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Biomedical subjects

G Deneffe

Publications and source records attributed to G Deneffe.

At least 37 records · Page 2Linked to original sources
PubMed1996

Verapamil as prophylactic treatment for atrial fibrillation after lung operations.

BACKGROUND: Atrial fibrillation is a frequently occurring arrhythmia after thoracic operations. Preventive strategies for this complication have been extensively evaluated after cardiac operations. METHODS: We performed a prospective, open randomized study, comparing intravenous verapamil and placebo in 199 patients after pneumonectomy or lobectomy at the University Hospital of Leuven. Verapamil was administered as a bolus of 10 mg over 2 minutes followed by a 30-minute infusion of 0.375 mg/min and then 0.125 mg/min for 3 days. The patients were continuously monitored in the postoperative intensive care unit. RESULTS: Atrial fibrillation occurred in 15% of the patients receiving placebo and in 8% of the patients receiving verapamil (difference not significant). The verapamil infusion was interrupted in 9% of the patients because of bradycardia and in 14% because of hypotension. CONCLUSIONS: If tolerated, continuous intravenous verapamil infusion showed only a modest prophylactic efficacy for the occurrence of atrial fibrillation after lung operations. In the dose employed the verapamil infusion was accompanied with a high incidence of side effects necessitating interruption of the therapy.

Amiodarone↗
PubMed1996

Second primary lung cancer in Flanders: frequency, clinical presentation, treatment and prognosis.

Patient and tumour characteristics of 23 patients presenting with a second primary lung cancer were analysed and compared with 534 patients with radically resected stage 1 non-small cell lung cancer (NSCLC). None of these characteristics is associated with a higher occurrence rate for second primary lung cancer. Prognosis in the latter patients is significantly worse than after resection of a 'solitary' NSCLC: the median survival time (MST) after resection of the first tumour is 50 months; after diagnosis of the second tumour only 14 months. Surgically retreated patients have a prognosis that is similar to that after resection of a 'solitary' NSCLC. No separate independent prognostic factors responsible for this survival difference could be isolated. Squamous histology and central location are associated with a longer recurrence free survival time. We conclude that the occurrence of a second primary lung cancer can not be predicted based on patient or tumour characteristics and that only surgical retreatment offers a chance of long survival in these patients.

Adult↗
PubMed1996

Tumors of the esophagogastric junction. Long-term survival in relation to the pattern of lymph node metastasis and a critical analysis of the accuracy or inaccuracy of pTNM classification.

From 1983 to 1989, 95 patients with carcinoma of the esophagogastric junction underwent resection. Overall hospital mortality rate was 6.2% (6/95). Actuarial survival analysis showed 5- and 10-year survivals of 33% and 31%, respectively. Five- and 10-year survivals of patients according to TNM stages were as follows: stage I (n = 13), 90% at both 5 and 10 years; stage II (n = 13), 70% at both intervals; stage III (n = 28), 28% at both intervals; and stage IV (n = 40), 11% and 8%, respectively. For patients with undiseased nodes (n = 26), 5- and 10-year survivals were 72% and 72%, compared with 18% and 16% for patients with diseased nodes (n = 68; p < 0.005). In patients who had involvement of both the abdominal and thoracic lymph nodes (n = 28), 5- and 10-year survivals were 13% and 13%, compared with 26% and 26% if metastases were confined to the abdomen (n = 37; p > 0.05). Grouping patients with diseased intrathoracic nodes together with patients with N2 abdominal nodes showed survivals of 14% at both 5 and 10 years. When tumors were staged as an esophageal carcinoma, classification of individual patients changed, as did the 5- and 10-year survivals. Five- and 10-year survivals were as follows: stage I (n = 8), 100% for both 5 and 10 years; stage II (n = 18), 68% for both 5 and 10 years; stage III (n = 27), 37% for both 5 and 10 years; and stage IV (n = 41), 10% for 5 years and 6% for 10 years. These data indicate that tumors of the esophagogastric junction tend to spread to both abdominal and thoracic nodes. However, reasonably good 5- and 10-year survivals can be obtained even in patients with nodal metastases in both areas. We suggest that N2 labeling be included for thoracic node metastases instead of the actual M+Ly label, because the N2 label better reflects the potential for curative surgery. Finally, staging tumors as gastric or esophageal carcinoma makes no significant difference in survival analysis, which raises the question whether these tumors behave more like esophageal carcinoma than gastric carcinoma.

Adenocarcinoma↗
PubMed1996

Bronchogenic cysts: a review of 20 cases.

OBJECTIVE: All cases of bronchogenic cysts treated in our center are analysed in order to define its clinical and pathological features. These data are used to determine whether surgical treatment in all cases is justified or whether there is a place for conservative treatment. METHODS: We retrospectively studied the medical records and pathology reports of all patients with bronchogenic cysts (n = 20) referred to our clinic between 1975 and 1993. RESULTS: Fourteen patients (70%) were asymptomatic. Six patients had symptoms because of cyst-related complications (infection or compression). In only 15 patients the diagnosis was established preoperatively. In the other five cases a solid tumour was suspected. All patients were treated by either thoracotomy (n = 19) or thoracoscopy (n = 1). The diagnosis was confirmed by histological examination. One cyst turned out to be degenerated into a squamous cell carcinoma. CONCLUSIONS: We conclude that both the risk of developing cyst-related complications and the even smaller risk of malignant degeneration justify surgical treatment in all cases.

Adult↗
PubMed1996

Surgery for non-small cell lung cancer with unsuspected metastasis to ipsilateral mediastinal or subcarinal nodes (N2 disease).

OBJECTIVE: Although the results after surgery for N2 disease are disappointing, there seems to be a subgroup of patients which may benefit from primary resection. These patients have clinically unrecognized N2 involvement that is discovered only at the time of thoracotomy (unsuspected or unforeseen N2 disease). It was the aim of this retrospective study to analyze the survival after resection for unforeseen N2 disease and to evaluate different prognostic factors. We were interested to see whether our strategy of rigorous staging of the mediastinum with mediastinoscopy or anterior mediastinotomy had an effect on the resectability rate and survival of unsuspected N2 disease. METHODS: Between 1985 and 1990, 859 patients with potentially operable non-small cell lung cancer were referred to our surgical department. Despite rigorous preoperative staging with computed tomography scan and cervical mediastinoscopy and/or anterior mediastinotomy, 103 patients (14.5%) had unsuspected N2 disease at thoracotomy. The tumor could be completely resected in 90 patients (87.5%). RESULTS: The 5-year survival after complete resection was 22%. Histology of the tumor, number of involved levels and extent of nodal disease had no effect on survival. CONCLUSION: We conclude that resection is justified in patients with unforeseen N2 disease. Rigorous staging of the mediastinum by cervical mediastinoscopy or anterior mediastinotomy results in a high resectability rate and avoids unnecessary thoracotomies. Mediastinoscopy plays a central role in the staging of patients with carcinoma of the lung.

Actuarial Analysis↗
PubMed1995

Surgical treatment of small cell lung cancer.

From 1970 till 1989, 30 patients underwent surgical resection for small cell lung cancer (SCLC). The 5-year survival in stage I patients was 31%, in stage II 17% and in stage III the projected 5-year survival was 9%. Among N2 patients there were only 25% survivors after 1 year and none after 2 years. The first group of 15 patients (1970-1979) received no adjuvant chemotherapy in contrast to the second group of 15 patients (1980-1989). The overall 5-year survival for the first group was 13% and the estimated 5-year survival for the second group was 27%. In stage I SCLC, the 5-year survival was 12% and 60%, respectively. These results confirm that surgery may lead to long-term survival in stage I and possibly stage II SCLC, with better prognosis in stage I when adjuvant chemotherapy is added.

Aged↗
PubMed1994

Competitive in situ hybridization in a mediastinal germ cell tumor.

We performed competitive in situ hybridization in a mediastinal germ cell tumor to identify chromosome 12 aberration(s). DNA from a mouse-human somatic hybrid cell line, containing an i(12p) as unique human material, was labeled and used as a probe. Our results confirm that the chromosome marker, observed in mediastinal germ cell tumor and cytogenetically identified as i(12p), is a true isochromosome of the short arm of chromosome 12.

Adolescent↗
PubMed1994

Incidence of cartilaginous and ligamentous lesions of the radio-carpal and distal radio-ulnar joint in an elderly population.

51 wrists of 30 embalmed cadavers have been used to perform an anatomical and radiological study relating cartilaginous and ligamentous lesions of the wrist with sex, age, ulnar variance (UV) and the state of the triangular fibrocartilage complex (TFCC) in an elderly population (mean 76.6 years). Two-thirds of all wrists (66%) showed cartilaginous lesions, mainly on the lunate (22, or 44%). The TFCC was perforated in 23 wrists (46%), and most were central degenerative perforations. Correlations were found between ulnar variance and TFCC thickness (P < 0.05) and ulnar variance and TFCC perforations (P < 0.05). A significant relation was observed between age and proximal row intercarpal ligamentous ruptures (P < 0.05) and between age and ulnar variance (P < 0.05). No statistical correlation was seen between ulnar variance and cartilaginous lesions on the lunate (P < 0.05) in this slightly ulnar negative population (mean-0.37 mm).

Age Factors↗
PubMed1994

Value of computed tomography and mediastinoscopy in preoperative evaluation of mediastinal nodes in non-small cell lung cancer. A study of 569 patients.

The efficacy of computed tomography (CT) and mediastinoscopy as staging modalities to assess mediastinal lymph node status was evaluated in 569 patients with a presumed resectable non-small cell lung cancer (NSCLC). Computed tomography scan was performed in every patient and followed by mediastinoscopy in 331 and by thoracotomy in 477 patients. Mediastinal lymph nodes on CT larger than 1.5 cm were considered pathological. Overall, CT had a sensitivity of 69%, a specificity of 71% and an accuracy of 71% in identifying mediastinal lymph node metastases. For mediastinoscopy these figures were 72%, 100% and 89%, respectively. Computed tomography accuracy was distinctly lower in squamous cell carcinomas and in central tumors, as CT sensitivity was significantly lower in left-sided tumors. The positive predictive value (PPV) of CT in T1 lesions (29%) and PPV and negative predictive value (NPV) of CT in T2 squamous cell carcinomas (30% and 83%, respectively) were low, so questioning its use in those instances. We perform a mediastinoscopy in every situation except for squamous cell carcinomas or small (less than 3 cm) peripheral tumors in the absence of enlarged mediastinal lymph nodes. This selective attitude is rewarding since a) the number of pN2 in the straight thoracotomy group was only 16% versus 41% in the mediastinoscopy group, b) the exploratory thoracotomy rate in the straight thoracotomy group was low (4.6%).

Adenocarcinoma↗
PubMed1994

Effect of loop diuretics on cholinergic neurotransmission in human airways in vitro.

BACKGROUND: Frusemide can inhibit various indirectly acting bronchoconstrictor stimuli in asthmatic patients. Both frusemide and bumetanide also modulate airway neurotransmission in some species but there are no data on the effect of loop diuretics on neurotransmission in man. An in vitro study was performed in human airways to investigate the possible neuromodulatory action of two loop diuretics, frusemide and bumetanide, and to elucidate whether a cyclooxygenase inhibitor such as indomethacin could modulate the effect of frusemide. The effect of acetazolamide, a carbonic anhydrase inhibitor, was also investigated. METHODS: Electrical field stimulation (EFS; 40 V, 0.5 ms, 0.5-32 Hz for 15 seconds) in human airways with or without epithelium was used to induce a cholinergic contraction (n = 5 in all experiments). Indomethacin was present throughout. After obtaining a control frequency-response curve, different concentrations of diuretic were added to the organ bath and another frequency-response curve was constructed. To determine whether the effect of the diuretic was prejunctional or postjunctional a cumulative concentration-response curve to exogenous acetylcholine (Ach, 0.3 mumol/l to 10 mmol/l) was constructed in the presence of a diuretic (frusemide 1 mmol/l or bumetanide 0.1 mmol/l) or its vehicle. In some experiments indomethacin was omitted from the organ bath to investigate the possible involvement of cyclooxygenase products. RESULTS: Both frusemide (10 mumol/l to 1 mmol/l) and bumetanide (1 mumol/l to 0.1 mmol/l) produced a concentration-dependent inhibition of the EFS-induced cholinergic contraction in human airways in vitro but only in epithelium denuded tissues. Frusemide (1 mmol/l) produced a maximum inhibition of 46.3% (SE 9.9%) at 0.5 Hz and bumetanide (0.1 mmol/l 39.6 (6.2)% at 0.5 Hz. Without indomethacin in the organ bath the frusemide-induced inhibition was enhanced at 4, 8, and 16 Hz, but bumetanide-induced inhibition was not enhanced at any frequency when indomethacin was omitted. Frusemide (1 mmol/l) and bumetanide (0.1 mmol/l) had no effect on the cumulative concentration-response curve to exogenous Ach (0.3 mumol/l to 10 mmol/l). Acetazolamide (100 mumol/l) had no effect on the EFS-induced cholinergic contraction in tissues with or without epithelium. CONCLUSIONS: In human airways in vitro both frusemide and bumetanide produced a concentration-dependent inhibition of the EFS-induced cholinergic contraction. This inhibition is mediated through a prejunctional mechanism. Epithelium removal was necessary to achieve this effect. The mechanism of action of frusemide and bumetanide on airway nerves remains unclear: inhibition of the Na-K-Cl cotransporter is a possibility and, for frusemide, release of endogenous cyclooxygenase products may be involved. Carbonic anhydrase inhibition, on the other hand, is unlikely to be a factor.

Acetazolamide↗
PubMed1994

Transcarinal needle aspiration biopsy in the staging of lung cancer.

Lung cancer without distant metastasis often requires an invasive surgical procedure to document inoperability. In order to determine how often puncture biopsy was a valid substitute for a surgical procedure, we investigated the performance of endoscopic staging by means of transcarinal needle aspiration biopsy during rigid bronchoscopy. Eighty lung cancer patients with subcarinal lymph nodes visible on computed tomography (CT) scan were studied. Specimens were of histological quality (i.e. lymph node tissue) in 59 out of 80 (74%) patients, and showed malignant invasion of this lymph node tissue in 43 cases. Specimens of cytological quality (i.e. lymph node cells) were obtained in 13 out of 80 (16%) patients, and showed malignancy in 7 cases. Therefore, adequate evaluation of the subcarinal lymph nodes was possible in 72 out of 80 (90%) patients. In 50 of these 72, malignant mediastinal spread was proven, and further invasive surgical staging could be avoided. Subgroup analysis showed that this outcome tended to be more likely in patients with abnormal endoscopic appearance of the main carina, with locally extensive tumours, and with nonsquamous histology. These results indicate that transbronchial needle aspiration biopsy of subcarinal lymph nodes can be a valuable alternative to more invasive surgical staging in patients selected by CT scan.

Adult↗
PubMed1993

Localized pleural mesothelioma.

The clinical and radiological presentation of five anatomo-pathologically proven cases of localized pleural mesothelioma are described. In all patients conventional chest films and CT scans were performed. Two patients had also an MR examination. On conventional chest films all lesions presented as sharply defined homogeneous masses. In most cases there was inhomogeneous contrast enhancement on CT. In two cases calcifications and pleural effusion were present. There was no chest wall invasion, nor mediastinal adenopathy. On MR T1-weighted images, the tumor had an intermediate to high signal intensity. In the one case in which T2-weighted sequences were performed, tumor signal intensity increased compared to that on T1-weighted images. In contrast to what is generally found in literature and probably because the series contained rather large masses, most patients had symptoms while the mass was inhomogeneous on CT. Conventional chest films together with CT and MRI are helpful in differentiating this entity from malignant mesothelioma. However, focal areas of malignant degeneration cannot be excluded radiographically.

Adult↗
PubMed1990

Bronchial stump recurrence after surgery for bronchial carcinoma.

In 10 out of 295 patients (3.4%), followed-up after radical resection for non-small cell bronchial carcinoma in the period from 1980 until 1986, bronchial stump recurrence developed. A good relationship was found between relapse time (4-52 months) and distance between the primary tumour and bronchial resection line (1-7 cm) (i.e. 5-8 months.cm-1) in 8 of the patients (p less than 0.01). The mean survival time after detection of the recurrence was 10 months (range 1-15 months), and was not clearly influenced by the therapy applied (resurgery, chemotherapy, radiation), nor by the TNM stage of the bronchial stump recurrence.

Aged↗
PubMed1989

Carcinosarcoma of the lung. Report of two cases and review of the literature.

Two cases of carcinosarcoma of the lung are presented. Until now, 76 cases have been recorded in the literature. The lesion contains an epithelial and a mesenchymal component, both with cytologic features of malignancy. A central endobronchial and a peripheral invasive type have been described. Fiberoptic biopsies usually show no tumour at all or contain only one of the two components. Treatment consists of lobectomy or pneumonectomy. Prognosis is not better for this tumour than for non-small cell bronchogenic carcinoma, and may even be worse.

Aged↗
PubMed1989

Pulmonary phospholipid accumulation distal to an obstructed bronchus. A morphologic study.

Alveolar proteinosis (AP) and postobstructive or endogenous lipid pneumonia (ELP) are two distinct morphologic types of phospholipid accumulation in the lung. In ELP, ultrastructurally amorphous fat accumulates in the cytoplasm of alveolar macrophages. In AP, lamellar surfactant bodies with an electron microscopic complex structure are stored within alveolar lumina. In contrast to ELP, AP has not been associated with bronchial obstruction. One case of postobstructive AP occurred distal to a central carcinoid tumor, and two cases of combined AP and ELP occurred next to a squamous cell carcinoma that obstructed a lobar bronchus. Results of histologic and ultrastructural studies were determined with regard to new insights into the physiology and biochemistry of pulmonary lipids. It was concluded that the morphology of accumulated fat in obstructed lung tissue may depend on local oxygen and carbon dioxide tensions.

Bronchial Neoplasms↗