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Biomedical subjects

M Meysman

Publications and source records attributed to M Meysman.

At least 37 records · Page 2Linked to original sources
PubMed1997

Interventional bronchoscopy: 5-year experience at the Academic Hospital of the Vrije Universiteit Brussel (AZ-VUB).

Our experience with interventional bronchoscopic techniques in a University Hospital is described: in 93 patients during a 5-year period, 149 interventional procedures (i.e., Nd-YAG laser photoresection and/or airway stenting and/or balloon dilatation) have been performed. Laser resection was successful in relieving major symptoms (intractable dyspnea, hemoptysis or retro-obstructive complications) in 35/41 (85%) of malignant indications, and in 18/19 (94%) of benign obstructions. Major complications included one death (1.6%) early in the series, and major nonfatal hemorrhage in three patients (5%), all with malignant disease. In 31/35 (89%) of malignant central airway stenoses treated with stents, respiratory symptoms could be palliated successfully. Mean survival after stenting was 6 +/- 5.3 months. In 20/23 (87%) of benign tracheal stenoses, temporary or permanent stenting allowed for complete restoration of airway patency. The development of inexpensive and simplified insertion techniques for existing stents, and of a new (and even less expensive) type of tracheal stent has enabled the use of airway stenting in all categories of patients. Bronchoscopic balloon dilatation was helpful in the mechanical dilatation of stenoses, and in the unfolding of unopened stents. Finally, a plea for an organised referral system and for active collaboration between interventional bronchoscopy centers is made.

Adult↗
PubMed1997

Comparison of video-assisted thoracoscopic talcage for recurrent primary versus persistent secondary spontaneous pneumothorax.

Thoracoscopic talcage (TT) is a safe and effective prophylactic treatment for patients suffering from recurrent primary spontaneous pneumothorax (PSP). Empirically, TT is considered equally effective in the treatment of persistent secondary spontaneous pneumothorax (SSP), although this has not yet been proved. In this study, the efficacy and safety of TT was prospectively evaluated in 28 patients (17 males and 11 females, mean age 27 +/- 8 yrs), with 31 episodes of recurrent PSP, and in 20 patients (13 males and 7 females, mean age 43 +/- 21 yrs) with persistent SSP. TT proved to be equally effective in achieving pleurodesis in both groups; there were 6.5% recurrences in the PSP group and 8.7% in the SSP group during a mean follow-up period of 18 months (p > 0.05). In the SSP group, there were significantly more prolonged postoperative air leaks (26 vs 0%; p = 0.004) and a longer postoperative chest tube drainage time (35.5 +/- 18 vs 24.9 +/- 3.2 hrs; p = 0.002) was necessary. All air leaks, however, ceased spontaneously during drainage. Duration of hospitalization was significantly longer in the SSP group (4.7 +/- 2 vs 3.2 +/- 0.5 days; p < 0.0001). Postoperative pain (90 vs 43%; p < 0.0001) and fever (65 vs 17%; p = 0.001) were more frequent in the PSP group than in the SSP group. There were no major peri- or postoperative complications in either group. We conclude that thoracoscopic talcage is as efficient and safe in achieving pleurodesis in persistent spontaneous pnuemothorax as in recurrent primary spontaneous pneumothorax.

Adult↗
PubMed1997

Chronic thromboembolic pulmonary hypertension and vascular transformation of the lymph node sinuses.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease often not recognized until it is far advanced. Medical management does not reverse the effects of the disease, nor does it prevent its progression. Pulmonary thromboendarterectomy is the preferred treatment. We present the case of a patient in whom CTEPH was mistaken for an interstitial lung disease with mediastinal lymph node enlargement. The mediastinal lymph node enlargement was due to vascular transformation of the lymph node sinuses (VTS). This is an unusual case of chronic thromboembolic pulmonary hypertension with vascular transformation of the lymph node sinuses.

Adult↗
PubMed1997

Bronchoscopic balloon dilatation in the combined management of postintubation stenosis of the trachea in adults.

Bronchoscopic balloon dilatation (BBD) using angioplasty balloon catheters has been employed successfully in the treatment of tracheobronchial stenoses in children and has worked with variable success in adults with bronchial stenosis. In adults with tracheal stenosis, BBD only has been reported anecdotally. In this study, experience with BBD using a valvuloplasty balloon catheter in the combined treatment (with Nd-YAG laser photoresection and stenting) of severe benign postintubation tracheal stenoses in three adults is delineated. BBD was particularly successful in establishing tracheal patency when laser photoresection was contraindicated or was too dangerous; BBD allowed easy insertion of tracheal stents and the "opening" of folded silicone stents. BBD is a simple, inexpensive, safe, and efficient adjunct in the combined treatment of severe postintubation rigid tracheal stenosis in selected adults.

Adult↗
PubMed1996

Emergency treatment of life-threatening spontaneous haematopneumothorax.

We report two cases of spontaneous life-threatening haemopneumothorax, successfully treated by early thoracotomy. In the first patient no source of bleeding could be identified. The second patient presented bleeding from a torn vascular adhesion at the apex of the lung. The first patient benefited from early clot evacuation and in the second patient the bleeding could be controlled by electrocautery and a single suture of the bleeding vessel. These cases stress the need for early recognition and management of a potentially life-threatening event.

Adult↗
PubMed1996

Broncho-mediastinal fistula following perforation of the oesophagus.

We present a 63-year old female with mediastinitis following an esophageal perforation, possibly favoured by an oesophageal motility-disorder and the use of non-steroidal anti-inflammatory drugs, who developed a broncho-mediastinal fistula in the left main bronchus. She was successfully treated with intravenous antibiotics, a cervical oesophagostomy and secondary isoperistaltic coloplasty.

Anti-Bacterial Agents↗
PubMed1996

Effect of posture on the flow-volume loop in two patients with euthyroid goiter.

In two patients with a goiter and respiratory symptoms occurring only in the recumbent posture, flow-volume loops (FVLs) were performed in various body postures: while sitting upright, supine, and left and right lateral decubitus. In both patients, flow rates, upper airway obstruction indices, and FVL morphologic features with patients in recumbent postures indicated the appearance of upper airway flow limitation with patients in the recumbent posture as compared with the upright posture. In the one patient who underwent thyroid surgery, these posture-related changes disappeared. We conclude that in patients with a goiter (or any extrinsic mass near to the upper airway), the comparison of FVLs performed in various body positions may help to clarify the origin of posture-related respiratory symptoms.

Adult↗
PubMed1996

Rapid healing of endobronchial tuberculosis by local endoscopic injection of corticosteroids.

We report a case in which two endobronchial tuberculous lesions were diagnosed by bronchoscopy. Under antituberculosis chemotherapy, one lesion was submucosally injected with corticosteroids. Twelve days later, this lesion had almost completely disappeared, whereas the other lesion had remained unchanged. The latter lesion was then injected with corticosteroids, which resulted, 14 days later, in complete healing. Six months later, there were no stenotic or other lesions. These observations suggest that local injection of corticosteroids in endobronchial tuberculous lesions induces a rapid and complete resolution of these lesions, and may prevent the development of bronchostenosis.

Adult↗
PubMed1995

Benign cystic teratoma: an uncommon cause of anterior mediastinal mass.

Teratomas of the mediastinum are rare, accounting for 8% to 13% of the tumours in this region. They primarily occur in the anterior mediastinum of young adults. Surgery should be performed whenever complications, such as atelectasis of lung tissue, adhesion to or compression of adjacent structures, or malignant transformation, are likely to be present. Results after surgical resection are excellent.

Adult↗
PubMed1995

Tuberculous pleural effusion following coronary artery bypass graft.

We present two patients with moderate left ventricular dysfunction, who developed a pleural effusion after coronary artery bypass grafting (CABG). The effusion was proven to be an exsudate of tuberculous origin. This illustrates that not all pleural exsudates developing after CABG are due to a post-pericardiotomy syndrome. Therefore microbiological examination of pleural fluid and if necessary pleural biopsy should be performed in all patients with an unresolving pleural effusion following CABG.

Aged↗
PubMed1995

Three cases of bronchial stump aspergillosis: unusual clinical presentations and beneficial effect of oral itraconazole.

Bronchial stump aspergillosis (BSA), i.e. Aspergillus infection of bronchial granulation tissue surrounding endobronchial suture threads, is a very rare variant of localized suppurative bronchial Aspergillus infection. The majority of reported cases have occurred within one year after lung surgery. We present three more patients, in whom BSA occurred very late (4.5, 6 and 7 yrs) after pulmonary resection. Other unusual features were: complete absence of symptoms in one patient, and simultaneous occurrence of aspergilloma in another. Removal of the endobronchial suture probably constitutes the key therapy for BSA. In all three of our patients oral itraconazole resulted in clinical, histological and microbiological improvement. In conclusion, BSA should be considered in the differential diagnosis of haemoptysis occurring up to 7 yrs after lung surgery, although an asymptomatic presentation is possible. Furthermore, BSA can be associated with other clinical presentations of Aspergillus infection, e.g. aspergilloma. Finally, long-term oral itraconazole therapy may represent a valid alternative when removal of the suture is not feasible.

Administration, Oral↗
PubMed1995

Non-small-cell lung cancer with multiple paraneoplastic syndromes.

We describe the case of a patient with multiple paraneoplastic syndromes, six in total, associated with a non-small-cell cancer of the lung. In this single patient we found hypertrophic pulmonary osteoarthropathy, hyperkeratosis of palms and soles, erythema annulare centrifugum, syndrome of inappropriate secretion of antidiuretic hormone (SIADH), and ectopic andrenocorticotrophic hormone (ACTH) and calcitonin production.

ACTH Syndrome, Ectopic↗
PubMed1995

Percutaneous needle biopsy of localized pulmonary, mediastinal, and pleural diseased tissue with an automatic disposable guillotine soft-tissue needle. Preliminary results.

Percutaneous needle biopsy (PNB) of localized thoracic disease has become a widespread procedure in many institutions. The development of special small caliber needles has increased the diagnostic yield of PNB partly by increasing the amount of tissue from biopsy, often enabling histologic examination. Nevertheless, in a significant number of patients only cytopathologic examination is possible on the retrieved biopsy fragments, necessitating the presence of a trained cytopathologist in the biopsy room. Furthermore multiple biopsy needle passages often are required, increasing the risk for complications such as pneumothorax. We have evaluated the use of a small-caliber tissue biopsy cutting needle, consistently yielding sufficient biopsy tissue for histologic examination. In 25 pleural and mediastinal lesions, which could be biopsied without passage through aerated lung, there was a 93% sensitivity (7% false-negative results) for neoplasm and a 100% accuracy for benign disease. There were no complications. In 32 patients with lesions of 1 cm in diameter or more surrounded with aerated lung tissue, adequate histologic examination was feasible on every biopsy specimen after only one needle passage. There was an 87% sensitivity of PNB in neoplastic disease (13% false-negatives). In the patients with benign disease, there was a 100% accuracy. There was a 15.6% risk for pneumothorax. In only one patient (3%), however, was chest drainage necessary. One patient (3%) had mild hemoptysis. We conclude that percutaneous biopsy of localized pulmonary, pleural, and mediastinal lesions with a new small-caliber automatic guillotine cutting needle is safe and efficient, enabling recovery of sufficient tissue for histologic examination with a single-pass procedure, thus minimizing the risk for pneumothorax, eliminating the need for a cytopathologist in the biopsy room, and shortening the duration of the procedure.

Adult↗
PubMed1994

Upper airway obstruction due to inoperable intrathoracic goitre treated by tracheal endoprosthesis.

Thyroidectomy is the treatment of choice in patients with thyroid enlargement complicated by compression or displacement of the trachea because of the risk of complete airway obstruction due to sudden enlargement of the goitre by, for example, haemorrhage. In patients who are medically inoperable an endoscopically inserted tracheal endoprosthesis may provide longstanding airway patency, as reported here.

Aged↗
PubMed1994

A simplified insertion technique for tracheobronchial silicone stents.

In many patients with central airway obstruction due to extrinsic compression or malacia, insertion of tracheobronchial stents can provide effective and permanent relief. Of the various types of prostheses described, the silicone Dumon-Artemis stents (Medicore, Brussels, Belgium) are probably the most efficient. The use of an elegant and safe specially designed stent introducer system combined with a special bronchoscope is proposed for insertion by Dumon. This combined stent insertion system, however, is relatively expensive and cumbersome, especially for centers where relatively limited numbers of patients are treated. We propose an alternative, simplified insertion technique of silicone Dumon-Artemis stents, which was proven safe and efficient in our series of patients.

Aged↗