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Biomedical subjects

M Smet

Publications and source records attributed to M Smet.

18 recordsLinked to original sources

Caroli's syndrome.

We report the case of a two-year-old girl presenting with recurrent episodes of fever and hepatomegaly. High resolution ultrasound (US) and computed tomography (CT) of the liver show dilated intrahepatic bile ducts with bridge formation and intraluminal protrusions. The extrahepatic bile duct is normal. The diagnosis of irregular dilated bile ducts with signs of cholangitis and cholangiolitis is proved by liver biopsy. The histologically associated congenital liver fibrosis in our patient enter into the Caroli's syndrome. We illustrate the high resolution US and the CT findings in this case.

Bile Ducts, Intrahepatic

Specific decrease of anti-pseudomonal IgA after anti-pseudomonal therapy in cystic fibrosis.

UNLABELLED: In patients with cystic fibrosis (CF) and chronic colonisation with Pseudomonas aeruginosa, specific anti-pseudomonal IgG and IgA, as well as serum immunoreactive protein C, WBC and differential count, ESR, pulmonary function and chest radiograph score were determined before and after a 2 week intravenous course of anti-pseudomonal antibiotics in 32 cases of acute exacerbation of pulmonary infection. Specific anti-pseudomonal IgA but not specific anti-pseudomonal IgG decreased significantly after treatment. Log of anti-pseudomonal IgA but not log anti-pseudomonal IgG correlated well with disease severity as assessed by the Brasfield chest radiograph score (r 0.57), forced expiratory volume in 1 s (r 0.6) as well as C-reactive protein (r 0.62). CONCLUSION: Specific anti-pseudomonal IgA may be a better parameter than specific IgG in the follow up of lung infection in patients with CF, probably because it more closely reflects ongoing endobronchial infection, the major pathology in CF lungs.

Antibodies, Bacterial

Experimental teleradiology. Novel telematics services using image processing, hypermedia and remote cooperation to improve image-based medical decision making.

We illustrate the possible impact of information technology on digital radiology using two pilot projects. The first aimed to improve the transfer of radiological information and the interaction between radiologist and referring physician, using hypermedia documents and hypermedia electronic mail. During a 12-month evaluation period, approximately 100 hypermedia reports were generated and distributed to hepatologists and neurosurgeons. The second project aimed to improve planning of orthopaedic surgery, using an image processing service for three-dimensional visualization and a conferencing system to support active cooperation. Over two months, 12 routine cases were reconstructed in three dimensions and conferencing was carried out between surgeons and radiologists in hospitals 15 km apart. Initial results were encouraging. Telematics may be valuable in reconciling the growing need for multidisciplinary cooperation with the growing geographical and organizational separation of different experts. We conclude that to benefit from information technology, the focus should not be on a direct translation of traditional working methods, but rather on possibilities that were not available in the film-based environment.

Belgium

Image segmentation: methods and applications in diagnostic radiology and nuclear medicine.

We review and discuss different classes of image segmentation methods. The usefulness of these methods is illustrated by a number of clinical cases. Segmentation is the process of assigning labels to pixels in 2D images or voxels in 3D images. Typically the effect is that the image is split up into segments, also called regions or areas. In medical imaging it is essential for quantification of outlined structures and for 3D visualization of relevant image data. Based on the level of implemented model knowledge we have classified these methods into (1) manual delineation, (2) low-level segmentation, and (3) model-based segmentation. Pure manual delineation of structures in a series of images is time-consuming and user-dependent and should therefore be restricted to quick experiments. Low-level segmentation analyzes the image locally at each pixel in the image and is practically limited to high-contrast images. Model-based segmentation uses knowledge of object structure such as global shape or semantic context. It typically requires an initialization, for example in the form of a rough approximation of the contour to be found. In practice it turns out that the use of high-level knowledge, e.g. anatomical knowledge, in the segmentation algorithm is quite complicated. Generally, the number of clinical applications decreases with the level and extent of prior knowledge needed by the segmentation algorithm. Most problems of segmentation inaccuracies can be overcome by human interaction. Promising segmentation methods for complex images are therefore user-guided and thus semi-automatic. They require manual intervention and guidance and consist of fast and accurate refinement techniques to assist the human operator.

Algorithms

A right lower quadrant mass in cystic fibrosis: a diagnostic challenge.

In a cystic fibrosis (CF) patient a right lower quadrant (RLQ) mass may be a difficult diagnostic problem. Most frequently it is due to a distal intestinal obstruction syndrome also called meconium ileus equivalent, but the possibility of intussusception and appendiceal abscess should also be considered. We describe three CF patients with an appendiceal abscess seen in a 4-year period. All three patients had a palpable RLQ mass. Chronicity and obliteration of the appendiceal lumen with abnormally viscid mucus may lead to concealed perforation and be responsible for the atypical presentation.

Abscess

Unilateral thalamic haemorrhage in the pre-term and full-term newborn.

One full-term and three premature newborns with a unilateral thalamic haemorrhage are reported. The lesion was diagnosed using cranial ultrasonography and confirmed in three using magnetic resonance imaging. Severe perinatal asphyxia occurred in all infants. The neonatal clinical history, subsequent neuro-developmental outcome and neuroimaging findings are discussed. As the prognosis appears to be much better than for infants with bilateral thalamic densities, it is important that this type of lesion is recognised as a separate entity.

Cerebral Hemorrhage

Infantile fibrosarcoma.

Explore the source record for details and available documents.

Antineoplastic Combined Chemotherapy Protocols

Cerebrovascular occlusive complications in osteopetrosis major.

We report the case of a 16-year-old patient with osteopetrosis major, complaining of transient sensory and motor disturbances in the left upper limb and dizziness on changing the position of his head. Selective angiography of the cerebral vessels showed severe narrowing of the internal carotid artery within the petrous carotid canal and in its supraclinoid portion. The cervical vertebral arteries showed multiple stenosis within the vertebral canal. These findings are explained by narrowing of the basal foramina by the osteopetrotic bone.

Adolescent

The role of high resolution ultrasound and MRI in the investigation of infants with macrocephaly.

External hydrocephalus was diagnosed using computed tomography in seven children presenting with macrocephaly. The value of different imaging techniques in distinguishing between subdural effusions and external hydrocephalus was investigated. High resolution ultrasonography combined with magnetic resonance imaging appeared to provide enough information to make a distinction between these two conditions. Radionuclide cisternography was still required to assess the flow pattern of the cerebrospinal fluid (CSF) which was important when placement of a lumboperitoneal shunt was considered.

Gestational Age

The role of short latency somatosensory evoked responses in infants with rapidly progressive ventricular dilatation.

The effect of hydrocephalus on somatosensory evoked potentials was studied in nine infants. An increase in N1 latency was found in five infants studied longitudinally during a period of progressive ventricular dilatation. A marked decrease in N1 latency was noted in 7 infants, within one week following shunt insertion and in two infants who showed spontaneous arrest of ventricular growth. A correlation was found between cerebrospinal fluid pressure and the delay in N1 latency, but the number of infants studied is still small. SEPs appear to be a useful additional test when assessing infants with progressive ventricular dilatation. Once a baseline value for N1 has been obtained following shunt insertion, SEPs may subsequently be useful when assessing a child with possible shunt dysfunction.

Cerebral Hemorrhage

Type IV and interstitial collagenolytic activities in normal and malignant trophoblast cells are specifically regulated by the extracellular matrix.

Type IV and interstitial collagenolytic activities were compared in human malignant and normal trophoblast cells cultured on plastic, in presence or absence of laminin in solution, on matrigel (a gel of basement membrane components) and on type I collagen gel. Laminin highly stimulated the type IV collagenolytic activity but not the interstitial collagenolytic activity, in malignant trophoblast cells. This glycoprotein had no effect on the interstitial collagenolytic activity and doubled the type IV collagenolytic activity in normal trophoblast cells. Thus malignant trophoblast cells produce preferentially the enzyme able to degrade basement membrane when in contact with laminin, and the enzyme able to degrade interstitial collagen fibers when cultured on type I collagen. On the contrary, type I collagen gel and matrigel equally increased both type IV and interstitial collagenolytic activities by normal trophoblast cells. Interactions of tumor trophoblast or normal trophoblast cells with the extracellular matrix result thus in distinct stimulations of collagenolytic activities. Increased production of type IV collagenolytic activity upon exposure to laminin appears to be specific of the metastatic phenotype.

Animals

Treatment of Pseudomonas lung infection in cystic fibrosis with piperacillin plus tobramycin versus ceftazidime monotherapy: preliminary communication.

Twenty-one patients with cystic fibrosis and chronic Pseudomonas lung infection were treated at random with ceftazidime, 150 mg/kg/day, or with piperacillin, 300 mg/kg/day, and tobramycin, 10 and more mg/kg/day for 14 days. On admission and at discharge, body weight, erythrocyte sedimentation rate, white blood cell count, and differential were determined. Pulmonary function analysis and chest X-rays were also obtained on both occasions as was sputum bacteriology. After hospitalization, the patients were followed in the outpatient department for 14-26 months. Both treatments were associated with significant improvement in most of the parameters that were studied, but neither treatment was superior.

Ceftazidime

Rickets due to dietary calcium deficiency.

Three children, aged 15-18 months were referred because of clinical, radiological and biochemical manifestations of rickets. Serum 25-hydroxycholecalciferol (25-OH-D3) values were within the normal range but 1,25-dihydroxychole-calciferol (1,25-diOH-D3) levels were markedly elevated. All signs and symptoms could be explained by dietary calcium deficiency. They all received the commercial Soya-drink - not adapted for infants - as their main source of nutrition for at least 6 months. Soya-drink has an extremely low calcium content. It should be remembered that defective calcium intake causes severe bone lesions and rickets in children in spite of adequate vitamin D supply.

Calcitriol

The influence of behavioural states on cerebral blood flow velocity patterns in stable preterm infants.

Previous Doppler ultrasound studies assessing cerebral blood flow velocities in the anterior cerebral artery (ACA) among healthy term and preterm infants, showed a widespread range for the calculated flow indices. However, only one of these studies accounted for the infant's behavioural state. In the present study a stable pattern of the cerebral blood flow velocity tracings and of the Pulsatility Index (PI) was observed during state 1, whereas marked fluctuations in cerebral blood flow velocity and PI were found during state 4 or active wakefulness. During state 2, minor variations of cerebral blood flow velocity and PI occurred though tended to be less pronounced than during active wakefulness. Thus at the time of Doppler assessment the cerebral blood flow velocity pattern and its variability will be better understood by taking into account the behavioural state of the infant.

Behavior

The effect of blood transfusion on cerebral blood-flow in preterm infants: a Doppler study.

Stable infants with anaemia needing a transfusion with adult red blood-cells were studied to elucidate changes in brain blood-flow velocity. Within 24 hours and at five to six days following transfusion a substantial mean flow velocity reduction was observed. Haemodynamic factors contributing to the reduction were an increase in cerebrovascular resistance and an increase in whole blood viscosity, as reflected by a raised pulsatility index. Transfusion with adult red blood-cells causes an elevation in haemoglobin concentration, thereby increasing the total oxygen-carrying capacity of arterial blood; however, this lowers the concentration of fetal haemoglobin which possesses a higher affinity for oxygen. Since cerebral oxygen transport is equal to the product of cerebral blood-flow and arterial oxygen content, this finding suggests the existence of a homeostatic mechanism for cerebral oxygen transport. The actual amount of cerebral oxygen transport was found to increase progressively as the percentage of fetal haemoglobin rose above 30 per cent. At higher fetal haemoglobin levels, appropriate elevations in cerebral blood-flow occurred, causing an increase in the supply of oxygen to the brain.

Blood Flow Velocity