Biomedical subjects

Robrecht Ceulemans

Publications and source records attributed to Robrecht Ceulemans.

3 recordsLinked to original sources

PubMed2004

Safe laparoscopic surgery in the elderly.

BACKGROUND: The elderly are more prone to complications of surgery because of comorbidity, and they may benefit most from a minimally invasive approach. This study was intended to evaluate the safety of the use of a laparoscopic approach for emergency and elective surgery in elderly patients. METHODS: From January 2000 to June 2001, all patients over 75 years of age who underwent a procedure that began laparoscopically were included. Physiologic and operative scores according to the POSSUM scoring system were recorded. These were then used to calculate predicted morbidity and mortality by both the POSSUM and P-POSSUM systems. Predicted outcomes were compared with actual outcomes. RESULTS: One hundred sixty-two patients with a mean age of 80 years were included; 52% were emergency cases. The overall morbidity was 14.5% and the mortality rate was 1.8%. Fourteen procedures (8.4%), all emergencies, were converted. Both mortality and morbidity rates were lower than the predicted values (P = 0.001 and P = 0.0001, respectively). CONCLUSIONS: A laparoscopic approach can be used safely in an elderly population undergoing surgery in a daily practice for miscellaneous conditions, whether elective or emergency operations.

Age Factors↗

PubMed2003

Contraceptive treatment after biliopancreatic diversion needs consensus.

BACKGROUND: An important population of patients who undergo biliopancreatic diversion (BPD) are fertile women. A consensus is needed with regard to contraceptive therapy after BPD by evaluating the risks of pregnancy, the safety of oral contraception and the changes in fertility after this bariatric surgery. METHOD: From May 1997 until May 1998, 40 women who underwent a BPD were included in a prospective study evaluating the hormone status preoperatively and postoperatively after 2 and 7 days, 3 and 6 months and 1 year. An extensive questionnaire, with regard to fertility and obstetric history, was sent at least 2 years after inclusion. A literature search was performed to understand the complex physiology of hormone changes after excess weight loss, as well as absorption and metabolism of oral contraceptives. RESULTS: Our laboratory results are consistent with hormone changes found in the literature, which show that rising levels of serum sex-hormone-binding globulin, follicle stimulating hormone and luteinizing hormone and decreasing levels of testosterone and dehydroepiandrosterone sulphate result in an improved fertility status, regulated through complex interactions, in particular with the gonatotropin-releasing-hormone pulse generator. The questionnaire shows the use of different types of contraception. From the 9 patients who only used oral contraception, 2 patients developed an unforeseen pregnancy after BPD. Although miscarriages and neonatal complications were seen in other patients in our hospital, none of these problems were seen in our study. CONCLUSION: Pregnancy should be avoided for 12 to 18 months after BPD. Fertility increases after BPD. As oral contraception is most popular and less reliable, we strongly believe that large multi-centre, prospective, randomized studies are necessary to come to a consensus about the use of contraceptive therapy after BPD.

Adolescent↗

PubMedDate not supplied

A new device for sentinel node detection in laparoscopic colon resection.

OBJECTIVE: To test the feasibility of using a newly developed device for laparoscopic lymphatic mapping of the colon by simultaneous and quantitative detection of both tissue coloration and radioactivity. METHODS: Four pigs were used in this study. In each animal, both blue dye and radioisotope injections were utilized. Lymphatic mapping was performed laparoscopically in the sigmoid mesocolon and in the right mesocolon. A solution containing a mix of 35 microcuries of Technetium Tc-99 sulfur Colloid and 1 mL of a vital blue dye was administered subserosally by percutaneous insertion of a 25 gauge needle under laparoscopic control. The new device for automated sentinel-node detection consists of a gamma-probe coupled with a laser device and can be passed through a regular 10-mm trocar. The device detects simultaneously both radioactivity and quantitative tissue coloration. Nodes showing a radioactivity at least 5 times higher than that of the background or that had a blue colorant concentration were considered our sentinel nodes. RESULTS: Laparoscopic simultaneous and quantitative detection of sentinel nodes was feasible in all pigs. One or more sentinel nodes were identified by either the blue dye or radioisotopic technique in both the sigmoid and right mesocolon. Quantitative tissue coloration detection led to the recognition of additional nodes that were not apparently colored to the naked eye. CONCLUSION: Laparoscopic sentinel node detection using a device combining gamma and color detection is feasible in the porcine model. The significance of nodes apparently clear but positive with the quantitative detection technique should be further evaluated.

Animals↗