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J L Gielen

Publications and source records attributed to J L Gielen.

At least 19 recordsLinked to original sources
PubMed2003

Recurrent arthritis as presenting symptom of osteomyelitis.

We present a patient who had one episode of prepatellar bursitis and subsequently several episodes of arthritis of his right knee. Cultures of several punctures of his knee remained sterile, but the patient had been taking oral antibiotics on each of these occasions against our medical advice. Ultimately a diagnostic puncture revealed growth of Staphylococcus aureus. An X-ray demonstrated an osteolytic lesion of the patella, but no defect in the articular surface of the patella could be visualised. MRI demonstrated a communication between the osteomyelitic focus through the medial retinaculum to the bursa suprapatellaris and the knee joint. Osteomyelitis of the patella is mainly a disease of childhood. This case is, to our knowledge, the first report on the association between bursitis, osteomyelitis of the patella and recurrent septic arthritis of the knee in an adult. The literature is reviewed and discussed briefly.

Anti-Bacterial Agents↗
PubMed2002

Gamma-probe-directed lymphatic mapping and sentinel lymphadenectomy in primary cutaneous melanoma.

BACKGROUND: Radiotracer and blue-dye lymphatic mapping is a recommended combined method to guide sentinel lymphadenectomy and full regional lymph node dissection in selected patients with cutaneous melanoma. OBJECTIVE: To evaluate the diagnostic accuracy and the prognostic value of gamma-probe-directed lymphatic mapping in cutaneous melanomas. METHODS: Sixty-five stage I and II melanoma patients underwent gamma-probe-directed lymphatic mapping. Sentinel lymph nodes were studied by both conventional and immunohistochemical stainings. The median follow-up was 11 months. RESULTS: Sensitivities of preoperative and intraoperative sentinel lymph node detection were 100 and 98%, respectively. Only 1 failure of detection and 1 missed same-basin metastasis were experienced in the axillary and cervical areas, respectively. Eleven patients (16.9%) had sentinel node metastases leading to adjuvant therapy. CONCLUSION: Gamma-probe-directed lymphatic mapping is useful for staging melanoma. However, in the expectation of a more specific identification of the sentinel lymph node, the standard protocol remains recommended for exploring the axillary and cervical areas. The histological examination supported in some cases by immunohistochemistry remains mandatory in all cases.

Female↗
PubMed2001

[Adipofascial flaps of the frontal-internal part of the leg: an alternative to free flaps for the repair of skin loss from the knee to the ankle. Report of a clinical experience with 17 cases].

Leg coverage remains a difficult challenge for plastic surgeon, especially in certain areas. Although treatment of osteomyelitis is well established, coverage of bone, tendinous or hardware exposure remain controversial. In these selected cases, adiposofascial pedicled flaps should constitute a interesting solution. The multiples vascular supplies to the adiposofascial tissue of the medial side of the leg constitute de basis of this flap family. These condition allows an extreme adaptability to a wide range of defect with maximal satisfaction.

Dermatologic Surgical Procedures↗
PubMed2001

[Scuba diving: risks for whom and why?].

Scuba diving is an occupation with a still growing expansion. Like every sport it has its own specific pathologies. Some accidents can be very serious and life-threatening. We discuss the 3 main groups of accidents: barotraumatism, gas toxicity and accidents related to aquatic environment. The knowledge of the mechanisms underlying these accidents leads to a less risky approach of scuba diving.

Accidents↗
PubMed2000

Physical constraints on body size in teleost embryos.

All members of the subphylum "Vertebrata" display the characteristics of the vertebrate body plan. These characteristics become apparent during the phylotypic period, in which all vertebrate embryos have a similar body shape and internal organization. Phylogenetic constraints probably limit the morphological variation during the phylotypic period. Physical laws, however, also limit growth and morphogenesis in embryos. We investigated to what extent oxygen availability-as a physical constraint-might limit morphological variation during embryonic development. This paper gives an analysis of time-dependent diffusion into spherical embryos without a circulatory system. Equilibrium appeared to settle in about 1.5 min in running water and in about 10min in stagnant water. Hence, steady-state conditions were assumed and expressions for maximum body size were obtained for spherical, cylindrical and sheet-like embryos in running water and spherical embyros in stagnant water. Predictions of the model based on literature data suggest that in running water-both for spherical, cylindrical and sheet-like embryos-diffusion alone suffices to cover the oxygen needs of a teleost embryo in its phylotypic period. The size of carp (Cyprinus carpio) and African catfish (Clarias gariepinus) embryos is very close to the predicted maximum. This suggests that in these species the development of a functional circulatory system is correlated with the onset of oxygen shortage. Oxygen availability is therefore a potentially important physical constraint on embryonic morphology, though in most species the circulatory system becomes functional well in advance of the onset of oxygen shortage and other demands than oxygen delivery (e.g. nutrient distribution, waste disposal, osmoregulation) might require the development of a circulatory system.

Animals↗
PubMed2000

[How I treat...decubitus ulcers surgically].

Although pressure sores occur frequently during the evolution of paraplegic patients, they can present in patients confined to bed or in casts. Ischiatic, sacral and trochanteric sores are the most frequent. For stade III & IV lesions surgical excision followed by a coverage with healty tissue remain the only right principle. Usually, flap transfert meats these requirements. However, the selection of the surgical procedure and the post-op care are the main factors for a successful treatment.

Debridement↗
PubMed1998

[Surgery of esophageal cancer in Liège. I. A study of mortality and perioperative morbidity].

BACKGROUND: To assess surgical outcome after oesophagectomy, we reviewed operative techniques and postoperative course among 90 patients who underwent oesophageal resection for malignancies from January 1989 to December 1995. METHODS: There were 73 males and 17 females; mean age was 64.2 years. Indications were squamous cell carcinoma in 49 patients and adenocarcinoma in 41. Preoperatively 7 patients had chemotherapy and 18 benefited from radiochemotherapy. There were 56 total thoracic oesophagectomies, with anastomosis in the neck in 34 patients and at the thoracic inlet in 22. In 34 cases operation was limited to distal oesophageal resections. Digestive continuity was restored with the stomach in 62 patients, with the colon in 24, and with a jejunal loop in 4. A feeding jejunostomy was constructed in 48 patients with a gastric transplant. RESULTS: Mortality was 10% (9 patients), decreasing from 18.5% (before 1993) to 3.8% (since 1993). One patient died in the colonic graft group and 8 in the gastric pull-up group. Postoperative complications occurred in 9 patients after colonic interposition and in 23 after gastric pull-up; they consisted in pulmonary infection or insufficiency in 26 patients, cerebrovascular accident in one, renal insufficiency in 2, recurrent nerve palsy in 4, and anastomotic leakage in 6. Transhiatal approach was not associated with a decreased incidence of postoperative deaths or complications. Eighteen patients (72%) developed postoperative pulmonary complications after preoperative chemotherapy. CONCLUSION: Oesophagectomy can be performed with low mortality. A colonic graft is not associated with an increased incidence of perioperative deaths or complications and is the substitute of choice when there is any question regarding gastric vascularization, or in young patients with long life expectancy. Preoperative neoadjuvant treatment significantly increases postoperative pulmonary complications.

Adenocarcinoma↗
PubMed1998

[Surgery of esophageal cancer in Liège. II. Analysis of factors influencing long-term survival after esophagectomy for epidermoid cancer or adenocarcinoma].

OBJECTIVE: To determine prognosis factors influencing long-term survival after surgical resection for oesophageal adenocarcinoma or squamous cell carcinoma. MATERIAL AND METHODS: Patients operated for oesophageal cancer between 1989 and 1995 were included in this study, excluding perioperative deaths. Were studied as potential prognosis factors: age, sex, operative intent, transfusion, digestive transplant, Barrett metaplasia, stage, tumoral extension (T), nodal involvement (N), distant metastases (M), tumoral differentiation, pre- or post-operative neoadjuvant treatment. RESULTS: Follow-up was 2 to 100 months. Median survival was 21 months for squamous cell carcinoma, and 12 months for adenocarcinoma. By univariate analysis, factors influencing survival were, for squamous cell carcinoma: nodal involvement (N) (p = 0.0003), stage (p = 0.006), and operative intent (p = 0.04); for adenocarcinoma: tumoral differentiation (p = 0.0015), local extension (T) (p = 0.0022), stage (p = 0.0043), nodal involvement (N) (p = 0.0052), operative intent (p = 0.006), and distant metastases (p = 0.014). By multivariate analysis, independent prognosis factors were, for squamous cell carcinoma, nodal involvement (N) (p = 0.0002), and for adenocarcinoma, operative intent (p = 0.0018) and tumoral differentiation (p = 0.0014). CONCLUSIONS: Diagnosis of oesophageal cancer at an early stage is the most important prognosis factor. This retrospective study failed to show any significant benefit from neoadjuvant treatment, in term of long-term survival. Patients with poor prognosis factors, such as determined by accurate preoperative staging, could potentially benefit from more aggressive multimodal therapies.

Adenocarcinoma↗
PubMed1998

[Diagnostic problems of circumscribed myositis ossificans: presentation of an atypical case].

The authors report the case of a 22-year-old female suffering from thigh pain for 5 months. The first diagnosis considered was circumscribed myositis ossificans but the duration of symptoms and the radiological aspect mimicking some malignant features led to consider parosteal sarcoma as a possible diagnosis. Surgical resection was therefore requested and histological analysis confirmed the diagnosis of circumscribed myositis ossificans. This case emphasizes the difficulty in differentiating circumscribed myositis ossificans from a slowly growing tumor as both can be associated with increasing pain and a malignant radiological aspect. A surgical approach is therefore frequently necessary for definitive diagnosis and treatment.

Adult↗
PubMed1998

[Surgery of esophageal cancer in Liège: III. Clinical and radiographic evaluation of long-term quality of life after esophagectomy].

OBJECTIVE: Functional evaluation of digestive transplants after oesophagectomy for cancer. MATERIAL AND METHODS: We evaluated alimentary comfort and quality of life and performed a videofluoroscopy (radiocinema) in 34 patients who were alive and disease-free one year or more after oesophagectomy for malignancy. There were 22 males and 12 females; mean age was 64 years. Twenty-three patients had a gastric pull-up and 11 a colonic graft. Mean follow-up was 36 months (range: 12-100 months). Possible correlations between clinical symptoms and radiographic observations were studied with Fisher's exact test. RESULTS: Most-cited symptoms were gurgling in 16 patients, early fullness during eating in 15, diarrhea in 14, postprandial sweating in 9, pyrosis in 8, nocturnal cough in 7, and dysphagia in 5. Most patients considered the side effects of the operation as mild to moderate and mean rating of alimentary comfort was 7.6/10. Twenty-five patients qualified their quality of life as good, 8 as satisfactory, and 1 as poor. Twenty-nine patients led active lives. Videofluoroscopic evaluation showed that colonic grafts emptied mainly by gravity, while active contractions were observed in the antrum of gastric transplants. There was a significant correlation between alimentary symptoms and radiographic distension of the transplant. Oro-pharyngeal abnormalities, site of proximal anastomosis, nature, motility, or active versus passive emptying of the transplant did not correlate with clinical complaints. CONCLUSIONS: In most patients quality of life and alimentary comfort are good after oesophagectomy and gastric or colonic interposition. Radiocinema is an adequate method to evaluate the dynamic of the transplant and shows a better emptying of gastric grafts, compared to colonic grafts, particularly when the proximal portion of the oesophagus triggers the progression.

Adult↗
PubMed1990

Growing bone cysts in long-term hemodialysis.

All patients with chronic renal failure undergoing hemodialysis for more than 10 years in the university hospitals of Leuven were selected for this study. The medical records and radiographs of these 21 patients were studied retrospectively. Skeletal surveys were examined for the presence and location of subchondral cysts. The predialysis films and the films taken after 5, 10, 15 and 20 years of dialysis were reviewed. Subchondral cysts that grew in size and number were found in the wrist, humeral head, hip, and patella. Accurate measurements were made of cysts in the wrist and compared with a control group. In the dialysis group, cystic involvement of the wrist was more common and the size and number of the cysts were larger. Soft tissue swelling was seen in the dialysis group but not in controls. Soft tissue swelling was assessed on shoulder radiographs by measuring the acromiohumeral distance (ACD) and in the knees by ultrasonic measurement of synovial thickness. In 11 patients synovial or bone biopsies or aspirated synovial fluid were available. All these patients had swollen joints and multiple subchondral periarticular cysts. Amyloid deposition was found in ten of these patients, and this proved to be composed of B2 microglobulins in seven.

Amyloidosis↗
PubMed1988

Renal thorium deposition associated with transitional cell carcinoma: radiologic demonstration in two patients.

Abdominal radiography, excretory urography, retrograde pyelography, and computed tomography were performed in two patients who had undergone retrograde pyelography with thorium dioxide (Thorotrast) approximately 40 years ago. Both patients developed a transitional cell carcinoma due to suburothelial thorium deposition. Typical thorium densities were demonstrated at CT in the peripelvicalyceal area as well as in retroperitoneal lymph nodes. Elderly patients in whom radiographic examination reveals retained Thorotrast in the kidney should be followed up because of the high risk of renal carcinoma.

Aged↗
PubMedDate not supplied

An unusual case of generalized oedema.

We present the case of a 66-year-old woman with generalized oedema and pain in the four limbs. Physical examination revealed a diffuse, painful, partly pitting, oedema of forearms, hands, lower legs and feet. There were no signs of synovitis. Laboratory investigation was non relevant, except for mild eosinophilia, which normalized subsequently. Cardiac, nephrological and venous disturbances were excluded. More uncommon disorders, such as eosinophilic fasciitis, early stage of scleroderma and polymyositis were considered. MRI scanning of the right forearm revealed an increased signal intensity in the superficial muscle fibers and thickening of the fascia (figure 1). Subsequently a full thickness biopsy of the musculus flexor digitorum superficialis was performed, revealing an inflammatory infiltration of lymphocytes and eosinophils, localized in the fascia. There was no necrosis of muscle fibers. No signs of scleroderma were found. The biopsy confirmed the diagnosis of eosinophilic fasciitis. Clinical and MRI findings suggested an early stage of disease and the patient was treated with low-dose corticosteroids.

Adrenal Cortex Hormones↗
PubMedDate not supplied

Analysis of factors influencing long-term survival after surgical resection for oesophageal squamous cell carcinoma.

OBJECTIVE: We evaluated prognostic factors in 34 patients discharged from hospital after surgical resection for oesophageal squamous cell carcinoma. MATERIAL AND METHODS: There were 22 males and 12 females; mean age was 59.3 years (range 42-77 years). Preoperative neoadjuvant treatment consisted in chemotherapy alone in three patients and in combined radiochemotherapy in 14. Digestive continuity was restored with a gastric transplant in 26 patients and a colonic graft in 8. Surgery was curative in 28 patients and palliative in 6. There were three stage I, 14 stage II, 13 stage III, and 4 stage IV diseases. In 19 patients the lymph nodes were invaded. The tumour was well differentiated in 17 patients, moderately in 9, and poorly in 8. RESULTS: Follow-up ranged from 2 to 100 months. Overall median postoperative survival was 21 months. By univariate analysis, factors influencing survival were curative surgery (p = 0.04), stage (p = 0.006), and nodal involvement (p = 0.0003). Nodal involvement was an independent prognostic factor by multivariate analysis (p = 0.0002). Patient age and sex, perioperative transfusion, digestive transplant, tumour local extension, grade of differentiation, and distant metastasis did not influence survival. Also, we did not observe any significant benefit of preoperative or postoperative chemotherapy or radiochemotherapy. CONCLUSIONS: Nodal involvement was the most important prognostic factor influencing survival. Therefore, an earlier diagnosis of oesophageal cancer in a less advanced stage is important to improve survival rates. Our study could not confirm the benefit of neoadjuvant therapy in terms of late survival.

Adult↗
PubMedDate not supplied

Paraspinal cervical calcifications associated with scleroderma.

Although soft tissue calcifications are well known to occur as a late manifestation in scleroderma, symptomatic paraspinal calcinosis is very rare. Clinically, patients present with focal neck pain, weakness or radiculopathy, and decreased range of motion of the neck. We describe the imaging features of a rare case of cervical paraspinal calcinosis in a 74-year-old woman with long-standing scleroderma. Standard radiography is usually sufficient to confirm the diagnosis, but CT-scan allows a more precise location of the calcifications around the facet joints, sometimes with associated erosions. The advantage of MRI is to evaluate the possible intraspinal extension of the calcifications in case of focal neurological symptomatology.

Aged↗