Abstractboek 2016 by az groeninge

ABSTRACT BOEK

WETENSCHAPPELIJKE PUBLICATIES VAN AZ GROENINGE

2016

CENTRA 04 ABDOMINALE HEELKUNDE

26 MEDISCHE BEELDVORMING 33 NEFROLOGIE

10 ANESTHESIE / INTENSIEVE ZORG 13 CARDIOLOGIE

41 ONCOLOGISCH CENTRUM

18 GYNAECOLOGIE / VERLOSKUNDE

44 ORTHOPEDIE/ HANDGROEP

21 INWENDIGE ZIEKTEN / GASTRO-ENTEROLOGIE

46 UROLOGIE

VU Inge Buyse, Pres. Kennedylaan 4 | 8500 Kortrijk Uitgegeven in opdracht van het wetenschappelijk comitÃ© van az groeninge

ABSTRACTBOEK | 2016

36 NUCLEAIRE GENEESKUNDE / PET CENTRUM WEST-VLAANDEREN

17 ENDOCRINO DIABETOLOGIE

24 KINDERGENEESKUNDE

35 NEUROLOGIE

50 VASCULAIRE EN THORACALE CHIRURGIE

Dit abstractboek is ook te raadplegen via www.azgroeninge.be /azgpublicaties

VOORWOORD

Geachte lezer

Nu het einde van de legislatuur van het huidige kabinet in zicht komt, laat het zich raden dat de klinische netwerken die al een tijd aangekondigd zijn, er nu ook effectief gaan komen. De ziekenhuizen hebben zich intussen spontaan aan het werk gezet, nog voor hierover een wettelijk kader bestaat en geformaliseerde samenwerkingsverbanden zijn vastgelegd, die voldoen aan eerder verschenen visieteksten. Intussen circuleert een voorontwerp van wettelijk kader. In parallel wordt ook regelmatig een lijst verspreid met regionale en supraregionale zorgopdrachten. Het is evident dat centra die supraregionale zorgopdrachten zullen claimen daarvoor aan een aantal criteria zullen moeten voldoen. Voldoende activiteit (drempelaantallen), wetenschappelijke publicaties, en bovenal gedocumenteerde goede klinische resultaten zullen daarin een belangrijke rol spelen. Onder meer om die redenen moedigen we wetenschappelijke activiteit in het algemeen, publicaties en deelname aan klinische studies aan. In 2018 wordt de GDPR (Global Data Protection Regulation) van kracht, een Europese directieve, die onze nationale privacywetgeving een heel stuk strenger zal maken. Het permanent bijhouden van gedetailleerde activiteitencijfers en databases met het oog op publicaties, maar ook voor het documenteren van de outcomes, zal er niet eenvoudiger op worden. Reden genoeg om aan alle artsen, verpleegkundigen en paramedici die bijgedragen hebben tot de publicaties die in dit tweede abstractboek opgenomen zijn, te danken voor hun enthousiaste ijver. DR. SERGE VANDERSCHUEREN MEDISCH DIRECTEUR

CENTRUM

ABDOMINALE CHIRURGIE ARTIKELS

ABSTRACT 2

ABSTRACT 1

Combined minimal invasive transdiaphragmatic resections of peripheral colorectal lung metastases in patients undergoing laparoscopic liver resections.

Central venous pressure drop after hypovolemic phlebotomy is a strong independent predictor of intraoperative blood loss during liver resection

Lerut P, Nuytens F, D’Hondt M. Annals of Surgical Oncology, 2016,Dec;23(Suppl 5),885

Ryckx A, Christiaens C, Clarysse M, Vansteenkiste F, Steelant PJ, Sergeant G, Parmentier I, Pottel H, D’Hondt M. Annals of Surgical Oncolcology,2016,24(5),1367-1375

INTRODUCTION/BACKGROUND Intraoperative hypovolemic phlebotomy (HP) has been suggested to reduce central venous pressure (CVP) before hepatectomy. This study aimed to analyze the impact of CVP drop after HP on intraoperative blood loss and postoperative renal function.

MATERIALS/METHOD A retrospective review of a prospective database including 100 consecutive patients (43 males and 57 females; mean age, 65 years; range 23-89 years) undergoing liver resection with HP was performed. The primary outcome variable was estimated blood loss (EBL), and the secondary outcome was postoperative serum creatinin (Scr). A multivariate linear regression analysis was performed to identify predictors of intraoperative blood loss.

RESULTS

MATERIALS/METHOD This report describes a combined minimally invasive transdiaphragmatic resection of peripheral colorectal lung metastasis in a patient undergoing a laparoscopic liver resection. General anesthesia was induced with placement of a double-lumen endotracheal tube to achieve single-lung ventilation. Once laparoscopic liver resection was completed, the left lung containing the metastatic lesion was deflated. The left hemidiaphragm was carefully divided using a 10-cm incision around the central tendon to avoid damage to the phrenic nerve. The lung metastasis was localized using intraoperative ultrasound, and the lesion was resected using endoscopic 60-mm vascular staplers. A thoracic tube was placed, and the diaphragm was closed with a running nonabsorbable suture.

CONCLUSION

ABSTRACTBOEK | 2015 2016

OBJECTIVE This video aims to demonstrate the authors’ first experience with this minimally invasive approach.

The median CVP before blood salvage was 8 mmHg (range 4-30 mmHg). The median volume of hypovolemic phlebotomy was 400 ml (range 200-1000 ml). After HP, CVP decreased to a median of 3 mmHg (range -2 to 16 mmHg), resulting in a median CVP drop of 5.5 mmHg (range 2-14 mmHg). The median EBL during liver resection was 165 ml (range 0-800 ml). The median preoperative serum creatinin (Scr) was 0.82 g/dl (range 0.5-1.74 g/dl), and the postoperative Scr on day 1 was 0.74 g/dl (range 0.44-1.68 g/dl). The CVP drop was associated with EBL (P < 0.001). There was no significant impact of CVP drop on postoperative Scr.

A CVP drop after HP is a strong independent predictor of EBL during liver resection. The authors advocate the routine use of HP to reduce perioperative blood loss and transfusion rates in liver surgery. As a predictive tool, CVP drop might help surgeons decide whether a laparoscopic approach is safe.

INTRODUCTION/BACKGROUND The management of patients with simultaneously diagnosed colorectal liver and lung metastases (SLLM) remains controversial. A recent study based on an analysis of the LiverMetSurvey demonstrated that patients with SLLM suitable for resection of all metastases have a survival similar to that of patients who undergo removal of isolated liver metastases. Simultaneous transdiaphragmatic resection of peripheral lung lesions and liver resection by laparotomy has been described previously. To the authors’ knowledge, no previous reports on a similar minimally invasive approach have been published. In April 2015, the authors started performing combined minimally invasive transdiaphragmatic resections of peripheral colorectal lung metastases in patients undergoing laparoscopic liver resections.

RESULTS The operative time was 180 min, and the blood loss was 100 ml. The postoperative course was uneventful. The patient was discharged on postoperative day 4. Pathology confirmed two colorectal metastases. Tumorfree margins of 5 mm for the liver and 7 mm for the lung were achieved.

CONCLUSION

ABSTRACT 4

Simultaneous transdiaphragmatic resection of peripheral lung lesions is feasible for patients undergoing laparoscopic liver resection. The low invasiveness of the described technique could facilitate an aggressive operative approach to SLLM.

Potential sexual function improvement by using transanal mesorectal approach for laparoscopic low rectal cancer excision. Pontallier A, Denost Q, Van Geluwe B, Adam JP, Celerier B, Rullier E. Surgical Endoscopy,2016,Nov;30(11):4924-4933

ABSTRACT 3 Laparoscopic parenchymal preserving hepatic resections in semiprone position for tumors located in the posterosuperior segments. D’Hondt M, Yoshihara E, Vansteenkiste F, Steelant PJ, Van Ooteghem B, Pottel H, Devriendt D, Van Rooy F. Langenbeck's Archives of Surgery, 2016,401(2),255-262

INTRODUCTION/BACKGROUND All patients who underwent laparoscopic liver resections in the posterosuperior segments (LPSS) at our center were positioned in semiprone since August 2011. The aims of this study were to assess differences in perioperative outcomes between laparoscopic left lateral sectionectomies (LLLS) performed in supine position and LPSS in semiprone position.

OBJECTIVE Preliminary results of the transanal approach for low rectal cancer suggest better oncological outcomes than the conventional laparoscopic approach. We currently report the functional results.

MATERIALS/METHOD From 2008 to 2012, 100 patients with low rectal cancer and suitable for sphincter-saving resection were randomized between transanal and laparoscopic low rectal dissection. Patients derived from this randomized trial were enrolled for functional assessment. End points were bowel function (LARS bowel and Wexner continence scores) and urogenital function (IPSS, IIEF-5 and FSFI-6 scores) obtained by questionnaires sent to patients with a follow-up more than 12 months.

MATERIALS/METHOD

RESULTS

We reviewed our prospectively collected database of all liver resections performed between January 2012 and January 2015. LLLS and LPSS were compared with respect to demographics and perioperative outcomes.

Overall, 76 patients were eligible and 72 responded to the questionnaire: 38 in the transanal group and 34 in the laparoscopic group. The bowel function did not differ between the transanal and the laparoscopic groups: LARS 36 versus 37 (p = 0.941) and Wexner 9 versus 10 (p = 0.786). The urologic function was also similar between the two groups: IPSS 5.5 versus 3.5 (p = 0.821). Among sexually active patients before surgery, 20 of 28 (71 %) patients in the transanal group and 9 of 23 (39 %) in the laparoscopic group maintained an activity after surgery (p = 0.02). Erectile function was also better in men after transanal compared to laparoscopic low rectal dissection: IIEF 17 versus 7 (p = 0.119).

RESULTS Forty-five patients underwent LLLS (n = 20) or LPSS (n = 25). There were no differences in patient demographics or tumor diameter (p = 0.946). There were no conversions. Pringle maneuver was not used in both groups. There was no difference in peroperative central venous pressure (p = 0.511). The median operative time in the LLLS group was 100 min (60-260) and 160 min (95-270) in the LPSS group (p = 0.002) with median intraoperative blood loss in the LLLS group of 50 ml (0-550) versus a larger 150 ml (50-700) (p = 0.010) for patients receiving LPSS. No patients required transfusion. Intraoperative and postoperative complication rates were similar in both groups. Median hospital stay was 6 days in both groups (p = 0.554).

CONCLUSION Transanal approach for low rectal cancer did not change bowel and urologic functions compared to the conventional laparoscopic approach. However, there was a trend to a better erectile function with a significantly higher rate of sexual activity in the transanal group.

CONCLUSION LPSS in semiprone can be performed with similar clinical outcomes as a minor laparoscopic liver resection except for longer operative time and larger intraoperative blood loss without the need for transfusion.

ABSTRACT 5 Prospective and longitudinal study of urogenital dysfunction after proctectomy for rectal cancer.

ABDOMINALE CHIRURGIE

Adam JP, Denost Q, Capdepont M, van Geluwe B, Rullier E. Diseases of the Colon & Rectum,2016, Sep;59(9):822-830

ABSTRACT 6 The practice of laparoscopic liver surgery in Belgium: a national survey.

INTRODUCTION/BACKGROUND Urogenital dysfunctions after rectal cancer treatment are well recognized, although incidence and evolution over time are less well known.

Tomassini F, Scuderi V, Berardi G, Dili A, Dâ&#x20AC;&#x2122;Hondt M, Sergeant G, Hubert C, Huysentruyt F, Berrevoet F, Lucidi V, Troisi RI. Acta Chirurgica Belgica,2016,117(1),15-20

OBJECTIVE We aimed to assess the evolution of urogenital functions over time after the treatment for rectal cancer.

MATERIALS/METHOD This is a prospective, longitudinal cohort study. This study was conducted at a quaternary referral center for colorectal surgery. A total of 250 consecutive patients treated for rectal cancer were prospectively enrolled for urogenital assessment. End points were the International Prostatic Symptom Score, the International Index of Erectile Function, and the Female Sexual Index obtained by questionnaires before (baseline status) and after preoperative radiotherapy and 3, 6, and 12 months after surgery.

RESULTS Overall, 169 patients (68%) responded to the questionnaires. The urinary function decreased temporary after irradiation in men (International Prostatic Symptom Score: 7.8 vs 4.9; p < 0.001). Sexual activity decreased significantly in women after radiotherapy (p = 0.02), and in all patients after surgery (p < 0.001). At 12 months, sexual activity in women declined from 59% before treatment to 36% (p = 0.02). In men, sexual activity (82% vs 57%), erectile function (71% vs 24%), and ejaculatory function (78% vs 32%) decreased from baseline (p < 0.001). Stage T3T4 tumors (OR = 5.72 (95% CI, 1.24-26.36)) and low rectal tumors (OR = 17.86 (95% CI, 1.58-20.00)) were independent factors of worse sexual function.

COMMENTS This study was limited by the proportion of uncompleted questionnaires, especially in women, and by its monocentric feature.

INTRODUCTION/BACKGROUND Laparoscopic liver surgery (LLS) gained popularity bringing several advantages including decreased morbidity and reduction of length of hospital stay compared to open.

MATERIALS/METHOD To understand practice and evolution of LLS in Belgium, a 20-questions survey was sent to all members of the Royal Belgian Society for Surgery, the Belgian Section of Hepato-Pancreatic and Biliary Surgery and the Belgian Group for Endoscopic Surgery.

RESULTS Thirty-seven surgical units representing 61 surgeons performing LLS in Belgium responded: 50% from regional hospitals, 28% from university and 22% from peripheral hospitals. Replies from high volume centers (>50 liver-surgery/year) were 19%. More than 25% of liver procedures were performed laparoscopically in 35% of centers. LLS is adopted since more than 15-years in 14.5% of centers with an increasing rate reported in 59%. Low relevance of LLS in the hospital organization (26.5%) and lack of time in surgical schedules (12%) or of specific training (9%) are the main barriers for further diffusion. More than 80% of the responders agreed to participate to a national prospective registry.

CONCLUSION The risk of a definitive stoma after SSR increased twofold between 1 and 10 years after surgery, from 11% to 22%. Ultralow conservative surgery (pISR and tISR) did not increase the risk of definitive stoma compared with conventional CAA or LCRA.

CONCLUSION Most patients experienced sexual dysfunction at 12 months after surgery for rectal cancer, and predictive factors for this dysfunction were related to characteristics of the tumor.

ABSTRACT 7 The risk of definitive stoma formation at 10 years after low and ultralow anterior resection for rectal cancer. Celerier B, Denost Q, Van Geluwe B, Pontallier A, Rullier E. Colorectal Disease,2016,Jan;18(1):59-66

ABSTRACTBOEK | 2015 2016

OBJECTIVE

ABSTRACT 2

The long-term risk of definitive stoma after sphincter-saving resection (SSR) for rectal cancer is underestimated and has never been reported for ultralow conservative surgery. We report the 10-year risk of definitive stoma after SSR for low rectal cancer.

How do I a laparoscopic resection in the posterosuperior segments D'Hondt M. Advanced laparoscopic liver (ALLIVER) masterclass, November 2016 (Ghent, Belgium)

MATERIALS/METHOD From 1994 to 2008, patients with low rectal cancer who were suitable for SSR were analyzed retrospectively. Patients were divided into the following four groups: low colorectal anastomosis (LCRA); coloanal anastomosis (CAA); partial intersphincteric resection (pISR); and total intersphincteric resection (tISR). The end-point was the risk of a definitive stoma according to the type of anastomosis.

RESULTS During the study period, 297 patients had SSR for low rectal cancer. The incidence of definitive stoma increased from 11% at 1 year to 22% at 10 years. The reasons were no closure of the loop ileostomy (4.7%), anastomotic morbidity (6.5%), anal incontinence (8%) and local recurrence (5.2%). The risk of definitive stoma was not influenced by type of surgery: 26% vs 18% vs 18% vs 19% (P = 0.578) for LCRA, CAA, pISR and tISR, respectively. Independent risk factors for definitive stoma were age > 65 years and surgical morbidity.

PRESENTATIES CONGRESSEN

COMMENTS Invited lecture

ABSTRACT 3 Pure laparoscopic liver resections in the posterosuperior segments in semiprone position. Single center experience and analysis of learning curve. D'Hondt M, Yoshihara E, Devriendt D, Van Rooy F, Vansteenkiste F, Parmentier I. 12th World Congress of the International Hepato-Pancreato-Biliary Association (IHPBA), April 2016 (Sao Paulo, Brazil)

INTRODUCTION/BACKGROUND Performing pure laparoscopic liver resections in the posterosuperior segments (LRPSS) remains challenging.

OBJECTIVE We analyzed our experience with laparoscopic resections of tumors in the posterosuperior segments in the semiprone position.

MATERIALS/METHOD Retrospective review of prospectively collected database on operative and postoperative characteristics and surgical outcomes of all patients in whom LRPSS was performed by one surgeon between September 2011 and September 2015.

ABSTRACT 1

RESULTS

Combined minimal invasive transdiaphragmatic resection of peripheral colorectal lung metastases in patients undergoing laparoscopic liver resection. Video presentation â&#x20AC;&#x201C; Competitive video session.

Forty nine patients underwent LRPSS.Median age was 64 years(range 23-82).In total 58 resections were performed in the posterosuperior segments.Seven patients underwent additional resections in other segments.Indication for surgery was mainly colorectal liver metastases (n=31;63.3%).There were 4 postoperative complications (Clavien Dindo I or II (1 bile leak)).Ninety day mortality was 0.There were 2(4.1%) conversions.Median operative time was 140min(50-260).Median intraoperative blood loss was 150 mL(0-1500) .A Pringle maneuver was never used.Median hospital stay was 7days (3-14).R0 resection rate was 100%.There was no difference in operative

Dâ&#x20AC;&#x2122;Hondt M, Vansteenkiste F, Lerut P. 12th World Congress of the International Hepato-Pancreato-Biliary Association (IHPBA), 20 - 23 April 2016, (Sao Paulo, Brazil) De tekst van het abstract is terug te vinden op pagina 4.

ABDOMINALE CHIRURGIE

times when comparing the first 25 cases with the last 24 cases (130 minutes(IQR 100-140) - first 25 cases;150 minutes(IQR 125-185) - last 24 cases(t = -1.75; p = 0.086)). There was no difference in blood loss when comparing the first 25 cases with the last 24 cases (150 mL(IQR 100350) - first 25 cases;165 mL(IQR 75-300) - last 24 cases(r = -0.20;p = 0.84)).

CONCLUSION LRPSS in semiprone are safe and feasible.Placing the patient in semiprone improves visualization, mobilization, enables this laparoscopic technique to provide safe and effective parenchyma preserving liver resections for lesions in these difficult segments and avoids a steep learning curve

CONCLUSION TLPD seems feasible and safe to perform during the initial learning curve by experienced pancreatobiliary surgeons with advanced laparoscopic skills.

ABSTRACT 5 Update on laparoscopic liver resection for colorectal liver metastases. D'Hondt M. Masterclass Multidisciplinary Management of Colorectal Liver Metastases, May 2016 (Vienna, Austria)

COMMENTS Invited lecture

ABSTRACT 4 Total laparoscopic pancreticoduodenectomy - Initial experience in a Belgian non-academic supraregional hospital. D'Hondt M, Kinget L, Vansteenkiste F. 12th World Congress of the International Hepato-Pancreato-Biliary Association (IHPBA), April 2016 (Sao Paulo, Brazil)

ABSTRACT 6 Video: advantages of articulating sealing device in laparoscopic liver surgery D'Hondt M, Nuytens F, Devriendt D, Vansteenkiste F, Van Rooy F, Yoshihara E. 12th World Congress of the International Hepato-Pancreato-Biliary Association (IHPBA),April 2016 (Sao Paulo, Brazil)

INTRODUCTION/BACKGROUND Total laparoscopic pancreaticoduodenectomy (TLPD) seems to be as safe as openPancreaticoduodenectomy when performed by skilled HPB surgeons. However, technical difficulties still prevent most surgeons from attempting this technique.

INTRODUCTION/BACKGROUND Laparoscopic parenchyma-preserving liver resections can be technically challenging. Recently a new articulating sealing device (Enseal® G2, Ethicon Endo-Surgery Inc., Cincinnati,OH) was introduced. We performed over 40 laparoscopic liver resections using this device.

OBJECTIVE We analyzed our initial experience with TLPD.

OBJECTIVE

MATERIALS/METHOD

The aim of this video is to demonstrate the advantages of this articulating sealing device in laparoscopic liver surgery illustrated by three cases.

We retrospectively analysed a prospectively maintained database of our pancreaticoduodenectomies. Clinicopathological data were reviewed to evaluate surgical outcomes following TLPD.

RESULTS Between January 2012 and September 2015, 24 TLPDs were performed in our unit. Median age was 67 years (range 43-82). Indication for TLPD was pancreatic adenocarcinoma (n = 12), ampullary adenocarcinoma (n=5), distal common bile duct adenocarcinoma (n = 3).

ABSTRACTBOEK | 2015 2016

MATERIALS/METHOD The first patient had a hepatocellular carcinoma in segment IVB. A segment IVB resection was performed using the Enseal®device. The second patient had two colorectal liver metastases: one in segment VI and one in segment VIII.Two metastasectomies with the articulating Enseal®device were performed. The third patient had three colorectal liver metastases in the posterosuperior segments: one in segment VI, one in segment VII near the vena cava and one in segment VIII. All lesions were

resected using the articulating Enseal速device.In case two and three the patient was placed in semiprone position.

RESULTS Total intraoperative blood loss ranged between 50-150 ml.Operating time ranged between 100-180 minutes. Total hospital stay ranged from 3 to 6 days. In all three cases the possibilities of the curved, articulating Enseal速 device are shown. The main advantages are the ability to manoeuver around corners and gain access to tissue in deep and narrow spaces. Furthermore the articulating Enseal速 facilitates a perpendicular approach. Since the introduction of the Enseal速 device we have experienced a reduction in number of trocars used to perform laparoscopic liver resections in the posterosuperior segments as well as reduced intra-operative blood loss.

COMMENTS Video presentation

ANESTHESIE / INTENSIEVE ZORG

CENTRUM

ANESTHESIE / INTENSIEVE ZORG ARTIKELS ABSTRACT 1 Long-term outcome in ICU patients with acute kidney injury treated with renal replacement therapy: a prospective cohort study. De Corte W, Dhondt A, Vanholder R, De Waele J, Decruyenaere J, Vanhalst J, Claus S, Hoste E. Critical Care,2016,Aug 12;20(1):256

OBJECTIVE The aim of this study was to evaluate variables associated with long-term survival and kidney outcome and to assess the composite endpoint major adverse kidney events (MAKE; defined as death, incomplete kidney recovery, or development of end-stage renal disease treated with RRT) in a cohort of ICU patients with AKI-RRT.

Spinazie, krachtvoedsel voor Popeye? Weinig gekende oorzaken van methemoglobinemie aan de hand van een casus

INTRODUCTION/BACKGROUND

MATERIALS/METHOD We conducted a single-center, prospective observational study in a 50-bed ICU tertiary care hospital. During the study period from August 2004 through December 2012, all consecutive adult patients with AKI-RRT were included. Data were prospectively recorded during the patients’ hospital stay and were retrieved from the hospital databases. Data on long-term follow-up were gathered during follow-up consultation or, in the absence of this, by consulting the general physician.

CONCLUSIONS This pilot study demonstrated the association between [TIMP-2]*[IGFBP7] increase and oliguria and may therefore indicate kidney damage during liver surgery. As Scr could not differentiate for these changes, patients did not meet the classical biomarker criteria for AKI.

RESULTS AKI-RRT was reported in 1292 of 23,665 first ICU admissions (5.5 %). Mortality increased from 59.7 % at hospital discharge to 72.1 % at 3 years. A Cox proportional hazards model demonstrated an association of increasing age, severity of illness, and continuous RRT with longterm mortality. Among hospital survivors with reference creatinine measurements, 1-year renal recovery was complete in 48.4 % and incomplete in 32.6 %. Dialysis

ABSTRACTBOEK | 2015 2016

CONCLUSION Our study demonstrates poor long-term survival after AKI-RRT that was determined mainly by severity of illness and RRT modality at initiation of RRT. Renal recovery is limited, especially in patients with acute-on-chronic kidney disease, making nephrological follow-up imperative. MAKE is associated mainly with variables determining mortality.

In intensive care unit (ICU) patients, acute kidney injury treated with renal replacement therapy (AKI-RRT) is associated with adverse outcomes.

dependence was reported in 19.0 % and was associated with age, diabetes, chronic kidney disease (CKD), and oliguria at the time of initiation of RRT. MAKE increased from 83.1 % at hospital discharge to 93.7 % at 3 years. Multivariate regression analysis showed no association of classical determinants of outcome (preexisting CKD, timing of initiation of RRT, and RRT modality) with MAKE at 1 year.

ABSTRACT 2

Carlier L, Van Belleghem V, Deleu F, Desmet M, Vanfleteren L, Carlier S. Tijdschrift voor Geneeskunde,2016,72,856-863

INTRODUCTION/BACKGROUND Een tien maanden oude tweeling met een grauwe kleur, uitgesproken perifere cyanose, gedaald bewustzijn en ernstige dyspneu wordt door de ouders naar de spoedopname gebracht. Een eerste onderzoek toont een gedaalde zuurstofsaturatie op de saturatiemeter. Deze saturatie stijgt niet ondanks toegediende zuurstof. Na verder klinisch en technisch onderzoek blijkt een met hemoglobinemie de onderliggende oorzaak te zijn van deze klachten. Deze is ontstaan na het eten van spinazie. Eén baby heeft sinds enkele dagen diarree. Na toediening van methyleenblauw ontstaat een snelle verbetering van de toestand. Methemoglobinemie kan zowel congenitaal als verworven zijn. Vanwege een linksverschuiving van de hemoglobinedissociatiecurve en een gedaald zuurstoftransport door hemoglobine, ontstaat een desaturatie die niet beantwoordt aan zuurstoftherapie. De omzetting van nitraat naar nitriet speelt hierin een sleutelrol. De diagnose – „blue baby syndrome” door methemoglobinemie – wordt gesteld door de symptomatologie, de chocoladebruine kleur van het arteriële bloed en de bepaling van het methemoglobinegehalte van het arteriële bloed. Methemoglobinemie interfereert met de „dual wave”

pulsoxymetrie, waardoor een dissociatie ontstaat tussen de saturatie gemeten via de saturatiemeter (SpO2) en de arteriĂŤle zuurstofsaturatie gemeten via bloedgas (SaO2), wat ernstige weefselhypoxie kan maskeren.

gastric bypass surgery. A sevoflurane-based protocol can help to avoid disturbing peristalsis.

PRESENTATIES CONGRESSEN ABSTRACT 3 The influence of propofol and sevoflurane on intestinal motility during laparoscopic surgery. Desmet M, Vander Cruyssen P, Pottel H, Carlier S, Devriendt D, Van Rooy F, De Corte W. Acta Anaesthesiol Scand,2016,Mar;60(3),335-342

ABSTRACT 1 The most relevant papers influencing regional anesthesia practice and patient outcome. Desmet M. Belgian Association for Regional Anesthesia, October 2016 (Brussels, Belgium)

INTRODUCTION/BACKGROUND Volatile anaesthetics have an influence on small bowel peristalsis during laparoscopic surgery. A recent study concluded that desflurane increased intestinal motility compared to sevoflurane. Hence, a desflurane-based anaesthesia protocol may reduce surgical exposure during intestinal suturing or stapling due to small bowel hyperperistalsis. The effect of propofol on intestinal motility is not well studied.

Er is geen abstract beschikbaar van deze presentatie.

OBJECTIVE

Desmet M. New York School of Regional Anesthesia, October 2016 (New York, USA)

We tested the hypothesis that a propofol-remifentanil anaesthesia increases intestinal contractions in comparison with a sevoflurane-remifentanil anaesthesia.

ABSTRACT 2 The truth about the value of additives for local anesthetics. Fascia iliaca, TAP and quadratus lumborum blocks demystified: clinical utility and techniques. Workshop instructor

Er is geen abstract beschikbaar van deze presentatie.

MATERIALS/METHOD Patients scheduled for laparoscopic gastric bypass surgery were randomized in this single blind randomized controlled trial to receive remifentanil combined with sevoflurane or propofol (ISRCTN 12921661). Bispectral index monitoring was used to guide depth of anaesthesia. Visual observation of peristaltic waves was performed during 1 min at the planned site of the jejunostomy. Statistical analysis was performed using Wilcoxon two-sample test.

RESULTS After obtaining written informed consent 50 patients were included. Groups were similar for demographic variables, and depth of anaesthesia during the observations. The median number of peristaltic waves was lower in the sevoflurane-remifentanil group compared to the propofol-remifentanil group (0 vs. 6, P < 0.001).

CONCLUSION Propofol-remifentanil increases intestinal motility compared to sevoflurane-remifentanil during laparoscopic

ABSTRACT 3 Shunting during carotid endarterectomy: is it safe? Lessons learned from diffusion-weighted magnetic resonance imaging! Lerut P, Wybaillie E, Ceuppens H, De Smul G, Wallaert P, Pottel H, Seynaeve P. April 2016,65th international congress of the European Society of Cardio Vascular Surgery (ESCVS),Belgrade (Serbia)

INTRODUCTION/BACKGROUND The use of a shunt during carotid endarterectomy (CEA) remains controversial. Assessment of shunting should be based on measuring cerebral ischemia. In the last years, diffusion-weighted magnetic resonance imaging (DWI) is increasingly used to identify cerebral ischemia. In this study, we want to assess the role of shunting in the occurrence of cerebral embolization during CEA, as detected by DWI.

ANESTHESIE / INTENSIEVE ZORG

MATERIALS/METHOD 366 CEA procedures, with a policy of selective shunting, were included in this retrospective cohort study for a period of 7 years. Two medical databases were reviewed to collect data on shunt use, perioperative neurological events and postoperative DWI. The primary outcome measure was the incidence of an emboligenic ischemic DWI lesion ipsilateral to the side of surgery. The incidence of these DWI lesions was compared between the shunting and the nonshunting group. A subgroup analysis was performed to differentiate between asymptomatic and symptomatic carotid stenosis.

RESULTS Shunt use was similar in both asymptomatic and symptomatic carotid stenosis group (21.8% vs. 26.2%, respectively; p=0.38). The overall incidence of emboligenic DWI lesions is 8.7% (32/366). In the non-shunting group (n=280), a 7.1% incidence is reported, whereas in the shunting group (n=86), a 14.0% incidence is seen (borderline non-significant difference;p=0.08). In the asymptomatic carotid stenosis group, there were significantly more emboligenic DWI lesions when a shunt was used, compared to when no shunt was used (16.3% vs. 5.7% incidence, respectively; p=0.03). In the symptomatic carotid stenosis group, no difference in incidence of emboligenic DWI lesions was found when a shunt was used or not (10.8% vs. 9.6%; p=0.76). Only one patient with an emboligenic DWI lesion presented with a stroke; all other lesions were clinically silent (31/32;97%).

CONCLUSION There is a tendency for higher incidence of emboligenic DWI lesions when using a shunt during CEA. Subgroup analysis for the asymptomatic carotid stenosis group shows a statistically significant higher incidence of emboligenic DWI lesions when a shunt was used, compared to when no shunt was used. Most of these emboligenic DWI lesions are clinically silent. The clinical relevance of cerebral embolization during CEA is still under debate. Therefore, the use of a shunt during CEA must be carefully considered especially in asymptomatic patients.

ABSTRACTBOEK | 2015 2016

CENTRUM

CARDIOLOGIE ARTIKELS ABSTRACT 1 A preclinical study of an implanted device in the pulmonary veins, intended for the treatment of atrial fibrillation in an ovine model. Vandecasteele T, Boussy T, Philpott M, Clement E, Schauvliege S, Van Den Broeck W, Van Loon G, Cornillie P, Van Langenhove G. Pacing and Clinical Electrophysiology, 2016,Aug;39(8):,822-829

INTRODUCTION/BACKGROUND Atrial fibrillation is the most frequent arrhythmia in adults of which the interventional cure is hampered by high recurrence rates. Recurrence after ablation is due to an incomplete isolation of the pulmonary veins. A new ablation technique was performed, in the antra of ovine pulmonary veins, by device implantation, which was heated through a wireless heat-generating system.

MATERIALS/METHOD Implants were placed transatrially in the pulmonary veins of sheep. Using a wireless heating system, the energy was afterward transferred through wires to the implanted device according to a defined protocol. The position of the implant and the applied lesions were macroscopically evaluated. Samples of the ablated tissue of the atriopulmonary vein junction were histologically and immunohistochemically examined.

CONCLUSION Six ablation procedures in four sheep were successfully performed without adverse cardiac reactions. Implantation of the device and the wireless heat generation was feasible. Sufficient heat was produced at the level of the antra of the pulmonary veins to create ablation lesions, which were histologically and immunohistochemically confirmed.

INTRODUCTION/BACKGROUND Although bioresorbable scaffolds offer potential advantages compared to metallic drug-eluting stents in the treatment of complex coronary bifurcation lesions, there are concerns that the polymeric scaffold integrity may be compromised. This in vivo study sought to provide insights about the feasibility of performing complex bifurcation stenting with Absorb bioresorbable vascular scaffolds (Abbott Vascular, Santa Clara, CA).

MATERIALS/METHOD Twenty New Zealand white rabbits underwent stenting of the nondiseased aortoiliac bifurcation with bioresorbable vascular scaffolds using provisional (PS, n=5), culotte (n=5), modified-T (n=5), or T-and protrusion (n=5) stenting techniques. Angiography, optical coherence tomography, and microcomputed tomography were performed. Angiographic results were excellent without evidence of dissection or side branch (SB) compromise. PS optimally opened the SB ostium without deforming the main vessel (MV) bioresorbable vascular scaffolds, avoiding malapposition, and revealing a single connector fracture in 1 of 5 cases on microcomputed tomography. Culotte stenting resulted in complete bifurcation coverage with extensive segments of double-layered struts and inappropriately apposed struts at the bifurcation level in 3 of 5 cases. On microcomputed tomography, there was MV and SB scaffold distortion at the bifurcation with single strut fractures in 4 of 5 and double fractures in 1 of 5. Modified-T and T-and protrusion resulted in complete bifurcation coverage and in minimal double-strut layers at the neocarina. On microcomputed tomography, no strut fractures were present after modified-T, whereas in 3 of 5 T-and protrusion procedures single strut fractures were noted.

CONCLUSION Bifurcation stenting using bioresorbable vascular scaffolds is feasible with excellent angiographic results. PS with additional T-and protrusion whenever needed seems a reasonable approach. Whenever a 2-stent technique is planned, modified T-stenting appears the most promising.

ABSTRACT 2 Absorb bioresorbable vascular scaffold in complex coronary bifurcation interventions: insights from an in vivo multimodality imaging study. Bennett J, Vanhaverbeke M, Vanden Driessche N, Adriaenssens T, Hiltrop N, Desmet W, Sinnaeve P, Dubois C. Circulation. Cardiovascular Interventions, 2016, ug;9(8),pii: e003849

ABSTRACT 3 Aortic regurgitation after TAVR: from bad to worse Hiltrop N, Adriaenssens T, Herijgers P, Dubois C. The Journal of Heart Valve Disease, 2016,Mar;25(2),182-184

CARDIOLOGIE

SUMMARY Transcatheter aortic valve replacement (TAVR) is a valuable alternative in surgical high-risk patients with symptomatic aortic valve stenosis. Here, the case is presented of very early transcatheter heart valve degeneration, probably caused by a ‘Venturi effect’ of a severe paravalvular regurgitant jet. This ultimately led to a leaflet being in the open position, creating severe valvular regurgitation that necessitated classical surgical revision. The occurrence of paravalvular regurgitation, and its known relationship with an adverse prognosis after TAVR, demonstrates the clear need for innovative alterations in valve design to prevent this complication.

ABSTRACT 4 Cancer in the left anterior descending artery: a therapeutic aspect of ahrombus aspiration? Dauwe D, Hiltrop N, Schurmans W, Moerman P, Bogaert J, Janssens S, Coosemans M. A Journal of the American College of Cardiology: Cardiovascular Interventions,2016,9(3),297-298

SUMMARY A 49-year-old male was admitted for surgical resection of a solitary pulmonary metastasis. A mixed germ cell testis tumor (mature teratoma and seminoma) was diagnosed 1 year before and treated with orchidectomy and adjuvant chemotherapy. Surgical resection of regional retroperitoneal disease progression during follow-up demonstrated transformation into high-grade sarcoma. Four days after lung surgery, he experienced chest pain. An electrocardiogram showed anteroseptal ST-segment elevation. Transthoracic echocardiography confirmed anteroseptal hypocontractility and revealed a large mobile left ventricular mass (Figure 1C, Online Video 1). Urgent coronary angiography demonstrated an occluded proximal left anterior descending coronary artery (Figure 1A). Evacuation of solid tissue during thrombus aspiration restored coronary perfusion with symptom relief and STsegment normalization (Figure 1B). Histopathology of the thrombus identified a high-grade sarcoma ex teratoma, suggesting embolization from an intracardiac metastasis (Figures 1D to 1G). The patient deceased shortly after due to therapy-resistant cerebral edema and intracranial compression attributable to 2 new brain metastases.

ABSTRACTBOEK | 2015 2016

Fitzmaurice DA, Accetta G, Haas S, Kayani G, Lucas Luciardi H, Misselwitz F, Pieper K, Ten Cate H, Turpie AG, Kakkar AK, Boussy T, GARFIELD-AF Investigators. British Journal of Haematology,2016,Aug;174(4),610-623

INTRODUCTION/BACKGROUND Vitamin K antagonist (VKA) therapy for stroke prevention in atrial fibrillation (AF) requires monitoring of the international normalized ratio (INR). We evaluated the agreement between two INR audit parameters, frequency in range (FIR) and proportion of time in the therapeutic range (TTR), using data from a global population of patients with newly diagnosed non-valvular AF, the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF). Among 17 168 patients with 1-year follow-up data available at the time of the analysis, 8445 received VKA therapy (±antiplatelet therapy) at enrolment, and of these patients, 5066 with ≥3 INR readings and for whom both FIR and TTR could be calculated were included in the analysis. In total, 70 905 INRs were analysed. At the patient level, TTR showed higher values than FIR (mean, 56·0% vs 49·8%; median, 59·7% vs 50·0%). Although patient-level FIR and TTR values were highly correlated (Pearson correlation coefficient [95% confidence interval; CI], 0·860 [0·852-0·867]), estimates from individuals showed widespread disagreement and variability (Lin's concordance coefficient [95% CI], 0·829 [0·821-0·837]). The difference between FIR and TTR explained 17·4% of the total variability of measurements. These results suggest that FIR and TTR are not equivalent and cannot be used interchangeably.

ABSTRACT 6 Intraluminal scaffold dismantling: the downside of positive remodeling? Bennett J, Hiltrop N, Triantafyllis A, Adriaenssens T, Desmet W, Sinnaeve P, Dubois C. Journal of the American College of Cardiology,2016,Jun 7;67(22),2702-4. Er is geen abstract beschikbaar van deze presentatie.

ABSTRACT 7

ABSTRACT 5

Late neoatherosclerotic scaffold failure: an unexpected achilles heel for current bioresorbable scaffold technology?

Comparison of international normalized ratio audit parameters in patients enrolled in GARFIELD-AF and treated with vitamin K antagonists.

Hiltrop N, Jorge C, Bennett J, Adriaenssens T. International journal of cardiology,2016,Nov 15;223,133-135

Er is geen abstract beschikbaar van deze presentatie.

ABSTRACT8 Lipemia and acute coronary syndrome: when color enlightens the truth. Triantafyllis AS, Hiltrop N, Bennett J. Hippokratia,2016,Apr-Jun;20(2),173

SUMMARY Hypertriglyceridaemia is a well-known cause of acute pancreatitis which can subsequently cause severe myocardial injury through a variety of mechanisms. Lipemia, manifesting as a turbid orange blood color, is a useful clinical sign of triglycerides accumulation. A 48-year-old man presented to the emergency department with a 3-day history of intermittent episodes of epigastric pain and nausea, and one day history of diarrhea and dyspnea. His medical history included untreated dyslipidemia due to statin-induced myopathy, alcohol abuse and obesity. Physical examination revealed abdominal tenderness. His blood pressure was 170/100 mmHg and body temperature 38 °C. A 12-lead electrocardiogram (ECG) showed ST elevation in leads V2-V3-V4. Venous blood sample noted elevated levels of highsensitive troponine T (hsT) (0.114 Ųg/L; normal: ≤0.013 Ųg/L) and C-Reactive protein (200 mg/L, normal: ≤5 mg/L) but the most astounding finding was its turbid orange coloring and the extremely high levels of triglycerides (12.076 mg/dl, normal: ≤150 mg/dl). The patient underwent an urgent coronary angiography which revealed a severe thrombotic stenosis of the proximal left anterior descending artery (LAD) and an abdominal computed tomography (CT) scan which demonstrated pancreatic edema and peripancreatic fluid. ECG, laboratory and angiography findings implied an acute coronary syndrome while his clinical presentation and CT findings confirmed acute pancreatitis. An everolimus-eluting stent was implanted in the proximal LAD and patient was started on aspirin, ticagrelor, ezetimibe, and fenofibrate. Plasmapheresis was successfully performed acutely lowering the triglycerides to 740 mg/dl. Hospital course was complicated by acute kidney failure requiring hemodialysis. Renal function and lipidemic profile improved gradually, and the patient was discharged in good condition. At 12 months follow-up, he was asymptomatic with normal lipids. The turbid orange blood color is indicative of lipemia, caused by triglycerides accumulation. Hypertriglyceridaemia is a well-established cause of acute pancreatitis. Mechanisms of myocardial injury during acute pancreatitis, include

hypovolemia, metabolic disorders, prothrombotic derangement and systematic inflammatory response syndrome (SIRS). Inflammatory cytokines hold a key role in the pathogenesis of acute pancreatitis related SIRS and coronary plaque destabilization as well. Therefore, acute hypertriglyceridaemic pancreatitis probably triggered the awakening of a pre-existing coronary plaque leading to acute coronary syndrome. However, physicians should be aware that possible ECG abnormalities and hsT leak may accompany acute pancreatitis without being diagnostic of coronary artery disease.

ABSTRACT 9 Optical coherence tomography-based assessment of bifurcation stenting using the Axxess Biolimus A9ªeluting stent system. Hiltrop N, Ughi GJ, Dubois C, Adriaenssens T. EuroIntervention,2016,11(9),1027 Er is geen abstract beschikbaar van deze presentatie.

ABSTRACT 10 Unusual stent fracture: diagnosis with optical coherence tomography. Bennett J, De Cock D, Hiltrop N, Adriaenssens T. Journal of Cardiovascular Medicine,2016,17,Suppl 2:e231e232. We report an unusual case of new-generation drugeluting stent fracture, diagnosed and managed with aid of optical coherence tomography.

ABSTRACT 11 XANTUS: a real-world, prospective, observational study of patients treated with rivaroxaban for stroke prevention in atrial fibrillation. Camm AJ, Amarenco P, Haas S, Hess S, Kirchhof P, Kuhls S, van Eickels M, Turpie AG, Boussy T, XANTUS Investigators. European Heart Journal,2016,Apr 7;37(14),1145-1153

INTRODUCTION/BACKGROUND Although non-vitamin K antagonist oral anticoagulants are recommended for stroke prevention in patients with non-valvular atrial fibrillation (NVAF) based on clinical trial results, there is a need for safety and efficacy data from unselected patients in everyday clinical practice. XANTUS investigated the safety and efficacy of the Factor CARDIOLOGIE

Xa inhibitor rivaroxaban in routine clinical use in the NVAF setting.

MATERIALS/METHOD Consecutive consenting patients with NVAF newly started on rivaroxaban were eligible and were followed up at ~3-month intervals for 1 year, or for at least 30 days after permanent discontinuation. All adverse events (AEs) were recorded as AEs or serious AEs; major outcomes (including major bleeding, symptomatic thromboembolic events [stroke, systemic embolism, transient ischaemic attack, and myocardial infarction], and all-cause death) were centrally adjudicated. There were 6784 patients treated with rivaroxaban at 311 centres in Europe, Israel, and Canada. Mean patient age was 71.5 years (range 1999), 41% were female, and 9.4% had documented severe or moderate renal impairment (creatinine clearance <50 mL/min). The mean CHADS2 and CHA2DS2-VASc scores were 2.0 and 3.4, respectively; 859 (12.7%) patients had a CHA2DS2-VASc score of 0 or 1. The mean treatment duration was 329 days. Treatment-emergent major bleeding occurred in 128 patients (2.1 events per 100 patientyears), 118 (1.9 events per 100 patient-years) died, and 43 (0.7 events per 100 patient-years) suffered a stroke.

CONCLUSION XANTUS is the first international, prospective, observational study to describe the use of rivaroxaban in a broad NVAF patient population. Rates of stroke and major bleeding were low in patients receiving rivaroxaban in routine clinical practice.

ABSTRACTBOEK | 2016

CENTRUM

ENDOCRINO-DIABETOLOGIE

ARTIKELS ABSTRACT 1 False-positive axillary lymph nodes due to silicone adenitis on (18)F-FDG PET/CT in an oncological setting D'hulst L, Nicolaij D, Beels L,Gheysens O, Alaerts H, Van de Wiele C, Maes A. Journal of Thoracic Oncology,2016,juni 11() :e73-75

SUMMARY The case of a 49-year-old transgender individual with a history of bilateral silicone breast implants and a right lung mass proven by biopsy to be a non-small cell lung cancer is presented. In addition to the primary malignancy, a positron emission tomography/computed tomography scan showed contralateral hypermetabolic adenopathy in the left axilla that was suggestive of nodal metastatic disease. Additional imaging and histological examination of the lymph nodes indicated silicone breast implant leakage and silicone adenitis as the underlying cause of the hypermetabolic axillary lymph node.

ENDOCRINO-DIABETOLOGIE

CENTRUM

GYNAECOLOGIE / VERLOSKUNDE ARTIKELS

can be reassured, but correct counseling and intensive neurosonographic follow-up remains important.

ABSTRACT 1 Congenitally infected CMV fetuses following first trimester maternal infection: neonatal and short- term outcome Vanwinkel S, De Keersmaecker B., Devlieger R, Naulaers G, De Catte L. The Journal of Maternal-Fetal & Neonatal Medicine, 2016,29(S1),125

ABSTRACT 2 Intracranial hemorrhage in the fetal brain. Prenatal diagnosis of 19 cases. De Keersmaecker B, Aertsen M, Jansen K, Naulaers G, De Catte L. Ultrasound in Obstetrics & Gynecology,2016,D ec;48(6):809-816

INTRODUCTION/BACKGROUND To document the course of neonatal and short-term outcome in infants of patients with first trimester primary CMV seroconversion and subsequent amniocentesis. The primary goal was to assess the residual risk of adverse outcome in pregnancies with negative amniocentesis for CMV.

MATERIALS/METHOD We conducted a retrospective cohort study on all primary CMV seroconversions discovered in pregnancy from November 2006 to July 2015. Pregnancies were included in cases of seroconversion before 14 weeks of gestation and if subsequent amniocentesis for PCR CMV occurred after 21 weeks of gestation. To retrieve the neonatal and short-term infant outcome, a questionnaire was sent to the patients and the referring physicians. Primary focus was on the auditive, visual, neuromotor and cognitive impairment. The study was approved by the ethical board.

RESULTS The study group included 198 pregnancies. In 44 cases amniocentesis revealed a positive PCR for CMV (early infected group), in 7 cases amniocentesis was negative and neonatal CMV screening appeared positive (late infected group) and 147 children were not CMV infected (control group). CMV infected children appeared significantly more frequently symptomatic at birth. In later life, the prevalence of hearing impairment (12,2%), visual impairment (14,6%), motor deficit (24,4%) and behavioral problems (7,3%) was significantly higher in the early infected group. No late CMV infected children showed short-term symptoms.

CONCLUSION Late CMV infected children present mild clinical symptoms at birth. From our results, we conclude that late infected children show significantly less sequelae, although mild audiological, visual en neurodevelopmental sequelae are described in the literature. When amniocentesis after maternal primary CMV infection appears negative, mothers 18

ABSTRACTBOEK | 2016

OBJECTIVE To review the sonographic and MR presentation of ICH. To determine the prognostic criteria and the outcome of this heterogenous condition.

MATERIALS/METHOD Retrospective review of all cases of ICH antenatally diagnosed from 2008 to 2015. ICH was classified according to the location; intraventricular bleeding was subdivided into type I to IV as in the neonate.

RESULTS From 2008 to 2015 in total 19 cases of fetal ICH including 3 subdural hematoma and 16 intracerebral hemorrhages were detected of which 3,1,4 and 6 cases were Grade I, II,III and IV respectively (2 unclassified). Mean gestational agent diagnosis was 29 5/7 weeks (SD: 4,59). In 12/16 cases ventriculomegaly was the most common early ultrasound finding. Of the 3 cases of subdural bleeding, 2 underwent TOP and 1 child died D5. In one pregnancy factor 8 and factor 5 concentrations were too low. The second case suffered from a coagulation disorder. In the last case two different factor V gen mutations were found in the parents. 2 cases of IVH Gr I were associated MCDA twinning and TTTS, and the third case with cCMV infection. All these children developed normally postnatally. The Gr II VH was caused by a vascular malformation. In the 4 cases of Gr III bleeding severe bilateral ventriculomegaly was diagnosed. One child with a bleeding in the basal ganglia presents with a speech delay at the age of 20 months. the second one has a left hemiplegia at the age of 7 and 2 children develop normally. TOP was performed in 5/6 Gr IV cases, the remaining died D9. A plausible cause was found in 10/19 cases. In 15/19 fetuses fetal MRI was performed and confirmed the sonographic diagnosis and the extent of the lesion without adding information changing perinatal outcome.

CONCLUSION Diagnosis of ICH is usually made late in second/ third

trimester. Prenatal investigation occasionally reveals the etiology, except for subdural hematoma all of which were related to coagulation disorders. MRI allows evaluation of the entire cerebral parenchyma although it did not add information to the prenatal ultrasound.

CONCLUSION Our findings broaden the spectrum of phenotypes caused by CEP120 mutations that account for nearly 1% of patients with JS as well as for more complex ciliopathy phenotypes. The lack of clear genotype-phenotype correlation highlights the relevance of comprehensive genetic analyses in the diagnostics of ciliopathies.

ABSTRACT 3 Mutations in CEP120 cause Joubert syndrome as well as complex ciliopathy phenotypes. Roosing S, Romani M, Isrie M, Rosti RO, Micalizzi A, Musaev D, Mazza T, Al-Gazali L, Altunoglu U, Boltshauser E, D'Arrigo S, De Keersmaecker B, Kayserili H, Brandenberger S, Kraoua I, Mark PR, McKanna T, Van Keirsbilck J, Moerman P, Poretti A, Puri R, Van Esch H, Gleeson JG, Valente EM. Journal of Medical Genetics, 2016 Sep;53(9):608-615.

INTRODUCTION/BACKGROUND Ciliopathies are an extensive group of autosomal recessive or X-linked disorders with considerable genetic and clinical overlap, which collectively share multiple organ involvement and may result in lethal or viable phenotypes. In large numbers of cases the genetic defect remains yet to be determined. The aim of this study is to describe the mutational frequency and phenotypic spectrum of the CEP120 gene.

MATERIALS/METHOD Exome sequencing was performed in 145 patients with Joubert syndrome (JS), including 15 children with oralfacial-digital syndrome type VI (OFDVI) and 21 Meckel syndrome (MKS) fetuses. Moreover, exome sequencing was performed in one fetus with tectocerebellar dysraphia with occipital encephalocele (TCDOE), molar tooth sign and additional skeletal abnormalities. As a parallel study, 346 probands with a phenotype consistent with JS or related ciliopathies underwent next-generation sequencing-based targeted sequencing of 120 previously described and candidate ciliopathy genes.

RESULTS We present six probands carrying nine distinct mutations (of which eight are novel) in the CEP120 gene, previously found mutated only in Jeune asphyxiating thoracic dystrophy (JATD). The CEP120-associated phenotype ranges from mild classical JS in four patients to more severe conditions in two fetuses, with overlapping features of distinct ciliopathies that include TCDOE, MKS, JATD and OFD syndromes. No obvious correlation is evident between the type or location of identified mutations and the ciliopathy phenotype.

ABSTRACT 4 Sonographic detection of central nervous system defects in the first trimester of pregnancy. Engels AC, Joyeux L, Brantner C, De Keersmaecker B, De Catte L, Baud D, Deprest J, Van Mieghem T. Prenatal diagnosis, 2016, Mar;36(3):266-273.

SUMMARY The fetal central nervous system can already be examined in the first trimester of pregnancy. Acrania, alobar holoprosencephaly, cephaloceles, and spina bifida can confidently be diagnosed at that stage and should actively be looked for in every fetus undergoing firsttrimester ultrasound. For some other conditions, such as vermian anomalies and agenesis of the corpus callosum, markers have been identified, but the diagnosis can only be confirmed in the second trimester of gestation. For these conditions, data on sensitivity and more importantly specificity and false positives are lacking, and one should therefore be aware not to falsely reassure or scare expecting parents based on first-trimester findings. This review summarizes the current knowledge of firsttrimester neurosonography in the normal and abnormal fetus and gives an overview of which diseases can be diagnosed.

ABSTRACT 5 Subependymal cysts in the fetal brain: prenatal diagnosis of 12 cases. De Keersmaecker B, Aertsen M, Jansen K, Naulaers G, De Catte L. Ultrasound in Obstetrics and Gynecology,2016, Dec;48(6):809-816.

OBJECTIVE To determine from our own series of 12 fetuses the sonographic criteria for the diagnosis of ependymal cyst, the role of MRI, the clinical implications and the outcome of this condition.

GYNEACOLOGIE / VERLOSKUNDE

MATERIALS/METHOD

PRESENTATIES CONGRESSEN

Retrospective review of all cases of antenatally diagnosed subependymal cysts from 2007 to 2015. Ultrasound was performed with GE Voluson 8. All cases were offered MRI. Our cases were divided in 2 groups : isolated cysts and subependymal cysts associated with other cerebral disorders.

Intracranial hemorrhage in the fetal brain. Prenatal diagnosis of 19 cases

RESULTS Mean gestational age was 28 4/7 weeks. (SD : 4,16) We found 2 cases of isolated subependymal cysts. No associated anomalies were revealed at consecutive ultrasound follow-up and fetal MRI. Infection was ruled out in both patients. 7 patients had a primary seroconversion of CMV in the first trimester of pregnancy. In 6/7 patients the fetal MRI confirmed the ultrasound diagnosis. In 3 patients a termination of pregnancy was performed. One pregnancy is still ongoing. One child had a normal neurological examination at the age of one. The remaining patient declined MRI and was lost for follow-up. In 2 patients multiple subependymal cysts were associated with progressive ventriculomegaly. Both children died; one child died at day 5 postnatally (mitochondrial disease); the other patient died at the age of 8 months with the diagnosis of respiratory lung chain deficiency. In a dichorionic diamniotic twin pregnancy a subependymal cyst in the frontoparietal and temporal region led to a selective feticide at 31 weeks of gestation. Investigation revealed molybdeen cofactor deficiency.

CONCLUSION Subependymal cysts are mainly diagnosed in the second and third trimesters of pregnancy. Fetal MRI efficiently rules out associated brain anomalies. Isolated subependymal cysts seems to have better prognosis. Often small subependymal cysts are cCMV related. Subsequential ultrasound follow-up monitors the number and growth of the cysts and the development of other brain lesions. Large and multiple subependymal cysts show more adverse outcome.

ABSTRACTBOEK | 2016

ABSTRACT 1

De Keersmaecker B, Aertsen M, Jansen K, Naulaers G, De Catte L. 26th World Congress on Ultrasound in Obstetrics and Gynecology, September 2016 (Rome, Italy) De tekst van het abstract is terug te vinden op pagina 18.

ABSTRACT 2 Subependymal cysts in the fetal brain : prenatal diagnosis of 12 cases. De Keersmaecker B, Aertsen M, Jansen K, Naulaers G, De Catte L. 26th World Congress on Ultrasound in Obstetrics and Gynecology, September 2016 (Rome, Italy) De tekst van het abstract is terug te vinden op pagina 19.

ABSTRACT 3 Congenitally infected CMV fetuses following first trimester maternal infection: neonatal and short- term outcome Vanwinkel S, De Keersmaecker B, Devlieger R, Naulaers G, and De Catte L. XXV European congress on perinatal medicine, 15-18 juni 2016 (Maastricht, Nederland) De tekst van het abstract is terug te vinden op pagina 18..

CENTRUM

INWENDIGE ZIEKTEN / GASTRO-ENTEROLOGIE

ARTIKELS

and for MNA versus PFS (p = 0.0007). The ECOG was no longer significant when excluding ECOG ≥ 2 patients.

ABSTRACT 1 AVAPLUS: Impact of geriatric assessment on first-line treatment duration (TD) and progression free survival (PFS) in mCRC patients ≥ 70 years Decoster L, Kenis C, Naessens B, Houbiers G, De Man M, Lambrecht G, Monsaert E, Moons V, Vergauwe P, Prenen H, et al. Annals of Oncology,2016,27,546P

CONCLUSION In older mCRC patients, ECOG is a strong predictive marker for treatment duration and PFS, mainly driven by patients with ECOG ≥ 2. In the large group of patients with ECOG ≤ 1, MNA is a predictive marker for PFS.

ABSTRACT 2 Een ongewone oorzaak van dysfagie

INTRODUCTION/BACKGROUND Geriatric assessments (GA) allow evaluation of individual global health status and treatment optimisation. This real-life study complements the knowledge on chemotherapy (CT) and bevacizumab usage in elderly with mCRC focussing the impact of geriatric screening and GA on TD, PFS and severe toxicity.

MATERIALS/METHOD This study included 252 Belgian mCRC patients ≥ 70 years receiving CT with or without bevacizumab. Eastern Cooperative Oncology Group (ECOG), geriatric screening with G8 and Flemish Triage Risk Screening Tool (fTRST), as well as GA including activities of daily living (ADL), instrumental activities of daily living (IADL), Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Mini Nutritional Assessment (MNA), Charlson Comorbidity Index (CCI), and Mobility-Tiredness Test (Mob-T) was performed in all patients at baseline. For correlations with the different screening and GA components, logrank tests (for TD and PFS), Wilcoxon or Student t-tests (for severe toxicity) and multivariate analyses were used. Additionally, a subgroup analysis excluding patients with ECOG ≥ 2 at baseline was performed.

Bourgeois S, Vergauwe P, D'Heygere F. Tijdschrift voor Geneeskunde,2016,72, nr 4,273-275

SUMMARY A 71-year-old woman with a medical history of a lobular breast carcinoma fourteen years ago treated with a mastectomy, an axillary lymph node dissection and postoperative chemotherapy, consulted with problems of dysphagia. The initial examination was negative. A CT scan of the thorax revealed distension of the esophageal wall. Biopts were taken and the pathological examination revealed metastatic cells of a lobular breast carcinoma. Staging with an FDG-PET-CT scan (fluorodeoxyglucosepositron emission-computed tomography) disclosed pleural and bone metastases. The patient was treated with chemotherapy, but died of neutropenic sepsis a few months later. In patients with a medical history of a lobular breast carcinoma, even years ago, it remains important to include metastasis of a lobular breast carcinoma in the differential diagnosis of new gastrointestinal symptoms.

RESULTS

ABSTRACT 3

Median TD (95% CI) was 5.5m (5.1-6.2) in the total safety population. In univariate analysis, ECOG > 1, which was only 14.6% of patients, and MNA were the only baseline parameters significantly associated with TD (p = 0.0006 and p = 0.0162, respectively), while G8 showed a trend (p = 0.0607). Significant correlations were observed for PFS vs. ECOG (p < 0.0001), MNA (p = 0.0001) and G8 (p = 0.0208) and for severe toxicity vs. ECOG (p < 0.0001) and G8 (p = 0.005). When lowering the G8 cut-off to 12 (i.e. median value), both TD and PFS were significantly associated with G8 (p = 0.0093 and p = 0.0002, respectively). No significant correlation was observed for fTRST. Multivariate analyses show significant correlations for ECOG vs. TD and PFS (p = 0.0047 and p < 0.0001, respectively)

Prospective non-interventional study to collect data on the use of bevacizumab and conventional chemotherapy for the treatment of previously untreated metastatic colorectal cancer in patients ≥70 years Van Cutsem E, Decoster L, Houbiers G, Naessens B, De Man M, Lambrecht G, Monsaert E, Moons V, Vergauwe P, Kenis C, et al. Annals of oncology,2016,27,ii113-ii114

INTRODUCTION/BACKGROUND This observational real life study aims to complement the knowledge on chemotherapy and bevacizumab usage in elderly patients in current practice in Belgium. The impact

INWENDIGE ZIEKTEN / GASTRO-ENTEROLOGIE

of comprehensive geriatric assessments (CGA) on the complex decision process when treating elderly patients with systemic chemotherapy was evaluated.

with previous observations in prospective randomized clinical trials and observational registry studies in the global mCRC population. Results of the CGA will be reported separately.

MATERIALS/METHOD National, multicentre, prospective, non-interventional, post-authorization study. Patients â&#x2030;Ľ 70 years with previous untreated mCRC and considered suitable to receive chemotherapy with or without bevacizumab were eligible for inclusion. Dosing and treatment were at the discretion of the investigator and in accordance with labelling. Primary objective was to observe in clinical practice the treatment duration in elderly patients with bevacizumab containing first-line chemotherapy for mCRC. Treatment duration with first line conventional chemotherapy, safety of bevacizumab in elderly, PFS and correlation with CGA scores were secondary objectives. In this observational study PFS assessments were not carried out at protocol pre-specified fixed intervals and were not independently assessed.

ABSTRACT 4 Wat vage buikpijn kan verbergen Vulsteke J, De Somer T, Derthoo D, D'Heygere F. Tijdschrift voor Geneeskunde,2016,72, nr. 13,806-809 A 78-year-old man presents to the emergency department complaining about malaise, a reduced appetite and vague abdominal pain since four weeks. A CT scan of the abdomen reveals a splenic infarction. Further investigation shows bacterial endocarditis due to Propionibacterium acnes underlying the splenic infarction. The clinical presentation and possible etiology of a splenic infarction and its occurrence with bacterial endocarditis are briefly reviewed.

RESULTS From August 2011 to July 2013 a total of 252 patients in 34 Belgian centres were included in the safety population (SA). The reference population (REF) consists of 250 patients with efficacy data. Median treatment duration, defined as the time between the first, first-line mCRC cancer treatment administration and the last, first line mCRC cancer treatment administration, in the SA population was 6.5 (5.5-7.4) months and 4.8 (3.8-5.5) months (p = 0.0002) in bevacizumab containing and conventional chemotherapy respectively. Median PFS in the REF population was 9.2 (8.0-11.2) and 8.7 (6.9-9.8) months in bevacizumab and conventional chemotherapy respectively (p = 0.2132). Mean (SD) number of days between two visits was 16.55 (9.39) days and 20.83 (17.61) days for bevacizumab and conventional chemotherapy respectively. In 70% of patients study was ended for progressive disease. 87/128 (68%) experienced an AE related to bevacizumab. 3 (2.3%) transient ischemic attacks, 17 (13.3%) venous thrombotic events, 17 (13.3%) patients with hypertension and 2 (1.6%) intestinal perforations were observed with bevacizumab. With conventional chemotherapy, 1 (0.8%) myocardial infarction, 1 (0.8%) cerebral infarction, 9 (7.3%) venous thrombotic events and 10 (8.1%) cases of hypertension were observed.

CONCLUSION In routine clinical practice, the median treatment duration of bevacizumab containing chemotherapy in this population was 6.5 months, in line with the elderly included in the Belgian observational study AVASTART. The observed safety profile of bevacizumab in this setting is consistent 22

ABSTRACTBOEK | 2016

It most commonly presents as left-sided abdominal pain and tenderness, although an asymptomatic presentation is frequent. Bacterial endocarditis and sickle cell anemia are classically associated with a splenic infarction, although other causes are frequent as well. Systemic embolization is common in bacterial endocarditis.

ABSTRACT 5 Unieke focus van koorts Desimpel J, De Bel A, Boudewijns M, Dubrulle F, D'Heygere F. Tijdschrift voor Geneeskunde,2016,72, nr.10,631-634

SUMMARY The medical history of a 30-year-old patient presenting with a fever after therapy with medicinal leeches is described. This treatment had been installed for venous congestion after bilateral breast amputation with reconstruction. Three weeks post-surgery, the patient presented with a fever and a painful breast with redness. A surgical exploration was executed and antibiotics were started. Aeromonas veronii was cultured from the pus and blood. The initial prophylactic therapy with quinolones proved inefficacious because of resistance. A treatment with ceftriaxone was started.

PRESENTATIES CONGRESSEN ABSTRACT 1 546P AVAPLUS : Impact of geriatric assessment on first-line treatment duration (TD) and progression free survival (PFS) in mCRC patients above 70 years. A prospective non-interventional study on the use of bevacizumab and conventional chemotherapy for firstline treatment in Belgian daily clinical practice

associated with G8 (p = 0.0093 and p = 0.0002, respectively). No significant correlation was observed for fTRST. Multivariate analyses show significant correlations for ECOG vs. TD and PFS (p = 0.0047 and p < 0.0001, respectively) and for MNA versus PFS (p = 0.0007). The ECOG was no longer significant when excluding ECOG ≥ 2 patients.

CONCLUSION Decoster L, Kenis C, Naessens B, Houbiers G, De Man M, Lambrecht G, Monsaert E, Moons V, Vergauwe P, Prenen H, Van Cutsem E, Beutels E, Frijns D, Wildiers H. European Society for Medical Oncology, October 2016 (Copenhagen, Denmark)

In older mCRC patients, ECOG is a strong predictive marker for treatment duration and PFS, mainly driven by patients with ECOG ≥ 2. In the large group of patients with ECOG ≤ 1, MNA is a predictive marker for PFS.

INTRODUCTION/BACKGROUND AGeriatric assessments (GA) allow evaluation of individual global health status and treatment optimisation. This real-life study complements the knowledge on chemotherapy (CT) and bevacizumab usage in elderly with mCRC focussing the impact of geriatric screening and GA on TD, PFS and severe toxicity.

RESULTS Median TD (95% CI) was 5.5m (5.1-6.2) in the total safety population. In univariate analysis, ECOG > 1, which was only 14.6% of patients, and MNA were the only baseline parameters significantly associated with TD (p = 0.0006 and p = 0.0162, respectively), while G8 showed a trend (p = 0.0607). Significant correlations were observed for PFS vs. ECOG (p < 0.0001), MNA (p = 0.0001) and G8 (p = 0.0208) and for severe toxicity vs. ECOG (p < 0.0001) and G8 (p = 0.005). When lowering the G8 cut-off to 12 (i.e. median value), both TD and PFS were significantly MEDISCHE BEELDVORMING

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KINDERGENEESKUNDE ARTIKELS ABSTRACT 1 Een tweeling van tien maanden met plotse cyanose Anseeuw S, Oosterlynck C, Dhont E. Tijdschrift voor Geneeskunde,2016, 72 nr 9,582-587

SUMMARY Een tweeling van tien maanden wordt naar de dienst spoedgevallen gebracht wegens gelijktijdig ontstane, plotse cyanose en een gedaald bewustzijn. Ze waren daarvoor niet ziek en hadden enkele uren voor hun aanmelding groentepap met spinazie gegeten. Het klinisch onderzoek was, behalve de opvallend centrale cyanose en de algemeen zieke toestand, verder niet afwijkend. Een veneuze en een arteriële bloedgasanalyse toonde bij beide zussen een methemoglobinemie van respectievelijk 40% en 36.5%. Er werd onmiddellijk methyleenblauw intraveneus toegediend , waarna beide zussen klinisch zeer snel opklaarden.

non-protein-coding RNAs involved in ribosome biogenesis. Here we show that biallelic mutations in the gene SNORD118, encoding the box C/D snoRNA U8, cause the cerebral microangiopathy leukoencephalopathy with calcifications and cysts (LCC), presenting at any age from early childhood to late adulthood. These mutations affect U8 expression, processing and protein binding and thus implicate U8 as essential in cerebral vascular homeostasis.

ABSTRACT 3 EFFECTS: an expanded access program of everolimus for patients with subependymal giant cell astrocytoma associated with tuberous sclerosis complex. Fogarasi A, De Waele L, Bartalini G, Jozwiak S, Laforgia N, Verhelst H, Petrak B, Pedespan JM, Witt O, Castellana R, Crippa S, Gislimberti G, Gyorsok Z. BMC Neurology, 2016 Aug 8;16:126

INTRODUCTION/BACKGROUND Methemoglobinemie is een zeldzame aandoening die vooral jonge kinderen treft. In ontwikkelde landen is de inname van nitraatrijke groenten bij zuigelingen de meest voorkomende oorzaak. Een behandeling met methyleenblauw is doeltreffend. Een snelle herkenning van methemoglobinemie is noodzakelijk gezien het een ernstige, mogelijk levensbedreigende aandoening is. Ouders van jonge zuigelingen moeten ingelicht worden over de risico's van nitraatrijke groenten indien deze niet op de correcte manier worden bereid.

Everolimus, a mammalian target of rapamycin (mTOR) inhibitor, has been shown to be effective and safe in the treatment of subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis complex (TSC). The Everolimus For Fast Expanded aCcess in TSC SEGA (EFFECTS) study was designed to provide everolimus access to patients with SEGA associated with TSC and to mainly assess the safety and also efficacy of everolimus in a real-world setting.

MATERIALS/METHODS ABSTRACT 2 Mutations in SNORD118 cause the cerebral microangiopathy leukoencephalopathy with calcifications and cysts. Jenkinson E, Rodero M, Kasher P, Uggenti C, Oojageer A, Goosey L, Rose Y, Kershaw C, Urquhart J, Williams S, Bhaskar S, O’Sullivan J, Baerlocher G, Haubitz M, Aubert G, Baraño K, Barnicoat A, Battini R, Berger A, Blair E, Brunstrom-Hernandez J, Buckard J, Cassiman D, Caumes R, Cordelli D, De Waele L, et al. Nature Genetics, 2016, Oct;48(10):1185-1192

SUMMARY Although ribosomes are ubiquitous and essential for life, recent data indicate that monogenic causes of ribosomal dysfunction can confer a remarkable degree of specificity in terms of human disease phenotype. Box C/D small nucleolar RNAs (snoRNAs) are evolutionarily conserved 24

ABSTRACTBOEK | 2016

EFFECTS was a phase 3b, open-label, noncomparative, multicenter, expanded access study. Eligible patients were ≥ 3 years of age, with a definite diagnosis of TSC, and with at least one SEGA lesion identified by MRI or CT scan. Patients received once daily everolimus (dose adjusted to attain a trough level of 5-15 ng/mL). Safety evaluation was the primary objective and included collection of adverse events (AEs) and serious AEs, with their severity and relationship to everolimus. Efficacy evaluation, which was the secondary objective, was based on the best overall response as per medical judgment.

RESULTS Of the 120 patients enrolled, 100 (83.3%) completed the study. Median age of patients was 11 years (range, 1-47). Median daily dose of everolimus was 5.82 mg (range, 2.0-11.8). Median duration of exposure was 56.5 weeks (range, 0.3-130). The overall incidence of AEs was 74.2%. Aphthous stomatitis (18 [15.0%]), pyrexia (18 [15.0%]), bronchitis (11 [9.2%]), and stomatitis (10 [8.3%]) were

the most common AEs reported. Overall, 25 patients had grade 3 AEs; most frequent was stomatitis (4 [3.3%]). Grade 4 AEs were reported in three (2.5%) patients. A total of 62 (51.7%) patients had suspected drug-related AEs, of which 15 (12.5%) were of grade 3 or 4. In eight (6.7%) patients, AEs led to drug discontinuation. With regard to efficacy, 81 (67.5%) patients had a partial response, 35 (29.2%) had a stable disease, and one (0.8%) had progressive disease. The response was unknown in three (2.5%) patients.

provement in stem cell transplantations will be achieved methods to noninvasively monitor these cells have been developed and are discussed. In some cases, stem cell monitoring even reached the clinical setting. We anticipate that by further exploring these imaging possibilities and unraveling their in vivo behavior further improvement in stem cell transplantations will be achieved..

CONCLUSION This study confirms the acceptable safety profile of everolimus in patients with SEGA associated with TSC in a real-world setting. The results further support the efficacy of everolimus in the treatment of SEGA associated with TSC. (EudraCT: 2010-022583-13).

ABSTRACT 4 Increased understanding of stem cell behavior in neurodegenerative and neuromuscular disorders by use of noninvasive cell imaging. Holvoet B, De Waele L, Quattrocelli M, Gheysens O, Sampaolesi M, Verfaillie CM, Deroose CM. Stem Cells International, 2016:6235687

SUMMARY Numerous neurodegenerative and neuromuscular disorders are associated with cell-specific depletion in the human body. This imbalance in tissue homeostasis is in healthy individuals repaired by the presence of endogenous stem cells that can replace the lost cell type. However, in most disorders, a genetic origin or limited presence or exhaustion of stem cells impairs correct cell replacement. During the last 30 years, methods to readily isolate and expand stem cells have been developed and this resulted in a major change in the regenerative medicine field as it generates sufficient amount of cells for human transplantation applications. Furthermore, stem cells have been shown to release cytokines with beneficial effects for several diseases. At present however, clinical stem cell transplantations studies are struggling to demonstrate clinical efficacy despite promising preclinical results. Therefore, to allow stem cell therapy to achieve its full potential, more insight in their in vivo behavior has to be achieved. Different methods to noninvasively monitor these cells have been developed and are discussed. In some cases, stem cell monitoring even reached the clinical setting. We anticipate that by further exploring these imaging possibilities and unraveling their in vivo behavior further imKINDERGENEESKUNDE

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MEDISCHE BEELDVORMING ARTIKELS ABSTRACT 1 ADAMTS13-mediated thrombolysis of t-PA-resistant occlusions in ischemic stroke in mice. Denorme F, Langhauser F, Desender L, Vandenbulcke A, Rottensteiner H, Plaimauer B, FranĂ§ois O, Andersson T, Deckmyn H, Scheiflinger F, Kleinschnitz C, Vanhoorelbeke K, De Meyer S. Blood,2016,127(19),2337-2345

SUMMARY Rapid vascular recanalization forms the basis for successful treatment of cerebral ischemia. Currently, tissue plasminogen activator (t-PA) is the only approved thrombolytic drug for ischemic stroke. However, t-PA does not always result in efficient thrombus dissolution and subsequent blood vessel recanalization. To better understand thrombus composition, we analyzed thrombi retrieved from ischemic stroke patients and found a distinct presence of von Willebrand factor (VWF) in various samples. Thrombi contained on average 20.3% Âą 10.1% VWF, and this was inversely correlated with thrombus red blood cell content. We hypothesized that ADAMTS13 can exert a thrombolytic effect in VWF-containing thrombi in the setting of stroke. To test this, we generated occlusive VWF-rich thrombi in the middle cerebral artery (MCA) of mice. Infusion of t-PA did not dissolve these MCA occlusions. Interestingly, administration of ADAMTS13 5 minutes after occlusion dose-dependently dissolved these t-PA-resistant thrombi resulting in fast restoration of MCA patency and consequently reduced cerebral infarct sizes (P < .005). Delayed ADAMTS13 administration 60 minutes after occlusion was still effective but to a lesser extent (P < .05). These data show for the first time a potent thrombolytic activity of ADAMTS13 in the setting of stroke, which might become useful in treatment of acute ischemic stroke.

to zero. A medical HDR display prototype based on two Liquid Crystal layers has been developed. The goal of this study is to evaluate the potential clinical benefit of such display in comparison with a low dynamic range (LDR) display.

MATERIALS/METHOD The study evaluated the clinical performance of the displays in a search and detection task. Eight radiologists read chest x-ray images some of which contained simulated lung nodules. The study used a JAFROC (Jacknife Free Receiver Operating Characteristic) approach for analyzing FROC data. The calculated figure of merit (FoM) is the probability that a lesion is rated higher than all rated nonlesions on all images. Time per case and accuracy for locating the center of the nodules were also compared. The nodules were simulated using Samei's model. 214 CR and DR images [half were "healthy images" (chest nodulefree) and half "diseased images"] were used resulting in a total number of nodules equal to 199 with 25 images with 1 nodule, 51 images with 2 nodules, and 24 images with 3 nodules. A dedicated software interface was designed for visualizing the images for each session. For the JAFROC1 statistical analysis, the study is done per nodule category: all nodules, difficult nodules, and very difficult nodules.

RESULTS For all nodules, the averaged FoMHDR is slightly higher than FoMLDR with 0.09% of difference. For the difficult nodules, the averaged FoMHDR is slightly higher than FoMLDR with 1.38% of difference. The averaged FoMHDR is slightly higher than FoMLDR with 0.71% of difference. For the true positive fraction (TPF), both displays (the HDR and the LDR ones) have similar TPF for all nodules, but looking at difficult and very difficult nodules, there are more TP for the HDR display. The true positive fraction has been also computed in function of the local average luminance around the nodules. For the lowest luminance range, there is more than 30% in favor of the HDR display. For the highest luminance range, there is less than 6% in favor of the LDR display.

ABSTRACT 2 Clinical evaluation of a medical high dynamic range display

CONCLUSION This study shows the potential benefit of using a HDR display in radiology.

Marchessoux C, de Paepe L, Vanovermeire O, Albani L. Medical Physics,2016,Jul;43(7),4023

ABSTRACT 3 INTRODUCTION/BACKGROUND Recent new medical displays do have higher contrast and higher luminance but do not have a High Dynamic Range (HDR). HDR implies a minimum luminance value close

ABSTRACTBOEK | 2016

CT perfusion and angiographic assessment of pial collateral reperfusion in acute ischemic stroke: the CAPRI study

Consoli A, Andersson T, Holmberg A, Verganti L, Saletti A, Vallone S, Zini A, Cerase A, Romano D, Bracco S, Lorenzano S, Fainardi E, Mangiafico S on behalf of the CAPRI Collaborative Group Journal of NeuroInterventional Surgery,2016,8(12)

INTRODUCTION/BACKGROUND The purpose of this study was to evaluate the correlation between a novel angiographic score for collaterals and CT perfusion (CTP) parameters in patients undergoing endovascular treatment for acute ischemic stroke (AIS).

MATERIALS/METHOD 103 patients (mean age 66.7±12.7; 48.5% men) with AIS in the anterior circulation territory, imaged with non-contrast CT, CT angiography, and CTP, admitted within 8 h from symptom onset and treated with any endovascular approach, were retrospectively included in the study. Clinical, neuroradiological data, and all time intervals were collected. Careggi Collateral Score (CCS) was used for angiographic assessment of collaterals and the Alberta Stroke Program Early CT Score (ASPECTS) for semiquantitative analysis of CTP maps. Two centralized core laboratories separately reviewed angiographic data, whereas CT findings were evaluated by an expert neuroradiologist. Univariate and multivariate analysis were performed considering CCS both as an ordinal and a dichotomous variable.

RESULTS 37/103 patients (35.9%) received intravenous tissue plasminogen activator. Median (IQR) ASPECTS was 9 (6–10) for admission CT, 9 (5–10) for cerebral blood volume (CBV) maps, 3 (2–3) for mean transit time maps, 3 (2–4), for cerebral blood flow maps, and 5 (3–7) for CTP mismatch. Univariate analysis showed a significant correlation between CCS and ASPECTS for all CTP parameters. Multivariate analysis confirmed an independent association only between CCS and CBV (p=0.020 when CCS was considered as a dichotomous variable, p=0.026 with ordinal CCS).

ABSTRACT 4 Do refined consensus guidelines improve the uniformity of clinical target volume delineation for rectal cancer? Results of a national review project. Joye I, Macq G, Vaes E, Roels S, Lambrecht M, Pelgrims A, Bussels B, Vancleef A, Stellamans K, Scalliet P, Weytjens R, Christian N, Boulanger AS, Donnay L, Van Brussel S, Moretti L, Van den Bergh L, Van Eycken E, Debucquoy A, Haustermans K. Radiotherapy and Oncology,2016 Aug;120(2):202-6,202206

SUMMARY In a previous national central review project, 74% of the rectal cancer clinical target volumes (CTVs) needed a modification. In a follow-up initiative, we evaluated whether the use of refined international consensus guidelines improves the uniformity of CTV delineation in clinical practice.

ABSTRACT 5 Influence de la réconstruction du ligament radio-dorsal sur la stabilité de l’articulation trapeziometacarpien Stockmans F, Dourthe B, Vanovermeire O, Dezillie M, Vanhaecke J, D’agostino P, Vereecke E, Kerkhof F. Hand Surgery and Rehabilitation,2016,35 (6),453-454

INTRODUCTION/BACKGROUND Biomechanical and anatomical research has shown that the dorsal radial ligament (DRL) is thicker and stiffer than the anterior oblique ligament (AOL). The DRL as the key stabilizing structure of the trapeziometacarpal (TMC) joint has been documented extensively. The aim of the current study is to quantify the influence of a surgical DRL reconstruction on TMC stability in non-traumatic instability patients.

MATERIALS/METHOD CONCLUSION A correlation between angiographic assessment of the collateral circulation and CTP seems to be present, suggesting that CCS may provide an indirect evaluation of the infarct core volume to consider for patient selection in AIS.

Eight patients with symptomatic TMC instability but no radiographic signs of osteoarthritis were recruited and dynamic CT scans of the thumb were made during active abduction-adduction, flexion-extension and two functional grip task using a radiolucent jig. After image acquisition and segmentation, metacarpal translation was expressed relative to the trapezial articular surface. In addition, intersection points and inclination angles of instantaneous helical axes with an anatomically defined

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plane were determined to facilitate motion comparison between subjects. Scans were acquired before and 6–12 months after reconstruction of the DRL.

RESULTS During active motion, there is motion at both the trapeziometacarpal (TMC) and trapezioscaphoid (STT) joints. However, joint motion patterns, defined as changes in helical axis inclination angles during opposition, differ between patients. In most patients, dorsal luxation of the first metacarpal (MC1) could be clearly seen and quantified during the full range of motion, as well as during function grip tasks. Furthermore, dorsal luxation results in higher point loading of TMC cartilage as could be demonstrated by mapping the changes in articular contact area for each active motion. After DRL reconstruction, patients report improvement in pain and subjective stability in the joint. Analyses of the dynamic CT scans demonstrate reduced translation and luxation of MC1 in all patients as well as reduced cartilage point loading.

CONCLUSION

CONCLUSION Our results emphasize that when patients are selected on the basis of angiographic and perfusion imaging, both older patients and patients with wake-up stroke may experience a favorable outcome after mechanical thrombectomy.

ABSTRACT 6

Söderqvist Å, Andersson T, Wahlgren N, Kaijser M. Journal of Stroke and Cerebrovascular Diseases, 2016,25(9),2276-2283

INTRODUCTION/BACKGROUND We have assessed to what extent age, sex, preintervention infarct size, time to groin puncture, and stroke severity are associated with outcome of mechanical thrombectomy in patients treated for acute ischemic stroke.

MATERIALS/METHOD All 192 patients treated with mechanical thrombectomy ABSTRACTBOEK | 2016

RESULTS For patients above 50 years with no neurological symptoms before stroke onset, the proportion gaining independence was unrelated to age group, ranging from 49% to 54%. For patients younger than 50 years of age, the proportion was significantly higher (81%). Patients with wake-up stroke did not differ from other patients with regard to outcome.

After DRL reconstruction, luxation of MC1 was reduced in all patients. We quantified movement in both TMC & STT joint, suggesting that pathologies at the TMC joint could lead to compensatory movements at the more proximal joints or vice versa. Simple DRL reconstruction is an attractive alternative for the more invasive anterior oblique ligament reconstruction described by Eaton, serving the same purpose, stabilizing the CMC joint. Future research should investigate if TMC instability and its altered kinematics lead to secondary joint problems (e.g. osteoarthritis) if left unattended.

Mechanical thrombectomy in acute ischemic strokepatients with wake-up stroke and the elderly may benefit as well.

for acute ischemic stroke from September 2005 to December 2011 were included in this observational study. Main outcomes were independence, defined as a modified Rankin Scale score of 0-2, an improvement in stroke severity score post-thrombectomy, and the occurrence of symptomatic hemorrhage. Exposure variables were sex, age, intravenous thrombolysis, prethrombectomy stroke severity grading, pretreatment infarct size, time from onset of symptoms to groin puncture, thrombectomy device used, and the angiographic result from the thrombectomy.

ABSTRACT 7 MR imaging of the anatomy of the anterior horn of the medial meniscus De Coninck T, Vanrietvelde F, Seynaeve P, Verdonk P and Verstraete K. Acta Radiologica, 58(4),2017,58(4):464-471

INTRODUCTION/BACKGROUND In cadaveric and arthroscopic studies different insertion locations of the anterior horn of the medial meniscus (AHMM) have been described.

OBJECTIVE To investigate if the different insertion locations of the AHMM, as described in cadaveric studies, can be determined on magnetic resonance imaging (MRI).

MATERIALS/METHOD MR images of 100 patients without meniscal tears on MRI were retrospectively evaluated. Two observers classified the AHMM insertion based on its position relative to the anterior tibial edge and the medial tibial spine. The association between AHMM insertion and tibial plateau slope,

meniscal radial displacement, and anterior intermeniscal ligament (AIL) presence was investigated.

RESULTS The AHMM inserted posterior to the anterior tibial edge in 93 knees and anterior to the tibial edge in seven knees (= type III). Of the 93 knees with AHMM insertion posterior to the anterior tibial edge, 63 inserted lateral to the medial tibial spine (= type I) and 30 medial (= type II). The AHMMs inserting anterior to the tibial edge had a significantly (P< 0.05) steeper anterior tibial plateau slope and a significantly (P< 0.05) higher presence of the AIL. No significant difference in radial displacement was observed between the three insertion types (P> 0.05). A strong inter-and intraobserver agreement was observed.

CONCLUSION Three different bony insertion locations of the AHMM, as described in cadaveric studies, could be identified on MRI. All AHMMs inserting anterior to the tibial edge displayed an AIL. Whether there is a clinical correlation with these insertion patterns remains unclear.

ABSTRACT 8 Training guidelines for endovascular ischemic stroke intervention: an international multi-society consensus document. Jansen O, Brouwer P, Andersson T, Meyers PM, et al. Neuroradiology,2016,58 (6),537-541

SUMMARY Ischemic stroke is a leading cause of death and disability worldwide. Much of the long-term disability occurs in patients with Emergent Large Vessel Occlusion (ELVO). In fact, in these patients, occlusion of a major intracerebral artery results in a large area of brain injury often resulting in death or severe disability. Until recently, intravenous tissue plasminogen activator (t-PA) was the only proven treatment for ELVO. However, the landscape of stroke treatment has changed with the publication of five randomized multicenter controlled clincal trials. These trials provide Class 1, Level A evidence that endovascular thrombectomy (ET) is the standard of care for patients with ELVO. In particular, thrombectomy results in significantly better clinical outcomes compared to best medical therapy in patients with acute occlusion of the intracranial internal carotid artery (ICA) and/or M1 segment of the middle cerebral artery (MCA). These results have led to guideline recommendations advocating for endovascular treatment in addition to t-PA for patients with ELVO. In addition, ET is now offered

as first line therapy for patients that are not eligible for intravenous thrombolysis. However, achieving the best possible clinical outcomes with endovascular stroke treatment mandates structured training and education of those physicians who are providing endovascular stroke treatment. In this regard, a recent meta-analysis of these five clinical trials showed that the vast majority of thrombectomies were performed by experienced neurointerventionalists. These include interventional neuroradiologists, endovascular neurosurgeons, and interventional neurologists who routinely perform neuroendovascular procedures [10]. None of the studies allowed physicians without previous experience in mechanical thrombectomy to enroll patients. The centers participating in these trials offered endovascular stroke therapy 24 h a day (with the exception of those in the EXTEND-IA trial) with expertise in vascular neurology and neurocritical care in a comprehensive stroke center. On-site expertise in vascular neurology and neurocritical care is paramount to achieving good clinical outcomes. Geographical limitations to rapid access to acute stroke centers providing mechanical thrombectomy have led some to suggest physicians without prior experience or formal neuroendovascular training should consider providing coverage for these procedures. A multidisciplinary British Intercollegiate Stroke Working Party put forth a document outlining the safe delivery of mechanical thrombectomy, which highlights that operators should not normally carry out procedures with which they are unfamiliar and that they should recognize ad hoc arrangements are not in the best interest of patients. It is also important to recognize that modern endovascular stroke therapy focuses on direct clot removal with mechanical devices, as compared with previous paradigms where intra-arterial thrombolytic infusion was an acceptable treatment option for large vessel occlusions. The technical skills needed to safely deliver devices into the intracranial circulation are significantly more involved than simply placing a catheter for medication infusion. Catheter skills from other circulations do not replace the need for formal training in safe intracranial microcatheter navigation and device placement. Acute ischemic stroke is a complex disease and successful endovascular treatment is based on the comprehensive ability to rapidly integrate multiple pieces of information, including: the patient's history, clinical examination, neuroradiological studies, and to subsequently formulate a treatment plan. Both patient selection and procedural expertise are critical to achieve a good clinical outcome. Hence, there is a clear rationale for formal training in both clinical neuroscience and interventional neuroradiology. The purpose of this document is to define what constitutes adequate training for physicians who can proMEDISCHE BEELDVORMING

vide endovascular treatment for acute ischemic stroke patients. These training guidelines are modeled after prior standards of training documents such as the training, competency and credentialing standards for diagnostic cerebral angiography, carotid stenting and cerebrovascular intervention and the performance and training standards for endovascular ischemic stroke treatment, written and endorsed by multispecialty groups. In addition, the importance of organ specific training, rigorous quality improvement benchmarks, and minimum volume requirements needed to maintain high quality care has been extensively described for acute myocardial infarction, an analogous time sensitive disease.

ABSTRACT9 Treatment of cerebral vasospasm with self-expandable retrievable stents: proof of concept. Bhogal P, Loh Y, Brouwer P, Andersson T, Söderman M. Journal of Neurointerventional Surgery,2016,9 (1),52-59

OBJECTIVE To report our preliminary experience with the use of stent retrievers to cause vasodilation in patients with delayed cerebral vasospasm secondary to subarachnoid hemorrhage.

MATERIALS/METHOD This document represents the cumulative work of the societies listed below, and represents an international consensus on adequate training to safely and effectively perform these procedures: • American Academy of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) • American Society of Neuroradiology (ASNR) • Asian Australasian Federation of Interventional and Therapeutic Neuroradiology (AAFITN) • Australian and New Zealand Society of Neuroradiology - Conjoint Committee for Recognition of Training in Interventional Neuroradiology (CCINTERVENTIONELE NEURORADIOLOGIE) representing the RANZCR (ANZSNR), ANZAN and NSA • Canadian Interventional Neuro Group (CING) • European Society of Neuroradiology (ESNR) • European Society of Minimally Invasive Neurologic Therapy (ESMINT) • Japanese Society for Neuroendovascular therapy (JSNET) • Sociedad Ibero Latino Americana de Neuroradiologica (SILAN) • Society of NeuroInterventional Surgery (SNIS) • Society of Vascular and Interventional Neurology (SVIN) • World Federation of Interventional and Therapeutic • Neuroradiology (WFITN) We, as a group of international multi-disciplinary NeuroInterventional societies involved in the endovascular management of acute ischemic stroke, have put forth these training guidelines. We believe that a neuroscience background, dedicated neurointerventional training, and stringent peer review and quality assurance processes are critical to ensuring the best possible patient outcomes. Well-trained neurointerventionalists are a critical component of an organized and efficient team needed to deliver clinically effective mechanical thrombectomy for acute ischemic stroke patients. 30

ABSTRACTBOEK | 2016

Four patients from two different high volume neurointerventional centers developed cerebral vasospasm following subarachnoid hemorrhage. In addition to standard techniques for the treatment of cerebral vasospasm, we used commercially available stent retrievers (Solitaire and Capture stent retrievers) to treat the vasospastic segment including M2, M1, A2, and A1. We evaluated the safety of this technique, degree of vasodilation, and longevity of the effect.

RESULTS Stent retrievers can be used to safely achieve cerebral vasodilation in the setting of delayed cerebral vasospasm. The effect is long-lasting (>24 hours) and, in our initial experience, carries a low morbidity. We have not experienced any complications using this technique although we have noted that the radial force was not sufficient to cause vasodilation in some instances. The vasospasm did not return in the vessel segments treated with stent angioplasty in any of these cases. In two of our cases stent angioplasty resulted in the reversal of focal neurological symptoms.

CONCLUSION Stent retrievers can provide long-lasting cerebral vasodilation in patients with delayed cerebral vasospasm.

ABSTRACT 10 Clinical outcome after surgical clipping or endovascular coiling for cerebral aneurysms: a pragmatic metaanalysis of randomized and non-randomized trials with short- and long-term follow-up. Falk Delgado A, Andersson T, Falk Delgado A. Journal of Neurointerventional Surgery,2016,9 (3),264-277

INTRODUCTION/BACKGROUND Two randomized trials have evaluated clipping and

coiling in patients with ruptured aneurysms. Aggregated evidence for management of ruptured and unruptured aneurysms is missing.

V, Andersson T. Clinical Neuroradiology,2016,26 (2),221-228

OBJECTIVE

Self-expanding stent-like retrievers for mechanical thrombectomy have been the focus of endovascular treatment for acute ischemic stroke since the first report by Castaño et al. in 2009 and a number of other case series of Solitaire (eV3, Irvine, CA) in 2009. More recently, in the TREVO 2 randomized controlled trial comparing the Trevo stent retriever with the Merci device (both Stryker, Kalamazoo, MI), the Trevo stent retriever showed a higher TICI 2–3 reperfusion rate of 86 vs. 60 % for the Merci and an improved 90-day rate of good functional outcome (modified Rankin Scale (mRS) 0–2: 40 vs. 22 %). Furthermore, fewer perforations were associated with Trevo than with Merci (1 vs. 10 %). In the Solitaire With the Intention For Thrombectomy (SWIFT) trial, the Solitaire also demonstrated an improved 90-day neurological outcome (58 vs. 33 %), reduced 90-day mortality (17 vs. 38 %), and a higher rate of successful recanalization in all treatable vessels compared with the Merci device. National and multinational registries (e.g., North American Solitaire Stent Retriever Acute Stroke Registry (NASA) and Endovascular Stroke Treatment Registry (ENDOSTROKE)) support the preliminary results derived from the initial case series concerning revascularization rates and clinical outcome. In essence, the concept of stent retrieval makes use of a self-expanding mesh that interacts with the clot, entangling the clot so that both can be withdrawn from an occluded artery by means of the introducer wire. This underlying concept has not changed over the past 5 years. Interestingly however, some of the initial efforts with Solitaire were aiming at re-establishing arterial flow by creating a channel through or past the clot. The design of the EmboTrap System® (Neuravi Ltd., Galway, Ireland) tries to address both demands, creating a flow channel and catching the clot at the same time. It comprises a two-layer Nitinol structure, with an inner 1.25-mm closed cell stent with a high radial force that is surrounded by an outer structure with a lower radial force profile (Figs. 1 and 2). The relatively large openings of the outer structure are designed to accept clot into the space between the two layers, while the inner stent creates a flow channel through the occlusion. The outer structure leaflets are intended to maintain apposition with the vessel wall to retain the captured clot during retraction through bends and past branch vessels, while the closed design of the tip aims at avoiding vessel damage distal to the clot and catching possible lost embolic fragments. The device was approved for use in Europe in late 2013 under the CE mark. It is delivered through a 0.021-inch

INTRODUCTION/BACKGROUND To conduct a meta-analysis evaluating clinical outcome after aneurysm treatment.

MATERIALS/METHOD PubMed, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov were searched for studies evaluating aneurysm treatment. The primary outcome measure was an independent clinical outcome (modified Rankin scale 0-2, Glasgow Outcome Scale 4-5, or equivalent). Secondary outcomes were poor outcome and mortality. ORs were calculated on an intention-to-treat basis with 95% CIs. Outcome heterogeneity was evaluated with Cochrane's Q test (significance level cut-off value at <0.10) and I2 (significance cut-off value >50%) with the Mantel-Haenszel method for dichotomous outcomes. A p value <0.05 was regarded as statistically significant.

RESULTS Searches yielded 18 802 articles. All titles were assessed, 403 abstracts were evaluated, and 183 full-text articles were read. One-hundred and fifty articles were qualitatively assessed and 85 articles were included in the meta-analysis. Patients treated with coiling (randomized controlled trials (RCTs)) had higher independent outcome at short-term follow-up (OR=0.67, 95% CI 0.57 to 0.79). Independent outcome was favored for coiling at intermediate and long-term follow-up (RCTs and observational studies combined-OR=0.80, 0.68 to 0.94 and OR=0.81, 0.71 to 0.93, respectively). Independent outcome and lower mortality was favored after coiling in unruptured aneurysms (database registry studies) at short-term follow-up (OR=0.34, 0.29 to 0.41 and OR=1.74, 1.52 to 1.98, respectively).

CONCLUSION This meta-analysis evaluating clinical outcome after coiling or clipping for intracranial aneurysms, indicates a higher independent outcome and lower mortality after coiling.

ABSTRACT 11 First-in-man procedural experience with the novel embotrap® revascularization device for the treatment of ischemic stroke - a European multicenter series. Kabbasch C, Mpotsaris A, Liebig T, Söderman M, Holtmannspötter M, Cronqvist M, Thornton J, Mendes Pereira

MEDISCHE BEELDVORMING

microcatheter and can be used with lesional aspiration through an intermediate catheter as well as with proximal aspiration, e.g., through a balloon guide catheter (BGC). The purpose of this case series was to evaluate the technical effectiveness of the EmboTrap device in achieving the revascularization of computed tomography (CT) angiography-proven large-vessel occlusions in acute ischemic stroke through studying the first-in-man experience across multiple European sites.

Andersson T, Franรงois O Vascular and Endovascular Challenges Update,2016,26-29 April 2016,45-50

MATERIALS/METHOD

Shunting during carotid endarterectomy: is it safe? Lessons learned from diffusion-weighted magnetic resonance imaging!

Er is geen abstract beschikbaar van deze presentatie.

PRESENTATIES CONGRESSEN ABSTRACT 1

A total of 40 patients with acute ischemic stroke due to large-artery occlusion were treated in five European centers. Clinical and procedural data were collected; selfreported angiographic results and neurologic outcome (discharge and 90 days) were assessed in a standardized manner.

RESULTS The median National Institutes of Health Stroke Scale at admittance was 16; no patient was treated after 12h. Intravenous thrombolysis (IVT) was received by 65 % of patients. The territorial distribution was as follows: 87.5 % in the anterior circulation: 62.5 % middle cerebral artery and 25 % internal carotid artery (ICA) terminus, comprising 20 % tandem occlusions; and 12.5 % in the posterior circulation, all of which were vertebrobasilar. Revascularization of TICI 2b-3 was achieved in 38 of 40 (95 %) treatments. Additional devices were utilized in 11 of 40 (28 %) cases after a mean of 2.6 passes with EmboTrap prior to switching. The mean number of EmboTrap passes needed was 1.8, with a mean procedural time to reperfusion of 54 min. One patient (2.5 %), who had not received IVT, experienced symptomatic intracranial hemorrhage post-interventionally. Procedural complications were encountered in 2 of 40 cases (5 %); both patients exhibited ICA dissection that was treated conservatively without clinical sequelae. There were no device-related complications. Of 23 available patients, 8 (35 %) had a good outcome after 90 days.

CONCLUSION The procedural results from these five centers suggest that EmboTrap is technically safe. Successful recanalization rates can be expected to be within the range of other stent retrievers.

ABSTRACT 12 Clot properties and technique may impact technical result and patient outcome.

ABSTRACTBOEK | 2016

Wybaillie E, Ceuppens H, De Smul G, Wallaert P, Pottel H, Seynaeve P, Lerut P. 28-30 September 2016,30th international congress of the European Society of Vascular Surgery (ESVS),(Copenhagen, Denmark) ipv Copenhagen (Denmark) De tekst van het abstract is terug te vinden op pagina 11.

CENTRUM

NEFROLOGIE ARTIKELS ABSTRACT 1 Inflammation and the bone-vascular axis in end-stage renal disease.

Evenepoel P, Meijers BK, Bammens B, Viaene L, Claes K, Sprangers B, Naesens M, Hoekstra T, Schlieper G, Vanderschueren D, Kuypers D. Nephrol Dial Transplant.,2016,Sep;31(9):,1508-1514

INTRODUCTION/BACKGROUND Viaene L, Behets G, Heye S, Claes K, Monbaliu D, Pirenne J, D’Haese PC, Evenepoel P. Osteoporosis International,2016,27(2),489-497

INTRODUCTION/BACKGROUND Vascular calcification is a common complication of endstage renal disease (ESRD) and is predictive of subsequent cardiovascular disease and mortality. Mounting evidence linking bone disorders with vascular calcification has contributed to the development of the concept of the bone-vascular axis. Inflammation is involved in the pathogenesis of both disorders. The aim of the present study was to evaluate the relationship between aortic calcification, inflammation, and bone histomorphometry in patients with ESRD.

MATERIALS/METHOD Parameters of inflammation and mineral metabolism were assessed in 81 ESRD patients (55 ± 13 year, 68 % male) referred for renal transplantation. Static bone histomorphometry parameters were determined on transiliac bone biopsies performed during the transplant procedure. Aortic calcification was quantified on lateral lumbar Xrays using the Kauppila method.

RESULTS Aortic calcification, low bone turnover, and low bone area were observed in 53, 37, and 21 % of patients respectively. Inflammatory markers were found to be independently associated with aortic calcification (hsIL-6) and low bone area (TNF-a). Low bone area associated with aortic calcification, independent of age, diabetes, and inflammation.

CONCLUSION Low bone area and inflammation associates with aortic calcification, independent of each other and traditional risk factors. Our data emphasize the role of (micro-)inflammation in the bone-vascular axis in CKD.

Phosphorus control is generally considered to be better in peritoneal dialysis (PD) patients as compared with haemodialysis (HD) patients. Predialysis phosphorus concentrations are misleading as a measure of phosphorus exposure in HD, as these neglect significant dialysis-related fluctuations.

MATERIALS/METHOD Parameters of mineral metabolism, including parathyroid hormone (PTH) and fibroblast growth factor-23 (FGF23), were determined in 79 HD and 61 PD patients. In PD, phosphorus levels were determined mid-morning. In HD, time-averaged phosphorus concentrations were modelled from measurements before and after the midweek dialysis session. Weekly renal, dialytic and total phosphorus clearances as well as total mass removal were calculated from urine and dialysate collections.

RESULTS Time-averaged serum phosphorus concentrations in HD (3.5 ± 1.0 mg/dL) were significantly lower than the mid-morning concentrations in PD (5.0 ± 1.4 mg/dL, P < 0.0001). In contrast, predialysis phosphorus concentrations (4.6 ± 1.4 mg/dL) were not different from PD. PTH and FGF-23 levels were significantly higher in PD. Despite higher residual renal function, total phosphorus clearance was significantly lower in PD (P < 0.0001). Total phosphorus mass removal, conversely, was significantly higher in PD (P < 0.05).

CONCLUSION Our data suggest that the time-averaged phosphorus concentrations in patients treated with PD are higher as compared with patients treated with HD. Despite a better preserved renal function, total phosphorus clearance is lower in patients treated with PD. Additional studies are needed to confirm these findings in a population with a different demographic profile and dietary background and to define clinical implications.

ABSTRACT 2 Phosphorus metabolism in peritoneal dialysis- and haemodialysis-treated patients.

ABSTRACT 3 Decreased circulating sclerostin levels in renal transplant recipients with persistent hyperparathyroidism.

MEDISCHE BEELDVORMING

Evenepoel P, Claes K, Viaene L, Bammens B, Meijers B, Naesens M, Sprangers B, Kuypers D. Transplantation.,2016,Oct;100(10),2188-2193

INTRODUCTION/BACKGROUND Sclerostin is an osteocyte-secreted soluble antagonist of the Wnt/Ă&#x;-catenin signaling pathway requisite for osteoblast development and activity. The regulation of sclerostin expression in bone is complex. Parathyroid hormone (PTH) is recognized to be an important suppressor. Circulating sclerostin levels are 2- to 4-fold higher in patients with end-stage renal disease as compared with individuals with normal renal function.

MATERIALS/METHOD We performed a longitudinal observational cohort study and case-control study in 50 de novo renal transplant recipients, 50 chronic kidney disease (CKD) patients (n = 50) matched for age, sex, and estimated glomerular filtration rate, and 23 renal transplant recipients referred for parathyroidectomy to define the impact of renal transplantation on circulating sclerostin levels and to clarify the role of persistent (tertiary) hyperparathyroidism.

RESULTS Sclerostin serum levels decreased by 61.2% (median) during the first 3 months after transplantation (1.24 vs 0.44 ng/mL, P < 0.0001) to increase thereafter toward levels observed in CKD counterparts (0.63 ng/ml). High PTH levels independently associated with low sclerostin levels, both at time of transplantation and at 1 year. Sclerostin levels significantly increased after parathyroidectomy (0.49 vs. 0.32 ng/ml, P < 0.0001). The time course of bone biomarkers after parathyroidectomy suggests that bone resorption normalizes earlier than bone formation.

CONCLUSION Circulating sclerostin levels appear to show a biphasic pattern after renal transplantation with a rapid and profound decrease, followed by gradual increase towards levels observed in CKD counterparts. Our data support the notion that PTH is an important regulator of circulating sclerostin levels.

ABSTRACTBOEK | 2016

PRESENTATIES CONGRESSEN ABSTRACT 1 Propofol sedation for endovascular thrombectomy for acute ischemic stroke: hemodynamic and neurological impact. Schockaert B, Desmet M, Missant C 2016,Networking World Anesthesia Convention, April 2016 (New York, USA) Er is geen abstract beschikbaar van deze presentatie.

CENTRUM

NEUROLOGIE ARTIKELS ABSTRACT 1 Motor neuron degeneration in spastic paraplegia 11 mimics amyotrophic lateral sclerosis lesions Denora PS, Smets K, Zolfanelli F, Ceuterick-de Groote C, Casali C, Deconinck T, Sieben A, Gonzales M, Zuchner S Darios F, Peeters D, Brice A, Malandrini A De Jonghe P, Santorelli FM Stevanin G, Martin JJ, El Hachimi KH. Brain 2016,Jun; 139 (Pt 6),1723-1734

INTRODUCTION/BACKGROUND The most common form of autosomal recessive hereditary spastic paraplegia is caused by mutations in the SPG11/KIAA1840 gene on chromosome 15q. The nature of the vast majority of SPG11 mutations found to date suggests a loss-of-function mechanism of the encoded protein, spatacsin. The SPG11 phenotype is, in most cases, characterized by a progressive spasticity with neuropathy, cognitive impairment and a thin corpus callosum on brain MRI. Full neuropathological characterization has not been reported to date despite the description of >100 SPG11 mutations.

OBJECTIVE We describe here the clinical and pathological features observed in two unrelated females, members of genetically ascertained SPG11 families originating from Belgium and Italy, respectively. We confirm the presence of lesions of motor tracts in medulla oblongata and spinal cord associated with other lesions of the central nervous system.

RESULTS Interestingly, we report for the first time pathological hallmarks of SPG11 in neurons that include intracytoplasmic granular lysosome-like structures mainly in supratentorial areas, and others in subtentorial areas that are partially reminiscent of those observed in amyotrophic lateral sclerosis, such as ubiquitin and p62 aggregates, except that they are never labelled with anti-TDP-43 or anti-cystatin C.

CONCLUSION The neuropathological overlap with amyotrophic lateral sclerosis, associated with some shared clinical manifestations, opens up new fields of investigation in the physiopathological continuum of motor neuron degeneration.

NEUROLOGIE

CENTRUM

NUCLEAIRE GENEESKUNDE ARTIKELS ABSTRACT 1 [18F]FDG PET/CT for the assessment of the volume of the spleen. Smeets P, Mees G, Ham H, Maes A, Verstraete K, Van De Wiele C. The Quarterly Journal of Nuclear Medicine and Molecular Imaging,2016,60(1),48-53

from the FDG PET part of the PET/CT examination through region growing and by using the CT part of the PET/CT examination as anatomical landmark for contour delineation. As opposed to ESV1 and ESV2, the PBM method does not suffer from a systematic bias and shows a smaller variation against the mean percentage difference. Combining functional and morphological data for spleen volume assessment is time-saving.

ABSTRACT 2 INTRODUCTION/BACKGROUND The aim of this study was to report on the feasibility and accuracy of spleen volume determination on FDG PET/CT imaging using region growing and the CT part of the PET/ CT examination as anatomical landmark (PET-CT based spleen volume method PBM) and volume summation of axial CT sections of the spleen as gold standard (true spleen volume (TSV). We also aimed to compare results obtained to the estimative methods (ESV).

Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws. Hudyana H, Maes A, Vandenberghe T, Fidlers L, Sathekge M, Nicolaj D, Van de Wiele C European Journal of Nuclear Medicine and Molecular Imaging,2016,43(2),349-354

INTRODUCTION/BACKGROUND MATERIALS/METHOD Thirty-nine FDG PET/CT images taken from 32 patients (15 women, age range: 16-83 years) suffering from lymphoma, covering a wide range of spleen volumes based on visual CT assessment, in whom CT as well as FDG PET images revealed no focal spleen abnormalities were included for analysis. ESV1, ESV2 and PBM were determined on all examinations and compared to TSV.

The aim of this retrospective study was to evaluate the accuracy of bone SPECT (single photon emission computed tomography)/CT (computed tomography) in diagnosing loosening of fixation material in patients with recurrent or persistent back pain that underwent lumbar arthrodesis with pedicle screws using surgery and clinical follow-up as gold standard.

MATERIALS/METHOD RESULTS ESV1 volumes were significantly larger (median 668 cm3 [range: 121-4303 cm3] [P=0.0001]) and ESV2 volumes significantly smaller (median 424 cm3 [range: 84-2679 cm3] [P=0.0001]) when compared to TSV volumes (median 582 cm3 [range: 105-4847 cm3] which was not so for PBS volumes (median 540cm3 [range: 120-4560 cm3]). Time needed for TSV assessment (median: 17 min. [range: 6-65 min.]) was related to spleen volume (r=0.691 [P=0.0001]). The mean and standard deviation of the percentage spread (ESV1, ESV2, PBM-TSV/100%) around the mean (ESV1, ESV2, PBM+TSV/2) were respectively 18%±15.6% (ESV1 vs. TSV), -25%±15.6% (ESV2 vs. TSV) and -2.8%±12.3% (PBM vs. TSV). Mean SUVmax of the spleen was 4.8 SUV (SD: 2.6 SUV), mean percentage cutoff for region growing was 7.3% (sd: 5.8%). Spleen volumes defined by PBM correlated with their corresponding SUVmax value (r=0.469 [P=0.03]). Time needed for PBM measurements was between 2-3 min in all patients.

CONCLUSION Spleen volumes may be rapidly and accurately derived

ABSTRACTBOEK | 2016

A total of 48 patients (median age 49 years, range 21-81 years; 17 men) who had undergone lumbar spinal arthrodesis were included in this retrospective analysis. SPECT/CT results were compared to the gold standard of surgical evaluation or clinical follow-up. Positive SPECT/ CT results were considered true positives if findings were confirmed by surgery or if clinical and other examinations were completely consistent with the positive SPECT/CT finding. They were considered false positives if surgical evaluation did not find any loose pedicle screws or if symptoms subsided with non-surgical therapy. Negative SPECT/CT scans were considered true negatives if symptoms either improved without surgical intervention or remained stable over a minimum follow-up period of 6 months. Negative SPECT/CT scans were determined to be false negatives if surgery was still required and loosening of material was found.

RESULTS The median length of time from primary surgery to bone SPECT/CT referral was 29.5 months (range 12-192 months). Median follow-up was 18 months (range 6-57)

for subjects who did not undergo surgery. Thirteen of the 48 patients were found to be positive for loosening on bone SPECT/CT. Surgical evaluation (8 patients) and clinical follow-up (5 patients) showed that bone SPECT/ CT correctly predicted loosening in 9 of 13 patients, while it falsely diagnosed loosening in 4 patients. Of 35 negative bone SPECT/CT scans, 12 were surgically confirmed. In 18 patients, bone SPECT/CT revealed lesions that could provide an alternative explanation for the symptoms of pain (active facet degeneration in 14 patients, and disc and sacroiliac osteodegeneration in 7 patients and 1 patient, respectively). Overall sensitivity and specificity for the detection of loosening were 100 % and 89.7 %, respectively. The positive and negative predictive values were 69 % and 100 %, respectively.

positive results on (18)F-FDG-PET/CT, our data indicate a significantly higher sensitivity of (18)F-FDG-PET/CT compared to BMB (100% vs 17%) but similar specificity. These data confirm the high diagnostic performance of (18)F-FDG-PET/CT for detecting BMI, but prospective studies are needed to determine whether (18)F-FDG-PET/ CT could indeed replace staging BMB in PTLD.

ABSTRACT 4 Diffuse 18F-FDG muscle uptake in trichinella spiralis infection. Deroose C, Van Weehaeghe D, Tousseyn T, Van Rompuy A, Vanderschueren S, Blockmans D, Gheysens O. Clinical Nuclear Medicine,2016,41(1),55-56

CONCLUSION This retrospective analysis suggests that bone SPECT/CT is a highly sensitive and specific tool for the exclusion of screw loosening in patients who present with recurrent low back pain after having undergone lumbar arthrodesis. In addition, it can identify other potential causes of recurrent low back pain in this patient population.

ABSTRACT 3 Detection of bone marrow involvement in newly diagnosed post-transplant lymphoproliferative disorder: (18)F-fluorodeoxyglucose positron emission tomography/computed tomography versus bone marrow biopsy. Gheysens O, Thielemans S, Morscio J, Boeckx N, Goffin K, Deroose C, Sagaert X, Wlodarska I, Verhoef G, Dierickx D, Tousseyn T. Leukemia & Lymphoma,2016,57(10),2385-2388

SUMMARY Two patients were referred to our emergency department with myalgia, fever, general malaise, eosinophilia, and elevated serum levels of creatine kinase and troponin T. 18F-FDG PET/CT scan was performed showing a diffuse and homogenous moderately elevated glucose uptake in all muscle groups. Trichinella spiralis infection was confirmed by a muscle biopsy and detection of trichinella antibodies. The muscle biopsy was taken in the left quadriceps because of equal involvement of the skeletal muscles. The differential diagnosis of diffuse 18F-FDG muscle uptake should include trichinella infection, in particular, in the presence of infectious symptoms, eosinophilia, and biochemical signs of muscle damage.

ABSTRACT 5 Evaluation of CT-based SUV normalization.

INTRODUCTION/BACKGROUND

Devriese J, Beels L, Maes A, Van de Wiele C, Pottel H. Physics in Medicine & Biology,2016,61(17),6369-6383

Detecting bone marrow involvement (BMI) in lymphoma is important as it adversely affects stage. Bone marrow biopsy (BMB) remains the standard to detect BMI but is prone to sampling error. We retrospectively investigated whether (18)F-fluorodeoxyglucose positron emission tomography with computed tomography ((18)F-FDG-PET/ CT) could identify BMI in patients with post-transplant lymphoproliferative disorder (PTLD) with sufficient accuracy in comparison with staging BMB. Twenty-five patients diagnosed with PTLD who underwent (18)FFDG-PET/CT and BMB within one month were evaluated. Based on our criteria, six patients (24%) were considered positive for BMI on (18)F-FDG-PET/CT compared to one by BMB. Although we cannot completely exclude false

The purpose of this study was to determine patients' lean body mass (LBM) and lean tissue (LT) mass using a computed tomography (CT)-based method, and to compare standardized uptake value (SUV) normalized by these parameters to conventionally normalized SUVs. Head-totoe positron emission tomography (PET)/CT examinations were retrospectively retrieved and semi-automatically segmented into tissue types based on thresholding of CT Hounsfield units (HU). The following HU ranges were used for determination of CT-estimated LBM and LT (LBMCT and LTCT): -180 to -7 for adipose tissue (AT), -6 to 142 for LT, and 143 to 3010 for bone tissue (BT). Formula-

INTRODUCTION/BACKGROUND

NUCLEAIRE GENEESKUNDE

estimated LBMs were calculated using formulas of James (1976 Research on Obesity: a Report of the DHSS/MRC Group (London: HMSO)) and Janmahasatian et al (2005 Clin. Pharmacokinet. 44 1051-65), and body surface area (BSA) was calculated using the DuBois formula (Dubois and Dubois 1989 Nutrition 5 303-11). The CT segmentation method was validated by comparing total patient body weight (BW) to CT-estimated BW (BWCT). LBMCT was compared to formula-based estimates (LBMJames and LBMJanma). SUVs in two healthy reference tissues, liver and mediastinum, were normalized for the aforementioned parameters and compared to each other in terms of variability and dependence on normalization factors and BW. Comparison of actual BW to BWCT shows a non-significant difference of 0.8 kg. LBMJames estimates are significantly higher than LBMJanma with differences of 4.7 kg for female and 1.0 kg for male patients. Formula-based LBM estimates do not significantly differ from LBMCT, neither for men nor for women. The coefficient of variation (CV) of SUV normalized for LBMJames (SUV-LBM-James) (12.3%) was significantly reduced in liver compared to SUVBW (15.4%). All SUV variances in mediastinum were significantly reduced (CVs were 11.1-12.2%) compared to SUVBW (15.5%), except SUVBSA (15.2%). Only SUVBW and SUVLBM-James show independence from normalization factors. LBMJames seems to be the only advantageous SUV normalization. No advantage of other SUV normalizations over BW could be demonstrated.

Early detection and accurate distinction of inflammation from infection are important to optimize and individualize therapy. Nuclear medicine is ideally suited for the detection of pathologic changes early on and is able to target a magnitude of role players involved in the aforementioned processes. Hybrid modalities such as PET/CT and PET/MRI offer high spatial resolution that combines morphologic and pathophysiological changes and add various quantification possibilities that are preferable in these settings. It follows then that the development of PET radiopharmaceuticals is imperative to make use of these latest advances. Gallium-68 (Ga-68)-based tracers are exceptionally well suited to these indications, considering the year-round availability from a single generator, the relative cost-effectiveness, and relative ease of labeling. Over the past few years, the development of Ga-68based tracers has understandably exploded with a recent growing interest in infection and inflammation imaging. This review aims to highlight some of the most important and interesting advances made with Ga-68-based PET/CT in the field of infection and inflammation imaging.

ABSTRACT 8 Increased understanding of stem cell behavior in neurodegenerative and neuromuscular disorders by use of noninvasive cell imaging. Holvoet B, De Waele L, Quattrocelli M, Gheysens O, Sampaolesi M, Verfaillie C, Deroose C. Stem Cells International,2016

ABSTRACT 6 False-positive axillary lymph nodes due to silicone adenitis on (18)F-FDG PET/CT in an oncological setting. D'hulst L, Nicolaij D, Beels L, Gheysens O, Alaerts H, Van de Wiele C, Maes A. Journal of Thoracic Oncology,2016,11(6),e73-e75

De tekst van het abstract is terug te vinden op pagina 25.

ABSTRACT 9 Lesion quantification and detection in myocardial (18) F-FDG PET using edge-preserving priors and anatomical information from CT and MRI: a simulation study.

De tekst van het abstract is terug te vinden op pagina 17.

ABSTRACT 7 Gallium-68 PET: a powerful generator-based alternative to infection and inflammation imaging

Turco A, Nuyts J, Gheysens O, Duchenne J, Voigt JU, Claus P, Vunckx K. European Journal of Nuclear Medicine and Molecular Imaging Physics,2016,3(1),9

INTRODUCTION/BACKGROUND Vorster M, Maes A, Van de Wiele C, Sathekge M. Seminars in Nuclear Medicine,2016,46(5),436-447

SUMMARY The process of inflammation (with or without infection) forms part of essentially every major debilitating disease.

ABSTRACTBOEK | 2016

The limited spatial resolution of the clinical PET scanners results in image blurring and does not allow for accurate quantification of very thin or small structures (known as partial volume effect). In cardiac imaging, clinically relevant questions, e.g. to accurately define the extent or the residual metabolic activity of scarred myocardial tissue, could benefit from partial volume cor-

rection (PVC) techniques. The use of high-resolution anatomical information for improved reconstruction of the PET datasets has been successfully applied in other anatomical regions. However, several concerns linked to the use of any kind of anatomical information for PVC on cardiac datasets arise. The moving nature of the heart, coupled with the possibly non-simultaneous acquisition of the anatomical and the activity datasets, is likely to introduce discrepancies between the PET and the anatomical image, that in turn might mislead lesion quantification and detection. Non-anatomical (edge-preserving) priors could represent a viable alternative for PVC in this case. In this work, we investigate and compare the regularizing effect of different anatomical and non-anatomical priors applied during maximum-a-posteriori (MAP) reconstruction of cardiac PET datasets. The focus of this paper is on accurate quantification and lesion detection in myocardial (18)F-FDG PET.

MATERIALS/METHOD Simulated datasets, obtained with the XCAT software, are reconstructed with different algorithms and are quantitatively analysed.

Devriese J, Beels L, Van De Wiele C, Maes A, Gheysens O, Pottel H. The Quarterly Journal of Nuclear Medicine and Molecular Imaging,2016,60(1),40-47

INTRODUCTION/BACKGROUND The aim of this study was to determine and validate a set of Hounsfield unit (HU) ranges to segment computed tomography (CT) images into tissue types and to test the validity of dual-energy X-ray absorptiometry (DXA) tissue segmentation on pure, unmixed porcine tissues.

MATERIALS/METHOD This preclinical prospective study was approved by the local ethical committee. Different quantities of porcine bone tissue (BT), lean tissue (LT) and adipose tissue (AT) were scanned using DXA and CT. Tissue type segmentation in DXA was performed via the standard clinical protocol and in CT through different sets of HU ranges. Percent coefficients of variation (%CV) were used to assess precision while % differences of observed masses were tested against zero using the Wilcoxon signed-rank Test.

RESULTS RESULTS The results of this simulation study show a superiority of the anatomical prior when an ideal, perfectly matching anatomy is used. The anatomical information must clearly differentiate between normal and scarred myocardial tissue for the PVC to be successful. In case of mismatched or missing anatomical information, the quality of the anatomy-based MAP reconstructions decreases, affecting both overall image quality and lesion quantification. The edge-preserving priors produce reconstructions with good noise properties and recovery of activity, with the advantage of not relying on an external, additional scan for anatomy.

Total mass DXA measurements differ little but significantly (P=0.016) from true mass, while total mass CT measurements based on literature values show non-significant (P=0.69) differences of 1.7% and 2.0%. BT mass estimates with DXA differed more from true mass (median -78.2 to -75.8%) than other tissue types (median -11.3 to -8.1%). Tissue mass estimates with CT and literature HU ranges showed small differences from true mass for every tissue type (median -10.4 to 8.8%).

CONCLUSION The most suited method for automated tissue segmentation is CT and can become a valuable tool in quantitative nuclear medicine.

CONCLUSION The performance of edge-preserving priors is acceptable but inferior to those of a well-applied anatomical prior that differentiates between lesion and normal tissue, in the detection and quantification of a lesion in the reconstructed images. When considering bull's eye plots, all of the tested MAP algorithms produced comparable results.

ABSTRACT 10 Preclinical validation of automated dual-energy X-ray absorptiometry and computed tomography-based body composition measurements.

PRESENTATIES CONGRESSEN ABSTRACT 1 Does SUV normalization based on individual CT-based LBM calculation provide better SUVs? Devriese J, Beels L, Maes A, Van de Wiele C, Pottel H. 29th Annual Congress of the European Association of Nuclear Medicine, October 2016 (Barcelona, Spain)

INTRODUCTION/BACKGROUND In positron emission tomography/computed tomography (PET/CT) semi-quantitative evaluation of tumour NUCLEAIRE GENEESKUNDE

metabolic activity is possible though the standardized uptake value (SUV), which is usually normalized for body weight (BW). Other proposed normalizations include lean body mass (LBM) and body surface area (BSA).

OBJECTIVE The purpose of this study was to determine patients’ LBM and lean tissue (LT) mass using a CT-based method, and to compare SUV normalized by these parameters to conventionally normalized SUVs.

MATERIALS/METHOD PET/CT examinations covering head to toe were retrospectively retrieved. LBM was determined using CT image segmentation (LBMCT) based on tissue-specific Hounsfield unit (HU) thresholds, and again using the predictive formulas of James (LBMJames) and Janmahasatian (LBMJanma). BSA was determined using the DuBois formula. LBMCT was compared to formula-based estimates using the Bland-Altman method. SUVs in two healthy reference tissues, liver and mediastinum, were normalized for the aforementioned parameters and compared to each other in terms of variability and dependence on normalization factors and BW, and within-patient SUV variation was assessed in an independent dataset.

RESULTS LBMJames estimates are significantly higher than LBMJanma with biases of 4.7kg (95%CI: 3.1 to 6.3) for females and 1.0kg (95%CI: 0.4 to 1.6) for male patients. Formula-based LBM estimates do not significantly differ from LBMCT, neither for men nor for women. Variance of SUV normalized for LBMJames (SUVLBM-James) was significantly reduced in liver compared to SUVBW. All SUV variances in mediastinum were reduced, except SUVBSA¬. Only SUVBW and SUVLBM-James¬ show independence from normalization factors.

CONCLUSION No advantage of alternative SUV normalization over BW could be demonstrated.

ABSTRACT 2 Semi-automated CT image segmentation provides accurate LBM measurements

parameter used in positron emission tomography/computed tomography (PET/CT), is defined as the ratio of measured radioactivity concentration to the injected dose per distribution volume unit. It is usually normalized for body weight (BW) and other proposed normalizations include e.g. lean body mass (LBM) since 18F-FDG distribution in fatty tissues is limited. LBM can be estimated by predictive equations or measured by e.g. CT. Since cancer patients often experience weight loss during treatment or disease progression, their body composition may vary. LBM estimated by predictive, generalizing, equations may therefore introduce error at individual patient level. Accurate individual LBM measurements through CT might lead to more accurate and reproducible LBM, and consequently more accurate and reproducible LBM-normalized SUVs.

OBJECTIVE The goal of this study was to segment human CT images into tissue types based on Hounsfield unit (HU) thresholds, and to test the validity of the LBM thus obtained.

MATERIALS/METHOD te vervangen door: PET/CT examinations covering head to toe were retrospectively retrieved and semi-automatically segmented into tissue types based on thresholding of CT HU. The following HU ranges were used: 180 to 7 for adipose tissue (AT), 6 to 142 for LT, and 143 to 3010 for bone tissue (BT). Total body volumes (V) per tissue type were determined and tissue masses calculated, using tissue densities of 0.90, 1.05, 1.85 kg/L for AT, LT, and BT, respectively. Besides these literature tissue densities, other coefficient sets were determined through regression in order to compensate for e.g. partial volume effect (PVE) and uncertainty concerning bone tissue density. The segmentation method was validated in an independent dataset by comparing patient BW to total CT-estimated BW (BWCT).

RESULTS

Three regression equations were tested in an independent dataset, of which BW _CT (kg)=0.95*AT+0.99*LT+2.11*BT yielded the best results. Comparison of actual BW to BWCT, shows a non-significant bias of 0.8 kg (95%CI: -1.3 to 4.1), with R2 = 0.989, RMSE = 1.626 and Lin’s concordance correlation coefficient (CCC) = 0.993.

CONCLUSION Devriese J, Beels L, Maes A, Van de Wiele C, Pottel H 29th Annual Congress of the European Association of Nuclear Medicine, October 2016 (Barcelona, Spain)

INTRODUCTION/BACKGROUND Standardized uptake value (SUV), a semi-quantitative 40

ABSTRACTBOEK | 2016

Although this is not a direct validation of our method, we are convinced that our segmentation method can reliably be used to accurately estimate AT, LT, and BT, and thus LBM, from CT images.

ONCOLOGISCH CENTRUM ARTIKELS

ABSTRACT 2

ABSTRACT 1

Implementation of uHear™ - an iOS-based application to screen for hearing loss-in older patients with cancer undergoing a comprehensive geriatric assessment.

A Belgian survey on geriatric assessment in oncology focusing on large-scale implementation and related barriers and facilitators. Decoster L, Van Puyvelde K, Conings G, Debruyne PR, Vanoverbeke K, Van den Bulck H, et al. The Journal of Nutrition Health and Aging,2016,20 (1),60-70

Lycke M, Boterberg T, Martens E, Ketelaars L, Pottel H, Lambrecht A, Van Eygen K, De Coster L, Dhooge I, Wildiers H, Debruyne PR. Journal of Geriatric Oncology,2016,7 (2),126-133

OBJECTIVE OBJECTIVE The aim of this study is to describe a large-scale, Belgian implementation project about geriatric assessment (=GA) in daily oncology practice and to identify barriers and facilitators for implementing GA in this setting. Design / setting / participants: the principal investigator of every participating hospital (n=22) was invited to complete a newly developed questionnaire with closed- and openended questions. The closed-ended questions surveyed how GA was implemented. The open-ended questions identified barriers and facilitators for the implementation of GA in daily oncology practice. Descriptive statistics and conventional content analysis were performed as appropriate.

RESULTS Qualifying criteria (e.g. disease status and cancer type) for GA varied substantially between hospitals. Thirteen hospitals (59.1%) succeeded to screen more than half of eligible patients. Most hospitals reported that GA data and follow-up data had been collected in almost all screened patients. Implementing geriatric recommendations and formulating new geriatric recommendations at the time of follow-up are important opportunities for improvement. The majority of identified barriers were organizational, with high workload, lack of time or financial/ staffing problems as most cited. The most cited facilitators were all related to collaboration.

CONCLUSION Interventions to improve the implementation of GA in older patients with cancer need to address a wide range of factors, with organization and collaboration as key elements. All stakeholders, seeking to improve the implementation of GA in older patients with cancer, should consider and address the identified barriers and facilitators.

Validation of uHear™ as a screening tool to detect hearing loss in older patients with cancer without a known diagnosis of presbycusis, as part of a Comprehensive Geriatric Assessment (CGA).

MATERIALS/METHOD Patients (≥70 years) with a histologically confirmed diagnosis of cancer, were enrolled at the time of CGA screening. Patients were evaluated by uHear™, which was compared to conventional audiometry as gold standard. We defined a pure-tone average (PTA) of ≥40dB HL as the pass or fail screening cut-off. Validation of uHear™ was defined in terms of diagnostic accuracy through Receiver Operating Characteristics (ROC)-analysis. To accept uHear™, we estimated that the Area Under the ROC-curve (AUC) had to differ significantly from 0.50 with an AUC of at least 0.70. The Whispered Voice Test and Hearing Handicap Inventory for the Elderly were also administered.

RESULTS Thirty-three patients consented for participation. In one patient, the results of one ear were excluded from the analysis as the patient was documented with a known hearing disorder in that ear. Significant hearing loss, defined by a PTA of ≥40dB HL calculated from the air conduction thresholds at 0.5, 1.0 and 2.0kHz, was found in 15.4% of tested ears. uHear™ showed excellent dia gnostic accuracy with an AUC±SE of 0.98±0.14. It provided maximum sensitivity (100.0%) but poor specificity (36.4%) at our predefined cut-off score of ≥40dB HL.

COMMENTS uHear™ can be implemented as a screening tool to detect hearing loss in older patients with cancer within a CGA.

ONCOLOGISCH CENTRUM

ABSTRACT 3 PARTNER: An open-label, randomized, phase 2 study of docetaxel/cisplatin chemotherapy with or without panitumumab as first-line treatment for recurrent or metastatic squamous cell carcinoma of the head and neck. Wirth LJ, Dakhil S, Kornek G, Axelrod R, Adkins D, Pant S, O’Brien P, Debruyne PR, Oliner KS, Dong J, Murugappan S. Oral Oncology,2016,61,31-40

OBJECTIVE This phase 2 estimation study evaluated docetaxel/ cisplatin with/without panitumumab, an anti–epidermal growth factor receptor monoclonal antibody, as first-line therapy for recurrent/metastatic squamous cell carcinoma of the head and neck (SCCHN).

MATERIALS/METHOD Randomized patients received docetaxel/cisplatin (75 mg/m2 each) with/without panitumumab (9 mg/kg) in 21-day cycles. Patients randomized to panitumumab + chemotherapy could continue panitumumab monotherapy after completing six chemotherapy cycles without progression; patients randomized to chemotherapy alone could receive second-line panitumumab after progression. Progression-free survival (PFS) was the primary endpoint. Secondary endpoints included overall survival (OS), overall response rate (ORR), time to response (TTR), duration of response (DOR), and safety. A protocol amendment limited enrollment to patients <70 years owing to excess toxicity in older patients and added mandatory pegfilgrastim/filgrastim support. Outcomes were also analyzed by human papillomavirus status.

RESULTS 103 of the 113 enrolled patients were evaluable and randomized to receive ≥ 1 dose of first-line treatment. Median PFS for panitumumab + chemotherapy was 6.9 (95% CI = 4.7–8.3) months versus 5.5 (95% CI = 4.1–6.8) months for chemotherapy alone (hazard ratio [HR] = 0.629; 95% CI = 0.395–1.002; P = 0.048). ORR for panitumumab + chemotherapy was 44% (95% CI = 31–58%) versus 37% (95% CI = 24–51%) for chemotherapy alone (odds ratio [OR] = 1.37; 95% CI = 0.57–3.33). Median OS for panitumumab + chemotherapy was 12.9 (95% CI = 9.4–18.5) months versus 13.8 (95% CI = 11.8–22.9) months for chemotherapy alone (HR = 1.103; 95% CI = 0.709–1.717). Median TTR for panitumumab + chemotherapy treatment was 6.9 weeks versus 11.0 weeks for chemotherapy alone. Median DOR was 8.0 (95% CI = 5.7–11.1) months

ABSTRACTBOEK | 2016

with panitumumab + chemotherapy versus 5.1 (95% CI = 4.4–7.2) months with chemotherapy alone. Grade 3/4 adverse event incidence was 73% with panitumumab + chemotherapy versus 56% with chemotherapy alone. 41% and 55% of patients in the panitumumab + chemotherapy and chemotherapy-alone arms, respectively, received panitumumab monotherapy.

CONCLUSION The addition of panitumumab to docetaxel/cisplatin may improve PFS in recurrent/metastatic SCCHN and has the potential to improve outcomes in these fully, or mostly, active patients.

ABSTRACT 4 Prognostic factors in second-line targeted therapy for metastatic clear-cell renal cell carcinoma after progression on an anti-vascular endothelial growth factor receptor tyrosine kinase inhibitor. Sacré A, Barthélémy P, Korenbaum C, Burgy M, Wolter P, Dumez H, Lerut E, Loyson T, Joniau S, Oyen R, Debruyne PR, Schöffski P, Beuselinck B. Acta Oncologica,2016,55 (3),329-340

INTRODUCTION/BACKGROUND About 40% of metastatic clear-cell renal cell carcinoma (m-ccRCC) patients receive a second-line targeted therapy after failure of anti-vascular endothelial growth factor receptor tyrosine kinase inhibitors (anti-VEGFRTKI). Efficacy of second-line therapy is usually limited and prognostic and predictive factors at the start of second-line therapy are lacking. To identify the subgroup of patients that will benefit from such treatment remains a challenge.

MATERIALS/METHOD We performed a multi-institutional, retrospective study of patients who received a second-line therapy after progression on an anti-VEGFR-TKI. Univariate and multivariate analyses were performed in order to identify prognostic factors for progressive disease (PD) as best response, progression-free survival (PFS) and overall survival (OS) on second-line therapy.

RESULTS For the whole cohort of 108 patients, mOS from the start of second-line therapy was 8.9 months while mPFS on second-line therapy was 2.8 months. A total of 49/105

(47%) patients had PD, 50/105 (48%) stable disease (SD) and 6/105 (6%) a partial response (PR). On multivariate analysis, the following markers were associated with improved outcome on second-line therapy: a PFS on firstline therapy ≥12 months (HR for PFS: 1.961; p = 0.008) (HR for OS: 1.724; p = 0.037) and Fuhrman grade 1-2 tumors (HR for OS: 2.198; p = 0.007). Markers associated with poorer outcome on second-line therapy were: elevated serum lactate dehydrogenase (LDH) levels (HR for PFS: 0.511; p = 0.04) (HR for OS: 0.392; p = 0.017), low albumin (HR for OS: 0.392; p = 0.01) and elevated corrected calcium levels (HR for OS: 0.416; p = 0.01). The impact on OS of the Memorial Sloan Kettering Cancer Centre (MSKCC) and International Renal Cell Carcinoma Database Consortium (IMDC) prognostic scores as calculated at start of second-line therapy was validated in our patient series.

CONCLUSION Duration of first-line PFS, Fuhrman grade, serum LDH levels, albumin levels, corrected calcium levels and the MSKCC and IMDC scores calculated at start of secondline therapy are prognostic factors for m-ccRCC patients treated with second-line targeted therapy.

PRESENTATIES CONGRESSEN ABSTRACT 1

with a baseline neuropsychological assessment including patient-reported outcome measures (PROMs). PROMs entailed distress, anxiety and depression, fatigue, and cognitive complaints. The neuropsychological assessment comprised several cognitive domains such as premorbid IQ, attention, processing speed, flexibility, verbal and visual episodic memory, and verbal fluency.

RESULTS Cross-sectional data of 125 patients were collected. Patients had a mean age of 60.9 years (range 30.0–85.0) and comprised primarily females (65.6%). Patients presented with cancer of following sites: breast (44.0%), digestive (28.8%), urological (11.2%), gynecologic (8.0%), hematologic malignancy (4.8%), and lung (3.2%). Patients presented with a premorbid IQ of 105.3 (range: 79.0-124.0). In 29.6% of patients, a CRCI was detected. Binary logistic regression analyses showed that a lower premorbid IQ (ß = -.084, P < .01) and a higher level of fatigue (ß = -.054, P < .05) predicted baseline CRCI. Premorbid IQ also predicted performance on individual cognitive domains. Some domains were also influenced by age, gender, having a breast cancer diagnosis, and an active treatment for hypertension.

CONCLUSION Premorbid IQ is an important predictor of baseline CRCI. Therefore, we advise researchers to implement a short IQ test when conducting clinical trials on CRCI.

Predictors of baseline cancer-related cognitive impairment in cancer patients scheduled for a curative treatment Lefebvre T, Lycke M, Pottel L, Pottel H, Ketelaars L, Stellamans K, Van Eygen K, Vergauwe P, Werbrouck P, Boterberg T, Debruyne PR. 18th World Congress of Psycho-Oncology and Psychosocial Academy, October 2016 (Dublin, Ireland)

INTRODUCTION/BACKGROUND Increasing research in the field of cancer-related cognitive impairments (CRCI) has shown CRCI presentation prior to treatment initiation. Some have attributed these problems to worry and fatigue, whereas others have suggested an influence of age, IQ and other psychosocial and medical factors.

MATERIALS/METHOD Patients (≥18 years) with a histologically confirmed diagnosis of a solid cancer or haematological malignancy, scheduled for a curative treatment, were evaluated

ONCOLOGISCH CENTRUM

CENTRUM

ORTHOPEDIE / HANDGROEP ARTIKELS RESULTS ABSTRACT 1 Endoscopic ankle lateral ligament graft anatomic reconstruction. Michels F, Cordier G, Guillo S, Stockmans F, ESKKA-AFAS Ankle Instability Group. Foot and Ankle Clinics,2016,21(3),665-680

SUMMARY Chronic instability is a common complication of lateral ankle sprains. If nonoperative treatment fails, a surgical repair or reconstruction may be indicated. Today, endoscopic techniques to treat ankle instability are becoming more popular. This article describes an endoscopic technique, using a step-by-step approach, to reconstruct the ATFL and CFL with a gracilis graft. The endoscopic technique is reproducible and safe with regard to the surrounding anatomic structures. Short and midterm results confirm the benefits of this technique.

The step-by-step approach allowed a good visualisation of the entire course of the ATFL and CFL. An endoscopic reconstruction of both ligaments was performed, and good stability was obtained. The measurements revealed a good positioning of the reconstructed ligament insertions with a maximal error of 2 mm in most specimens. Anatomical dissection revealed no damage to the surrounding anatomical structures that were at risk. The average distance to the superficial peroneal nerve was 11.9 Âą 5.3 mm (standard deviation), and the average distance to the sural nerve was 17.4 Âą 3.2 mm (standard deviation). A safe zone was defined with regard to the surrounding nerves.

CONCLUSION The described technique, which involves an anatomical endoscopic reconstruction of the ATFL and CFL, using a gracilis graft, is a viable option to treat lateral ankle instability. This technique is reproducible and safe with regard to the surrounding anatomical structures.

ABSTRACT 2 Endoscopic reconstruction of CFL and the ATFL with a gracilis graft: a cadaveric study.

ABSTRACT 3 How to drill the talar tunnel in ATFL reconstruction?

Michels F, Cordier G, Guillo S, Stockmans F, ESKKA-AFAS Ankle Instability Group. Knee Surgery, Sports Traumatology, Arthroscopy, 2016, Apr,24(4):1007-1014

Michels F, Guillo S, Vanrietvelde F, Brugman E, Ankle Instability Group, Stockmans F Knee Surg Sports Traumatol Arthrosc,2016,24(4),991-997

OBJECTIVE

Reconstruction of the anterior talofibular ligament may be indicated in cases of residual instability after conservative treatment. Often, a bone tunnel is used for fixation in the talar bone. The purpose of this study is to evaluate possible routes for drilling the talar tunnel.

OBJECTIVE The purpose of this study was to evaluate a step-by-step approach to endoscopic reconstruction of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL).

ABSTRACTBOEK | 2016

MATERIALS/METHOD

Fourteen lower extremity cadaveric specimens were used. Four standard portals were defined and used. A step-by-step approach using several anatomical landmarks was used to reconstruct the ATFL and CFL. The feasibility of visualising the anatomical landmarks and both ligaments and their footprints was assessed. Both ligaments were reconstructed using a gracilis graft fixed in bone tunnels. The lateral side of the ankle was completely exposed and dissected. The specimen was assessed for clinical stability of the reconstruction and damage to the surrounding anatomical structures. The distance between the centre of the tunnel and the anatomical insertions of the ligaments was measured. The distance between the portals and the nerves was measured.

Virtual tunnels were generated in a 3D bone model, oriented towards the following external landmarks: the talar neck, the most anterior point of the medial malleolus (MM), the most distal point of the MM, the most medial point of the MM, and the most posterior point of the MM. The parameters analyzed for tunnels with lengths of 20, 25, and 30 mm were the maximum distance inside the bone and the distance from the tunnel to the bone surface. A minimal safe distance (MSD) was calculated for a tunnel with a diameter of 5 mm.

RESULTS The shortest measured distance before arriving out-

side the talar bone was 16.7 mm. The longest distances were obtained in the tunnels oriented towards the talar neck (mean value of 36.6, SD 2.8) and towards the most posterior point of the MM (mean value of 35.8, SD 0.3). Only one tunnel, measuring 20 mm in depth and oriented towards the most posterior point of the MM, revealed no individual values below the MSD.

CONCLUSION External landmarks are useful for drilling a talar tunnel during reconstruction of the anterior talofibular ligament. Only one tunnel, oriented towards the most posterior point of the MM, measuring 5 mm in diameter and with a maximum depth of 20 mm, was safe in all individuals. Surgeons should be aware of these limits when treating patients with ankle instability.

ABSTRACT 4 Arthroscopic anatomical reconstruction of the lateral ankle ligaments. Guillo S, Takao M, Calder J, Karlson J, Michels F, Bauer T, Ankle Instability Group. Knee Surg Sports Traumatol Arthrosc, 2016, 24(4) 998-1002

SUMMARY Chronic ankle instability secondary to lateral ligament insufficiency is common after sports injury. Many surgical techniques have been described for the treatment of the lateral ankle ligament complex. They can be classified into repair or reconstruction, and non-anatomical or anatomical. A few authors have recently published innovative techniques for arthroscopic ankle ligament management. This paper describes the arthroscopic techniques enabling anatomical lateral ligament reconstruction using gracilis autograft or allograft for chronic ankle instability. This technique and the steps have been developed by the Ankle Instability Group to make this a reproducible procedure. The purpose of this presentation is to document the technique in the future with a view to a clinical study investigating the results of such surgery in a cohort of suitable patients with chronic ankle instability.

ORTHOPEDIE / HANDGROEP

CENTRUM

UROLOGIE ARTIKELS

ABSTRACT 2

ABSTRACT 1

An evidence-based laparoscopic simulation curriculum shortens the clinical learning curve and reduces surgical adverse events.

A randomized trial of abiraterone acetate (AA) administered With 1 of 4 glucocorticoid (GC) regimens in metastatic castration-resistant prostate cancer (mCRPC) patients (pts). Attard G, Tombal B, Merseburger A, Sternberg C, Cerbone L, Recine F, Jones R, Feyerabend S, Berruti A, Joniau S, Schatteman P, Géczi L, Tenke P, Werbrouck P, Nave Shelby F, Lahaye M, Pick C, Lefresne F. Journal of Clinical Oncology,2016,34, no. 2,suppl,261

INTRODUCTION/BACKGROUND AA is approved for mCRPC, coadministered with prednisone (P) (5 mg BID) to prevent adverse events (AEs) associated with mineralocorticoid excess (ME). Lower GC doses had not previously been formally evaluated in combination with AA.

MATERIALS/METHOD This was an open-label, multicenter, phase 2 trial (NCT01867710) of asymptomatic chemotherapy-naïve mCRPC pts randomized 1:1:1:1 to AA (1000 mg QD) plus P 5 mg BID or P 5 mg QD or P 2.5 mg BID or dexamethasone (DEX) 0.5 mg QD. Pts who had previously received GC or ketoconazole were excluded. The primary end point was no ME (% of pts experiencing neither hypokalemia nor hypertension during the first 24 weeks of treatment). Secondary end points included additional safety, as well as response rate in the first 24 weeks, defined as a decline in prostate-specific antigen (PSA) ≥ 50% confirmed after 4 weeks.

RESULTS 164 pts were randomized; 133 (81.6%) completed 24 weeks’ treatment. Median age: 70 years. Table 1 shows the rates of ME, hypertension, hypokalemia and PSA response. Changes in HbA1c values were minimal and observed in 16 (10.7%) pts.

CONCLUSION These data suggest that P 5 mg BID, which is approved in combination with AA, and DEX 0.5 mg QD, are effective in preventing ME-associated AEs, and that P 2.5 mg BID and P 5 mg QD can be safely used with appropriate monitoring. The suggestion of a higher PSA response rate with DEX 0.5 mg QD arm warrants further validation.

De Win G, Van Bruwaene S, Kulkarni J, Van Calster B, Aggarwal R, Allen C, Lissens A, De Ridder D, Miserez M. Advances in Medical Education and Practice,2016,Jun 30:7,357-370

INTRODUCTION/BACKGROUND Surgical simulation is becoming increasingly important in surgical education. However, the method of simulation to be incorporated into a surgical curriculum is unclear. We compared the effectiveness of a proficiency-based preclinical simulation training in laparoscopy with conventional surgical training and conventional surgical training interspersed with standard simulation sessions.

MATERIALS/METHOD In this prospective single-blinded trial, 30 final-year medical students were randomized into three groups, which differed in the way they were exposed to laparoscopic simulation training. The control group received only clinical training during residency, whereas the interval group received clinical training in combination with simulation training. The Center for Surgical Technologies Preclinical Training Program (CST PTP) group received a proficiency-based preclinical simulation course during the final year of medical school but was not exposed to any extra simulation training during surgical residency. After 6 months of surgical residency, the influence on the learning curve while performing five consecutive human laparoscopic cholecystectomies was evaluated with motion tracking, time, Global Operative Assessment of Laparoscopic Skills, and number of adverse events (perforation of gall bladder, bleeding, and damage to liver tissue).

RESULTS The odds of adverse events were 4.5 (95% confidence interval 1.3-15.3) and 3.9 (95% confidence interval 1.59.7) times lower for the CST PTP group compared to the control and interval groups. For raw time, corrected time, movements, path length, and Global Operative Assessment of Laparoscopic Skills, the CST PTP trainees nearly always started at a better level and were never outperformed by the other trainees.

CONCLUSION Proficiency-based preclinical training has a positive

ABSTRACTBOEK | 2016

impact on the learning curve of a laparoscopic cholecystectomy and diminishes adverse events.

and readmission rates.

MATERIALS/METHOD ABSTRACT 3 Bilateral renal tumors in an adult man with SmithMagenis syndrome: The role of the FLCN gene. Dardour L, Verleyen P, Lesage K, Holvoet M, Devriendt K. European Journal of Medical Genetics,2016,Sep 12;59(10),499-501

INTRODUCTION/BACKGROUND Smith-Magenis syndrome (SMS) is a contiguous-gene disorder most commonly caused by a deletion of chromosome 17p11.2.

RESULTS We report a 57 year-old man with SMS who presents bilateral renal tumors. This is most likely related to haploinsufficiency of FLCN gene, located in the deleted region, and a known tumor suppressor gene. Haploinsufficiency of FLCN causes Birt-Hogg-DubĂŠ syndrome (BHDS), characterized by pulmonary cysts, renal and skin tumors.

CONCLUSION The present observation suggests that the follow-up of patients with SMS should also focus on possible manifestations of BHDS.

We analyzed our database of all patients undergoing RARP with Robocare between July 2012 and December 2013 at Peter MacCallum Cancer Centre, Australia (PMCC). Compliance, Length of Stay and Postoperative Course were analysed. Patient satisfaction was assessed.

RESULTS Overall 124 patients underwent RARP with 105 (85%) being discharged day 1 post-op (mean 1.3 days). Postoperative support phone calls were received by >95% of patients. Thereafter, 74 patients (60%) were followed in the long-term follow-up phone clinic. Twenty-nine complications were identified of which 19 (66%) were resolved by the nurse specialist. Eighteen patients had psychologist, 44 sexual health and 44 physiotherapist referral. Patient satisfaction in 74 (60%) returned surveys revealed 71 (96%) being well/very well supported.

CONCLUSION The Robocare pathway is safe with high patient satisfaction. It contributes to reducing post-operative length of stay and readmission rates as well as the outpatient follow-up. A true multidisciplinary approach that is nurse-led likely improves care and outcomes for RARP patients and may lower impact on hospital resources.

ABSTRACT 5 ABSTRACT 4 Developing and evaluating Robocare; an innovative, nurse-led robotic prostatectomy care pathway. Birch E, van Bruwaene S, Everaerts W, Schubach K, Bush M, Krishnasamy M, Moon DA, Goad J, Lawrentschuk N, Murphy DG. European Journal of Oncology Nursing,2016,Apr; 21,120125

Phase III randomised chemoprevention study with selenium on the recurrence of non-invasive urothelial carcinoma. The SELEnium and BLAdder cancer Trial. Goossens ME, Zeegers MP, van Poppel H, Joniau S, Ackaert K, Ameye F, Billiet I, Braeckman J, Breugelmans A, Darras J, Dilen K, Goeman L, Tombal B, Van Bruwaene S, Van Cleyenbreugel B, Van der Aa F, Vekemans K, Buntinx F. European Journal of Cancer,2016,Dec; 69,9-18

OBJECTIVE A Robotic Prostatectomy Care Pathway ("Robocare"), aiming to prepare men for robotic-assisted radical prostatectomy (RARP) and manage side-effects and long-term follow-up in a multidisciplinary fashion was established. The pathway enhances patient care by providing adequate information and support and optimizes efficiency by reducing length of stay and minimizing hospital visits. Our study assesses the pathway for patient satisfaction, co-ordination of care between disciplines, length of stay

INTRODUCTION/BACKGROUND In Belgium, bladder cancer (BC) is the fifth most common cancer in men. The per-patient lifetime cost is high. Previous epidemiological studies have consistently reported that selenium concentrations were inversely associated with the risk of BC.

OBJECTIVE We therefore hypothesised that selenium may be suitable for chemoprevention of recurrence of BC.

UROLOGIE

MATERIALS/METHOD

The Selenium and Bladder Cancer Trial (SELEBLAT) was an academic phase III placebo-controlled, double-blind, randomised clinical trial designed to determine the effect of selenium on recurrence of non-invasive urothelial carcinoma conducted in 14 Belgian hospitals. Patients were randomly assigned by a computer program to oral selenium yeast 200 Îźg once a day or placebo for three years, in addition to standard care. All study personnel and participants were blinded to treatment assignment for the duration of the study. All randomised patients were included in the intention to treat (ITT) and safety analyses. Per protocol analyses (PPAs) included all patients in the study three months after start date.

A literature search of the English literature was performed in October 2015 on PubMed using the search terms "bladder cancer", "node-positive" and "prognosis/outcome". Papers were only selected when separate information on the node-positive subpopulation was available. Data from prospective studies, meta-analysis or multi-institutional were selected primarily.

RESULTS Between September 18, 2009 and April 18, 2013, 151 and 141 patients were randomised in the selenium and placebo group. Patients were followed until December 31, 2015. The ITT analysis resulted in 43 (28%; 95% CI, 0.21-0.35) and 45 (32%; 95% CI, 0.24-0.40) recurrences in the selenium and placebo group. The hazard ratio (HR) was 0.85 (95% CI, 0.56-1.29; p = 0.44) while the HR for the PPA resulted in 42 and 39 (28%; 95% CI, 0.20-0.35) recurrences in the selenium and placebo group (HR = 0.96 [95% CI, 0.62-1.48]; p = 0.93).

CONCLUSION Selenium supplementation does not lower the probability of recurrence in BC patients.

RESULTS Current 2010 TNM classification of nodal disease seems to have limited prognostic value. Several other nodal parameters such as number of positive nodes, number of resected nodes, LN density and extracapsular extension have been extensively evaluated and show potential in distinguishing prognostic subgroups. Although nodepositive bladder cancer is often seen as systemic disease local tumor characteristics such as T stage and histological variants seem to remain important. Molecular markers are promising in stratifying patients with bladder cancer but need further validation in a specific nodepositive subgroup. Neo-adjuvant chemotherapy seems to improve the prognosis of clinical node-positive patients and evaluation of response could help in selecting patients who benefit from consolidating surgery. Although retrospective studies convincingly suggest improved clinical outcome with adjuvant chemotherapy for pathological node-positive patients, these findings are not consistently confirmed in recent prospective studies.

CONCLUSION ABSTRACT 6 Prognosis of node-positive bladder cancer in 2016.

Future research should aim at the incorporation of prognostic variables into clinically applicable nomograms and identification of the subgroup of patients who will benefit from adjuvant treatments.

Van Bruwaene S, Costello AJ, Van Poppel H. Minerva Urologica e Nefrologica,2016,Apr;68(2),125-137

ABSTRACT 7 INTRODUCTION/BACKGROUND Lymph node (LN) positive bladder cancer is a serious disease associated with a poor prognosis. Nevertheless even after radical cystectomy and lymph node dissection alone long-term oncologic control has been reported in a subset of these patients. Efforts have been made to stratify LN-positive patients according to various prognostic factors to make more individualized risk estimations.

OBJECTIVE This review attempts to summarize the existing data on prognostic determinants in node-positive bladder cancer.

ABSTRACTBOEK | 2016

Randomized, double-blind, placebo-controlled phase III study of tasquinimod in men with metastatic castration-resistant prostate cancer. Sternberg C, Armstrong A, Pili R, Ng S, Huddart R, Agarwal N, Khvorostenko D, Lyulko O, Brize A, Vogelzang N, Delva R, Harza M, Thanos A, James N, Werbrouck P, BĂśgemann M, Hutson T, Milecki P, Chowdhury S, Gallardo E, Schwartsmann G, Pouget JC, Baton F, Nederman T, Tuvesson H, Carducci M Journal of Clinical Oncology,2016,34(22),2636-2643

OBJECTIVE Tasquinimod, a novel oral therapy targeting the tumor microenvironment, significantly improved progressionfree survival (PFS) in a randomized, placebo-controlled phase II trial in men with metastatic castration-resistant prostate cancer (mCRPC). This phase III study was conducted to confirm the phase II results and to detect an overall survival (OS) benefit.

MATERIALS/METHOD Men with chemotherapy-naïve mCRPC and evidence of bone metastases were assigned (2:1) to receive tasquinimod once per day or placebo until progression or toxicity. The primary end point was radiographic PFS (rPFS; time from random assignment to radiologic progression or death) per Prostate Cancer Working Group 2 criteria and RECIST 1.1. The study had 99.9% power to detect an rPFS hazard ratio (HR) of 0.6 with a two-sided alpha error of .05 and 80% power to detect a target HR of 0.8 for OS, the key secondary end point.

RESULTS In all, 1,245 patients were randomly assigned to either tasquinimod (n = 832) or placebo (n = 413) between March 2011 and December 2012 at 241 sites in 37 countries. Baseline characteristics were balanced between groups: median age, 71 years; Karnofsky performance status ≥ 90%, 77.3%; and visceral metastases, 21.1%. Estimated median rPFS by central review was 7.0 months (95% CI, 5.8 to 8.2 months) with tasquinimod and 4.4 months (95% CI, 3.5 to 5.5 months) with placebo (HR, 0.64; 95% CI, 0.54 to 0.75; P < .001). Median OS was 21.3 months (95% CI, 19.5 to 23.0 months) with tasquinimod and 24.0 months (95% CI, 21.4 to 26.9 months) with placebo (HR, 1.10; 95% CI, 0.94 to 1.28; P = .25). Grade ≥ 3 adverse events were more frequent with tasquinimod (42.8% v 33.6%), the most common being anemia, fatigue, and cancer pain.

CONCLUSION In chemotherapy-naïve men with mCRPC, tasquinimod significantly improved rPFS compared with placebo. However, no OS benefit was observed.

UROLOGIE

CENTRUM

VASCULAIRE EN THORACALE CHIRURGIE ARTIKELS ABSTRACT 1 Combined minimal invasive transdiaphragmatic resections of peripheral colorectal lung metastases in patients undergoing laparoscopic liver resections. Lerut P, Nuytens F, D'Hondt M. Annals of Surgical Oncology,2016,23,885 De tekst van het abstract is terug te vinden op pagina 4.

PRESENTATIES CONGRESSEN ABSTRACT 1 Combined minimal invasive transdiaphragmatic resection of peripheral colorectal lung metastases in patients undergoing laparoscopic liver resection. Video presentation. Lerut P, Vansteenkiste F, Dâ&#x20AC;&#x2122;Hondt M 24th European Conference on General Thoracic Surgery (ESTS), 29 mei - 1 juni 2016, (Naples, Italy) De tekst van het abstract is terug te vinden op pagina 4

ABSTRACT 2 Shunting during carotid endarterectomy: is it safe? Lessons learned from diffusion-weighted magnetic resonance imaging! Wybaillie E, Ceuppens H, De Smul G, Wallaert P, Pottel H, Seynaeve P, Lerut P. 30th international congress of the European Society of Vascular Surgery (ESVS), 28-30 September 2016 (Copenhagen, Denmark) De tekst van het abstract is terug te vinden op pagina 11

ABSTRACTBOEK | 2016

az groeninge is internationaal erkend door jci voor veilige zorg en kwaliteit. www.azgroeninge.be/kwaliteit VASCULAIRE EN THORACALE CHIRURGIE

ABSTRACTBOEK | 2016