Biomedical subjects

V Vander Poorten

Publications and source records attributed to V Vander Poorten.

18 recordsLinked to original sources

PubMed2006

Evaluation of the larynx for tumour recurrence by diffusion-weighted MRI after radiotherapy: initial experience in four cases.

Radiotherapy-induced changes in the soft tissues of the neck hamper the early detection of persistent or recurrent tumour by clinical examination and imaging procedures. Diffusion-weighted (DW) MRI is a non-invasive technique capable of probing tissue properties by measuring the movement of water. The purpose of the ongoing study is to examine the usefulness of DW-MRI for differentiation of persistent or recurrent tumour from post-radiotherapeutic sequelae or complications. Four patients, suspected of tumour recurrence after radiotherapy for laryngeal squamous cell carcinoma, were examined using a DW-MRI sequence on a clinical 1.5 T MR system prior to surgery. In two patients, the DW-MRI images showed an asymmetric hyperintense lesion on b1000 images with low apparent diffusion coefficient (ADC)-value, compatible with tumour on histopathology. All surrounding tissue presented high ADC values and absent signal on the b1000 images, histopathologically correlating to post-radiotherapeutic changes. The images of the third and fourth patient showed absent or minimal symmetric hyperintensity of the laryngeal soft tissues on the b1000 images and high ADC-values. In these cases, the histopathological diagnosis of radionecrosis was made and no tumour was found. In all four cases, differentiation of tumoral tissue from radiotherapy-induced tissue alterations was possible with DW-MRI.

Aged↗

PubMed2006

Levothyroxine replacement therapy after thyroid surgery.

INTRODUCTION AND AIM: New entities, such as 'subclinical' over- and undersubstitution, are easily diagnosed after thyroid surgery due to improved testing methods, and the incidence of thyroidectomy with lifelong hormone substitution is increasing. Thus, there is a need to review conventional replacement therapy after thyroid surgery. We investigated the adequacy of our thyroid hormone replacement therapy for three months after total-, subtotal-, and hemithyroidectomy using an upper reference limit of thyrotropin (TSH) of 4.6 mU/L. MATERIALS AND METHODS: Eighty-seven patients undergoing thyroidectomy for benign thyroid pathology participated. Levothyroxine (L-T4) treatment began five days after surgery. Preoperatively euthyroid patients received 150 microg L-T4 daily following total thyroidectomy, 100 microg L-T4 after subtotal thyroidectomy, and 50 microg L-T4 after hemithyroidectomy. Preoperatively hyperthyroid patients received 100 microg L-T4 following total thyroidectomy and 50 microg L-T4 following subtotal thyroidectomy. An average of six weeks after surgery, thyrotropin (TSH) was measured (reference limits 0.15-4.60 mU/L), and necessary dose adjustments were made. RESULTS: Of the patients who were preoperatively euthyroid, 45% with total thyroidectomy, 42% with subtotal thyroidectomy, and 17% with hemithyroidectomy required L-T4 dose adjustments. Of the patients who were preoperatively hyperthyroid, 60% of those with total thyroidectomy and all of those with subtotal thyroidectomy required L-T4 dose adjustments. CONCLUSIONS: To avoid over- and undersubstitution after thyroidectomy, an optimal replacement therapy dose is necessary. A small majority of our preoperatively euthyroid patients received adequate therapy. Endocrinological follow-up six weeks after surgery revealed the need for L-T4 dose adjustments, especially in preoperatively hyperthyroid patients. When the extent of resection was similar for hyperthyroid and euthyroid patients, the same initial dose of L-T4 was justified.

Adult↗

PubMed2005

Completion thyroidectomy after the unexpected diagnosis of thyroid cancer.

The optimal surgical management of well-differentiated thyroid cancer (DTC) remains a controversial topic. Preoperative and peroperative investigations quite frequently fail to detect thyroid cancer in cold nodules, and only postoperative histological examination reveals malignancy. In these cases many physicians perform a completion thyroidectomy. Others recommend a conservative approach with close follow-up because of the increased risk of complications after re-operation. In our department, routine management includes completion thyroidectomy once the histopathological report concludes that there is carcinoma, except in cases of papillary carcinoma measuring less than 1 cm. The aim of our study was to determine the incidence of contralateral malignancy and of complications after completion thyroidectomy. We reviewed the records of 29 patients--25 women and 4 men-- who all underwent completion thyroidectomy because of an unexpected diagnosis of DTC. Residual malignancy was found in 12 patients (41.4%) after completion thyroidectomy. In ten patients (34.5%) the malignancy was localised in the contralateral lobe and two patients (6.9%) had lymph node metastases. Postoperative transient hypocalcaemia (< 8.0 mg/dl) occurred in five patients (17.2%) and permanent hypocalcaemia (lasting longer than 6 months) was a feature in two patients. One patient suffered transient laryngeal nerve injury occurred in one patient and there were no permanent lesions. In conclusion, we found residual DTC in 41.4% of patients undergoing reintervention. Because of the rather low re-operation rate, we prefer to perform a completion thyroidectomy to remove potential occult malignancy and to allow for postoperative 131I-treatment in all patients with a diagnosis of malignancy in their thyroid lobectomy specimen, with the exception of papillary carcinoma < 1 cm.

Adenocarcinoma, Follicular↗

PubMed2005

Cancer of the nasal vestibule, nasal cavity and paranasal sinuses.

The usual clinical presentation of sinonasal tumours includes symptoms that are indistinguishable from inflammatory sinus disease, namely nasal airway obstruction, pain, and epistaxis. Abnormal V1 and/or V2 sensations are a strong indication of the possibility of tumour. Computed tomography is the most reliable and informative imaging tool for evaluating the cancers of the paranasal sinuses. Magnetic resonance imaging is essential for tumour mapping because of the excellent tissue characterisation and the possibility of differentiating between neoplasms and retained secretions. A wide variety of histologies may be encountered, although squamous cell carcinoma (SCCA) is the most common. Radiation is a common adjuvant to surgery. The response of sinonasal tract tumours to radiation therapy varies with the stage and histology of the tumour. Rehabilitation after surgical resection may be accomplished with prosthodontics or reconstructive flaps. Bony erosion of the orbital walls does not constitute an indication for orbital exenteration. Patients with tumour involvement of the skull base, either in the infratemporal fossa or at the fovea ethmoidalis and cribriform plate, should be considered for craniofacial resection. Management of these tumours requires a multimodal approach, involving surgery, radiation therapy and, increasingly in recent years, chemotherapy. Management should therefore be entrusted to multidisciplinary teams only.

Chemotherapy, Adjuvant↗

PubMed2005

Management of stridor in neonates and infants.

Stridor is the sound caused by abnormal air passage into the lungs and can exist in different degrees and be caused by obstruction located anywhere in the extra-thoracic (nose, pharynx, larynx, trachea) or intra-thoracic airway (tracheobronchial tree). Stridor may be congenital or acquired, acute, intermittent or chronic. Laryngotracheal inflammation (croup) is the most common cause of acute stridor. Laryngotracheomalacia is the most common cause of congenital, chronic stridor. Stridor is a clinical sign and not a diagnosis. The golden standard in the workup of stridor is an upper and lower airway endoscopy under general anaesthesia. Endoscopic examination under general anaesthesia requires a multidisciplinary approach and close cooperation between anaesthesiologist, paediatrician, ENT surgeon and nursing staff. Following this procedure, a place in the intensive care unit should be available for those cases presenting with stridor in which a definite diagnosis could not yet be established. Although important, pre-endoscopy assessment including history, physical examination and radiological examination, is only a guide to the type and degree of pathology found during endoscopy. About 1 out of 10 infants are found to have lesions in more than one anatomical site of the upper aerodigestive tract.

Airway Obstruction↗

PubMed2005

Initial assessment of a neck mass in children.

OBJECTIVE: To propose national recommendations for the initial assessment of a mass in the neck in children. METHODS: Comprehensive review of the available literature and consensus discussion with national experts in the field. RESULTS: Consensus guidelines are proposed concerning the work up of children presenting with a mass in the neck.

Adolescent↗

PubMed2005

Initial work-up in head and neck squamous cell carcinoma.

OBJECTIVE: To propose national guidelines for the initial assessment of head and neck squamous cell carcinoma. METHODS: Comprehensive review of the literature and consensus discussion with national experts in the field. RESULTS: Consensus guidelines are proposed concerning the work-up of patients with a presumed diagnosis of a squamous cell carcinoma of the upper aero-digestive tract.

Biopsy, Fine-Needle↗

PubMed2005

Swallowing and functional outcome after partial laryngectomy: a literature review.

There is a wide range of partial surgical resections for the treatment of laryngeal tumours. In addition to good cure rates, the main aim is to preserve a competent and functional larynx. Functional outcomes have proven to have a substantial effect on postoperative quality of life and are usually included in clinical studies. This article reviews reported functional outcomes after partial laryngectomies, particularly when related to swallowing. In the majority of patients, reports indicate acceptable feeding without the presence of a permanent tracheostomy. However, a wide variety of methods and variables are used to describe these functional outcomes, making the comparison of functional outcome after different treatment modalities and resections difficult. More objective evaluation procedures are needed for swallowing to reveal the exact pathophysiology, spontaneous progression and prognostic factors after well-defined laryngeal resections.

Deglutition↗

PubMed2005

Brown tumour: presenting symptom of primary hyperparathyroidism.

The skeletal lesions of primary hyperparathyroidism, including brown tumour, are rare nowadays, with the practice of checking serum calcium levels leading to an earlier diagnosis of hyperparathyroidism. Clinical, laboratory, radiographic and histological investigations can lead to a correct diagnosis. Treatment of brown tumour focuses on the hyperparathyroidism, and is usually followed by a regression of the brown tumour. The diagnosis of hyperparathyroidism and brown tumour should be considered in patients with hypercalcaemia and an osteolytic expansive bone lesion. We present a patient where a brown tumour of the mandible was the presenting symptom of primary hyperparathyroidism.

Adenoma↗

PubMed2001

Pre- and intra-operative findings in primary hyperparathyroidism.

The files were studied of 300 patients operated for primary hyperparathyroidism for the first time. Their median age was 60 years. The female/male ratio was 3/1, but in the younger patients males and females were about equally present. Preoperatively, one third was considered as asymptomatic with respect to hyperparathyroidism. In this subgroup the hypercalcemia was detected coincidentally and the mean parathyroid hormone level was lower than in the others. Another third of the patients had nephrolithiasis, they were on the average younger and there were more males. Finally one third showed other symptoms as gastrointestinal disease, bone disease or general malaise. Intraoperatively, we found a solitary adenoma in 90% of the cases, a double adenoma in 5% (on each side of the neck in half of the cases) and hyperplasia in 4%. The adenomas had a tendency to occur more often in the upper parathyroid glands, but the difference was not important enough to influence the surgical technique. Hyperplasia patients were, on the average, younger and double adenoma patients older. The female/male ratio was 1/1 for hyperplasia and 15/1 for double adenoma.

Adenoma↗

PubMed2001

Postoperative course of serum parathyroid hormone and calcium after surgery for primary hyperparathyroidism.

The aim of this study was to describe the course of parathyroid hormone (PTH) and serum calcium after surgery for primary hyperparathyroidism, and to evaluate the usefulness of daily measurement of these parameters. PTH and serum calcium were daily monitored during the early postoperative period in 45 patients where a parathyroid adenoma was removed. PTH showed a sharp drop to a very low level already on the first postoperative day, whereafter a rapid recovery began. Serum calcium decreased more slowly: on the average, the lowest calcium level was seen on the second day. A majority of the patients were temporarily hypocalcemic, apparently to various degrees. After two weeks 38 patients showed a normal calcemia, while six patients remained slightly hypocalcemic. It is concluded that after removal of a parathyroid adenoma an abrupt fall of PTH precedes the decrease of serum calcium. The first day's PTH level is a reliable indicator of the success of the intervention and it should be a major point in the postoperative biochemical follow-up. Repeated measurements of serum calcium are useful, in contrast with the daily dosage of PTH which can be omitted for economical reasons.

Adenoma↗

PubMed2001

Parathyroid function in the early postoperative period after thyroidectomy.

Serum levels of parathyroid hormone (PTH) and calcium were studied in 132 patients, divided into three groups: unilateral thyroid-lobectomy, (sub)total thyroidectomy for non-toxic goitre and (sub)total thyroidectomy for hyperthyroidism. It was found that all types of thyroidectomy, even unilateral lobectomy, had a temporary influence on the PTH and calcium metabolism in the early postoperative period, albeit to different degrees. The effect was most pronounced after surgery for hyperthyroidism, which carries the greatest risk for postoperative hypocalcemia. The pathogenesis of transient postoperative hypocalcemia as well as the implications for the surgical management are discussed.

Adult↗

PubMed2000

Results of larynx preservation surgery for advanced laryngeal cancer through tracheal autotransplantation.

OBJECTIVE: To evaluate the use of tracheal autotransplantation for reconstruction of the hemilaryngectomy defect that includes the hemicricoid cartilage and results from resection of laryngeal or hypopharyngeal cancer. DESIGN: The clinical records of 28 patients undergoing primary or salvage hemicrico-hemilaryngectomy for laryngeal (26 patients) and pyriform sinus (2 patients) cancer were analyzed for function and local control. SETTING: Academic center. PATIENTS: Case series review of 28 consecutive patients treated during a 3(1/2)-year period who had an average follow-up period of 19 months. INTERVENTION: Twenty-five men and 3 women, aged from 28 to 79 years, underwent a hemilaryngectomy that included the hemicricoid cartilage, the ipsilateral thyroid lobe, and a unilateral or bilateral lymph node dissection. In 26 patients, these extensive defects were reconstructed with a tracheal autotransplantation that restored the larynx at the glottic and subglottic levels. In 2 patients, the defect was converted into a total laryngectomy because of tumor extension beyond the resection margins of a hemicrico-hemilaryngectomy. MAIN OUTCOME MEASURES: The times to decannulation and retake of full oral feeding, the quality of speech, and the incidence and site of recurrent cancer were assessed. RESULTS: Of the 26 patients undergoing tracheal autotransplantation, 24 were decannulated and all regained the ability to maintain nutrition by mouth. Ultimate voice quality was "subnormal" to "moderately hoarse" in all patients. Five recurrences developed of which 2 were treated with total laryngectomy. CONCLUSIONS: Functional reconstruction of extensive laryngeal defects can be achieved with an autotransplantation of cervical trachea, with favorable functional results and acceptable morbidity. This technique expands the limits of conservation surgery for selected laryngeal and hypopharyngeal tumors.

Adult↗

PubMed2000

Transplantation of tracheal autografts: is a two-stage procedure necessary?

BACKGROUND: Tracheal autotransplantation has been shown to be a reliable technique for repairing the hemilaryngectomy defect that includes the hemicricoid cartilage and results from resection of unilateral laryngeal cancer with significant subglottic extension. The technique involves a two-stage procedure of cervical tracheal revascularization by wrapping the trachea in a vascularized radial forearm flap and subsequent tracheal transplantation on a newly created vascular pedicle consisting of the radial artery and vein (1, 2). OBJECTIVES: To experimentally (rabbits) investigate if a one-stage tracheal revascularization and transplantation procedure could be a viable option. METHODS: Tracheal patch autografts (1.5 cm x 1 cm) were excised and reimplanted at the anterior cervical trachea with four different patterns of vascular supply: group I: tracheal patch wrapped with vascularized fascia 14 days before excision of the patch (two-stage procedure); group II: tracheal patch wrapped with vascularized fascia at the time of patch excision; group III: tracheal patch without tissue wrapping; and group IV: tracheal patch wrapped with a sheet of Gore-Tex after reimplantation. After orthotopical reimplantation, the patches showed decreasing vascular contacts from group I to group IV. The patches were evaluated morphologically at the moment the animal became dyspnoeic or two weeks after reimplantation in asymptomatic animals. RESULTS: Group I patches fully preserved their viability (median percentage mucosal viability of 100%). Autografts in group II and III showed varying degrees of necrosis and graft take with a median percentage graft viability of 59 and 69% respectively. All group IV tracheal patches showed full thickness necrosis over the majority of their surface area (median percentage graft viability of 10%). CONCLUSION: Fascia enwrapped tracheal autografts show reliable revascularization through the intercartilaginous ligaments only when a 2 stage revascularization technique is used.

Animals↗

PubMed2000

Minimally invasive endoscopic management of malignant sinonasal tumours.

A large retrospective study from two belgian institutions of 78 patients who underwent minimally invasive endoscopic management for malignant sinonasal tumors from, 1992-1999 is presented. We attempt to assess the results of this less invasive approach. The spectrum of disease included adenocarcinoma, squamous cell carcinoma, olfactory neuroblastoma and other malignant tumors. All patients were treated primarily for cure. 66 patients were operated on by a purely endoscopic technique, while 9 patients had a simultaneous neurosurgical and endoscopic approach, and 3 a limited orbital approach. 16 patients (20.5%) presented with local recurrence, 6 patients (7.7%) sustained distant metastases and 7 patients (9%) presented simultaneous local recurrence and distant metastases. The 2-years and 5-years survival rates of the whole group were respectively 73.1% and 52.3%, while the adenocarcinoma group exhibits a significantly better prognosis than other histological types with 2-years and 5-years survival rates of 89.8% and 63.8%. Patients who could be treated purely endoscopically had a significantly better survival in comparison to patients treated by an external and endoscopic approach. Morbidity was minimal and the local control rate as well as survival rates were comparable to literature data. Endoscopic resection was adequate, providing clear margins and en bloc removal in most cases. Our results encourage us to use this minimally invasive approach in selected cases as a reliable alternative to the systematic use of an exclusively external approach.

Adolescent↗

PubMed1999

Progress in larynx-sparing surgery for glottic cancer through tracheal transplantation.

The current surgical treatment for unilateral, advanced glottic cancer is a total laryngectomy. Usually, the noninvolved hemilarynx needs resection because the resulting laryngeal defect cannot be reconstructed after adequate tumor resection. Experimental findings suggest that segments of autologous trachea may restore extended laryngeal defects. The authors used tracheal transplantation to save laryngeal function after the removal of advanced glottic cancer. In this case series review, 10 patients were treated during a 1.5-year period, with an average follow-up of 8 months. Evaluated factors included survival of the tracheal transplant and functional outcome with regard to the onset and quality of the airway, speech, and deglutition. The authors showed that segments of cervical trachea may restore extended laryngeal defects after initial revascularization by a radial forearm fascial flap. The fascial flap served as a vascular carrier for the transplanted trachea. Follow-up showed the stability of the reconstruction. Compared with a total laryngectomy, a striking improvement in patient comfort and function was noticed. Transplantation of the trachea is a technique that may save laryngeal function after the treatment of advanced-stage glottic cancer. These findings may improve laryngeal preservation strategies in treating laryngeal cancer.

Arteries↗

PubMed1999

Autotransplantation of the trachea: experimental evaluation of a reconstructive technique for extended hemilaryngectomy defects.

Vascularized segments of trachea were used to repair extended hemilaryngectomy defects in a rabbit model. The cervical trachea was revascularized in a first stage by a fascia flap. In a second stage, the cervical trachea was isolated and transformed into a patch that could be autotransplanted on a vascular carrier. The patches were used for the reconstruction of hemilaryngectomy defects including half of the cricoid. Two months after transplantation, the vascular and morphologic characteristics of the tracheal patches were examined with silicone dye angiography and magnetic resonance imaging. The tracheal patches showed a reliable blood supply when wrapped in vascularized fascia. The patches provided a functional reconstruction of hemicricolaryngectomy defects. It is concluded that autotransplantation of the trachea should be further explored as a potential means for extending the limits of conservation laryngeal surgery.

Animals↗

PubMedDate not supplied

Non-traumatic giant aneurysm of a superficial temporal artery.

We present a case of giant aneurysm in the superficial temporal artery. A 59-year-old male was admitted to our hospital with a slowly growing swelling just in front of his right ear. Diagnosis was made by US and CT. CTA was able to provide accurate anatomic information and to eliminate the risks associated with diagnostic conventional angiography. A superselective embolization of the giant temporal aneurysm was performed.

Aneurysm↗