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Biomedical subjects

R Vereecken

Publications and source records attributed to R Vereecken.

At least 19 recordsLinked to original sources
PubMed2001

Surgical correction of vesicoureteral reflux: 5-year follow-up with 99Tcm-DMSA scintigraphy.

AIM: To evaluate kidney function before and after surgical correction of vesicoureteral reflux. The long-term effect was measured with quantitative nephro-scintigraphy using 99Tcm labelled dimercaptosuccinic acid (99Tcm-DMSA). METHODS: Forty-five children with a history of urinary tract infections due to vesicoureteral reflux (VUR) were studied. VUR grade was determined with contrast voiding cystourethrography. Planar scintigraphy was performed with 99Tcm-DMSA and uptake measured as a percentage of injected dose. Kidney function was evaluated at baseline and 5 years after corrective surgery. RESULTS: Three months after surgery, persistent mild reflux was found in eight of 76 treated renal units. Kidney uptake at 5-year follow-up was unchanged in the majority of children, indicating preservation of renal function found at baseline. The split renal function showed an excellent correlation (r = 0.99) between baseline and follow-up studies (regression slope 1.01). Percentage uptake had a regression slope of 0.89 significantly different from unity (P<0.05). Empirical kidney-depth correction techniques were compared. The scintigraphic pattern worsened in six kidneys, indicative of increased scarring in a minority of children. CONCLUSION: Planar nephro-scintigraphy with 99Tcm-DMSA was well tolerated in our paediatric population, and appeared appropriate to evaluate kidney function in time. After surgical correction of VUR, the baseline function was maintained in 94% of kidneys.

Adolescent↗
PubMed1998

Microsurgery for intra-abdominal testicular retention.

OBJECTIVES: In cases of high intra-abdominal retention of the testis a standard technique of cryptorchidy treatment will not be able to bring down the testis into the scrotum. In this study we wanted to evaluate the feasibility and reliability of the technical aspects of testicular autotransplantations in children under the age of 5 years. STUDY DESIGN: A series of 25 microsurgical autotranslantations of testes performed on 17 boys since July 1984 are reviewed. Emphasis was placed on the microvascular transplantation technique, the age of the patient and the long term viability of the autotransplants. An end-to-end microvascular anastomosis between the deep inferior epigastric artery and the testicular artery was performed in an end-to-end way using mattress stitches to accommodate the difference in diameter between the donor and recipient vessels. Also the testicular veins were anastomosed to the deep inferior epigastric veins. RESULTS: Of the 25 transplantations (96%) were successful after a mean follow up of 24 months, the one failure was ascribed arterial thrombosis. CONCLUSION: Our results show a 96% survival of the transplanted testes using the end-to-end vascular anastomosis as described here.

Abdomen↗
PubMed1998

Intravesical application of a stable oxybutynin solution improves therapeutic compliance and acceptance in children with neurogenic bladder dysfunction.

PURPOSE: To improve patient compliance with and acceptance of intravesical oxybutynin therapy for neurogenic bladder dysfunction we developed a stable oxybutynin solution that eliminates the complicated crushing procedure. MATERIALS AND METHODS: From January 1995 to January 1997 we prospectively evaluated 15 children with a mean age of 6.1 years with persistent detrusor hyperactivity or significant side effects on oral oxybutynin therapy who received intravesically 0.2 mg./kg. (maximum 5 mg.) of a stable oxybutynin solution (5 mg./5 ml., pH 5.85) twice daily. RESULTS: The oxybutynin solution remained stable up to 24 months. In 13 of the 15 children therapeutic compliance was excellent. Detrusor hyperactivity decreased and systemic side effects were absent or minimal. After 4 and 24 months mean cystometric bladder capacity plus or minus standard error of mean increased from 114+/-15.2 to 161+/-26.6 and 214+/-21.7 ml. (p <0.01), mean ratio of cystometric-to-expected bladder capacity increased from 0.88+/-0.12 to 1.18+/-0.14 and 1.24+/-0.16 (p <0.01), and end filling bladder pressure decreased from 57.0+/-7.1 to 25.6+/-4.4 and 30.8+/-4.4 cm. water (p <0.01), respectively. CONCLUSIONS: Intravesical instillation of a specially prepared oxybutynin solution is safe and reliable in children with persistent detrusor hyperactivity or side effects on oral oxybutynin therapy. Eliminating the complex crushing preparation of the solution by the child or parent has made this therapy easy to use and acceptable in the long term.

Administration, Intravesical↗
PubMed1998

Tethered cord syndrome in occult spinal dysraphism: timing and outcome of surgical release.

OBJECTIVE: To investigate the influence of neurosurgical intervention on the appearance of upper motor neuron (UMN) signs in newborns diagnosed with occult spinal dysraphism and tethered cord (TC) during the first month of life. METHODS: A prospective study (1990 to 1996) of 22 consecutive newborns with occult spinal dysraphism monitored for the appearance of UMN signs. Untethering was performed when neurologic or urodynamic investigation indicated the presence of UMN dysfunction. RESULTS: Of 22 patients, 10 remained free of UMN symptoms during follow-up (mean, 67+/-22 months). Untethering was performed in 12 of 22 patients because of the presence of UMN symptoms. In 7 of these 12 patients, there was a documented asymptomatic period of 13+/-11 months before the onset of UMN symptoms. Untethering at a mean age of 18+/-17 months restored normal neurologic and urinary function in all patients (mean postoperative follow-up, 25+/-16 months). Of the 12 children, 5 presented with UMN signs at birth. In these children, untethering was performed at a mean age of 9+/-5 months. In two of these five patients, UMN symptoms did not resolve after surgery, and ongoing conservative bladder treatment was required (mean follow-up, 37+/-14 months). In none of the 12 operated children did signs of retethering occur. CONCLUSIONS: A significant number (10/22) of children born with occult spinal dysraphism and TC did not develop UMN symptoms during follow-up; neurosurgical correction after the appearance of an UMN sign restored normal neurologic and urinary function in all children; and untethering in children presenting at birth with UMN symptoms resulted in poorer outcome.

Child, Preschool↗
PubMed1995

Treatment of neurogenic bladder dysfunction in infants and children with neurospinal dysraphism with clean intermittent (self)catheterisation and optimized intravesical oxybutynin hydrochloride therapy.

Clean intermittent (self)catheterisation (CIC) in combination with oral anticholinergic drugs (oxybutynin hydrochloride [OH] is the present standard therapy for neurogenic bladder dysfunction (NBD) with detrusor hyperactivity. However, complete suppression of detrusor contractions and complete urinary continence is not always obtained despite maximal dosage, and the high incidence of severe systemic anticholinergic side-effects often impairs therapeutic compliance, resulting in dose reduction or even discontinuation of therapy. The intravesical administration of OH has been shown recently to be an effective alternative for treating persistent detrusor hyperactivity, and occurrence and severity of systemic side-effects appeared to be significantly decreased. However, available data are limited from a paediatric view. Furthermore, it is our belief that the use of crushed OH tablets with consequent problems of impracticability accounts for the variable long-term patient compliance reported to be the only disadvantage to intravesical OH. Using an optimized drug preparation we demonstrate the superiority of intravesical OH for treatment of NBD in 15 children (range 0.6-13.75 years, mean 6.1) with incomplete detrusor activity suppression and/or intolerable systemic side-effects on oral OH therapy. Since the previous reported problems of impracticability and variable long-term patient compliance can be resolved by optimized drug preparation, we therefore conclude that the era of crushing OH tablets should be over in order to allow the intravesical OH therapy on a long-lasting and large-scale basis.

Administration, Intravesical↗
PubMed1990

Conservative versus neurosurgical treatment of tethered cord patients.

We compared the outcome of neurosurgical release of a tethered spinal cord in 20 children with the neurological evolution of 21 other children known iwth a tethered spinal cord on nuclear magnetic resonance scan (NMR). Neurosurgery yielded stabilisation of the symptoms without any lasting improvement. Pre-operative conservative medical treatment had to be continued in all operated children. Three of the 20 operated children are showing signs of retethering despite appropriate neurosurgery, indicating that retethering should be considered as a major and frequent complication. In the majority of our children, symptomatic (re)tethering was recognised by the appearance of increased tendon reflexes and a progressive pes cavus, suggestive of an upper motor neuron disease involvement.

Child↗
PubMed1987

Xanthogranulomatous pyelonephritis with emphasis on computerized tomography scan. Retrospective study of 20 cases and literature review.

The authors reviewed 20 cases of xanthogranulomatous pyelonephritis. An accurate preoperative diagnosis of this disease is difficult because of its clinical and radiologic similarities to various other renal lesions. A resistant urinary tract infection in a patient with a nonfunctioning kidney and a perinephric abscess should lead to the condition being suspected. Although xanthogranulomatous pyelonephritis is mainly a histologic diagnosis, computerized tomography opens new perspectives in the preoperative determination. This could allow less radical surgery in selected cases.

Aged↗
PubMed1987

Solitary benign schwannoma in the psoas muscle.

Schwannomas, which also are referred to as neurinoma or neurilemmoma, are rare. We report a case of a solitary benign schwannoma in the psoas muscle, which was not associated with von Recklinghausen's disease. The tumor was excised successfully. Its appearance on clinical examination is described, the preoperative investigations and operative findings are presented, and the literature is reviewed.

Adult↗
PubMed1986

Iatrogenic ureteral injury: aggressive or conservative treatment.

Many different approaches are advocated for management of iatrogenic (operative) ureteric injury. We herein report our experience with 28 ureteral injuries in 26 patients. In six patients, seven injuries were recognized at the time of the initial operation; four end-to-end anastomoses and three ureteroneocystostomies were successfully performed. In 20 patients the diagnosis of injury was delayed. In 14 of them a ureteroneocystostomy with or without Boari bladder flap was performed. The other six patients were first treated by percutaneous nephrostomy, which was successful in only two cases. The other four needed subsequent operative management. The main point that has emerged from our review is that early definitive operative repair is both feasible and preferable.

Adult↗
PubMed1986

Radiotherapy in multiple fractions per day for prostatic carcinoma: late complications.

The late complications associated with two different irradiation schedules with multiple fractions per day (MFD) used for the treatment of prostatic carcinoma are analyzed in 91 patients. There is a relatively high rate of side-effects with fifteen patients (16.5%) developing severe complications due to the radiotherapy. Complications are generally localized in the urinary system and consist mainly of chronic cystitis and incontinence, with only a few exclusive gastro-intestinal problems. The causative factor seems to be pronounced fibrosis of the normal pelvic tissues.

Aged↗
PubMed1986

[Sexual ambiguity and non-fluorescent Y chromosome in 45,X/46,XY mosaicism].

The authors report 2 cases of mixed gonadal dysgenesis in a 45,X/46,XYnf mosaicism. The second case could also be considered as a true hermaphrodite at the time of examination. The discussion concerns the data (clinical, anatomical, histological and cytogenetic) which allowed for the diagnosis and treatment which relies overall on the configuration of the external genitalia.

Chromosome Banding↗
PubMed1985

Clinical evaluation of 99mTc-DMSA renogram.

Two hundred-two 99mTc-DMSA renograms for urologic problems were evaluated. Some technical aspects of the examination and the value of the scintigraphic depth estimation are discussed. Pre- and postoperative uptake values in patients with renal surgery and sequential postoperative examinations are considered. The value of DMSA renograms in predicting recovery in obstructive uropathy and in deciding to opt for conservative therapy or nephrectomy is discussed.

Aged↗
PubMed1983

Hemospermia owing to utricular cyst: embryological summary and surgical review.

We report the first case of hemospermia owing to a utricular cyst. The embryologic distinction between utricular cysts, which are of endodermal origin, and müllerian duct cysts, which are of mesodermal origin, is described. The surgical management of utricular and müllerian duct cysts is reviewed, stressing the difficulty and hazards of attempts at complete excision and the efficacy of less heroic surgical procedures.

Adult↗
PubMed1981

A boy with Leydig cell tumour and precocious puberty: ultrasonography as a diagnostic aid.

A 7 1/2 year-old boy developed pseudoprecocious puberty. The diagnosis of Leydig cell tumour was suggested by clinical and hormonal findings and greatly facilitated by ultrasonographic investigation of the testes. Surgical exploration was in keeping with the diagnosis and the tumour was removed. Orchidectomy was not necessary. It appears that ultrasonography may be very useful in diagnosing a testicular tumour. It facilitates surgical intervention since it permits localization of the lesion which is usually very small and limited to a small part of the testis, as in this case.

Child↗
PubMed1976

[Micturitional disorders in multiple sclerosis (author's transl)].

Micturitional disorders in multiple sclerosis have often an insidious onset; they aggravate during acute attacks of the nervous disease and are strongly influenced by the general condition of the patient, the evolution of his muscular spasms and the therapeutical measures. This changing behaviour of the bladder makes it necessary to perform repeated cystometries, uroflowmetries and electromyographies of the striated sphincter in order to adapt vesical therapy to the evolutive stadia of the disease. Although good results are frequently obtained by drugs (sympathicomimetics, sympathicolytics, muscle relaxants, parasympathicomimetics, parasympathicolytics), by transurethral resections of internal and/or external sphincters and by phenolisation, we feel that urinary derivations remain indicated for some patients, especially in order to facilitate social integration.

Aged↗