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Biomedical subjects

L Broeckaert

Publications and source records attributed to L Broeckaert.

At least 19 recordsLinked to original sources
PubMed1993

Endoscopic injection therapy to prevent rebleeding from peptic ulcers with a protruding vessel: a controlled comparative trial.

Seventy five patients with severely bleeding peptic ulcer were included in a controlled comparative trial to assess the efficacy and safety of endoscopic injection therapy in preventing rebleeding from peptic ulcers that presented at endoscopy with a protruding vessel. Twenty five patients were treated with injection of epinephrine followed by polidocanol, 25 were treated with injection of absolute alcohol, and 25 with sham injection. Rebleeding occurred in 44% of patients in the sham group, 40% of those treated with epinephrine and polidocanol, and in 20% of those treated with absolute ethanol. The difference in the haemostasis rate between the control and ethanol treated subjects nearly reached significance (p = 0.07). A second therapy session resulted in haemostasis rates of 68% in the epinephrine-polidocanol group and of 88% in the absolute ethanol group. These rates after two treatments as well as the emergency surgery rates (32% in the epinephrine-polidocanol group and 8% in the absolute ethanol group; p = 0.07) were not significantly different. In eight of the 11 patients with rebleeding in the sham treatment group, definitive haemostasis was achieved by elective injection therapy. Overall transfusion requirements were mean (SD) 6.0 (0.7) units in the sham group, 6.0 (0.9) in the epinephrine-polidocanol group, and 3.9 (0.5) in the absolute ethanol group. Only the difference between ethanol and sham was significant (p = 0.02). This study shows that injection with absolute ethanol reduces rebleeding in these patients and significantly lowers transfusion requirements. Absolute ethanol was superior to epinephrine-polidocanol, which was not significantly better than sham therapy.

Adult↗
PubMed1993

Mesenteric involvement of thromboangiitis obliterans (Buerger's disease) in a woman.

Although patients with peripheral arterial occlusive disease due to thromboangiitis obliterans (TAO) have been well characterized and the relationship of this disease to tobacco is stressed, little attention has been focused on its ability to involve the mesenteric vasculature and its ability to affect women. We report a rare case of a known TAO female patient who presented with abdominal pain due to inflammatory changes of the mesenteric vessels. The resulting small bowel ischemic changes and formation of intramural gas were demonstrated on a small bowel follow-through and a plain abdominal film. An angiography finally showed a superior mesenteric artery occlusion.

Adult↗
PubMed1991

Conventional X-ray examination in esophageal cancer: an opinion.

Double contrast is the best radiological technique for the detection of small esophageal cancer. Gastrografin is indicated when a blind mediastinal fistula is suspected; in cases of choking or suspicion of a fistula with the airways, a low osmotic hydrosoluble Iodium compound must be used. Conventional radiology and endoscopy are complementary techniques for the detection of esophageal cancer, as some lesions may be missed or misinterpreted by both. The need for endoscopic biopsy being incontestable for diagnostic confirmation and characterization, radiology presents some advantages over classic esophagoscopy for preoperative and the general pretherapeutic staging of esophageal carcinoma: assessment of topographical relation with the surrounding organs is possible and with the upper esophageal sphincter is easier; appreciation of tumoral extension along the longitudinal axis (tumor length, gastric invasion) remains mostly possible even in cases of severe stenosis; tumoral extension along the transverse axis (kinking, fistula) may be evaluated; detection of a second tumor or concomitant pathology distally from a stenosing tumor is mostly possible; moreover radiology is important before starting radiotherapy; and finally, previous radiology may reduce the (small) risk of endoscopic perforation. Radiology is indispensable or indicated in the posttherapeutic follow-up of esophageal carcinoma, as well after surgery as after endoscopic interventions, radiotherapy or chemotherapy.

Diatrizoate Meglumine↗
PubMed1989

Comparison of endoscopic polidocanol injection and YAG laser therapy for bleeding peptic ulcers.

392 patients were examined by endoscopy for acute upper gastrointestinal bleeding; 140 had ulcers containing an actively bleeding visible vessel or a non-bleeding visible vessel and were enrolled in a randomised trial of three endoscopic methods of haemostasis--adrenaline (1/10(4] alone, adrenaline plus polidocanol 1%, and adrenaline followed by yttrium-aluminium-garnet (YAG) laser photocoagulation. For patients with non-bleeding visible vessels sham treatment was significantly less effective in achieving haemostasis (8 of 20 patients) than were adrenaline plus polidocanol (18 of 20; p = 0.002) and adrenaline plus laser (16 of 20; p = 0.012). All three treatments significantly reduced total transfusion needs compared with sham treatment. For the whole group of patients, adrenaline plus polidocanol was significantly more effective than adrenaline alone in achieving permanent haemostasis; adrenaline plus laser was also more effective than adrenaline alone, but not significantly so. The efficacy of the three treatments was enhanced by repeated application on recurrence of bleeding. Since injection therapy with adrenaline and polidocanol was at least as effective as adrenaline plus laser therapy, it should be preferred over laser therapy because it is cheaper, easier to use, and perhaps also safer.

Acute Disease↗
PubMed1988

Transendoscopic Doppler ultrasound: usefulness for diagnosis and treatment of vascular malformations.

Vascular malformations of the GI tract can be treated by thermal methods, including the YAG laser. The diagnosis of these lesions is not always easy, and it is difficult to evaluate the completeness of therapy of these lesions. We investigated the value of Doppler ultrasound in this respect. The TVD-1 (Key Med) transendoscopic vascular detector using the 2.5 mm diameter probe emitting at 7 MHz, was used through standard endoscopes. Outputs were monitored through a loudspeaker, and imaged on an oscilloscope, or recorded on a mingograph. Diagnostic usefulness was studied in 64 vascular lesions, 36 in the colon and 28 in the upper GI tract in ten patients. A Doppler signal was detected in 75% of the lesions, including all lesions larger than 5 mm in diameter. Forty-five lesions in 13 patients were studied before and immediately after laser therapy. Three out of five patients in whom Doppler-positive lesions persisted after laser treatment rebled, as compared with 2 out of 8 patients with Doppler-negativity. Disappearance of the signal, however, may be transient, and is probably due to laser-induced edema. These results suggest that endoscopic Doppler ultrasound may have a role in the diagnosis and treatment of vascular anomalies of the GI tract, and should stimulate further research.

Adult↗
PubMed1988

Endoscopic sclerotherapy of esophageal varices. Long-term follow-up, recurrence, and survival.

One hundred thirty-three patients (34.5% Child's C class) with at least one severe variceal hemorrhage and treated with repeated endoscopic sclerotherapy had a follow-up of 1-6 years (mean 20 months). The risk of rebleeding decreased significantly from 2 months after onset of sclerotherapy. Sixty-four patients (or 48%) rebled, within 2 months in 45 (70%). The incidence of rebleeding correlated with Child's category and with the size of the varices. The 2-month mortality rate was 28.6%; two-thirds died of severe rebleeding. Thirteen patients underwent emergency surgery for bleeding uncontrolled by sclerotherapy; nine of them died. Of the 120 treated only by sclerotherapy 93% ultimately died, 90% from variceal rebleeding. Mortality related to the liver disease was thus determined by rebleeding mainly within 2 months and by hepatic failure but not by etiology of the disease or number of previous hemorrhages. The more pronounced mortality in Child C versus B or A patients is thus due to early rebleeding and to more pronounced liver insufficiency in the early and later period. Varices could not be eradicated within 1 year by sclerotherapy in 9 patients; 68 of the 72 patients alive had total eradication, but recurrence of varices was observed in 19 (or 28%) within 1 year, independent of the etiology and severity of liver disease and varices. Only four patients rebled within 1 year, with no mortality. After 1-4 years, another five recurrences were noted, with two nonfatal bleeding episodes. This study argues for continuation of sclerotherapy until total eradication of varices as well as for regular follow-up to avoid recurrences.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Neodymium-YAG laser photocoagulation versus multipolar electrocoagulation for the treatment of severely bleeding ulcers: a randomized comparison.

A randomized trial comparing the efficacy of BICAP electrocoagulation and YAG laser photocoagulation was carried out in 100 patients presenting at endoscopy with peptic ulcer and a spurting or oozing vessel or a nonbleeding vessel. Fifty patients were enrolled in each treatment group. All lesions were pretreated with injection of epinephrine 1:10,000. Subsequently, 1-sec pulses of 80 watt YAG laser power were applied to the vessel or 1- to 2-sec pulses of electrocoagulation of 25 watt BICAP at a setting of 10. The 10 F BICAP probe was always used. Definitive hemostasis after one treatment amounted to 72% in both the laser and in the BICAP group. After two sessions the cumulative success rate was 88% in the laser group and 86% in the BICAP group. Emergency surgery and mortality were also comparable. One perforation occurred in each treatment group and both patients were operated upon without complications. It is concluded that both YAG laser and BICAP are highly and equally effective in the treatment of severe bleeding from peptic ulcers. This study stresses the importance of repeated treatment sessions in order to obtain optimal results.

Adult↗
PubMed1987

Hepatic echinococcosis ruptured into the biliary tract. Clinical, radiological and therapeutic features during five episodes of spontaneous biliary rupture in three patients with hepatic hydatidosis.

Three patients are described with hepatic involvement by Echinococcus granulosus, complicated by spontaneous rupture into the biliary tract. Clinical features consisted of upper abdominal pain, jaundice, fever, anorexia, and vomiting. Hepatomegaly and marked epigastric tenderness were consistently observed. Laboratory findings included obstructive liver function tests, leucocytosis, eosinophilia, and hyperamylasemia. Abdominal computed tomography, showing the cystic wall, the presence of wall calcifications, daughter cysts and wall enhancement, provided a correct diagnosis of hepatic hydatidosis in all patients. Dilatation of the bile ducts with the presence of intraluminal material was clearly shown by sonography and endoscopic retrograde cholangiography. These abnormalities were most frequently found in the common bile duct and in the left hepatic duct. On sonography, the intraluminal material appeared as amorphous, sludge-like hydatid sand, and as daughter cysts. On ERCP, the intrabiliary parasitic material appeared as non-homogeneous, irregularly shaped and mobile filling defects. Other findings at ERCP were displacement and distortion of intrahepatic bile ducts by the hepatic cysts and a mild dilatation of the pancreatic duct. In one occasion, evacuation of a daughter cyst through the papilla was observed. The therapeutic value of mebendazole and endoscopic sphincterotomy in our patients is discussed.

Adult↗
PubMed1985

Long term results of treatment of vascular malformations of the gastrointestinal tract by neodymium Yag laser photocoagulation.

The effect of Yag laser photocoagulation on the course of bleeding of gastrointestinal vascular malformations was studied in 59 patients, with a total of 482 lesions. The lesions were located in the upper gastrointestinal tract alone in 25 patients, in the lower tract alone in 31 patients and in both the lower and the upper gastrointestinal tract in three patients. In the month before laser therapy the number of bleeding episodes averaged 1.09 +/- 0.6 (SD) per patient (n = 57) and the transfusion requirements 2.4 +/- 2.6 red blood cells units per patient, while in the month after treatment the bleeding incidence averaged 0.16 +/- 0.5 and the transfusion requirements 0.21 +/- 0.8 (both p less than 0.001). Long term results were analysed considering for each patient an equally long pretreatment and follow up period. After a mean follow up period of 11.5 months (1-48 months), 17 of the 57 patients available for follow up rebled. The reduction of the bleeding rate was statistically significant at one, six, 12, and 18 months of follow up, while transfusion rate was significantly decreased at one, six, and 12 months. The results were disappointing in patients with Osler-Weber-Rendu (n = 4) and in patients with angiomas associated with Von Willebrand's disease (n = 3), who all rebled. In angiodysplasia the treatment was successful in 82% of the 49 patients. The more numerous the lesions, the less effective the reduction in bleeding rate by laser treatment was. Histological studies showed that the haemostatic effect of Yag laser photocoagulation was obtained by destruction of the lesion. Rebleeding was due to lesions missed at the first treatment, incompletely treated lesions and recurrence of new lesions. In two patients a free caecal perforation necessitated a right hemicolectomy. In both patients numerous or very large lesions had been treated in the caecum.

Adolescent↗
PubMed1984

Sclerotherapy of oesophageal varices after variceal haemorrhage.

Fifty-six patients with recent variceal haemorrhage were studied in a trial of repeated injection sclerotherapy through the flexible oesophagoscope, with a mean follow-up of 15.2 months (1-39). Twenty-five patients (45%) did not suffer further bleedings. The risk of bleeding per patient-month of follow-up decreased significantly (p less than 0.05) after starting therapy, in all groups of cirrhosis, classified according to Child's criteria. Mortality during the study period was 39% (19.6% due to recurrence of variceal bleeding). The main complications of the procedure were the development of oesophageal wall ulcerations and oesophageal stricture.

Adolescent↗
PubMed1984

A new and effective technique of Yag laser photocoagulation for severe upper gastrointestinal bleeding.

A new technique of treating acute severe upper gastrointestinal haemorrhage was evaluated. The technique consisted of epinephrine injections in the bleeding lesion combined with YAG laser radiation in short pulses, applied until the bleeding vessel was completely closed. This new treatment modality was tried in 54 consecutive patients with severe upper gastrointestinal bleeding from a spurting artery, or an ulcer with a non-bleeding visible vessel in the floor of the ulcer crater at endoscopy. Permanent haemostasis was achieved in 87% of the 54 patients. Emergency surgery was needed in 13%. The mortality rate was only 10%. No complications occurred. It is concluded that this new technique of treating severe upper gastrointestinal bleeding from a spurting artery, or an ulcer with a visible vessel results in a significant improvement of the success rate (permanent haemostasis) and a marked reduction in the mortality rate.

Adolescent↗
PubMed1983

Neodymium-Yag laser photocoagulation for haemostasis of gastrointestinal non-variceal haemorrhage.

Neodymium-Yag laser treatment in 130 patients with upper gastrointestinal bleeding, including spurting arterial bleeding, active oozing or fresh stigmata of bleeding (fresh clot or non-bleeding vessel), permitted overall initial haemostasis in 95% of the patients. Total laser failures (rebleeds) amounted to 22%. Considering only the ulcers with vessels in 36 patients, initial control of haemorrhage was achieved in 83%, but the total failure rate amounted to 50%. A controlled randomized study in 129 patients with oozing bleeding and patients with stigmata of bleeding showed a significant (p less than 0.001) reduction of duration and of the recurrence rate of bleeding and a significant decrease (p less than 0.05) of operative indications. Mortality rates however were not lowered by laser therapy. Complications of lasertherapy did not occur. One hundred thirty-eight gastrointestinal angiomas were treated by Yag laser photocoagulation in 32 patients without complications. Although the results of Yag laser treatment of gastrointestinal bleeding seem promising, endoscopic laser techniques should be improved to optimise the results and to improve the prognosis of life-threatening gastrointestinal bleedings.

Gastrointestinal Hemorrhage↗
PubMed1982

Controlled trial of YAG laser treatment of upper digestive hemorrhage.

A trial of neodymium-yttrium-aluminum-garnet laser treatment was conducted in 152 patients with upper gastrointestinal hemorrhage. Laser photocoagulation was applied in 0.5- to 1-s pulses of 55-80 W power. A first part of the trial studying patients with arterial bleeding was uncontrolled. Spurting arterial bleedings could be stopped in 87% of the 23 patients with acute arterial hemorrhage. The recurrence rate after endoscopic treatment of this type of bleeding was high (55%). The operation rate of 61% was, however, lower than the operative indications amounting to 95% in patients with arterial spurters admitted previously to our department. One hundred twenty-nine patients were included in a controlled randomized trial of laser photocoagulation. In 86 patients with active, nonspurting bleeding, the laser was significantly better (p less than 0.001) at stopping the bleeding than conservative treatment in randomized controls, and there was a numerical although not significant reduction of the rate of bleeding recurrence and the necessity for surgery (both p less than 0.1). In 43 patients with fresh stigmata of bleeding (i.e., fresh clot or visible vessel) laser treatment resulted in a numerical reduction in the rate of rebleeding and in the operative indications, but the difference did not reach statistical significance. The mortality rates were not influenced in any of the groups.

Adolescent↗
PubMed1981

Histochemistry of gamma-glutamyl transpeptidase in human liver biopsies.

The histochemical activity of gamma-glutamyl transpeptidase is examined in human liver biopsy specimens in normal and pathological conditions. Different histochemical patterns can be recognized. In histologically normal liver a faint sinusoidal membrane staining is observed. In pathological liver tissue invariably a pronounced canalicular gamma-GT activity is detected in addition to the faint sinusoidal membrane activity. The canalicular staining pattern is variable in extent and staining intensity, without clear correlation with specific disease entities. Cases with severe degrees of cholestasis, however, show a "washed-out" appearance of the tissue, apparently parallel to the degree of cholestasis. This phenomenon may be explained by the detergent action of bile salts accumulating in cholestatic tissue.

Bile Acids and Salts↗
PubMed1981

Human non-A, non-B hepatitis: ultrastructural alterations in hepatocytes.

Ultrastructural investigation of liver biopsies from two patients with non-A, non-B hepatitis revealed cytoplasmic and nuclear alterations in the hepatocytes. The lesions in both patients, one with acute and one with chronic hepatitis, were similar and distinct from those previously described in other forms of hepatitis. These findings are compared with the reported findings in chimpanzee liver after inoculation with non-A, non-B infective material. The intranuclear findings are similar to the aggregations of 20-27 nm particles described in some infected chimpanzees, and the cytoplasmic alterations seem to be similar to the cytoplasmic structures and tubular arrangements reported in other inoculated chimpanzees. A striking finding of this study is the presence of both alterations together in the same biopsy in two different patients, suggesting that they represent a different stage of viral infection or different parts of the viral agent. It still remains to be proved that the ultrastructural particles indeed contain antigen(s) of the non-A, non-B hepatitis virus. The nuclear and cytoplasmic alterations are, however, characteristic for non-A, non-B hepatitis and are useful as ultrastructural hallmarks of this form of hepatitis.

Adult↗
PubMed1981

Safety and efficacy of Neodymium-Yag laser photocoagulation: an experimental study in dogs.

Acute and chronic experiments were carried out in 26 beagle dogs to study the safety and efficacy of Neodymium-Yag laser photocoagulation in the treatment of bleeding gastric lesions. Continuous high power (50-60 W) Neodymium-Yag laser photocoagulation applied to the exposed stomach of the dog produced evaporation lesions that reached the muscle layer after six to 10 seconds and caused free perforation after 10 to 12 seconds. The tissue damage caused by these long lasting exposures was closely related to the working distance. Moreover, long pulses of high power photocoagulation were not always effective in stopping experimentally induced gastric bleedings. Short pulses (1/2-1 s) of very high power (60-70 W) caused less tissue evaporation, which reached the muscle layers only after 14 to 18 pulses and caused free perforation after 22 to 24 pulses. The tissue damage was not related to the working distance when short pulses were used. Repeated shots of high power Yag laser radiation always resulted in stopping the experimental bleedings without deep injury. It is concluded that high power Neodymium-Yag laser photocoagulation is safe and may be used with success in the treatment of bleeding gastric lesions if the radiation is performed in shots of short duration (1 s or less). Clinical studies in man are warranted and indicated.

Animals↗