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Biomedical subjects

M Meysman

Publications and source records attributed to M Meysman.

At least 19 recordsLinked to original sources
PubMed2006

Stenting allows weaning and extubation in ventilator- or tracheostomy dependency secondary to benign airway disease.

Central airway obstruction can cause severe respiratory insufficiency leading to mechanical ventilation (MV) or artificial airway (AA) dependency. Interventional bronchoscopic procedures have been reported to be of help in weaning patients with malignant airway stenoses from mechanical ventilation, whereas their use in benign disease is only anecdotal. The objectives of this study are to evaluate early, intermediate and long-term outcome of interventional bronchoscopy and stent placement in the treatment of MV/AA dependency due to benign airway obstruction. In a retrospective cohort analysis for the period 1999-2004, we evaluated 15 consecutive ICU patients with documented benign central airway obstruction, who were referred for bronchoscopic management of their condition after multiple failed attempts at weaning from MV or decannulation of the AA. Indications for bronchoscopic treatment were surgery refusal, medical or surgical inoperability, or absence of alternative treatment options. Malacia, post-intubation stenosis and goiter were the main causes of airway obstruction and MV/AA dependency. All patients were treated by means of rigid bronchoscopy, dilatation procedures and stent insertion. All but one patient (93.3%) were successfully and permanently extubated/decanulated immediately after the bronchoscopy. Minor complications occurred in 6 patients (40%) leading to a second intervention. All complications could be managed endoscopically and long-term follow up was uneventful. Interventional bronchoscopy with stent insertion can allow successful withdrawal from MV/AA and can offer longstanding airway patency in selected ventilator- or tracheostomy-dependant individuals with benign airway stenoses,when surgery in not feasable or contra-indicated.

Aged↗
PubMed2004

Music: a new cause of primary spontaneous pneumothorax.

Most cases of primary spontaneous pneumothorax are thought to be caused by air leaks at so-called "emphysema-like changes" or in areas of pleural porosity at the surface of the lung. Environmental pressure swings may cause air leaks as a result of transpulmonary pressure changes across areas of trapped gas in the distal lung. This is the first report of music as a specific form of air pressure change causing pneumothorax (five episodes in four patients). While rupture of the interface between the alveolar space and pleural cavity in these patients may be linked to the mechanical effects of acute transpulmonary pressure differences caused by exposure to sound energy in association with some form of distal air trapping, we speculate that repetitive pressure changes in the high energy-low frequency range of the sound exposures is more likely to be responsible. Exposure to loud music should be included as a precipitating factor in the history of patients with spontaneous pneumothorax.

Adult↗
PubMed2002

Effects of formoterol (Oxis Turbuhaler) and ipratropium on exercise capacity in patients with COPD.

Although long-acting inhaled beta 2-agonists improve various outcome measures in COPD, no double-blind study has yet shown a significant effect of these drugs on exercise capacity. In a randomized, double-blind, placebo-controlled, crossover study, patients received formoterol (4, 5, 9, or 18 micrograms b.i.d. via Turbuhaler), ipratropium bromide (80 micrograms t.i.d. via pMDI with spacer), or placebo for 1 week. Main endpoint was time to exhaustion (TTE) in an incremental cycle ergometer test. Secondary endpoints were Borg dyspnoea score during exercise, lung function, and adverse events. Thirty-four patients with COPD were included, mean age 64.8 years, FEV1 55.6% predicted, reversibility 6.1% predicted. All doses of formoterol, and ipratropium significantly improved TTE, FEV1, FEF25-75%, FRC, IVC, RV and sGAW compared with placebo. A negative dose-response relationship was observed with formoterol. Ipratropium increased time to exhaustion more compared with formoterol, 18 micrograms, but not with formoterol, 4.5 and 9 micrograms. No changes in Borg score were found. There was no difference in the adverse event profile between treatments. In conclusion, 1 week of treatment with formoterol and ipratropium significantly improved exercise capacity and lung function compared with placebo. However, a negative dose-response relation for formoterol was unexpected and needs further investigation.

Administration, Inhalation↗
PubMed2000

Real time CT-fluoroscopy: diagnostic and therapeutic applications.

The synergetic progression of CT technology and computer hardware has made ultrafast acquisition and image reconstruction possible. This has lead to the availability of CT interactive diagnosis and therapeutic procedures. Making use of our own material (337 intervention procedures during the last 17 months), we have compared our techniques and results to the recent literature data. One of the advantages of the biopsy technique is an improved sensitivity for neoplastic lesions, most certainly in cases of intrapulmonary lesions, surrounded by aerated tissue (now 94% compared to 87% in our previous study). A second advantage is the safety of the technique (only one major complication in our series). Fluid collection drainages, and more complex interventions like local injection of drugs, radio-frequency ablation, wire hook placement and ethanol injection were performed without complication. Yet another interesting feature is the shortening of the procedure time (reduced in average to an 'in-room' time of less than 30 min), which has definite economical implications. Furthermore it increases the patient's comfort and safety, and extends the scope of outpatient procedures (80% outpatient procedures in our material). On the other side the radiation exposure can be raised as an issue, especially when we consider the operator's hands. However, the described technique and the use of dedicated tools can alleviate the problem. As a conclusion, real time CT fluoroscopy has given a new input and broadens the scope of clinical indications of CT-guided diagnostic and therapeutic procedures.

Adolescent↗
PubMed2000

Rib fractures induced by coughing: an unusual cause of acute chest pain.

We report three patients with stress fractures of the ribs induced by coughing. Standard radiographs of the chest and ribs did not reveal evidence of rib fractures in any of the patients. Bone scintigraphy, performed 1 to 2 weeks after initial onset of symptoms, showed a focal area of increased uptake along the chest wall in all cases. Thin section angulated helical CT directly visualized the subtle rib fractures. Initial diagnosis of a cough-induced fracture of the rib may be difficult because of the associated underlying disorder, and unnecessary examinations are commonly performed. Identification of a cough-induced fracture of the rib using helical CT may be clinically important to avoid unnecessary concern and additional examinations.

Adult↗
PubMed2000

Absence of bacterial colonization of the airways after therapeutic rigid bronchoscopy without stenting.

Following airway stenting, bacterial colonization of the airways with potentially pathogenic micro-organisms occurs within 4 weeks after treatment in the majority of patients. The objective of this study was to prospectively investigate whether nonstenting therapeutic rigid bronchoscopy (using laser, cryotherapy, mechanical dilatation or debridement) is followed by airway colonization or infection. Protected specimen brush sampling of the central airways and quantitative culture were performed immediately prior to, and 4 weeks after nonstenting therapeutic rigid bronchoscopy in 20 consecutive patients with central airway lesions. Prior to therapeutic bronchoscopy, airway colonization/infection was present in nine of 20 (45%) patients. In these nine patients, 10 different potential pathogens were identified: Streptococcus pneumoniae (four cases), Pseudomonas aeruginosa (three), Haemophilus influenzae (two), and Serratia marcescens (one). Eight of these nine patients had a history of postobstructive infections, of which three were currently being treated with antibiotics. Four weeks following therapeutic bronchoscopy, airway colonization/infection was present in five of 20 (25%) patients, each of whom had airway colonization/infection prior to bronchoscopy. In three of these five patients, the same organisms were found 4 weeks after bronchoscopy as at baseline bronchoscopy. In two of five patients new organisms were identified: one case of Streptococcus viridans and one case of Haemophilus parainfluenzae, both considered to be nonpathogens. In four of nine patients with airway colonization/infection prior to bronchoscopy, the airways were clear of micro-organisms after the procedure. The authors conclude that: 1) nonstenting therapeutic rigid bronchoscopy is not complicated by airway colonization or infection by new potential pathogens; and 2) therapeutic rigid bronchoscopy led to clearing of airway colonization/infection in almost half of the patients studied.

Adult↗
PubMed1999

Bacterial colonization of central airways after stenting.

Airway stenting (AS) is increasingly used in the management of obstructive lesions of the central airways. Although retention of secretions and infection have been reported as complications of AS, the microbiological consequences of AS have not yet been evaluated. In this study, we prospectively performed protected specimen brush (PSB) sampling of the airways, before and 3 to 4 wk after AS, in 14 consecutive patients (65 +/- 17 yr), suffering from bronchial (5), extensive esophageal (2), thyroid (1), and adenocystic (1) carcinoma, stenotic tracheal burn lesions (2), postintubation stenosis (2), and Wegener's granulomatosis (1). A cutoff value of >/= 10(2) colony-forming units (cfu). ml(-)(1) was considered diagnostic for airway colonization (AC). PSB results were related to the presence and degree of secretion retention (SR) at the level of the stent. In five of the 14 patients, AC was present prior to AS; in three of these, potentially pathogenic microorganisms (PPM) were identified. After AS, AC was found in 11 (including seven patients without prior AC) of the 14 patients. In six of these patients, one or more PPM were present (Pseudomonas aeruginosa [4], Staphylococcus aureus [3], Streptococcus pneumoniae [1], Klebsiella spp. [1]). Although AC tended to be associated with the presence of SR (PSB >/= 10(2) cfu. ml(-)(1) in 10 of 12 SR-positive and in zero SR-negative cases; PSB < 10(2) cfu. ml(-)(1) in two SR-positive and in two SR-negative cases), statistical significance was not reached (Fisher exact test, p = 0.06). We conclude that AS is frequently followed by AC, the majority of which occurs in patients without AC prior to AS, and is caused by PPM. In no case, however, AC was associated with clinical signs of infection. AC tended to be associated with SR in the stent.

Aged↗
PubMed1999

Screw-thread vs Dumon endoprosthesis in the management of tracheal stenosis.

STUDY OBJECTIVES: A frequent complication of the widely used Dumon silicone stent is its tendency to migrate when used in tracheal stenosis. We compared the clinical efficacy and complications (including migration) of the Dumon stent with a screw-thread stent, a device with an increased stent-to-wall contact surface and, theoretically, less tendency to migrate. DESIGN: Retrospective case analysis. SETTING: Academic hospital. MATERIALS AND METHODS: Forty-six patients with tracheal stenoses (23 benign and 23 malignant) requiring the placement of 50 stents (29 Dumon and 21 screw-thread) were studied. In 26 patients Dumon stents were used, and in 20 patients screw-thread stents were used. Both patient groups had comparable clinical and stenosis-related characteristics. RESULTS: Stent insertion and follow-up were uneventful in both the Dumon and the screw-thread insertions, respectively: 62% vs 67% (not significant). There were seven migrations in the Dumon group, compared to only one migration in the screw-thread group, respectively: 24% vs 5%. This difference did not reach statistical significance (p = 0.1). All of the migrations occurred in the benign stenosis group, and none occurred in the malignant-stenosis group, respectively: 8 of 23 vs 0 of 23, p = 0.004. Within the benign-stenosis group, the Dumon stent had a significantly increased risk for migration when compared to the screw-thread stent, respectively: 7 of 13 vs 1 of 11, p = 0.033. CONCLUSIONS: The screw-thread stent and the Dumon stent are equally effective in the management of tracheal stenosis. There is a general trend toward a decreased migration rate, and a significantly lower risk for migration in patients with benign tracheal stenosis. The (less expensive) screw-thread stent may represent an attractive alternative in the management of tracheal stenosis in general, and may be preferable to the Dumon stent in treating benign tracheal stenosis.

Aged↗
PubMed1998

Thoracoscopic T2-T3 sympathicolysis for essential hyperhidrosis in childhood: effects on pulmonary function.

Thoracoscopic T2-T3 sympathicolysis (TS) is a minimally invasive treatment for patients suffering from severe, refractory essential hyperhidrosis (EH). TS has previously been shown to be safe and efficacious in children. In order to examine the effects of TS on respiratory function, pulmonary function tests (PFT) were performed prior to and 6 weeks and 6 months after TS in 12 children with EH (3 boys; mean age 12.8+/-2.5 years). Small asymptomatic decreases in forced expiratory volume in one second (FEV1; -2%), forced expiratory flow after expiration of 75% of vital capacity (FEF75; -9.6%), total lung capacity (TLC; -1%), transfer factor for diffusion of carbon monoxide (T(LCO); -7.6%), and transfer coefficient for diffusion of carbon monoxide (K(CO); -1.5%) were observed 6 weeks after TS. These changes are comparable to those observed in adults but did not reach statistical significance in small children. In line with observations in adults, TLC (and T(L,CO)) returned to baseline values 6 months after TS, whereas FEV1, FEF75, and K(CO) remained at their 6-week level. In conclusion, TS causes only small, statistically insignificant, and asymptomatic decreases in pulmonary function in children. TS can, therefore, be considered a safe treatment option in children suffering from severe, refractory EH.

Adult↗
PubMed1998

Thoracoscopic splanchnicolysis for the relief of chronic pancreatitis pain: experience of a group of pneumologists.

Intractable pain is the most invalidating symptom in patients suffering from chronic pancreatitis. Anatomical interruption of the major afferent pain nerves is indicated in severe refractory cases. Among the various techniques and sites of interruption, thoracoscopic splanchnicectomy has emerged as an efficient alternative for the more aggressive open surgical splanchnicectomy, and for the (solely temporarily efficacious) transcutaneous neural blocks, which moreover bear some serious complications. Until now, all reports on thoracoscopic splanchnicectomy were typically surgical, using video-assisted thoracoscopic surgery techniques, double-lumen intubation, and so on. In analogy with thoracoscopic upper dorsal T2-T3 sympathicolysis for essential hyperhidrosis, a simplified thoracoscopic splanchnicolysis technique used in 8 patients suffering from either severe refractory chronic pancreatitis pain (7 patients) or postsurgical epigastric pain is described. Pain control was achieved in 5 of the 7 patients with chronic pancreatitis with a short (20+/-8 min) intervention, short hospitalization (2 days), and simple (single-lumen intubation, no chest drains) procedure. Thus, this simplified thoracoscopic splanchnicolysis technique may represent a valid alternative in the often difficult treatment of refractory chronic pancreatitis pain or other upper abdominal pain.

Abdominal Pain↗
PubMed1998

Effect of body posture on spirometric values and upper airway obstruction indices derived from the flow-volume loop in young nonobese subjects.

STUDY OBJECTIVE: To define the effect of changes in body posture on flow-volume loops (FVLs) and four commonly used indices of upper airway obstruction (UAO) in young, nonobese normal subjects. DESIGN: Prospective comparative study. SETTING: Pulmonary function laboratory at an academic hospital. PARTICIPANTS: Thirty-one normal volunteers. INTERVENTION: At least three FVLs per posture were obtained in the sitting, supine, and left and right lateral recumbent postures while maintaining a constant position of the head and neck in relation to the trunk. In each body posture, the largest observed flow rates were used to calculate the UAO indices. RESULTS: When subjects changed from the sitting to each of the three recumbent postures, all spirometric values decreased significantly (p<0.0001). However, among the four UAO indices, only the FEV1/peak expiratory flow ratio increased significantly (although only slightly, by 2.9 and 4.4%, respectively) in both the right and left lateral recumbent postures (p<0.0001), but not in the supine posture. None of the subjects developed an inspiratory or expiratory plateau on the FVL in any of the three recumbent postures. CONCLUSIONS: In young, nonobese normal subjects, recumbency does not induce UAO, at least not detectable by changes in the FVL configuration or in UAO indices derived from the FVL. Furthermore, the study provides the upper limits of recumbency-related changes in the various UAO indices for young, nonobese normal subjects.

Adult↗
PubMed1997

Severe community-acquired pneumonia caused by atypical organisms.

Three cases of community-acquired pneumonia (CAP), requiring intensive care admission, are presented. The clinical picture of a "typical" bacterial pneumonia in the three patients led to an initial empirical treatment with amoxicillin clavulanic acid or 2(nd) generation cephalosporins. The treatment had to be changed in all three because of clinical failure. Erythromycin was added to the therapy with good clinical evolution. Serology confirmed atypical organisms to be responsible. Only the chest X-ray might have suggested an "atypical" or a "viral-like" agent. A proposition is made for an empirical combination of antibiotics in severely ill patients with CAP with more than unilobar consolidation.

Adult↗