed1995

Contribution of PET in the diagnosis of recurrent colorectal cancer: comparison with conventional imaging.

The clinical value of total body PET with FDG was evaluated in 76 patients presenting with or suspected of recurrent local or distant colorectal cancer. PET results were compared to those of routine imaging (CT pelvis, CT/US liver and CXR). The accuracy of PET for local disease was 95% which was superior to CT-pelvis (accuracy 65%). PET accuracy for liver metastases (98%) compared favourably to CT/US-liver accuracy (93%). Unexpected extra-hepatic mestastases were detected by PET in 14 locations in 10 patients. Also, a primary breast cancer was found in one patient. The main value of PET appeared an improved staging of apparently resectable, local or distant recurrent disease. Thereby, a more adequate indication of major secondary surgery could be attained.

Colorectal Neoplasms↗
PubMed1995

Radical versus local surgical treatment for rectum carcinoma. A variety of options?

Local excision has to be classified as either indeterminate or non curative from a surgical oncological point of view. It seems to be an acceptable procedure for well differentiated, exophytic/polypoid pT1 lesions of less than 3 cm in diameter, providing the resection margins are tumour-free. For all other lesions radical surgery is to be preferred, unless the patient is unfit for major surgery or refuses an eventual permanent colostomy. Complete local excision followed by radiation therapy may become a valuable alternative for well differentiated, small pT2 lesions, but results are too preliminary. If radical surgery is indicated, the distal clearance margin (to be measured in the fresh, unstretched specimen) may be reduced to 2 cm if taking more distal tissue would jeopardise the anal sphincter. The mesorectum should be completely cleared in patients with low- or mid-rectal cancer. A benefit of excision of the internal iliac nodes in rectal cancer below the peritoneal reflection has not been demonstrated. Low anterior resection is the operation of choice for carcinoma with its lower border above 8 cm from the anal verge. Complete, restorative rectum excision with colo-anal anastomosis (CAA) is the option for tumours with their lower border between 6 and 8 cm from the anal verge if an acceptable margin of distal clearance is obtained. Rectal cancer with its distal border below 6 cm usually requires abdominoperineal rectum excision, although restorative proctectomy with CAA may be a valuable alternative in selected patients with small, well or moderately differentiated tumours.

Anastomosis, Surgical↗
PubMed1994

Clinical value of whole-body positron emission tomography with [18F]fluorodeoxyglucose in recurrent colorectal cancer.

To assess the clinical value of whole-body positron emission tomography (PET) with [18F]fluorodeoxyglucose (FDG) in recurrent colorectal cancer, 35 patients were studied: 15 had resectable liver metastases, one a resectable lung metastasis, eight resectable pelvic recurrence, eight a presacral mass with equivocal findings on imaging, and three increasing serum levels of carcinoembryonic antigen (CEA) without clinical or radiological signs of recurrent disease. PET affected management decisions in seven of 16 patients with metastatic disease. In one of eight patients with pelvic recurrence demonstrated by computed tomography (CT), PET detected unknown pulmonary metastases. In five of eight presacral masses with equivocal CT findings, PET was correct and unexpected distant metastases were detected in one of these patients. In two of three patients with increasing CEA levels and normal pelvic CT findings, pelvic recurrence was identified. Overall, whole-body PET affected management in 14 patients. PET is a valuable tool for staging local recurrence and metastatic disease.

Aged↗
PubMed1994

Interleukin-6 and coagulation-fibrinolysis fluctuations after laparoscopic and conventional cholecystectomy.

This study assesses quantitatively the fluctuations of interleukin-6 (IL-6) and coagulation-fibrinolysis proteins in patients undergoing elective laparoscopic (n = 14) and conventional (n = 10) cholecystectomy. The patients in both groups were comparable in age and sex. Serum levels of interleukin-6, and plasma levels of fibrinogen, von Willebrand factor-antigen, tissue-type plasminogen activator-antigen, and plasminogen activator inhibitor-1 were determined for up to 48 h postoperatively. The postoperative changes of all parameters tested were comparable in both patient groups with a trend toward a higher interleukin-6 response at 8 h postincision (NS) and a trend toward a higher fibrinolysis inhibition (NS) after conventional cholecystectomy.

Blood Coagulation Factors↗
PubMed1994

Restorative proctocolectomy in elective and emergency cases of ulcerative colitis.

A consecutive series of restorative proctocolectomy for ulcerative colitis was reviewed to determine whether an emergency restorative proctocolectomy procedure leads to a higher morbidity, more especially anastomotic leakage. Severity of illness and nature of surgery were divided in two categories: (1) no acute disease and elective surgery (18 patients), (2) acute disease requiring emergency surgery either immediately or within one week of admission (12 patients). Morbidity after elective surgery was 27% and after emergency surgery 66% (P < 0.06). Pouch-anal leakage occurred in 11% and 41% respectively (P = 0.08). Five risk factors significantly influenced the leak rate including preoperative white blood cell count > 10,000/microliter (P < 0.02), urgent nature of surgery (P < 0.02), the combination of leucocytosis and urgent nature of surgery (P = 0.02), the combination of leucocytosis and preoperative corticosteroid dose equivalent to > or = 200 mg hydrocortisone/24 h (P = 0.006), postoperative pelvic haematoma (P < 0.05). In conclusion, restorative proctocolectomy is contraindicated in emergency circumstances, especially in patients with signs of sepsis on a high corticosteroid dose. To reduce operative risk and number of procedures required, patients with relapsing ulcerative colitis should be referred for restorative proctocolectomy while being in remission.

Adult↗
PubMed1993

The costs and effects of open versus laparoscopic cholecystectomies.

The costs and effects of open versus laparoscopic cholecystectomies are compared, from the point of view of hospitals and patients, for a consecutive series of 47 patients undergoing a cholecystectomy in the University Hospital Gasthuisberg, in Belgium. For the patients the laparoscopic technique is superior, since effects are better and direct costs are lower than for the open technique. From a financial viewpoint, hospitals have to weigh the higher costs of the laparoscopic equipment against the lower variable costs due to the shorter postoperative length of stay. Total hospital costs would be lower in case all cholecystectomies were performed with the laparoscopic rather than with the open technique if at least 140 cholecystectomies are done annually with the electrocautery technique, or 300 procedures with laser. However, more recent data reveal that the operating time reduces with the number of laparoscopic procedures (learning effects), implying that the laparoscopic electrocautery procedure would already be the cheaper alternative if more than 70 cholecystectomies are done annually, if disposables are used (or if 50 procedures are done with re-usables). It can be concluded that, once sufficient experience with laparoscopy has been achieved, most hospitals could realise cost savings by switching, as much as is medically justified, to laparoscopic procedures. This will also hold for hospitals performing few cholecystectomies, as long as re-usables and electrocautery are used.

Adult↗
PubMed1992

The internal anal sphincter can not close the anal canal completely.

We determined the maximum closing capability of the internal anal sphincter muscle ring in vitro and in vivo. The internal sphincter, 4 to 6 mm thick, cannot close the anal canal hermetically, not even during maximal contraction. The blood-filled anal cushions have to fill up an intrasphincteric gap of at least 7 to 8 mm in diameter.

Anal Canal↗
PubMed1992

Major histocompatibility class II expression on the small intestinal nervous system in Crohn's disease.

Widespread alterations of the gut autonomic nervous system have been described in Crohn's disease. Immunohistochemistry shows that these alterations are associated with the expression of major histocompatibility (MHC) class II antigens (HLA-DR) on enteroglial cells in the ganglia of the submucous and myenteric plexuses and on the enteroglial sheaths of the nerve extensions. Neuronal cell bodies and extensions do not express MHC class II antigens. The class II expression is associated with the presence of UCHL1-positive T lymphocytes. MHC class II expression can also be found on endothelial cells and vascular smooth muscle cells but not on smooth muscle cells of the muscularis mucosae or propria. The intensity of MHC class II expression on the glial cells of the enteric nervous plexus and on endothelial cells correlates well with the intensity of class II expression on epithelial cells.

Adolescent↗
PubMed1992

The internal anal sphincter: mechanisms of control and its role in maintaining anal continence.

The human IAS has particular structural and functional characteristics. This smooth muscle constantly generates rhythmic electrical slow waves, but no action potentials. The slow waves are linked to calcium fluxes and both are essential for mechanical activity, i.e. the ASPW. The IAS is pharmacologically characterized by the presence of alpha excitatory and beta inhibitory adrenergic receptors. Cholinergic drugs have an indirect effect through the release of an inhibitory neurotransmitter, very probably VIP, from NANC nerves. The myogenic activity of the IAS is enhanced by its extrinsic sympathetic innervation. Thus, at rest, the IAS is in a state of partial tetanus and contributes approximately 55% of the MABP. Because the IAS ring cannot be completely closed, the anal mucosa and the haemorrhoidal plexuses fill the gap. By compressing these tissues, the IAS perfectly closes the anal canal to retain not only solids but also fluid stool and gas. Acute rectal distension and rectal activity, mainly through intramural pathways, induce reflex IAS relaxation, permitting the rectal contents to be sampled by receptors in the upper anal canal while continence is temporarily maintained by EAS activity and by expansion of the haemorrhoidal cushions. There is a correlation between the volume of rectal distension and the parameters of IAS relaxation. At maximal IAS relaxation, ASPW are absent, indicating the completeness of the inhibition. Although this RAIR is not essential for defecation, insufficient relaxation may be implicated in constipation. Hyperactivity of the IAS resulting in a high MABP and AUSPW has been considered both as a cause and as an effect in haemorrhoids and anal fissure. Continence for fluids and gas is impaired if IAS activity is decreased (i.e. a low MABP), either by direct trauma or by damage of its sympathetic innervation. Severe faecal incontinence will develop when the contractility of both the IAS and the EAS is affected.

Anal Canal↗
PubMed1992

Rifabutin and ethambutol do not help recurrent Crohn's disease in the neoterminal ileum.

We tested the efficacy of rifabutin and ethambutol in combination in healing severe recurrent Crohn's disease in the neoterminal ileum. Sixteen patients who had undergone an ileal resection with partial colectomy and ileocolonic anastomosis and who had severe recurrent lesions in the neoterminal ileum at baseline ileocolonoscopy were included in the study. The patients received rifabutin in a dose of 5 mg/kg together with ethambutol, 20 mg/kg. Ten patients were treated for 6 months; six patients dropped out because of adverse events. As no effect was observed after 6 months, five patients completed a 12-month therapy course. Follow-up ileocolonoscopy was performed at 3, 6, and 12 months. In none of the 10 patients who completed the 6-month trial and in none of the five patients who completed 12 months of therapy was endoscopic improvement of the lesions observed. In four patients the disease was clinically progressive, and two patients underwent a reresection after 6 and 8 months, respectively. This study shows that long-term therapy with rifabutin and ethambutol does not heal Crohn's disease in the neoterminal ileum and does not prevent recurrence of symptoms and complications.

Adult↗