ABSTRACT BOEK
WETENSCHAPPELIJKE PUBLICATIES VAN AZ GROENINGE
2017
1
CENTRA 04 ALGEMENE HEELKUNDE
39 NEFROLOGIE
11 ANESTHESIE / INTENSIEVE ZORG
38 NEUROLOGIE
13 APOTHEEK
41 NUCLEAIRE GENEESKUNDE
14 CARDIOLOGIE
52 ONCOLOGIE
15 ENDOCRINO- / DIABETOLOGIE
58 ORTHOPEDIE / HANDGROEP
16 GYNAECOLOGIE / VERLOSKUNDE
57 PSYCHIATRIE
19 INWENDIGE ZIEKTEN GASTRO-ENTEROLOGIE
58 RADIOTHERAPIE 60 UROLOGIE
23 KINDERGENEESKUNDE 25 KLINISCH LABORATORIUM
63 VASCULAIRE EN THORACALE CHIRURGIE
27 MEDISCHE BEELDVORMING
VU Inge Buyse, Pres. Kennedylaan 4 | 8500 Kortrijk Uitgegeven in opdracht van het wetenschappelijk comité van az groeninge
2
ABSTRACTBOEK | 2017
Dit abstractboek is ook te raadplegen via www.azgroeninge.be /azgpublicaties
VOORWOORD
Geachte lezer
D
e ziekenhuisnetwerken hebben zich gevormd en wachten op hun erkenning. Ook de eerstelijnszorg wordt hervormd: de zones zijn bepaald en staan in hun startblokken. Regionale zorgzones worden nog gevormd en groeperen best een aantal eerstelijnszones die zo veel mogelijk met de locoregionale klinische netwerken overeenkomen. Een aantal RIZIV conventies, die de concentratie van complexe chirurgie op het oog hebben, worden voorbereid. Er worden lijsten verspreid met diverse type zorgopdrachten. Sommige van deze zorgopdrachten zullen niet in elk ziekenhuis en zelfs niet in elk ziekenhuisnetwerk aangeboden worden. Het wordt een periode van grote uitdagingen, waarin alle actoren hun plaats zullen moeten zoeken. De ziekenhuisnetwerken, die bij hun start nog aanvoelen als een groep ziekenhuizen samenwerkend in een los verband, zullen misschien wel evolueren naar regionale gezondheids zorgsystemen waarin de grenzen tussen de individuele z iekenhuizen vervagen. De opdracht van deze netwerken is in essentie zowel de kwaliteit als de efficiëntie van de gezondheidszorg te bevorderen. Artsen die naast hun klinische praktijk nog wetenschappelijk actief zijn, volgen doorgaans de recentste wetenschappelijke evoluties op de voet, participeren aan congressen, houden data bij over hun resultaten die ze kritisch aftoetsen aan eerder door gerenommeerde groepen gepubliceerde resultaten. Ze publiceren hun resultaten en bewijzen zo over expertise te beschikken, die niet in elk centrum voorhanden is. Maar bovenal draagt hun inspanning bij tot het verbeteren van de kwaliteit van het medisch aanbod in ons ziekenhuis en bij verlening in ons ziekenhuisnetwerk. Dit abstractboek bundelt de publicaties die het voorbije jaar tot stand gekomen zijn in AZ Groeninge of in nauwe samenwerking met artsen, apothekers, verpleegkundigen en paramedici van AZ Groeninge. DR. SERGE VANDERSCHUEREN MEDISCH DIRECTEUR
3
CENTRUM
ALGEMENE HEELKUNDE ARTIKELS
ABSTRACT 2
ABSTRACT 1
Totally extraperitoneal laparoscopic inguinal hernia repair using a self-expanding nitinol framed hernia repair device: A prospective case series.
Transanal endoscopic operation for benign rectal lesions and T1 carcinoma. D'Hondt M, Yoshihara E, Dedrye L, Vindevoghel K, Nuytens F, Pottel H. Journal of the Society of Laparoendoscopic Surgeons, 2017, 21(1),1-8
INTRODUCTION/BACKGROUND Transanal endoscopic operation (TEO) is a minimally inva sive technique used for local excision of benign and selected malignant rectal lesions.
OBJECTIVE The purpose of this study was to investigate the feasibility, safety, and oncological outcomes of the procedure and to report the experience in 3 centers.
MATERIALS/METHODS Retrospective review of a prospectively collected database was performed of all patients with benign lesions or cT1N0 rectal cancer who underwent TEO with curative intent at 3 Belgian centers (2012 through 2014).
D'Hondt M, Nuytens F, Yoshihara E, Adriaens E, Vansteenkiste F, Pottel H. International Journal of Surgery, 2017, 40,139-144
INTRODUCTION/BACKGROUND The use of a self-expanding nitinol framed prosthesis (Re boundHRD®) for totally extraperitoneal laparoscopic in guinal hernia repair (TEP-IHR) could solve issues of mesh shrinkage and associated pain.
OBJECTIVE We prospectively evaluated the use of the ReboundHRD® mesh for TEP-IHR.
MATERIALS/METHODS All patients who underwent a TEP-IHR using the ReboundHRD® Large mesh from April 2014 till May 2015, were included. No mesh fixation was performed. Follow-up assessments were performed at the day of surgery, 1, 2, and 7 days, 1, 3, 6, and 12 months. Outcome measures include postoperative pain (visual analogue scale, VAS), operative details, complications, and recurrence rate.
RESULTS Eighty-three patients underwent 84 TEOs for 89 rectal lesions (37 adenomas, 43 adenocarcinomas, 1 gastro intestinal stromal tumor, 1 lipoma, 2 neuroendocrine tumors, and 5 scar tissues). Operative time was associa ted with lesion size (P .001). Postoperative complications occurred in 13 patients: 7 hemorrhages, 1 urinary tract infection, 1 urinary retention, 2 abscesses, 1 anastomotic stenosis, and 1 entrance into the peritoneal cavity. Median hospital stay was 3 days (range, 1–8). During a median follow-up of 13 months (range, 2–27), there was 1 recurrence.
CONCLUSION Although longer follow-up is still necessary, TEO appears to be an effective method of excising benign tumors and low-risk T1 carcinomas of the rectum. However, TEO should be considered as part of the diagnostic work-up. Furthermore, the resected specimen of a TEO procedure allows adequate local staging in contrast to an endoscopic piecemeal excision. Nevertheless, definitive histology must be appreciated, and in case of unfavorable histology, radical salvage resection still has to be performed.
4
ABSTRACTBOEK | 2017
RESULTS In total, 69 TEP-IHR procedures were performed in 54 patients (15 bilateral hernias). No perioperative and 5 (9%) postoperative complications occurred, all graded Clavien-Dindo I-II. The median length of stay was 1 day (range 0-3), with 78% of the operations performed in an ambulatory setting. Median VAS score decreased from 3 (range 0e4) on the day of surgery to 1 (range 0-2) on day 7. Patients were completely pain-free at a median time of 5 (range 1-60) days. The majority (80.4%, 37/46) of the active patients went back to work within 2 weeks (maximum 6 weeks). At a median follow-up of 19 months (range 16-26 months), no recurrences occurred.
CONCLUSION TEP-IHR using a self-expanding nitinol framed hernia repair device is a safe technique in longterm follow-up. The technique is associated with a low incidence of postoperative pain, a short hospital stay and quick return to normal activities.
ABSTRACT 3 The interval approach: an adaptation of the liver-first approach to treat synchronous liver metastases from rectal cancer. D'Hondt M, Lucidi V, Vermeiren K, Van Den Bossche B, Donckier V, Sergeant G. World Journal of Surgical Oncology, 2017, 15 (1),1-4
treatment modality for low anterior resection syndrome (LARS).
OBJECTIVE The primary aim of this study is to investigate the impact of SNS on all symptoms of LARS, not merely on fecal incontinence. Furthermore, we wanted to evaluate w hether the LARS score could be useful as a tool to evaluate SNS treatment.
INTRODUCTION/BACKGROUND The waiting interval after chemoradiotherapy (CRT) is an interesting therapeutic window to treat patients with syn chronous liver metastases (SLM) from rectal cancer.
MATERIALS/METHODS A retrospective analysis was performed of 18 consecutive patients (M/F 10/8, age (range) 60 (51-75) years) from five institutions who underwent liver resection of SLM during the waiting interval after CRT for rectal adenocarcinoma.
MATERIALS/METHODS All patients diagnosed with minor or major LARS, unrespon sive to conservative therapy for fecal incontinence, who underwent sacral neuromodulation for LARS at Groeninge Hospital, Kortrijk, Belgium, were prospectively enrolled in the study. The primary endpoint was the reduction in the severity of LARS. This was assessed by validated question naires: the LARS score and the Wexner score.
RESULTS RESULTS All patients underwent interval liver surgery for a median (range) of 4 (2-14) liver metastases. Metastases involved a median (range) of 4 (1-7) liver segments. Median (range) time between end of CRT and liver surgery was 22 (6-45) days. Laparoscopic liver surgery was performed in 12 (67%) patients. No severe complications (Clavien- Dindo ≥ 3b) occurred after liver surgery. Median (range) length of hospital stay after liver surgery was 5 (1-10) days. All patients subsequently underwent rectal resection at a median (range) of 10 (8-13) weeks after end of CRT. Median (IQR) time-to-progression after liver surgery was 4.2 (2.89.2) months.
Eleven patients underwent definite implantation of the SNS device. All patients showed a substantial decrease in their Wexner scores: The mean score was reduced from 17.7 to 4.6 (Z: 2.93; p: 0.0033). Additionally, the mean LARS score dropped from 36.9 to 11.4 (Z: 2.93; p: 0.0033). Further more, there was a significant amelioration of all symptoms of LARS.
CONCLUSION Our study shows that SNS is effective for all symptoms of LARS. The authors believe that in patients who receive SNS for LARS, it could be useful to determine the LARS score to evaluate the complexity of the symptoms and their response to treatment.
CONCLUSION The waiting interval after neoadjuvant CRT is a valuable option to treat SLM from rectal cancer. More data are necessaryto confirm its oncological efficacy.
ABSTRACT 5 Chronic refractory constipation due to neurogenic bowel dysfunction can be successfully treated by sacral neurostimulation.
ABSTRACT 4 Sacral neurostimulation for low anterior resection syndrome after radical resection for rectal cancer: evaluation of treatment with the LARS score.
Nuytens F, D'Hondt M. Acta Chirurgica Belgica, 2017, 3,1-4
D'Hondt M, Nuytens F, Kinget L, Decaestecker M, Borgers B, Parmentier I. Techniques in Coloproctology, 2017, 21 (4),301-307
In the last few decades, sacral neurostimulation (SNS) has proven to be an effective treatment option for functional bowel disorders. Experience concerning the role of SNS in the treatment of chronic constipation due to neurogenic bowel dysfunction (NBD) however is limited.
INTRODUCTION/BACKGROUND
INTRODUCTION/BACKGROUND Sacral neurostimulation (SNS) has proven to be an effective
ALGEMENE HEELKUNDE
5
MATERIALS/METHODS In this report, we present the case of a 44-year old patient, with chronic refractory neurogenic constipation after a spontaneous cerebral hemorrhage, who was treated with SNS.
RESULTS Prior to treatment with SNS, the Constipation Scoring System showed a score of 22/30. Three months after SNS implantation, this score was reduced to 5/30. Patient had successful evacuation of stool every one to two days. Medication could be reduced to 15 drops of picosulphate per day. Patient experienced a significant improvement in quality of life.
CONCLUSION We believe that SNS could offer a safe, effective and relatively cost-effective treatment for patients with NBD refractory to conservative treatment.
ABSTRACT 6 Conversion for unfavorable intraoperative events results in significantly worst outcomes during laparoscopic liver resection: lessons learned from a multicenter review of 2861 cases. Halls MC, Cipriani F, Berardi G, Barkhatov L, D'Hondt M, Lainas P, Alzoubi M, Rotellar F, Dagher I, Aldrighetti L, Troisi RI, Edwin B, Hilal MA. Annals of Surgery, 2017,265(6)
aintained databases of 7 tertiary liver centers across m Europe was performed.
RESULTS Neo-adjuvant chemotherapy, previous liver resection(s), resections for malignant lesions, postero-superior loca tion, and the extent of the resection are associated with an increased risk of conversion. Patients who require con version have longer operations with higher blood loss; a longer HDU and total hospital stay, increased frequency and severity of complications and higher 30- and 90-day mortality. Patients who had an elective conversion for an unfavorable intraoperative finding had better outcomes than patients who had an emergency conversion second ary to an unfavorable intraoperative event in terms of HDU and total hospital stay, severity of complication, and 90-day mortality.
CONCLUSION Our study highlights the risk factors for conversion and suggests that conversion for unfavorable intraoperative events is associated with worse outcomes.
ABSTRACT 7 Central venous pressure drop after hypovolemic phlebo tomy is a strong independent predictor of intraoperative blood loss during liver resection. Ryckx A, Christiaens C, Clarysse M, Vansteenkiste F, Steelant PJ, Sergeant G, Parmentier I, Pottel H, D'Hondt M. Annals of Surgical Oncology, 2017, 24 (5),1367-1375
INTRODUCTION/BACKGROUND Multiple previous studies demonstrate that laparoscopic liver surgery reduces intraoperative blood loss, hospital stay, and morbidity while maintaining comparable onco logical and survival outcomes when compared with open liver resections. However, limited information is available regarding the possible sequelae of conversion to open surgery, especially with regards to cause of conversion.
OBJECTIVE To investigate the risk factors for conversion during laparo scopic liver resection and its effect on patient outcome in a large cohort of patients. Additional analysis of outcomes in patients who required conversion for unfavorable intra operative findings and conversion for unfavorable intra operative events will be performed to establish if the cause of conversion effects outcome.
MATERIALS/METHODS A retrospective analysis of 2861 cases from prospectively
6
ABSTRACTBOEK | 2017
INTRODUCTION/BACKGROUND Intraoperative hypovolemic phlebotomy (HP) has been suggested to reduce central venous pressure (CVP) before hepatectomy.
OBJECTIVE This study aimed to analyze the impact of CVP drop after HP on intraoperative blood loss and postoperative renal function.
MATERIALS/METHODS A retrospective review of a prospective database inclu ding 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 multi variate linear regression analysis was performed to identify predictors of intraoperative blood loss.
RESULTS The median CVP before blood salvage was 8 mmHg (range 4–30 mmHg). The median volume of hypovolemic phle botomy 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 postope rative 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.
CONCLUSION 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.
measure was the presence of anastomotic leak within 30 days of surgery, using a pre-specified definition. Mixed effects logistic regression models were used to assess the association between leak and anastomosis method, adjus ting for patient, disease and operative cofactors, with cen tre included as a random effect variable.
RESULTS This study included 3208 patients, of whom 78.4% (n=2515) underwent surgery for malignancy and 11.7% (n=375) for Crohn's disease. An anastomosis was performed in 94.8% (n=3041) of patients, which was handsewn in 38.9% (n=1183) and stapled in 61.1% (n=1858) cases. Patients undergoing handsewn anastomosis were more likely to be emergency admissions (20.5% handsewn versus 12.9% s tapled) and to undergo open surgery (54.7% ver sus 36.6%). The overall anastomotic leak rate was 8.1% (245/3041), which was similar following handsewn (7.4%) and stapled (8.5%) techniques (p=0.3). After adjustment for cofactors, the odds of a leak were higher for stapled ana stomosis (adjusted odds ratio 1.43, 95% confidence interval 1.04-1.95, p=0.03).
ABSTRACT 8 Hoe een hardnekkige rash door een chirurg kan worden genezen... Salembier A, Bonny M, Vansteenkiste F, D'hondt M, Meersman W, D'heygere F. Tijdschrift voor Geneeskunde, 2017, 73(21),1333-1338
CONCLUSION Despite being used in lower risk patients, stapled anastomosis was associated with an increased anastomotic leak rate in this observational study. Further research is needed to define patient groups in whom a stapled ana stomosis is safe.
De tekst van het abstract is terug te vinden op pagina 19.
ABSTRACT 10 ABSTRACT 9 The relationship between method of anastomosis and anastomotic failure after right hemicolectomy and ileocaecal resection: an international snapshot audit
Laparoscopic parenchymal preserving liver resections for colorectal liver metastases in the era of highly effective systemic therapy and selective internal radiation therapy can often prevent a hemihepatectomy.
Van Geluwe B. 2015 European Society of Coloproctology collaborating group Colorectal Disease, 2017, 19(8), e296-e311
D'Hondt M, Ververken F, Nuytens F. Surgical Oncology, 2017, 26(4), 345-346
INTRODUCTION/BACKGROUND
MATERIALS/METHODS
Preservation of hepatic parenchyma is important in liver surgery to prevent postoperative liver failure and accor ding to some reports it could offer a prolonged survival and lower recurrence rates compared to major hepatectomies in patients with colorectal liver metastases. However, lapa roscopic parenchyma-preserving liver resections can be technically challenging.
This was a prospective, multicentre, international audit including patients undergoing elective or emergency right hemicolectomy or ileo-caecal resection operations over a two-month period in early 2015. The primary outcome
The aim of this video is to illustrate the concept of laparoscopic parenchymal-preserving liver resections after
INTRODUCTION/BACKGROUND Anastomosis technique following right sided colonic resec tion is widely variable and may affect patient outcomes. This study aimed to assess the association between leak and anastomosis technique (stapled versus handsewn).
OBJECTIVE
ALGEMENE HEELKUNDE
7
conversion chemotherapy with targeted therapy.
MATERIALS/METHODS In this video we present three cases in which a laparoscopic parenchymal-preserving liver resection was performed after neo-adjuvant therapy: the first patient had a giant solitary colorectal metastasis in segment V and VIII. Neoadjuvant chemotherapy was given, resulting in a 30% volume reduction of the lesion after which a laparoscopic anterior sectionectomy was successfully performed. The second patient had five colorectal liver metastases. After conversion chemotherapy, four remaining metastases were resected by laparoscopic surgery. The last patient had 7 colorectal liver metastases. After 18 cycles of neo-ad juvant chemotherapy and a good response to selective internal radiation therapy, a laparoscopic liver resection of six metastases and radio-frequency ablation of 1 central lesion were performed.
op te stellen. Anamnese en anorectaal klinisch onderzoek vormen de hoeksteen in de diagnostiek. De belangrijkste aanvullende technische onderzoeken zijn echo-endografie (evaluatie sfincter-apparaat), en rx defecografie (uitsluiten rectale prolaps) om geassocieerde anatomische afwijkingen te detecteren, en de impact van een eventuele heelkundige correctie hiervan te evalueren.
ABSTRACT 2 Laparoscopic versus open parenchymal preserving liver resections in the posterosuperior segments: a case matched study D’Hondt M, Boscart I, Parmentier I, Vansteenkiste F, et al. 6 July 2017, World Congress of the International Laparo scopic Liver Society, Paris, France
RESULTS
ABSTRACT 3
The video of these three cases shows that laparoscopic parenchymal-preserving liver surgery is feasible after neo-adjuvant systemic therapy and selective internal radiation therapy.
Simultaneous laparoscopic colorectal and hepatic resection for patients with colorectal cancer and synchronous liver metastases: a multicenter, retrospective study
CONCLUSION The emergence of more effective systemic chemotherapies with biologicals and SIRT for the treatment of colorectal liver metastases often creates a possibility for parenchymal- preserving liver resections to achieve an R0 resection.
PRESENTATIES/ CONGRESSEN
Van der Poel MJ, D’Hondt M, Gobardhan PD. et al. July 2018, World Congress of the International Laparoscopic Liver Society, Paris, France
INTRODUCTION/BACKGROUND Laparoscopic resection is considered a viable treatment option for both colorectal cancer and colorectal liver meta stases. Simultaneous laparoscopic resections have been described in preliminary studies with promising overall results.
OBJECTIVE ABSTRACT 1 Fecale incontinentie: Welke diagnostiek bij welke patiënt? Van Geluwe B. april 2017, Nederlands-Vlaams IGO (Infertiliteit, Gynaecologie, Obstetrie)-Doelencongres, Rotterdam, Nederland
INTRODUCTION/BACKGROUND Fecale incontinentie is het ongewild verlies van stoelgang, en kan in verschillende gradaties voorkomen. Het kan een ernstige invaliderende impact hebben op het functioneren en het sociale leven van de patiënt. Meestal zijn de k lachten progressief en reeds lang bestaande alvorens medische hulp wordt gezocht. De diagnostische oppuntstelling is cruciaal om een correct en adequaat behandelingsplan
8
ABSTRACTBOEK | 2017
The aim of this study was to present the results of a combined, multicenter experience with totally laparoscopic simultaneous colorectal and liver resection.
MATERIALS/METHODS All associated centers retrospectively reviewed databases containing their complete experience with laparoscopic liver resection (LLR) until January 2017 and selected all patients with colorectal liver metastases that underwent simultaneous resection of colorectal primary and liver metastases. Patient, tumor and procedure characteristics, operative variables and postoperative outcomes were reported.
RESULTS A total of 63 patients, 35 (55%) males with a mean age of 64 (range 35-91), met the inclusion criteria. Patients
most frequently presented with a primary tumor located in the sigmoid (n=27, 42%) and a solitary or multiple small liver metastases. In most cases (n=54, 86%) single stage minor liver resection sufficed for a curative resection. Hand-assistance was used in 6 (9%) and robot-assistance was used in 2 (3%) cases. Overall median operative time was 206 minutes (IQR 170-310) and median blood loss was 200 ml (IQR 100-700). A conversion was necessary in 3 patients (5%). Major postoperative morbidity and 30 day mortality were 18% (n=11) and 0%, respectively.
CONCLUSION Laparoscopic simultaneous colorectal and liver resection seems a safe and a feasible treatment strategy in patients with synchronous colorectal liver metastasis. Especially during early experience, patients with solitary or multiple small liver metastasis that require minor liver resection only should be considered ideal candidates for this approach.
ABSTRACT 4 The effectiveness of a clinical pathway in laparoscopic liver surgery: a case control study. Ovaere S, Parmentier I, Boscart I, Pottel H, D’Hondt M. July 2017, World Congress of the International Laparo scopic Liver Society, Paris, France
RESULTS Overall analysis: A total of 147 patients were included for analysis. 80 patients (32 males, 48 females) were cared for according to traditional management standards. Sixty- seven patients (34 males, 33 females) recovered according to CP principles. In the CP group, 6 of 67 patients had one or more postoperative complication, which is significantly less than 18 of 80 patients in the traditional care cohort (p<0.027). Readmission rate was similar (3.0% in the CP vs 3.8% in TM setting; p=0.57). Median hospital stay was halved, from a six day hospital stay before implementation, to three days after implementation of a CP (p<0.001). Case-match analysis: forty-four patients from the TM cohort were matched with forty-four patients from the CP cohort. Although not statistically significant, there was a reduction in postoperative morbidity in the CP setting ( 6.8% in CP vs 22..7% in TM setting; p=0.068). There was no differ ence in readmission rate (CP n = 0, TM n = 2; p=1.0). Median hospital stay was shortened with 2 days, from 6 days in the TM cohort to 4 days in the CP cohort (p<0.001).
CONCLUSION By implementing a clinical pathway for laparoscopic liver surgery, hospital stay was significantly reduced without increasing the postoperative morbidity or readmission rate. A CP for laparoscopic liver surgery can be safely implemented.
INTRODUCTION/BACKGROUND Clinical pathways have been applied succesfully to patients undergoing colorectal, pancreatic, gastric or oesphageal surgery. However, in the field of liver surgery, evidence on the effectiveness of a standardized clinical pathway (CP) is limited.
OBJECTIVE The aim of this study was to analyse the effect of a CP designed specifically for patients undergoing laparscopic liver surgery. The impact in hospital stay, postoperative morbidity and readmission rates was evaluated.
ABSTRACT 5 Laparoscopic right anterior and right posterior sectionectomy – a standardized approach. Video presentation. Ovaere S, Ververken F, D’Hondt M. July 2018, World Congress of the International Laparo scopic Liver Society, Paris, France
OBJECTIVE Video presentation
MATERIALS/METHODS
MATERIALS/METHODS
This is a prospective observational study. Two cohorts were formed of all patients undergoing laparoscopic liver surgery during a defined period before and after introduc tion of a CP for liver surgery (June 2015), generating a CP cohort and a traditional management (TM) cohort. The study p eriod was defined from September 2011 until June 2016. In addition to an overall analysis of the TM and CP co horts, a case-match analysis, based on the patient’s tumor location (same segment) and the Brisbane classification of the resection, was performed.
This video illustrates a step-by-step approach for both RA and RP sectionectomies.
RESULTS In our center, both procedures are standardized. RA sectionectomies are installed in supine position, whereas semiprone position for RP sectionectomies is used. This semiprone position achieves maximal working space be tween the right subphrenic region. The sulcus of Rouvière, present in 82% of patients, is an important anatomical land
ALGEMENE HEELKUNDE
9
mark in both procedures. A Glissonian approach is used to allow for safe and masse control of portal structures. Emphasis is put on the importance of patient positioning, anatomical landmarks, adequate mobilization of the liver and assessment of liver viability after pedicle clamping.
ABSTRACT 6 Laparoscopic hepato-pancreatectomy for metastatic glucagonoma. Video presentation. D’Hondt M, Ververken F, Vansteenkiste F. July 2017, World Congress of the International Laparoscopic Liver Society, Paris, France
INTRODUCTION/BACKGROUND Glucagonoma is a rare neuroendocrine tumor. Delays in diagnosis are common for this slow growing tumor and half of patients will have metastatic disease when diagnosed. Complete resection of the primary tumor and all meta stases is the only chance of cure.
MATERIALS/METHODS This video shows a case of a 79 year old female diagnosed with a large symptomatic glucagonoma of the d istal pancreas, a large liver metastasis in segment V and a smaller one in segment VIII. She suffered from a norexia, cheilitis, glossitis, weight loss and necrolytic migratory erythema.
MATERIALS/METHODS The patient was positioned in semiprone position in order to get better exposure during laparoscopic liver and lung resection. A laparoscopic resection of a large metastasis in segment VII was performed. The right lung was deflated and the right diaphragm was opened. Using intra-opera tive ultrasound, the two metastasis in the right lung were localized and resected using endoscopic 60-mm vascular staplers. A thoracic tube was inserted and the diaphragm was closed with a non-absorbable running suture. Opera tive time was 215 min and blood loss was 300ml.
RESULTS
RESULTS The postoperative course was uneventful and the patient was discharged on postoperative day 4. Tumorfree margins of 6mm for the liver and 12mm for the lung were achieved.
ABSTRACT 7
D’Hondt M, Willems E, Lerut P. July 2017, World Congress of the International Laparoscopic Liver Society, Paris, France
ABSTRACTBOEK | 2017
OBJECTIVE This video aims to demonstrate our first experience of a combined minimally invasive transdiaphragmatic resection of right sided colorectal lung metastases in a patient under going a laparoscopic liver resection of a liver metastasis in the posterosuperior segments.
A laparoscopic distal pancreatectomy, splenectomy, wedge resection of the colon and laparoscopic hepatectomy (ana tomical segment V resection and metastasectomy in seg ment VIII) was perfomed. Operative time was 325 minutes and the estimated blood loss was 200 mL. The patient had a short hospital stay with quick recovery and good outcome at 10 months follow-up.
Combined laparoscopic transdiaphragmatic resections of right sided colorectal lung metastases in patients undergoing laparoscopic liver resection in the posterosuperior segments.
10
INTRODUCTION/BACKGROUND A recently published analysis based on the LiverMetSurvey demonstrated that patients with simultaneously diagnosed colorectal liver and lung metastases (SLLM) suitable for resection of all metastases have a survival similar to that of patients who undergo removal of isolated liver metastases. We recently reported our first experience with combined minimally invasive liver resections in the anterolateral seg mentsand transdiaphragmatic resections of peripheral lung metastases in the left lung.
CENTRUM
ANESTHESIE/ INTENSIEVE ZORG
ARTIKELS
ABSTRACT 2
ABSTRACT 1
Acute and life-threatening remifentanil overdose resulting from misuse of a syringe pump
A longitudinal supra-inguinal fascia iliaca compartment block reduces morphine consumption after total hip arthroplasty.
Vanneste B, Van de Velde M, Struys M, Rex S. Acta Anaesthesiologica Belgica, 2017, 68,87-89
Desmet M, Vermeylen K, Van Herreweghe I, Carlier L, Soetens F, et al. Regional Anesthesia and Pain Medicine, 2017, 42(3),327-333
INTRODUCTION/BACKGROUND The role of a fascia iliaca compartment block (FICB) for postoperative analgesia after total hip arthroplasty (THA) remains questionable.High-dose local anesthetics and a proximal injection site may be essential for successful analgesia. High-dose local anesthetics may pose a risk for local anesthetic systemic toxicity.We hypothesized that a high-dose longitudinal supra-inguinal FICB is safe and decreases postoperative morphine consumption after anterior approach THA.
MATERIALS/METHODS We conducted a prospective, double blind, rand omized controlled trial. Patients scheduled for THA were randomized to group FICB (longitudinal supra-inguinal FICB with 40-mL ropivacaine 0.5%) or group C (control, no block). Standard hypothesis tests (t test or Mann-Whitney U test, χ2 test) were performed to analyze baseline characteristics and outcome parameters. The primary end point of the study was total morphine (mg) consumption at 24 hours postoperatively. Serial total and free ropi-vacaine serum levels were determined in 10 patients.
RESULTS After obtaining ethical committee approval and written informed consent, 88 patients were included. Mean (SD) morphine consumption at 24 hours postoperatively was reduced in group FICB compared to group C: 10.25 (1.64) mg versus 19.0 (2.4) mg (P = 0.004). Using a mean dose of 2.6-mg/kg ropivacaine (range, 2–3.4mg/kg), none of the patients had total or free ropivacaine levels above the maximum tolerated serumconcentration.
CONCLUSION We conclude that a high-dose longitudinal supra-inguinal FICB reduces postoperative morphine requirements after anterior approach THA.
ABSTRACTBOEK | 2015
INTRODUCTION/BACKGROUND In the perioperative setting, syringe pumps are frequently used. They guarantee constant plasma levels of hypnotics, opioids, cardiovascular medication, insulin or other drugs. We present a case in which an inadvertent rapid intravenous injection of 2 mg remifentanil occurred due to the misuse of a syringe pump.
ABSTRACT 3 Gamma-hydroxybutyrate (GHB), an unusual cause of high anion gap metabolic acidosis. Carlier L, Van Belleghem V, Croes K, Hooft F, Desmet M, et al. Canadian Journal of Emergency Medicine, 2017, 2,1-4
INTRODUCTION/BACKGROUND The causes of high anion gap metabolic acidosis (HAG MA) are well described in the literature. However, some times more frequent causes of HAGMA cannot explain its occurrence. In the case of HAGMA and severe n eurological depression in the absence of other causes of HAGMA, clinicians should consider an intoxication with gamma- hydroxybutyrate (GHB) as a possible cause. GHB is endo genous to the mammalian central nervous system (CNS). Synthetic GHB was initially used as an anesthetic but is now only licensed for medical use in a limited number of indi cations such as the treatment of narcolepsy. Because of its euphoric effects, it became popular for recreational use under the street names: Liquid Ecstasy, Georgia Home Boy, and Liquid G. We describe the clinical case of a patient who suffered from severe neurological depression and HAGMA.
ABSTRACT 4 Epidemiology and outcome in intensive care patients with acute kidney injury treated with renal replacement therapy De Corte W. PhD dissertation, Ghent University, Faculty of Medicine and Health Sciences
ANESTHESIE/ INTENSIEVE ZORG
11
AKI is a frequent finding in ICU patients. Despite decades of progress in critical care it is associated with adverse out comes such as increased LOS, short and longterm mortality and ESKD. In its most severe form AKI is treated with RRT. AKI-RRT in critically ill patients is associated with morta lity, development of CKD and ESKD. The overall aim of this doctoral thesis was to describe the epidemiology of AKI in critically ill patients treated with RRT. Special attention was paid to some of the conventional indications of initiation of RRT. In addition, the short- and long-term patient and kidney outcomes and long-term quality of life in critically ill patients AKI-RRT were explored. There is a longstanding consensus to initiate RRT in life-threatening situations such as severe acidosis, electrolyte disorders, the presence of uremic signs or in case of volume overload. However, the precise timing of initiation of RRT remains a matter of de bate. The present work evaluated some conventional indi cations for initiation of RRT. First we investigated whether the commonly used serum urea cut-off concentrations for initiation of RRT had a possible predictive value for morta lity. We found that they had no predictive value for hospital mortality in severely ill patients with AKI. Second, we ex plored another indication for initiation of RRT in critically ill patients with AKI: severe lactic acidosis (SLA). As literature describing this condition is scarce we described the epide miology of SLA and determined possible factors influencing outcome. We found that severe lactic acidosis was present in about one third of critically ill patients with AKI treated with RRT. We demonstrated that the administration of RRT improved acid-base balance in most patients. Further, lac tate concentration at initiation of RRT could not be used to discriminate between survivors and non-survivors. As a consequence, the administration of RRT may act as a bridge that treats the underlying cause of the acidosis. We found that AKI-RRT occurred in 5.5% of patients admitted to the ICU. Mortality rates were high, with almost 60% of the patients dying during their hospital stay and approxi mately an additional 10% per year of the hospital survivors in the years following discharge. Mortality was associated with advancing age and clinical status at initiation of RRT. Further, renal recovery was limited. Almost one-fifth of the AKIRRT survivors had ESKD at one year. Renal recovery was often incomplete and associated with comorbidities such as diabetes and CKD. These findings highlight the need for long-term nephrological follow-up. Finally we described the long-term quality of life in this specific cohort of patients. These patients are amongst the most severely ill patients in the ICU. In addition, AKI-RRT patients who survive may develop CKD, including ESKD. As expected, their HrQOL was lower than the general population. However, despite the heavy burden of disease, their QOL was comparable to
12
ABSTRACTBOEK | 2017
matched survivors without AKI-RRT. Moreover, the majority of the patients wanted to be readmitted to the ICU when needed.
PRESENTATIES / CONGRESSEN ABSTRACT 1 A multidisciplinary local trauma system reduces time to CT head after traumatic brain injury Helsloot D, Edmonds M, Ellis DY. October 2017, The Royal College of Emergency Medicine Annual Scientific Conference, Liverpool, UK
INTRODUCTION/BACKGROUND For trauma patients with traumatic brain injury (TBI), a timely definite diagnosis is critical for further manage ment and intervention. CT head is the gold standard for the diagnosis of TBI. In 2014 we optimized our local trauma guidelines, redefined our trauma criteria and introduced a weekly multidisciplinary audit with active involvement of the radiology department. The aim was to optimize assess ment time in the emergency department, improve cooper ation with the radiology department and improve time to final diagnosis and definite management of TBI.
MATERIALS/METHODS We conducted a single-center retrospective data analysis. The time from arrival of the trauma patient with retro spectively proven TBI to CT head was compared between 2 patient groups: 251 patients (2008-2010) before and 220 patients (2015-2017) after the changes to our local trauma system. No other specific changes were made that would directly affect the time to CT.
RESULTS The mean/median time to CT head in the first group (20082010) was 112/54 minutes, in our second group (20152017) 86/36 minutes. (p=0.087)
CONCLUSION The optimization of local trauma guidelines with a multi disciplinary approach and active involvement of the radiology department can reduce the time to CT head, which in turn will lead to a shorter time to definitive diagnosis and may optimize ongoing treatment and definitive care.
CENTRUM
APOTHEEK
PRESENTATIES / CONGRESSEN ABSTRACT 1 Implementation of BacT/ALERT® (BioMérieux) culture bottles in a hospital pharmacy production unit for the sterility testing of chemotherapeutic batches
CONCLUSION BacT/ALERT® culture bottles can successfully be imple mented in a hospital pharmacy production unit. Our goal to install a more sensitive and rapid detection method for sterility testing could be achieved and led to a more secure system in the release of chemotherapeutic infusions. Fur ther research with other cytotoxic drugs will be needed to validate this method.
De Jonghe PJ. March 2017, Annual Congress of the European Association of Hospial Pharmacists, Cannes, France
OBJECTIVE The goal of the study is to create a more sensitive steri lity test, which assures us a more quick and reliable result which minors the period of quarantine of chemotherapeutic infusions from that batch. Due to an increase in production of chemotherapeutics, we implemented dosebanding of chemotherapeutic drugs to prevent errors and improve the quality of the cytotoxic drug preparation. The standard ste rility tests who are recommended by the European Pharma copeia on chemotherapeutic batches are time-consuming (14 days incubation before final result).
MATERIALS/METHODS We investigated the BacT/ALERT® FA (BioMérieux) culture bottles (ref.410851) as a rapid microbiological method. Microbiological growth creates CO2 production which is detected by an automatic photometric method. We ino culated the bottles with one of 4 standard microorganisms (10-100 colony-forming units) which are recommended in the European Pharmacopeia (Staphylococcus aureus (SA, ATCC6538), Pseudomonas aeruginosa (PA, ATCC9027), Bacillus subtilis (BS, ATCC6633) and Candida albicans (CA, ATCC10231)). We compared every step with a tradi tional trypcase soy broth (BioMérieux, ref.42633) with a phased incubation period (14 days) as recommended in the PIC/s. We also have to take the possible inhibition of microorganism growth by the cytotoxic drugs in account. We tested the bacterial growth with the highest cyto toxic batch-concentration, 0,4 mg/ml for paclitaxel and 1,9 mg/ml for trastuzumab.
RESULTS All microorganisms were detected in the BacT/ALERT® culture bottles with or without cytotoxic drug. The rapid microbacterial method was as expected more sensitive and easier in detection than the classic method, with a difference of 7 days. Paclitaxel has a low inhibiting effect on the growth of Pseudomonas aeruginosa and Candida albicans.
APOTHEEK
13
CENTRUM
CARDIOLOGIE ARTIKELS ABSTRACT 1 Heart failure with preserved ejection fraction: blame the veins
Hiltrop N, Bennett J, Desmet W. Catheterization and Cardiovascular Interventions, 2017,89(1),78-92
INTRODUCTION/BACKGROUND Jorge C, Hiltrop N, Desmet W, European Heart Journal, 2017,38(5),376
INTRODUCTION/BACKGROUND A 59-year-old female with heart failure with preserved ejection fraction (HFpEF), NYHA class III, with eccentric left ventricle (LV) hypertrophy and anterior inverted T waves on the ECG (Panel A), underwent a coronary angi ography that excluded coronary artery disease. However, an unusual venous circulation pattern was incidentally observed: persistent embryonic coronary arterial fistulas (CAF) from the left and right coronaries to both ventricular cavities (see Supplementary material online, VideosS2 and S4). This corresponds to an unusually severe form of The besian veins. This exuberant venous drainage displayed a dense intramyocardial sinusoidal network, extensive enough to produce LV endocardial blush (Panels B–C, ar rowheads) and a late ventriculography pattern (Panel D), by only coronary contrast injection. No contrast was seen in venous time frames over the coronary sinus (Panel D.1), that on c oronary CT scan appeared hypoplasic as well as the cardiac veins. Remarkably, the CAF were so highly de veloped that they could be visualized throughout the LV myocardium in the CT scan (Panel E, arrowheads). Fur thermore, tortuous coronaries, fistulae-flow-mediated, with long intramyocardial coronary paths (Panel F) were also displayed. Ischemic heart failure by coronary steal phenomenon was excluded by dobutamine-stress cardiac magnetic resonance imaging. Exuberant Thebesian veins having origin on both coronary system and draining to both ventricles, is an extremelly rare entity. Although the majority of patients are asymptomatic, dyspnea and fatigability, can be the presenting symptoms. Coronary arterial fistulas have repeatedly been reported as a cause of abnormalities in myocardial microcirculation, inducing reactive myocardial hypertrophy, leading to dias tolic dysfunction and HFpEF, as in this patient. Other causes of LV hypertrophy were excluded.
ABSTRACT 2 Circumflex coronary artery injury after mitral valve surgery: A report of four cases and comprehensive review of the literature
14
ABSTRACTBOEK | 2017
As the LCx is closely related to the mitral valve annulus, it is susceptible to perioperative injury. Various under lying mechanisms, predisposing factors, and therapeutic strategies have been suggested but disagreement exists. Using a MeSH terms-based PubMed search, 44 cases of mitral valve surgery-related LCx injury were detected, in cluding our 4 cases. We provide a comprehensive review of current knowledge regarding mitral valve surgery-re lated left circumflex coronary artery (LCx) injury. Pre operative coronary angiography was performed in 55% (n = 24). Coronary abnormalities were present in 11% (n = 5). Coronary dominance was reported in 73% (n = 32), predominantly showing left (69%, n = 22) or balanced (19%, n = 6) circulations. Right coronary dominance was present in 12% (n = 4). Ischemia was detected in the pe rioperative or early postoperative phase in 86% (n = 30). Delayed symptoms were present in 14% (n = 5). Echocardiography demonstrated new regional wall motion abnormalities in 80% (n = 24), but was negative in 20% (n = 6) despite coronary compromise. Electro cardiography showed myocardial ischemia in 97% (n = 34), including regional ST-segment elevations in 68% (n = 23). Primary treatment was surgical in 42% (n = 15) and percutaneous in 58% (n = 21), reporting success ratios of 87% (n = 13) and 81% (n = 17), respectively. We confirm an augmented risk of mitral valve surgery-related LCx injury in balanced or left-dominant coronary circulations. Pre operative knowledge of coronary anatomy does not pre clude LCx injury. An anomalous LCx arising from the right coronary cusp was identified as a possible specific high-risk entity. Electrocardiographic monitoring and intraoperative echocardiography remain paramount to ensure a timely diagnosis and treatment.
ABSTRACT 3 Neoatherosclerosis: an emerging and conceptually unexpected cause of very late bioresorbable vascular scaffold failure Hiltrop N, Desmet W, Adriaenssens T, Bennett J. EuroIntervention, 2017,12(16),2031
CENTRUM
ENDOCRINO-DIABETOLOGIE ARTIKELS ABSTRACT 1 Wanneer diabetes mellitus niet gewoon type 1 of 2 is: monogene diabetes mellitus MODY 2 Bongers C, Vanhaverbeke G. Tijdschrift voor Geneeskunde, 2017, 73 (5),262-268
ABSTRACT “Maturity onset diabetes of the young” (MODY) werd voor het eerst als ziektebeeld beschreven in de jaren ’70 van de twintigste eeuw. Deze vorm van diabetes mellitus (DM) wordt autosomaal dominant overgeërfd en is gekenmerkt door een defect in de bètacel van de pancreas. Bij MODY 2 situeert het probleem zich ter hoogte van de glucose-“sensing”, bij de andere MODY-vormen betreft het eerder een defect in de insulineproductie. Differentiëren met andere vormen van DM is belangrijk om wille van het verschil in prognose en nood tot behandeling. Bij MODY 2 verwacht men minder complicaties en blijkt een behandeling van de milde hyperglycemie niet nuttig. Tijdens de zwangerschap wordt de nood tot een behan deling bepaald op basis van de biometrische kenmerken van de foetus.
ENDOCRINO-DIABETOLOGIE
15
CENTRUM
GYNAECOLOGIE / VERLOSKUNDE ARTIKELS ABSTRACT 1 ISUOG Practice Guidelines: performance of fetal magnetic resonance imaging Prayer D, Malinger G, Brugger PC, De Catte L, De Keersmaecker B, et al. Ultrasound in Obstetrics & Gynecology, 2017, 49(5):671-680 ABSTRACT The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) is a scientific organization that encour ages sound clinical practice, and high‐quality teaching and research related to diagnostic imaging in women's health care. The ISUOG Clinical Standards Committee (CSC) has a remit to develop Practice Guidelines and Consensus Statements as educational recommendations that provide healthcare practitioners with a consensus‐based approach, from experts, for diagnostic imaging. They are intended to reflect what is considered by ISUOG to be the best practice at the time at which they are issued. Although ISUOG has made every effort to ensure that Guidelines are accurate when issued, neither the Society nor any of its employees or members accepts any liability for the consequences of any inaccurate or misleading data, opinions or statements issued by the CSC. The ISUOG CSC documents are not intended to establish a legal standard of care because inter pretation of the evidence that underpins the Guidelines may be influenced by individual circumstances, local protocol and available resources. Approved Guidelines can be distributed freely with the permission of ISUOG (info@isuog.org). These guidelines are based on consensus reached between participants following a survey of current practices, conducted by ISUOG in 2014 (Appendix S1).
cephaly (MCPH) and holoprosencephaly. In this report, we describe a family with multiple miscarriages and 2 termi nations of pregnancy due to marked fetal microcephaly, delayed cortical gyrification, and dysgenesis of the corpus callosum. Whole exome sequencing allowed us to iden tify novel compound heterozygous mutations in STIL. The mutations lie, respectively, in the CPAP/CENPJ and the hsSAS6 interacting domains of STIL. M-phase synchronized amniocytes from both affected fetuses did not display an aberrant number of centrioles, as shown previously for either STIL-depleted or overexpressing cells. However, we observed an elongation of at least 1 centriole for each dupli cated centrosome. These preliminary results may point to a novel mechanism causing MCPH and embryonic lethality in humans.
PRESENTATIES / CONGRESSEN ABSTRACT 1 Termination of pregnancy for Central Nervous System (CNS) anomalies: correlation of prenatal with postmortem diagnosis Dendas W, De Keersmaecker B, Develter W, Aertsen M, De Catte L. September 2017, World Congress of the International Society of Ultrasound in Obstetrics & Gynecology, Vienna, Austria
OBJECTIVE To evaluate the correlation of prenatal imaging (ultrasound and/or MRI) with findings at pathological investigation(PI) or virtual necropsy(VN) in termination of pregnancy (TOP) for central nervous system (CNS) anomalies.
MATERIALS/METHODS ABSTRACT 2 Novel STIL Compound Heterozygous Mutations Cause Severe Fetal Microcephaly and Centriolar Lengthening
All TOP’s with CNS involvement between 2006 and 2016 were retrospectively analyzed. The level of agreement between prenatal findings and postmortem investigation for different groups of CNS malformations was analyzed.
RESULTS Cristofoli F, De Keersmaecker B, De Catte L, Vermeesch J, Van Esch H. Molecular Syndromology, 2017, 8,282–293
INTRODUCTION/BACKGROUND STIL (SCL/TAL1 interrupting locus) is a core component of the centriole duplication process. STIL mutations have been associated with both autosomal recessive primary micro
16
ABSTRACTBOEK | 2017
Of 764 TOP’s, 255 cases had a CNS anomaly detected prena tally (33.4%). Mean gestational age at TOP was 23.9 ± 11.7 weeks (mean ± 2SD). All genetic anomalies (n=40) were excluded from final analysis, as well as 42 cases without postmortem investigations, due to a known genetic condi tion (45.2%) or a proven infection (35.7%). Of 192 included cases, full agreement between prenatal and postmortem diagnosis was found in 74.0% (142/192). Minor
and major additional findings were present in 4.7% (9/192) and 13.5% (26/192) respectively. In 9 cases (4.7%), some detected elements could not be confirmed postmortem. No agreement was found in 6 cases (3.1%), because of autolysis (n=4) or an altered final diagnosis (n=2). NTD and destructive abnormalities both accounted for the largest share of the cases, with the highest full post TOP agree ment of respectively 85.5% (47/55) and 94.4% (51/54). In midline anomalies and isolated hydrocephaly full agree ment was found in only 44.4% (20/45) and 50.0% (9/18) respectively, while their rate of major additional findings was the highest, accounting for 24.4% (11/45) and 38.9% (7/18) respectively.
and cases without both postmortem MRI and conven tional autopsy were excluded. We included 68 cases for analysis. Disagreement between postmortem MRI and conventional autopsy was observed in 22 cases (32.4%). In 8 cases (11.8%) more information was obtained by conventional autopsy compared to MRI, however these findings were considered major additional findings when compared to prenatal diagnosis in only 2 cases. In 14 cases (20.6%) MRI was superior to conventional autopsy because of additional cerebral findings undetected by autopsy (n=6) and/or because of severe autolysis making pathology of the CNS impossible (n=9).
CONCLUSION
Our data point out that an adequate postmortem evalua tion, valuable in parental counseling, can be provided by a postmortem MRI in 97% of the cases.
CONCLUSION A high correlation between prenatal and postmortem final diagnosis in TOP’s for a CNS anomaly was found in 78.6%. Postmortem investigations contributed to final diagnosis and parental counseling in 15% of the cases, including cases with major additional postmortem findings or with an altered post-TOP diagnosis. Even after exclusion of 40 cases with genetic anomalies, targeted genetic testing still reveals a genetic condition in 5%.
ABSTRACT 2 Postmortem MRI in termination of pregnancy for central nervous system (CNS) anomalies
ABSTRACT 3 Termination of pregnancy for midline anomalies Dendas W, De Keersmaecker B, Aertsen M , Develter W, De Catte L. September 2017, World Congress of the International Society of Ultrasound in Obstetrics & Gynecology, Vienna, Austria
OBJECTIVE Dendas W, De Keersmaecker B, Develter W, Aertsen M, De Catte L. September 2017, World Congress of the International Society of Ultrasound in Obstetrics & Gynecology, Vienna, Austria
In this retrospective study of all TOP’s with a midline central nervous system anomaly, our aims were twofold. At first, we aimed to evaluate the correlation between prenatal and postmortem diagnosis. Secondly, to determine the additional value of postmortem investigations in parental counseling.
OBJECTIVE To evaluate the concordance of conventional autopsy and postmortem MRI after termination of pregnancy (TOP) in fetuses with prenatally detected central nervous system (CNS) anomalies. Secondly, to determine the most valuable postmortem investigation in parental counseling.
MATERIALS/METHODS All TOP’s between 2006 and 2016 with prenatally detected CNS involvement and having a postmortem MRI and conventional autopsy as postmortem examinations were retrospectively analyzed and concordance level was esta blished.
RESULTS Of 764 TOP’s, 255 cases had a CNS anomaly detected prenatally (33.4%). Fetal genetic anomalies (n=40)
RESULTS After exclusion of genetic anomalies and cases without postmortem investigations, we included 45 cases for ana lysis. At first, agreement between prenatal and postmortem diagnosis was established. Full agreement was present in 44.4% of the cases. Minor additional findings were present in 6.7% (3) of the cases, they did not change final diagnosis. Major additional findings were present in 11 cases (24.4%). They had major impact on final diagnosis en therefore on parental counseling.
CONCLUSION - -
Postmortem investigations lead to additional findings with major impact on final diagnosis en parental counseling in 24.4%. Conventional autopsy is uninformative in 25%.
GYNEACOLOGIE / VERLOSKUNDE
17
- -
Postmortem MRI is superior to conventional autopsy in 47%. Postmortem MRI was equivalent or superior to conventional autopsy in 94% of the cases (16/17).
ABSTRACT 4 Borderlinebevindingen en prognostische uitdagingen in het centraal zenuwstelsel De Catte l, De Keersmaecker B. April 2017, Nederlands - Vlaams Doelencongres Infertiliteit, Gynaecologie en Obstetrie, Rotterdam, Nederland
18
ABSTRACTBOEK | 2017
CENTRUM
INWENDIGE ZIEKTEN / GASTRO-ENTEROLOGIE ARTIKELS
ABSTRACT 1 Unusual complication of Osler-Weber-Rendu disease Kaze E, D'heygere F. Louvain Médicale, 2017, 136(4),238-243
INTRODUCTION/BACKGROUND The combined syndrome of juvenile polyposis / inherited hemorrhagic telangiectasia (JD-HHT Syndrome) is rare, caused by mutations in the MADH4 gene. Affected indi viduals exhibit the clinical manifestations of both patho logies and are at increased risk of gastrointestinal cancer (1). We report the case of a 41-year-old woman with Os ler-Weber-Rendu disease, or hereditary hemorrhagic tel angiectasia, who presented with severe pain in the right hypochondrium. The clinical investigations showed the presence of a hepatocellular adenoma,probably induced by prolonged estrogen-progestogen intake. At a later time, genetic analysis revealed that the patient carried a mutation in the MADH4 gene. Afterwards, the patient was found to suffer from colon adenocarcinoma. Based on this unique case, we describe the features of this rare clinical entity and focus on the role of genetics in the management of patients with juvenile polyposis or Osler-Weber-Rendu disease.
ABSTRACT 2 Een slepend verhaal van proctitis Debeuckelaere C, D'heygere F. Tijdschrift voor geneeskunde, 2017, 73(8),481-483
INTRODUCTION/BACKGROUND A 51-year-old man was sent to the department of internal medicine with diarrhea, extreme weight loss, severe fa tigue, night sweats and a shivery feeling with subfebrility. His medical history reveals ungoing arthralgias, refractory to anti-rheumatic therapy. A gastroduodenoscopy reveals the macroscopic image of Whipple’s disease. Polymerase chain reaction (PCR) analyses by Dr. Raoult at his laboratory in Marseille confirmed this assumption. The epidemiology, etiology and pathofysiology of Whipple’s disease are briefly discussed. Furthermore the clinical manifestations, the diagnosis and the treatment are explained.
ABSTRACT 4 Buikpijn en koorts bij een 88-jarige man Follet L, Verhamme M, D'heygere F. Tijdschrift voor geneeskunde, 2017, 73(21),1346-1351
INTRODUCTION/BACKGROUND Listeria monocytogenes is a well-known bacteria in obste tric pathology. However, the bacteria increasingly appears in an older population, becoming a significant threat to the elderly. Immunocompromised people are also more frequently at risk for Listeria infections. Listeria monocy togenes is frequently associated with cheese, but other aliments are involved as well. The medical history of a geriatric patient with a mycotic Listeria infection is reported. The patient was treated successfully with a sixweek course of antibiotics (amox icillin).
INTRODUCTION/BACKGROUND The medical history of a man who presented with a chronic problem of proctitis, is reported. He is an HIV patient, trea ted with efavirenz/ emtricitabine/tenofovir (Atripla). Sig moidoscopy shows multiple ulcerations in the distal rectum. There was the suspicion for lymphogranulorum venereum, due to an infection with Chlamydia trachomatis, serovars L1, L2 and L3. The etiology, epidemiology, diagnostic tools and treatment of lymphogranuloma venereum are di scussed.
ABSTRACT 3 Een hardnekkig geval van „reuma” met vermagering en rode ogen Couvreur F, Alaerts H, Meerssemann W, D'heygere F. Tijdschrift voor geneeskunde, 2017, 73(3),147-150
ABSTRACT 5 Hoe een hardnekkige rash door een chirurg kan worden genezen … Salembier A, Bonny M, Vansteenkiste F, D'Hondt M, Meerssemann W, D'heygere F. Tijdschrift voor geneeskunde, 2017, 73(21),1333-1338
INTRODUCTION/BACKGROUND A glucagonoma is a very rare type of tumor that can present with the so-called glucagonoma syndrome, a syndrome comprising weight loss, diabetes mellitus, depression and deep venous thrombosis. Probably the most noticeable sign, however, is a very specific dermatitis, the necrolytic migratory erythema. The medical history of a patient who presented with an extensive and invalidating glucagonoma syndrome, with complete resolution of symptoms after surgical removal of INWENDIGE ZIEKTEN / GASTRO-ENTEROLOGIE
19
the glucagonoma, is reported. A short review of the litera ture regarding glucagonoma and glucagonoma syndrome is included.
ABSTRACT 6
BACKGROUND
Een 21-jarige Somaliër met spier- en gewrichtspijn en aanhoudende koorts
Adalimumab (ADM) has been shown efficacious in ulcera tive colitis (UC). In randomized controlled trials, dose esca lation from 40 mg ADM every other week to 40 mg every week was required in 20%-25% of patients within 1 year. Real-life data suggest higher escalation rates. Attempts for dose de-escalation have not been studied yet. We assessed the need for, outcome of, and predictors of dose escala tion and de-escalation in a large retrospective cohort of UC patients treated with ADM.
Meersseman W, Dekervel J, Van Geluwe B, D'heygere F. Tijdschrift voor geneeskunde, 2017, 73(17),1059-1060
INTRODUCTION/BACKGROUND Een 21-jarige man van Somalische origine wordt naar de spoedgevallen verwezen wegens pijn aan de spieren en de gewrichten en hoofdpijn. De klachten zouden enkele dagen bezig zijn en de man zou sedert meerdere weken koorts hebben. Er is geen buikpijn of diarree, noch respira toire klachten. De man woont sinds anderhalf jaar in België. Klinisch onderzoek toont een normaal gebouwde man die niet cachectisch is en die algemeen niet zwaar ziek over komt. Er zijn geen klieren te voelen. Er is geen artritis te weerhouden. Het hartritme bedraagt 88 per minuut en de bloeddruk 108/55 mmHg. Het klinische onderzoek is eigen lijk volledig normaal behalve een verhoogde lichaamstem peratuur (38,5 °C). In het bloedonderzoek valt enkel een verhoogde C-reactieve proteïne op (203 mg/l; nl 0,0-5,0). Leukocytose bedraagt 5,15 × 109 /l met 55% segmenten, het trombocytenaantal is 307 × 109 /l. Levertesten, inclusief LDH, zijn binnen de normale grenzen. Een HIV-serologie is negatief. Een thoraxfoto is normaal. Urinesediment toont wat hematurie. Hemoculturen, kweken van luchtwegaspi raat en urinekweken blijven steriel. Een tuberculinehuidtest is positief. Een CT-scan van de thorax en het abdomen toont wat vrij vocht abdominaal met vergrijzing van het mesente riële vet en mild vergrote klieren ter hoogte van de rechter longhilus en paratracheaal rechts. Er zijn geen afwijkingen ter hoogte van het longparenchym. Een positronemissie tomografie toont meerdere hypermetabole klieren onder en boven het diafragma. De meeste afwijkingen zijn te zien ter hoogte van de leverhilus en het peritoneum. Wegens aanhoudende koorts en het uitblijven van een diagnose wordt overgegaan tot een diagnostische laparoscopie. Er zijn honderden rijstkorrelige letsels te zien op het perito neum, het omentum en de dunne darm ( fig. 1). Er worden talloze biopten genomen.
ABSTRACT 7 Incidence and predictors of success of adalimumab dose escalation and de-escalation in ulcerative colitis: a real-world belgian cohort study.
20
ABSTRACTBOEK | 2017
Baert F, Vanden Branden S, Amininejad L, Dewint P, Van Moerkercke W, Rahier JF, Hindryckx P, Bossuyt P, et al. Belgian Inflammatory Bowel Diseases Research and De velopment (BIRD), 0, 5
METHODS We included 231 consecutive patients from 10 Belgian centers initiating ADM treatment for active UC before September 1, 2015 (follow-up ≥1 year in each patient). We performed detailed chart review to identify variables asso ciated with short-term clinical benefit (based on physician global assessment and absence of rectal bleeding at week 10), success of dose escalation, and dose de-escalation. Backward Cox regression and Wald Logistic regression were used to identify predictive variables.
RESULTS Short-term clinical benefit was achieved in 101 patients (44%) and was less frequent in infliximab failures [37% vs 50%, Odds ratio 0.57 (95% CI 0.34-0.97), P = 0.038]. After a median of 2.8 (1.7-5.1) months, 164 patients (71%) n eeded ADM discontinuation (n = 35, 15%) or dose escalation (n = 129, 56%). Dose escalation was successful in 77/129 (60%). Dose de-escalation was attempted in 71% (55/77) after a median of 4.3 (2.9-7.2) months and was successful in 80% (43/54).
CONCLUSIONS In this cohort, 56% of patients with UC required ADM dose escalation with a 60% success rate. Of note, most patients could be successfully de-escalated later on.
ABSTRACT 8 A case of pseudorenal failure - spontaneous rupture of the urinary bladder. Bourgeois S, Decupere M, Devriendt D, Lesage K, Van Moerkercke W. Acta Gastro-Enterologica Belgica, 2017,3,419-421
ABSTRACT 9 Belgian experience with direct acting antivirals in people who inject drugs. Bourgeois S, Decaestecker J, Janssens F, Cool M, Van Overbeke L, Van Steenkiste C, D'heygere F, et al. Drug and Alcohol Dependence, 2017,177,214-220
BACKGROUND AND AIM Hepatitis C viral infection (HCV) has become a curable disease due to the development of direct acting antivirals (DAA). The WHO has set a target to eliminate HCV com pletely. Therefore, people who inject drugs (PWID) also need to be treated. In this study, we compared the real-life uptake and outcome of DAA treatment for HCV in PWID and non-PWID.
METHODS We performed a nation-wide, retrospective cohort study in 15 hospitals. All patients who were treated with sime previr-sofosbuvir, daclatasvir-sofosbuvir, or ombitasvir/ paritaprevir ritonavir-dasabuvir between December 2013 and November 2015 were included.
RESULTS The study population consisted of 579 patients: 115 PWID (19.9%) and 464 non-PWID (80.1%). Of the PWID 18 were active PWID (15.6%), 35 still received opiate substitution therapy (OST) (30.4%) and 62 were former PWID without OST (53.9%). PWID were more infected with genotype 1a and 3 (p=0.001). There were equal rates of side-effects (44.7% vs. 46.6%; p=0.847), similar rates of treatment completion (95.7% vs 98.1%; p=0.244) and SVR (93.0% vs 94.8%; p=0.430) between PWID and non-PWID, respec tively.
Bourgeois S, Decaestecker J, de Galocsy C, Janssens F, Van Overbeke L, Van Steenkiste C, D'Heygere F, Cool M, et al. Journal of Viral Hepatitis,2017,24(11),976-981
INTRODUCTION/BACKGROUND Recently, concerns were raised of high rates of HCC recur rence in patients treated with direct-acting antivirals (DAA) for hepatitis C infection. We investigated the HCC occur rence and recurrence rates within 6 months after treatment with DAA with or without pegylated interferon (PEG-IFN) in real life. This is a retrospective, multicenter cohort tri al, executed in 15 hospitals distributed across Belgium. Populations were matched based on fibrosis score (Metavir F3-F4). Patients with a Child-Pugh score ≥ B were e xcluded. In total, 567 patients were included, of whom 77 were treated with PEG-IFN+DAA between 2008 and 2013 and 490 with DAA without PEG-IFN between 2013 and 2015. Patients treated with PEG-IFN+DAA (53±9y) were younger than patients treated with DAA without PEG-IFN (59±12y) (P=.001). 47% of patients treated with PEG-IFN+DAA were in the F4 stage vs 67% of patients treated with DAA with out PEG-IFN (P=.001). Screening was inadequate in 20% of both patient groups (P=.664). The early occurrence rate of HCC was 1.7% and 1.1% in patients treated with DAA with and without PEG-IFN, respectively (P=.540). The early recurrence rate was 0% in patients treated with PEG-IF N+DAA and 15.0% in patients treated with DAA without PEG-IFN (P=.857). There is no difference in early occurrence of new HCC between patients treated with DAA with and without PEG-IFN. We did observe a high early recurrence rate of HCC in patients treated with DAA without PEG-IFN. However, these patients were at baseline more at risk for HCC. Finally, in 20%, screening for HCC was inadequate.
CONCLUSION
ABSTRACT 11
PWID, especially active users, are underserved for DAA treatment in real life in Belgium. Reimbursement criteria based on fibrosis stage make it difficult to treat PWID. Treatment adherence is similar in PWID and the general population, even in patients with active abuse. DAA were safe and effective in PWID despite the higher prevalence of difficult-to-treat genotypes. Based on these data more efforts to treat PWID are needed and policy changes are necessary to reach the WHO targets.
Characteristics of patients with hepatitis B virus and hepatitis C virus dual infection in a Western European country: Comparison with monoinfected patients. Laleman W, de Galocsy C, Reynaert H, D'Heygere F, Moreno C, Doerig C, Henrion J, et al. Clinics and Research in Hepatology and Gastroenterology, 2017,41(6),656-663
ABSTRACT ABSTRACT 10 The risk of early occurrence and recurrence of hepato cellular carcinoma in hepatitis C-infected patients treated with direct-acting antivirals with and without pegylated interferon: A Belgian experience.
The epidemiology of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections is continuously evolving. Updated data on dual HBV and HCV infection are still needed.
INWENDIGE ZIEKTEN / GASTRO-ENTEROLOGIE
21
AIMS To assess the main characteristics of patients with HBV and HCV dual infection, to compare these with those of patients infected with either HBV or HCV and, among patients with dual infection, to assess fibrosis according to HCV replication.
METHODS Data of 23 patients with dual infection were compared to data from 92 age and sex-matched HBV or HCV monoinfected patients.
RESULTS Patients with dual infection were more often immigrants from Africa or Asia than HCV or HBV patients (52% vs. 20% and 22%, respectively, P=0.01). Intravenous drug use was the route of transmission in 22% of patients with dual in fection, which was less frequent than in HCV patients (41%) but more frequent than in HBV patients (0%). Extensive fibrosis or cirrhosis was as frequent among dual-infected patients as among those with HCV or chronic hepatitis B infection (19% vs. 29% vs. 14%, respectively, P=0.4), even when fibrosis stage was reported considering the duration of infection. In dual-infected patients, the prevalence of extensive fibrosis or cirrhosis was similar in patients with and without detectable HCV RNA (18% vs. 20%).
CONCLUSIONS Patients with HBV and HCV dual infection were more o ften immigrants from Africa or Asia and had similar fibrosis stages than HCV or HBV monoinfected patients. In patients with dual infection, extensive fibrosis or cirrhosis was not associated with HCV replication.
22
ABSTRACTBOEK | 2017
CENTRUM
KINDERGENEESKUNDE ARTIKELS
ABSTRACT 2
ABSTRACT 1
Activin a modulates CRIPTO-1/HNF4α+ cells to guide cardiac differentiation from human embryonic stem cells
Massive parallel sequencing identifies RAPSN and PDHA1 mutations causing fetal akinesia deformation sequence Winters L, Van Hoof E, De Catte L, Van Den Bogaert K, de Ravel T, De Waele L, Corveleyn A, Breckpot J. European Journal of Paediatric Neurology, 2017, 21(5), 745-753
INTRODUCTION/BACKGROUND Fetal akinesia deformation sequence (FADS) or arthro gryposis multiplex congenita (AMC) is characterized by clinical ambiguity and genetic heterogeneity, hampering genetic diagnosis via traditional sequencing methods. Next generation sequencing (NGS) of all known disease-causing genes offers an elegant solution to identify the genetic etiology of AMC/FADS in a diagnostic setting.
MATERIALS/METHODS An in-house developed disease-associated gene panel was conducted in two unrelated fetuses with FADS. First, a de novo analysis was performed on the entire diseaseassociated gene panel. If no pathogenic mutation was identified, analysis of variants retained in a specific subpanel with arthrogryposis/fetal akinesia-causing genes was performed.
RESULTS In the first family, FADS relates to a homozygous c.484G > A (p.Glu162Lys) mutation in the gene RAPSN. The second case concerns a sporadic patient with brain anomalies and arthrogryposis due to a de novo hemizygous c.498C > T splice-site mutation in the pyruvate dehydrogenase-alpha 1 (PDHA1) gene.
Duelen R, Gilbert G, Patel A, de Schaetzen N, De Waele L, Roderick L, et.al. Stem Cells International, 2017, Article ID 4651238
INTRODUCTION/BACKGROUND The use of human pluripotent stem cells in basic and trans lational cardiac research requires efficient differentiation protocols towards cardiomyocytes. In vitro differentiation yields heterogeneous populations of ventricular-, atrial-, and nodal-like cells hindering their potential applications in regenerative therapies. We described the effect of the growth factor Activin A during early human embryonic stem cell fate determination in cardiac differentiation. Addition of high levels of Activin A during embryoid body cardiac differentiation augmented the generation of e ndoderm derivatives, which in turn promoted cardiomyocyte differentiation. Moreover, a dose-dependent increase in the coreceptor expression of the TGF-β superfamily mem ber CRIPTO-1 was observed in response to Activin A. We hypothesized that interactions between cells derived from meso- and endodermal lineages in embryoid bodies contributed to improved cell maturation in early stages of cardiac differentiation, improving the beating frequency and the percentage of contracting embryoid bodies. Ac tivin A did not seem to affect the properties of cardiomy ocytes at later stages of differentiation, measuring action potentials, and intracellular Ca2+ dynamics. These findings are relevant for improving our understanding on human heart development, and the proposed protocol could be further explored to obtain cardiomyocytes with functional phenotypes, similar to those observed in adult cardiac myocytes.
CONCLUSION NGS facilitated genetic diagnosis, and hence genetic counseling, for both families with AMC/FADS. Biallelic RAPSN mutations typically result in congenital myasthenia syndrome, or occasionally in FADS. This is the first report attributing the RAPSN mutation c.484G > A, identified in a homozygous state in patient 1, to FADS. The second patient represents the first case of AMC due to a PDHA1 mutation, advocating that pyruvate dehydrogenase deficiency should be considered in the differential diagnosis of fetal akinesia. This study illustrates the relevance of a disease-associatedgene panel as a diagnostic tool in pregnancies complicated by this genetically heterogeneous condition.
ABSTRACT 3 Multiple sclerosis in Belgian children: A multicentre retrospective study Verhelst H, De Waele L, Deconinck N, Ceulemans B, Willekens B, Van Coster R. European Journal of Paediatric Neurology, 2017, 21(2), 358-366
INTRODUCTION/BACKGROUND Although the diagnosis of multiple sclerosis (MS) in the paediatric population remains challenging, p aediatric-onset MS is increasingly recognized worldwide.
KINDERGENEESKUNDE
23
MATERIALS/METHODS
ABSTRACT 5
We report on the clinical and biochemical features of a Belgian multicentre cohort of paediatric MS patients in a national retrospective descriptive study.
Onverklaarbaar bewustzijnsverlies bij kinderen: denk ook aan intoxicatie
RESULTS Twenty one paediatric MS patients from four Belgian University Hospitals were included. In nine patients, on set of MS was before the age of ten years which makes the study cohort of special interest. We report a higher incidence of acute disseminated encephalomyelitis (ADEM)-like first MS attacks and an overall higher propor tion of polysymptomatic episodes than in adult and most paediatric cohorts reported in the literature. The clinical presentation in our cohort was rather severe with high median EDSS-score during the first clinical manifestation and barely more than half of our study patients showing full recovery after their first clinical manifestation. Also, a significant proportion of children in our cohort has severe disease progression despite disease modifying therapy and 9.5% of patients showed transition to secondary pro gressive multiple sclerosis during adolescence.
CONCLUSION An early and correct diagnosis of paediatric MS is essen tial to start early adequate treatment. As illustrated by our study cohort, current treatment options in childhood are unsatisfactory.
ABSTRACT 4 Recurrent spontaneous pneumomediastinum in a child with tracheomalacia. Dewulf J, Van Daele S, De Baets F. Pediatric Pulmonology, 2017,73(13),849-852
INTRODUCTION/BACKGROUND Spontaneous pneumomediastinum in children is a very rare, benign entity. Recurrent episodes are exceptional. Identifying an underlying trigger is crucial, and very o ften, spontaneous pneumomediastinum occurs in association with an asthma exacerbation. We report the case of a patient in which we hypothesize that an underlying tracheomalacia can be held responsible for the recurrent pneumomediastinum, which is to this date the first case with this assumption.
24
ABSTRACTBOEK | 2017
Van den bosch D, Van Belleghem V, Van Ooteghem B, Croes K, Heylen O, De Muynck B. Tijdschrift voor geneeskunde, 73(13), 2017,849-852 Inexplicable loss of consciousness in the childhood: importance of a heteroanamnesis A grandmother found her two-year-old grandchild unconsciously at the breakfast table. Emergency services were alerted and the emergency doctor on duty found a vomiting child with miotic pupils, a slow heart rhythm and clammy and sweaty extremities. The other vital signs were normal. The child had not experienced any abnormal signs in the days before. Venous and arteri al blood samples, brain imaging and routine toxicological screening tests showed negative results. Lumbar puncture showed an elevated leukocyte count and therefore a menin gitis treatment was started on an empirical basis. Atypically for an assumed meningitis case, the child fully recovered clinically over the next few hours. Two days later the father admitted a history of liquid ecstasy use. The positive results of a gas chromatography – mass spectrometry (GC-MS) test for Gamma Hydroxybutyrate (GHB) confirmed an in toxication in this infant. GC-MS and liquid chromatogra phy – mass spectrometry (LC-MS) are currently the most reliable methods for detection of GHB with a diagnostic window of approximately two hours. Intoxication with GHB is c haracterised by coma, miotic pupils, respiratory depression, slow heart rate, vomiting and hypothermia. The possibility of an intoxication should always be considered in children presenting with one of these symptoms.
CENTRUM
KLINISCH LABORATORIUM ARTIKELS
ABSTRACT 1 Nontuberculous mycobacteria among pulmonary tuberculosis patients: a retrospective Belgian multicenter study De Keukeleire S, Mathys V, Van den Wijngaert S, Van De Vyvere M, Jonckheere S, De Beenhouwer H, De Bel A, et al. Acta Clinica Belgica, 72(1),45-48
OBJECTIVES Currently, there are no European data about the frequency and clinical significance of nontuberculous mycobacteria (NTM) grown from respiratory samples during the treat ment of tuberculosis (TB). We determined the frequency and clinical significance of NTM isolated before or during pulmonary tuberculosis treatment in Belgian laboratories.
METHODS We conducted a nationwide retrospective multicenter cohort study on the co-isolation of TB and NTM in Belgium. Starting from laboratory data between 2006 and 2013, possible TB-NTM co-isolations were searched for.
METHODS We evaluated the performance of turbidimetric polyclonal Freelite (The Binding Site, Birmingham, UK) assays on Cobas 6000 (Roche Diagnostics, Rotkreuz, Switzerland) and nephelometric monoclonal N Latex (Siemens Health care Diagnostics, Marburg, Germany) assays on BN ProSpec (Dade Behring, Deerfield, IL) vs established nephelometric Freelite assays on BN ProSpec.
RESULTS Analytical performance was acceptable. Method comparison (n = 118) showed significant proportional FLC differences for N Latex assays. However, good correlation and clinical concordance were shown. Recovery study in the low concentration range demonstrated consistent over- and underrecovery for Freelite reagents, hampering future research on prognostic value of suppressed non involved FLC. Antigen excess detection was successful for κ FLC in three-fourths of cases with Freelite reagents and in all cases with N Latex reagents. However, the latter resulted in underestimated κ FLC concentrations.
CONCLUSIONS FLC analysis requires continuous awareness of analytical limitations. Monitoring of disease response requires FLC analysis on the same platform using the same reagents.
RESULTS A total of 2569 unique culture-positive pulmonary tuberculosis cases were included in the study. Only 35 (1.4%) of these TB cases had an NTM co-isolated, and two of these 35 fulfilled the ATS criteria for NTM lung disease.
ABSTRACT 3 A longitudinal supra-inguinal fascia Iliaca compartment block reduces morphine consumption after total hip arthroplasty
CONCLUSION A very low prevalence of 1.4% NTM co-isolations was found in Belgian patients with culture-proven pulmonary TB.
ABSTRACT 2 Performance evaluation of serum free light chain analysis nephelometry vs turbidimetry, monoclonal vs polyclonal reagents Messiaen AS, De Sloovere M, Claus PE, Vercammen M, Van Hoovels L, Heylen O, et al. American Journal of Clinical Pathology, 2017, 147(6)-622
OBJECTIVES Free light chain (FLC) measurement gained a lot of interest for diagnostic workup of monoclonal gammopathy.
Desmet M, Vermeylen K, Van Herreweghe I, Carlier L, Soetens F, Lambrecht S, Croes K, Pottel H and Van de Velde M. Regional Anesthesia and Pain Medicine, 2017, 42 (3), 327-333 Het abstract is te vinden op pagina 11.
ABSTRACT 4 Gamma-hydroxybutyrate (GHB), an unusual cause of high anion gap metabolic acidosis Carlier L, Van Belleghem V, Croes K, Hooft F, Desmet M, Heylen O, et al. Canadian Journal of Emergency Medicine, 2017,1-4 Het abstract is te vinden op pagina 11.
KLINISCH LABORATORIUM
25
ABSTRACT 5 Onverklaarbaar bewustzijnsverlies bij kinderen: denk ook aan intoxicatie Van den bosch D, Van Belleghem V, Van Ooteghem B, Croes K, Heylen O, et al. Tijdschrift voor Geneeskunde, 2017, 73(13) ,849 - 852 Het abstract is te vinden op pagina 24.
PRESENTATIES / CONGRESSEN ABSTRACT 1 The effect of the presence of a clinical pharmacist on the nutritional policy in an intensive care unit of a general hospital. Van Laer E. September 2017, Annual Congress of the European Society for Clinical Nutrition and Metabolism, Den Haag, The Netherlands
INTRODUCTION/BACKGROUND Malnutrition is a common problem in hospitalized patients. Given that critically ill patients are often in pro-inflammatory state, the effects of malnutrition are likely to be more magnified in the ICU.1 Critically ill patients frequently receive inadequate nutritional therapy because of underestimation of the nutritional needs of patients.2 Introduction of a electronical Pa tient Data Management System revealed similar data of prolonged hypocaloric feeding due to unawareness. OBJECTIVE We hypothesized that an introduction of a MULTI DISCIPLINARY APPROACH involving a clinical pharmacist, intensivist, dietician and nurse, leads to an improvement of achieving nutritional targets, based on the ESPEN guide lines.
MATERIALS/METHODS During 3 months, all patients of a mixed ICU in a general hospital were screened. Exclusion criteria were a stay of less than 3 days on ICU or no need for nutritional support therapy. A dedicated clinical pharmacist checked and evaluated criteria including the pathology, the lab results, the Nutritional Risk Score (NRS), the individual nutritional needs, the risk of refeeding and the presence of contra- indications for tube feeding. Three times a week recom mendations were discussed with the treating intensivists
26
ABSTRACTBOEK | 2017
and referring physicians. The NUTRITIONAL GOALS of this cohort WERE COMPARED TO THE NUTRITIONAL RESULTS IN A RETROSPECTIVE HISTORICAL COHORT (same time frame one year earlier).
RESULTS 98 patients were screened, of which a total of 60 PA TIENTS were included. On average, nutritional therapy was started after 3.5 days with a huge improvement to less than 2 days by the end of the study period; 48% of patients were treated with enteral nutrition (EN) and 35% received total parenteral nutrition (TPN). By introducing PROTEIN-RICH EN an increase from 48% to 80% ADEQUATE ENERGY administration and an increase from 26% to 55% ADEQUATE PROTEIN ADMINISTRATION was observed. Up to 100% of the patients that received protein-rich EN were adequately fed, according to their protein and energy needs.
CONCLUSION PDMS data extraction can reveal undernutrition, leading to optimization of nutritional therapy. A short term improvement of nutritional care is feasible with a multidisciplinary approach with a dedicated clinical pharmacist.
CENTRUM
MEDISCHE BEELDVORMING
ARTIKELS
ABSTRACT 3
ABSTRACT 1
Ruptured carotid-ophthalmic aneurysm treatment: a non-inferiority meta-analysis comparing endovascular coiling and surgical clipping
Whole-body MRI, dynamic contrast-enhanced MRI, and diffusion-weighted imaging for the staging of multiple myeloma Dutoit J, Verstraete K. Skeletal Radiology, 2017, 46(6), 733-750
INTRODUCTION/BACKGROUND Magnetic resonance imaging (MRI) is the most sensitive imaging technique for the detection of bone marrow infiltration, and has therefore recently been included in the new diagnostic myeloma criteria, as proposed by the International Myeloma Working Group. Nevertheless, conventional MRI only provides anatomical information and is therefore only of limited use in the response a ssessment of patients with multiple myeloma. The additional infor mation from functional MRI techniques, such as diffu sion-weighted imaging and dynamic contrast-enhanced MRI, can improve the detection rate of bone marrow infil tration and the assessment of response. This can further enhance the sensitivity and specificity of MRI in the staging of multiple myeloma patients. This article provides an over view of the technical aspects of conventional and functional MRI techniques with practical recommendations. It reviews the diagnostic performance, prognostic value, and role in therapy assessment in multiple myeloma and its precursor stages.
Andersson T, Delgado F. British Journal of Neurosurgery, 2017, 31(3),345-349
INTRODUCTION/BACKGROUND Aneurysms of the carotid-ophthalmic segment are rela tively rare, comprising only five percent of all intracranial aneurysms. There is no consensus regarding the optimal management for ruptured carotid-ophthalmic aneurysms, whether endovascular coiling or surgical clipping provide the most favourable patient outcome. The aim of this meta-analysis is to analyse these two treatment modalities for ruptured carotid-ophthalmic aneurysms with respect to independent clinical outcome.
MATERIALS/METHODS We performed a systematic literature search in PubMed, Cochrane Central Registry of Controlled Trials and Clini caltrials.gov for treatment of ruptured carotid-ophthalmic aneurysms, comparing endovascular coiling and surgical clipping. Primary outcome in the study was independent clinical patient outcome at follow up (defined as Glasgow Outcome Scale four-five). Secondary outcomes were poor clinical patient outcome, mortality and total angiographic occlusion. The meta-analysis was performed using the Man tel-Haenszel method for dichotomous outcome.
RESULTS ABSTRACT 2 Intracranial solitary fibrous tumor Claus E, Seynaeve P, Ceuppens J, Vanneste A, Verstraete K. Journal of the Belgian society of Radiology, 2017, 101(1),5
INTRODUCTION/BACKGROUND Solitary fibrous tumours are rare mesenchymal spindle-cell tumours that occur most often in the visceral pleura or liver. If they occur intracranially, they are extra-axially located and develop from the meninges. In those cases, the differential diagnosis has to be made with other intra cranial extra-axial-located tumours, such as meningeoma and hemangiopericytoma. We report a 32-year-old w oman with an intracranial solitary fibrous tumour and review the latest literature regarding the imaging characteristics of this tumour.
Four studies met the inclusion criteria and were included in the meta-analysis. In total, 152 patients were included. Sixtyseven of these patients were treated with endovascular coiling and 85 patients were treated with microsurgical clipping. The proportion of patients with an independent clinical outcome after coiling and clipping was comparable, OR 1.04 (95% CI: 0.40, 2.71). The proportion of patients with an independent outcome in the endovascular group was 76% and in the surgical group 71%. Mortality between the two treatment arms was equal.
CONCLUSION Clinical outcome after endovascular coiling and surgical clipping for ruptured carotid-ophthalmic aneurysms was comparable between surgical clipping and endovascular coiling. There was no proven difference in clinical outcome after endovascular coiling and surgical clipping for ruptured carotid-ophthalmic aneurysms but the evidence was based on few studies of moderate to low quality and we cannot rule out the possibility of a difference in clinical outcome between the two treatment modalities. MEDISCHE BEELDVORMING
27
ABSTRACT 4 Erratum to: training guidelines for endovascular stroke intervention: an international multi-society consensus document Lavine SD, Cockroft K, Hoh B, Bambakidis N, Khalessi AA, et al. Neuroradiology, 2017, 59(8), 829
95% CI: 3.37-29.19, P ≤ .001), mortality (OR: 21.99, 95% CI: 7.98-60.58, P < .001), and SICH (OR: 8.57, 95% CI: 2.87-25.59, P < .001).
CONCLUSION Compared with the pre-thrombolysis score, ASPECTS measured at 24 hours as well as serial change in ASPECTS is a better predictor of 3-month functional outcome.
ABSTRACT 6 ABSTRACT 5 Validation of serial Alberta stroke program early CT score as an outcome predictor in thrombolyzed stroke patients. Kong WY, Tan BYQ, Ngiam NJH, Tan DYC, Yuan CH, Holmin S, Andersson T. Journal Of Stroke And Cerebrovascular Diseases, 2017, 26 (10),2264-2271
INTRODUCTION/BACKGROUND The Alberta Stroke Program Early CT Score (ASPECTS) on baseline imaging is an established predictor of functional outcome in anterior circulation acute ischemic stroke (AIS). We studied ASPECTS before intravenous thrombolysis (IVT) and at 24 hours to assess its prognostic value.
MATERIALS/METHODS Data for consecutive anterior circulation AIS patients treated with IVT from 2006 to 2013 were extracted from a prospectively managed registry at our tertiary center. Pre-thrombolysis and 24-hour ASPECTS were evaluated by 2 independent neuroradiologists. Outcome measures in cluded symptomatic intracranial hemorrhage (SICH), modi fied Rankin Scale (mRS) at 90 days, and mortality. Unfavor able functional outcome was defined by mRS >1. Dramatic ASPECTS progression (DAP) was defined as d eterioration in ASPECTS by 6 points or more.
Thrombectomy in acute ischemic stroke: challenges to procedural success. Yoo AJ, Andersson T. Journal Of Stroke, 2017, 19(2),121-130
INTRODUCTION/BACKGROUND The overwhelming clinical benefit of intra-arterial stroke therapy owes to the major advance in revascularization brought on by the current generation of thrombectomy devices. Nevertheless, there remains a sizeable proportion of patients for whom substantial reperfusion cannot be achieved or is achieved too late. This article addresses the persistent challenges that face neurointerventionists and reviews technical refinements that may help to mitigate these obstacles to procedural success. Insights from in vitro modeling and clinical research are organized around a con ceptual framework that examines the interaction between the device, the thrombus and the vessel wall.
ABSTRACT 7 Analyses of thrombi in acute ischemic stroke: A consensus statement on current knowledge and future directions. De Meyer SF, Andersson T, Baxter B, Bendszus M, Brouwer P, et al. International Journal Of Stroke, 2017, 12(6),606-614
RESULTS Of 554 AIS patients thrombolyzed during the study period, 400 suffered from anterior circulation infarction. The median age was 65 years (interquartile range (IQR): 59-70) and the median National Institutes of Health Stroke Scale score was 18 points (IQR: 12-22). Compared with the pre-IVT ASPECTS (area under the curve [AUC] = .64, 95% confidence interval [CI]: .54-.65, P = .001), ASPECTS on the 24-hour CT scan (AUC = .78, 95% CI: .73-.82, P < .001), and change in ASPECTS (AUC = .69, 95% CI: .64-.74, P < .001) were better predictors of unfavorable functional outcome at 3 months. DAP, noted in 34 (14.4%) patients with good baseline ASPECTS (8-10 points), was significantly associated with unfavorable functional outcome (odds ratio [OR]: 9.91, 28
ABSTRACTBOEK | 2017
INTRODUCTION/BACKGROUND Limited data exist on clot composition and detailed char acteristics of arterial thrombi associated with large vessel occlusion in acute ischemic stroke. Advances in endo vascular thrombectomy and related imaging modalities have created a unique opportunity to analyze thrombi removed from cerebral arteries. Insights into thrombus composition, etiology, physical properties and neuro vascular interactions may lead to future advancements in acute ischemic stroke treatment and improved clinical out comes. Advances in imaging techniques may enhance clot characterization and inform therapeutic decision-making prior to treatment and reveal stroke etiology to guide
secondary prevention. Current imaging techniques can pro vide some information about thrombi, but there remains much to evaluate about relationships that may exist among thrombus composition, occlusion characteristics and treatment outcomes. Improved pathophysiological cha racterization of clot types, their properties and how these properties change over time, together with clinical corre lates from o ngoing studies, may facilitate revasculariza tion with thrombolysis and thrombectomy. Interdisciplinary approaches covering clinical, engineering and scientific aspects of thrombus research will be key to advancing the understanding of thrombi and improving acute ischemic stroke therapy. This consensus statement integrates recent research on clots and thrombi retrieved from cerebral arteries and provides a rationale for further analyses, including current opportunities and limitations.
ephropathy on follow-up. The radiation dose was slightly n increased from a mean of 4.26 mSV (range, 3.88-4.70 mSV) to 5.17 (range, 3.95 to 6.25 mSV).
ABSTRACT 8
Yeo LLL, Tan BYQ, Andersson T. European Journal Of Radiology, 2017, 96,145-152
Nongated cardiac computed tomographic angiograms for detection of embolic sources in acute ischemic stroke
CONCLUSION Including the heart and ascending aorta in a routine nonECG-gated computed tomographic angiogram enhances an existing imaging modality, with no increased incidence of contrast-induced nephropathy and minimal increase in radiation dose. This may help in the detection of high-risk cardiac and aortic sources of embolism in acute stroke pa tients.
ABSTRACT 9 Review of post ischemic stroke imaging and its clinical relevance.
ABSTRACT Yeo LLL, Holmin S, Andersson T, Lundström E, et al. Stroke, 2017, 48(5),1256-1261
INTRODUCTION/BACKGROUND We assessed the feasibility of obtaining diagnostic quality images of the heart and thoracic aorta by extending the z axis coverage of a non-ECG-gated computed tomographic angiogram performed in the primary evaluation of acute stroke without increasing the contrast dose.
MATERIALS/METHODS Twenty consecutive patients with acute ischemic stroke within the 4.5 hours of symptom onset were prospectively recruited. We increased the longitudinal coverage to the domes of the diaphragm to include the heart. Contrast administration (Omnipaque 350) remained unchanged (injected at 3-4 mL/s; total 60-80 mL, triggered by bolus tracking). Images of the heart and aorta, reconstructed at 5 mm slice thickness in 3 orthogonal planes, were read by a radiologist and cardiologist, findings conveyed to the treating neurologist, and correlated with the transthoracic or transesophageal echocardiogram performed within the next 24 hours.
RESULTS Of 20 patients studied, 3 (15%) had abnormal findings: a left ventricular thrombus, a Stanford type A aortic dissection, and a thrombus of the left atrial appendage. Both throm bi were confirmed by transesophageal echocardiography, and anticoagulation was started urgently the following day. None of the patients developed contrast-induced
In this day and age, multiple imaging modalities are avail able to the stroke physician in the post-treatment phase. The practical challenge for physicians who treat stroke is to evaluate the pros and cons of each technique and select the best choice for the situation. The choice of imaging modality remains contentious at best and varies among different institutions and centres. This is no s imple task an there are many factors to consider, including the differential diagnosis which need to be evaluated, the availability and reliability of the imaging technique and time and expertise required to perform and interpret the scanning. Other an cillary competing interest also come into play such as the financial cost of the modality, the requirement for patient monitoring during the imaging procedure and patient com fort. In an effort to clear some of the ambiguity surrounding this topic we present some of the current techniques in use and others, which are still in the realm of research and have not yet transitioned into clinical practice.
ABSTRACT 10 Synchronous cardiocerebral infarction in the era of endovascular therapy: which to treat first? Yeo LLL, Andersson T, Yee KW, Tan BYQ, Paliwal P, et al. Journal Of Thrombosis And Thrombolysis, 2017, 44(1),104-111
INTRODUCTION/BACKGROUND A cardiocerebral ischemic attack (CCI) or a concurrent acute ischemic stroke (AIS) and myocardial infarction MEDISCHE BEELDVORMING
29
(AMI) is a severe event with no clear recommendations for ideal m anagement because of the rarity of the scenario. The narrow time window for treatment and complexity of the treatment decision puts immense pressure on the trea ting physician. We evaluated this challenging situation at our tertiary center. Using our prospective stroke database out of a total of 555 patients with acute ischemic stroke between 2009 and 2014, we identified five consecutive cases with CCI (incidence 0.009%). Demography, risk factor characteristics, vascular occlusions and treatment approach were recorded. Good functional outcome was defined by the modified Rankin scale (mRS) score of 0-2 points. Out of five patients, AIS was trea-ted with endo vascular treatment in three cases, while two were treat ed with intravenous thrombolysis only. One out of three patients had embolectomy of the brain performed prior to the coronary intervention, while the other two patients underwent coronary intervention first. One patient deve loped sudden cardiac arrest on day-2 and passed away. CCI is an uncommon and devastating clinical scenario, further research is needed for the ideal management strategy that provides the best outcomes. However, the rarity of the di sease does not lend itself to the conduct of a trial easily. We have proposed a considered treatment algorithm based on the current literature and our experience.
number of potential thrombectomies expected in Sweden by extrapolating our treatment proportions to the rest of Sweden through the use of data from the Swedish National Stroke Registry.
ABSTRACT 11
Bhogal P, Loh Y, Brouwer P, Andersson T, Söderman M. Journal Of Neurointerventional Surgery, 2017, 9(1),52-59
Thrombectomy in acute ischemic stroke: estimations of increasing demands.
RESULTS The number of potential thrombectomies would have been more than five times higher (1268 estimated compared with 232 actually reported in the National Stroke Registry) if the new recommendations for thrombectomy in acute ischemic stroke had been implemented in 2013 (the year from which we had the most recent available data from the Swedish Stroke Registry).
CONCLUSION When the new recommendations are implemented broadly, there may be a substantial increase in demand for thrombectomies. Our study highlights the need for policymakers and healthcare professionals to prepare for the increasing demands for advanced endovascular stroke treatment.
ABSTRACT 12 Treatment of cerebral vasospasm with self-expandable retrievable stents: proof of concept.
OBJECTIVE Kuntze Söderqvist Å, Andersson T, Ahmed N, Wahlgren N, Kaijser M. Journal Of Neurointerventional Surgery, 2017, 9(9),830833
To report our preliminary experience with the use of stent retrievers to cause vasodilation in patients with delayed ce rebral vasospasm secondary to subarachnoid hemorrhage.
INTRODUCTION/BACKGROUND
Four patients from two different high volume neuro interventional centers developed cerebral vasospasm following subarachnoid hemorrhage. In addition to s tandard 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.
MATERIALS/METHODS New recommendations for mechanical thrombectomy in acute ischemic stroke suggest that thrombectomy should be considered for eligible patients with a large artery occlusion in the anterior circulation within 6 hours of stroke onset. The resources are unevenly spread and, in order to be able to meet a potentially increased demand, we have estimated the future need for thrombectomy.
MATERIALS/METHODS The new treatment recommendations are similar to those that have been in use at the Karolinska University Hospital since 2007. Using our local thrombectomy data (20092011), we calculated the proportion of thrombectomies performed at our hospital by level of stroke severity accor ding to the National Institutes of Health Stroke Scale score (0-5, 6-11, 12-19, and 20-35). We then estimated the total 30
ABSTRACTBOEK | 2017
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 experi enced 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
term follow-up (RCTs and observational studies com bined-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 (data base 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).
Stent retrievers can provide long-lasting cerebral vaso dilation in patients with delayed cerebral vasospasm.
CONCLUSION
ABSTRACT 13
This meta-analysis evaluating clinical outcome after coiling or clipping for intracranial aneurysms, indicates a higher independent outcome and lower mortality after coiling.
Clinical outcome after surgical clipping or endovascular coiling for cerebral aneurysms: a pragmatic meta-analysis of randomized and non-randomized trials with short- and long-term follow-up.
Imaging features of morel-lavallée lesions
ABSTRACT 14
Andersson T, Falk Delgado A. De Coninck T, Vanhoenacker F, Verstraete K. Journal Of Neurointerventional Surgery, 2017, 9(3), Journal of the Belgian Society of Radiology, 2017, 101(S2),15 264-277
OBJECTIVE 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.
OBJECTIVE To conduct a meta-analysis evaluating clinical outcome after aneurysm treatment.
MATERIALS/METHODS 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). S econdary outcomes were poor outcome and mortality. ORs were calculated on an intention-to-treat basis with 95% CIs. Out come 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-
To review the imaging characteristics of Morel-Lavallée lesions with both ultrasound and magnetic resonance imaging (MRI).
MATERIALS/METHODS We retrospectively analyzed 31 patients (mean age = 46 years), diagnosed with a Morel-Lavallée lesion, on ultrasound (n = 15) or MRI (n = 16). On ultrasound the echo genicity, internal septations, hyperechoic fat globules, compressibility and Doppler signal were evaluated. On MRI, T1- and T2-signal intensity, capsule presence, internal septations, enhancement, mass-effect and fluid-fluid levels were assessed. The MR images were classified according to the classification of Mellado and Bencardino.
RESULTS Most of the lesions were situated peritrochanteric, around the knee or the lower leg. The majority of the lesions had a heterogeneous hypoechoic appearance with septations and intralesional fat globules. On MRI, most of the c ollections were hypointense on T1-weighted images and hyper intense on T2-weighted images. Half of the collections were e ncapsulated, and most collections demonstrated septations. The collections were classified as seroma (n = 10), s ubacute hematoma (n = 2) and chronic organizing hematoma (n = 5).
CONCLUSION Ultrasound is the imaging method of choice to diagnose Morel-Lavallée lesions. MRI can be of use in selected cases (extension in different compartments, large collections, superinfection). Characteristic imaging features include a fusiform fluid collection MEDISCHE BEELDVORMING
31
ABSTRACT 15
Dekeyzer S, Nikoubashman O, Lutin B, De Groote J, Vancaester E, et al.
MR imaging of the anatomy of the anterior horn of the medial meniscus
De tekst van het abstract is terug te vinden op pagina 41.
De Coninck T, Vanrietvelde F, Seynaeve P, Verdonk P, Verstraete K. Acta Radiologica, 2017, 58(4),464-471
ABSTRACT 17
INTRODUCTION/BACKGROUND
The distress thermometer predicts subjective, but not o bjective, cognitive complaints six months after treatment initiation in cancer patients.
In cadaveric and arthroscopic studies different insertion locations of the anterior horn of the medial meniscus (AHMM) have been described.
Lycke M, Lefebvre T, Pottel L, Pottel H, Ketelaars L, et al. Journal of Psychosocial Oncology, 35(6),741-757
OBJECTIVE
De tekst van het abstract is te vinden op pagina 52.
To investigate if the different insertion locations of the AHMM, as described in cadaveric studies, can be determined on magnetic resonance imaging (MRI).
ABSTRACT 18 Imaging features of morel-lavallée lesions
MATERIALS/METHODS 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 ante rior 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.
De Coninck T, Vanhoenacker F, Verstraete, K. Journal of the Belgian Society of Radiology, 2017, 101(S2),15
OBJECTIVE To review the imaging characteristics of Morel-Lavallée lesions with both ultrasound and magnetic resonance imaging (MRI).
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 interand intra-observer agreement was observed.
MATERIALS/METHODS We retrospectively analyzed 31 patients (mean age = 46 years), diagnosed with a Morel-Lavallée lesion, on ultrasound (n = 15) or MRI (n = 16). On ultrasound the echo genicity, internal septations, hyperechoic fat globules, compressibility and Doppler signal were evaluated. On MRI, T1- and T2-signal intensity, capsule presence, internal septations, enhancement, mass-effect and fluid-fluid levels were assessed. The MR images were classified according to the classification of Mellado and Bencardino.
RESULTS 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 16 Distinction between contrast staining and hemorrhage after endovascular stroke treatment: one CT is not enough
32
ABSTRACTBOEK | 2017
Most of the lesions were situated peritrochanteric, around the knee or the lower leg. The majority of the lesions had a heterogeneous hypoechoic appearance with septations and intralesional fat globules. On MRI, most of the collections were hypointense on T1-weighted images and hyperintense on T2-weighted images. Half of the collections were en capsulated, and most collections demonstrated septations. The collections were classified as seroma (n = 10), subacute hematoma (n = 2) and chronic organizing hematoma (n = 5).
CONCLUSION
insertion patterns remains unclear
Ultrasound is the imaging method of choice to diagnose Morel-Lavallée lesions. MRI can be of use in selected cases (extension in different compartments, large collections, superinfection). Characteristic imaging features include a fusiform fluid collection.
Distinction between contrast staining and hemorrhage after endovascular stroke treatment: one CT is not enough
ABSTRACT 19 MR imaging of the anatomy of the anterior horn of the medial meniscus
ABSTRACT 20
Dekeyzer S, Nikoubashman O, Lutin B, De Groote J, Vancaester E et al. Journal of Neurointerventional Surgery, 2017, 9(4),394398
De Coninck T, Vanrietvelde F, Seynaeve P, Verdonk P, Verstraete K. Acta Radiologica, 2017, 58(4),464-471
De tekst van het abstract is terug te vinden op pagina 39
INTRODUCTION/BACKGROUND
The use of uHear™ to screen for hearing loss in older patients with cancer as part of a comprehensive geriatric assessment
ABSTRACT 21 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/METHODS 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 ante rior 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 signif icantly ( 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 intra-observer 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
etelaars L, Van Eygen K, Derijcke S, Werbrouck P, V K ergauwe P, Stellamans K, Clarysse P, et al. Acta Clin Belg, 2017, oct 24,1-7 De tekst van het abstract is terug te vinden op pagina. 59.
PRESENTATIES/ CONGRESSEN ABSTRACT 1 Succesful thrombectomies: impact of clot, technique and operator bias Andersson T. January 2017, ABC-WIN (Anatomy-Biology-Clinical corre lations - Working group in Interventional Neuroradiology) Seminar, Val d'Isere , France
INTRODUCTION/BACKGROUND When performing a mechanical thrombectomy for acute ischemic stroke, the ultimate goal is to remove the clot as quickly as possible without patient complications and with out losing fragments in the same or previously unaffected territories. Main factors that decide whether the procedure will be successful are: • Clot properties • Patient specifics e.g. constitution and vascular anatomy • Devices and other material • Operator and chosen technique
MEDISCHE BEELDVORMING
33
RESULTS They all interact and the question becomes whether its possible to suggest a certain procedural approach that will work for most clots and most operators. Some procedural principles should from any perspective be quite obvious, as well as confirmed in studies, but are still not generally prac ticed. You may ask yourself why. The answer to this enigma is mostly the operator as these highly skilled individuals still may have prejudices and be biased against certain technical features for reasons that are clearly irrational and nothing but scientific. In addition, there is equipoise regarding the indication for acute adjunctive therapies like carotid stenting.
with the ECMINT-course cycle as an example, discuss what characterize a good teacher and how we shall pass on our knowledge and experience to the next generation. Further, I will try to debate why the best operators quite often are the worst teachers and why we, and the authorities, accept that doctors operating in the human brain, basically holding life and death in the palm of their hands, are mostly not structurally trained, rather have had to gain their knowledge and experience by random. Would this really be accepted in other professions with similar risk profile involving human lives?
ABSTRACT 3 So, in this post-study era that reign today, in which the trend is to treat more patients with larger core infarcts, we need to: Understand the enemy, i.e. the clot, and develop devices and techniques that are safe and efficient. Promote procedural techniques that are accessible for most operators and based on experience and studies, not on economic interests, tunnel vision or ego. In my experience, the second item will probably be the most difficult one.
Imaging features of Morel-Lavallée lesions De Coninck T, Vanhoenacker F, Verstraete K. December 2017, Seminars in MSK radiology, Brussels, Belgium
ABSTRACT 4 Imaging of spinal infections: atypical findings Winnock de Grave P, Pannecoeck P, Seynaeve P, Verstraete K. September 2017, World Congress of Neurology, Kyoto, Japan
INTRODUCTION/BACKGROUND ABSTRACT 2 Why do we accept bad and unstructered training for future neurointerventions? Time, ego or both? Andersson T. January 2017 , ABC - (Anatomy-Biology-Clinical correla tions - Working group in Interventional Neuroradiology) Seminar, Val d'Isere, France
INTRODUCTION/BACKGROUND The first ECMINT-course cycle in interventional neuro radiology started in December 2014 with course 1.1. The fourth and final course in the cycle, 1.4, was held in June 2016. In September the same year, eligible students had the opportunity to sit for the ESMINT-diploma in relation to the annual conference in Nice. The course cycle was a great success, highly appreciated by the students as re flected in the course evaluations, and 17 of them managed to pass the prestigious diploma examination. The written part of all examinations were conducted in cooperation with the company “Orzone”, specialized in education and evaluations, and thereby completely computerized. Coming from a teaching background, I will in this short presentation,
34
ABSTRACTBOEK | 2017
Spinal infections are considered uncommon, with an incidence of 1 case per 100,000-250,000 population per year. However, some reviews suggest that the incidence of spinal infections is now increasing. This increase may be secondary to increased use of vascular devices and o ther forms of instrumentation and to increasing rates of IV drug abuse. Because of its rarity and vague initial signs and symptoms, diagnosis is often delayed. Discitis and osteo myelitis peak in pediatric patients. The incidence of spinal infections then decreases until middle age, when a second peak in incidence is observed at an approximately age of 50 years. However, in less developed nations, infectious osteomyelitis is more common. Presumably, a distant focus of infection provides an infective nidus from which bacteria spread by the bloodstream to the spinal column. The skin and the genitourinary tract are common antecedent sites, but a review to the literature reveals multiple foci, such as septic arthitis, sinusitis, subacute bacterial endocarditis and respiratory, oral or gastorintestinal infection. Aproximately 30-70% of patients with vertebral osteomyelitis have no obvious prior infection. Risk factors for developing osteomyelitis include conditions
that compromise the immune system, such as the following: advanced age, IV drug abuse, congenital immunodepres sion, organ transplantation, malnutrition and cancer. In the adult, after bacterial colonisation of the metaphyseal region, the avascular disk is secondarily invaded by bacteria from the endplate region and subsequently in the adjacent vertebral body. Intermetaphyseal communicating arteries allow the spread of septic thrombi from one metaphysis to the other in a single vertebral body without involvement of the midportion of the vertebra. In children, vascular channels are present across the growth plate, allowing primary infection of the disc with subsequent secondary infection of the vertebral body. Although the arterial route is the usual route of bacterial spread to a vertebra, another proposed route of infection is the retrograde seeding of venous blood via the Batson plexus. During periods of increased intra-abdominal pressure, venous blood is shunted to the vertebral venous plexus. Some authors have proposed that the venous system may be the route of bacterial spread from genitourinary tract infections. Another possible way of infection is by the spread of contiguous infection into the vertebrae and disk (eg, from a reytropharyngeal abscess or a retroperito neal abscess, facetarthritis, resulting in osteomyelitis and diskitis.
François O, Vanacker P, Dewaele T, Denorme F, De Meyer SF, Andersson T. May 2017, European Stroke Organization Conference, Prague, Czech Republic
INTRODUCTION/BACKGROUND Stroke remains a leading cause for death and permanent disability. In addition to treatment availability and delayed care seeking, failed and futile revascularization due to pro longed procedures may prove to be important negative predictors. The aim of this study was to evaluate thrombus visibility on non-contrast computed tomography (NCCT) and relate this to difficulties in mechanical removal and to known clot origin and composition.
MATERIALS/METHODS All stroke patients treated at our centre are included in a quality database (EVAS-BE) approved by the local ethical committee. Data on stroke etiology according to TOAST- criteria have previously been extracted and correlated with thrombus composition as presented in a separate abstract (Denorme et al, Abstract, ESOC, 2017). For this study, clot hyperdensity was measured in Hounsfield units on NCCT and difficulties in clot removal were estimated by number of thrombectomy attempts and the clot extraction time.
RESULTS
RESULTS
Computed tomography (CT) can help for detecting bony destructions and reactive sclerosis, although infections can be missed before bone destruction occurs. Magnetic reso nance imaging (MRI) is the imaging modality of choice for spinal infections, since it is even more sensitive and s pecific than bone scan and labeled white cell scans. Typical MR signs are vertebral endplate destruction, bone marrow edema, disk abnormalities and paravertebral or epidural abscesses.
75 patients were included in this study. Thrombi with car diogenic origin, proven to contain a higher percentage of fibrin (Denorme et al, 2017), were less dense in Hounsfield units and more difficult to mechanically remove requiring significantly more thrombectomy attempts and longer ex traction times.
CONCLUSION Especially when some of the classic MR-findings are ab sent or when there are unusual patterns of infectious spondylitis, the diagnosis of spinal infections can become a real challenge. Besides, non-infectious inflammatory and degenerative diseases can simulate spinal infections. This is why it is important to be familiar with atypical MRI-findings of spinal infections.
CONCLUSION Cardioembolic thrombi having high fibrin content in relation to red blood cells revealed less hyperdensity in Hounsfield units on NCCT and were more difficult to mechanically remove as compared to thrombi with atherosclerotic or other known origin. These results highlight the necessity for suitable thrombectomy techniques and development of devices capable of removing also such firm thrombi.
ABSTRACT 6 Imaging of spinal infections: atypical findings
ABSTRACT 5 Cardiogenic thromboemboli are rich in fibrin and von Willebrand factor, less visible on non-contrast CT and more difficult to mechanically remove.
Winnock de Grave P, Pannecoeck P, Seynaeve P, Verstraete K. 20.09.2017, WCN (World Congress of Neurology), Kyoto - Japan
MEDISCHE BEELDVORMING
35
INTRODUCTION/BACKGROUND Spinal infections are considered uncommon, with an in cidence of 1 case per 100,000-250,000 population per year. However, some reviews suggest that the incidence of spinal infections is now increasing. This increase may be secondary to increased use of vascular devices and oth er forms of instrumentation and to increasing rates of IV drug abuse. Because of its rarity and vague initial signs and symptoms, diagnosis is often delayed. Discitis and osteo myelitis peak in pediatric patients. The incidence of spinal infections then decreases until middle age, when a second peak in incidence is observed at an approximately age of 50 years. However, in less developed nations, infectious osteomyelitis is more common. Presumably, a distant focus of infection provides an infective nidus from which bacteria spread by the bloodstream to the spinal column. The skin and the genitourinary tract are common antecedent sites, but a review to the literature reveals multiple foci, such as septic arthitis, sinusitis, subacute bacterial endocarditis and respiratory, oral or gastorintestinal infection. Aproximately 30-70% of patients with vertebral osteomyelitis have no obvious prior infection. Risk factors for developing osteomyelitis include conditions that compromise the immune system, such as the following: advanced age, IV drug abuse, congenital immunodepres sion, organ transplantation, malnutrition and cancer. In the adult, after bacterial colonisation of the metaphyseal region, the avascular disk is secondarily invaded by bacteria from the endplate region and subsequently in the adjacent vertebral body. Intermetaphyseal communicating arteries allow the spread of septic thrombi from one metaphysis to the other in a single vertebral body without involvement of the mid portion of the vertebra. In children, vascular channels are present across the growth plate, allowing primary infec tion of the disc with subsequent secondary infection of the vertebral body. Although the arterial route is the usual route of bacterial spread to a vertebra, another proposed route of infection is the retrograde seeding of venous blood via the Batson plexus. During periods of increased intra-abdominal pressure, venous blood is shunted to the vertebral venous plexus. Some authors have proposed that the venous system may be the route of bacterial spread from genitourinary tract infections. Another possible way of infection is by the spread of contiguous infection into the vertebrae and disk (eg, from a reytropharyngeal abscess or a retroperito neal abscess, facetarthritis, resulting in osteomyelitis and diskitis.
RESULTS Computed tomography (CT) can help for detecting bony destructions and reactive sclerosis, although infections can 36
ABSTRACTBOEK | 2017
be missed before bone destruction occurs. Magnetic reso nance imaging (MRI) is the imaging modality of choice for spinal infections, since it is even more sensitive and s pecific than bone scan and labeled white cell scans. Typical MR signs are vertebral endplate destruction, bone marrow edema, disk abnormalities and paravertebral or epidural abscesses.
CONCLUSION Especially when some of the classic MR-findings are absent or when there are unusual patterns of infectious spondy litis, the diagnosis of spinal infections can become a real challenge. Besides, non-infectious inflammatory and de generative diseases can simulate spinal infections. This is why it is important to be familiar with atypical MRI-findings of spinal infections. radiology, Brussels, Belgium
ABSTRACT 7 Imaging features of Morel-Lavallée lesions De Coninck T, Vanhoenacker F, Verstraete K. December 2017, Seminars in Musculoskeletal Radiology radiology, Brussels, Belgium
ABSTRACT 8 Carotid stenting - indication and choice of treatment method Andersson T. May 2017, ATNT, Neurovascular meeting, Tel Aviv, Israel
ABSTRACT 9 Retrievers, flow-arrest and aspiration: optimal technique in different situations Andersson T. May 2017, ATNT, Neurovascular meeting, Tel Aviv - Israel
ABSTRACT 10 Two cases: aneurysm and AIS Andersson T. May 2017, World Live, Neurovascular Conference, Los Angeles, USA
Who should do mechanical thrombectomies in the future?
Andersson T. August 2017, European Society of Minimally Invasive Neu rological Therapy Annual Meeting, Nice, France
Andersson T. June 2017, Neurovascular Mortality/Morbidity Meeting, Jackson Hole, USA
Clinical selection and IV thrombolysis
ABSTRACT 11
ABSTRACT 18
Complications in neurointervention
Andersson T. September 2017, European Society of Neuroradiology Annual Neuroradiology Meeting, Malmö, Sweden
Andersson T. June 2017, Neurovascular Mortality/Morbidity Meeting, Jackson Hole, USA
Clinical selection and IV thrombolysis
ABSTRACT 12
ABSTRACT 19
Challenging clots
Andersson T. September 2017, European Society of Neuroradiology Annual Meeting, Malmö, Sweden
Andersson T. June 2017, Neurovascular Mortality/Morbidity Meeting, Jackson Hole, USA
Clot: Origin, etiology and imaging
ABSTRACT 13
ABSTRACT 14 Amnis GR - a novel type of stent retriever Andersson T. June 2017, Neurovascular Mortality/Morbidity Meeting, Jackson Hole, USA
ABSTRACT 15 Mechanical thrombectomy - organization and skills. How and who? Andersson T. August 2017, National Stroke Conference, Oslo, Norway
ABSTRACT 20
Andersson T. September 2017, European Society of Neuroradiology Annual Meeting, Malmö, Sweden
ABSTRACT 21 Clot properties and technique - what is the impact on technical result and clinical outcome? Andersson T. September 2017, European Society of Neuroradiology Annual Meeting, Malmö, Sweden
ABSTRACT 22 Flow diversion has NOT improved our care over the last decade misuse!
ABSTRACT 16 Delayed treatment of ruptured aneurysms - yes, it's ok to wait! Andersson T. August 2017, European Society of Minimally Invasive Neurological Therapy, Annual Meeting, Nice, France
Andersson T. October 2017, World Federation of Interventional and Therapeutic Neuroradiology Biannual Congress, Budapest, Hungary
ABSTRACT 17 Optimizing thrombectomy - it's nog just about TICI 2b-3!
MEDISCHE BEELDVORMING
37
ABSTRACT 23 It's all about teamwork Andersson T. October 2017, World Federation of Interventional and Therapeutic Neuroradiology Biannual Congress, Budapest, Hungary
ABSTRACT 24 Is 'suboptimal thrombectomy' better than 'no thrombectomy'? Andersson T. December 2017, Internation Clot Summit, ÂAmsterdam, The Netherlands
ABSTRACT 25 Clot composition - problems that we don't see Andersson T. December 2017, Internation Clot Summit, ÂAmsterdam, The Netherlands
38
ABSTRACTBOEK | 2017
CENTRUM
NEFROLOGIE ARTIKELS ABSTRACT 2 ABSTRACT 1 Circulating levels of sclerostin but not DKK1 associate with laboratory parameters of CKD-MBD.
Bone histomorphometry in de novo renal transplant recipients indicates a further decline in bone resorption 1 year posttransplantation
Behets GJ, Viaene L, Meijers B, et al. Plos One, 2017, 12(5),e0176411
Evenepoel P, Behets GJ, Viaene L, D'Haese P. Kidney International, 2017,91(2),469-476
INTRODUCTION/BACKGROUND
INTRODUCTION/BACKGROUND
Mounting evidence indicates that a disturbed Wnt-β- catenin signaling may be involved in the pathogenesis of chronic kidney disease-mineral and bone and m ineral disorder (CKD-MBD). Data on the impact of CKD on circulating levels of the Wnt antagonists sclerostin and Dickkopf related protein 1 (DKK1) and the relationship with laboratory parameters of CKD-MBD are incomplete.
Renal transplantation is believed to have a major impact on bone health. The present prospective observational bone biopsy study aimed to define the natural history of bone histomorphometry parameters in contemporaneous de novo renal transplant recipients. Paired bone biopsies were performed at the time of transplantation and at one-year posttransplantation in an unselected cohort of 36 patients referred for deceased kidney replacement. Parameters of mineral metabolism and circulating bone turnover markers were monitored as well. Static parameters of bone forma tion and especially bone resorption being already low-nor mal in the majority of patients at the time of renal trans plantation, further declined during the first posttransplant year. However, interindividual variation was substantial, and significance was reached only for bone resorption parameters. Bone mineralization and trabecular bone volume were within the normal range at the time of trans plantation (83.3% and 91.7% of graft recipients, respective ly) and showed little change one-year posttransplantation. Changes in osteoclast number were paralleled by changes in circulating tartrate-resistant acid phosphatase 5b levels. Finally, cumulative glucocorticoid dose, but not the post transplantation parathyroid hormone level, associated with trabecular bone loss. Thus, the impact of renal transplanta tion on bone histomorphometry is limited with only bone resorption, being already low at the time of transplantation, showing a further decline.
MATERIALS/METHODS We analyzed serum sclerostin and DKK1 in 308 patients across the stages of chronic kidney disease (kDOQI stage 1-2 n = 41; CKD stage 3 n = 54; CKD stage 4-5 n = 54; hemodialysis n = 100; peritoneal dialysis n = 59) as well as in 49 healthy controls. We investigated associations with d emographics, renal function, parameters of mineral metabolism in cluding 25(OH) vitamin D, 1,25(OH)2 vitamin D, biointact fibroblast growth factor 23 (FGF23), and parathyroid hormone (PTH), and bone turnover markers.
RESULTS Serum sclerostin, but not DKK1, increases in more a dvanced stages of CKD and associates with PTH, phosphate, and 1,25(OH)2 vitamin D concentrations. Bone turnover markers are highest in hemodialysis patients presenting the combination of high PTH with low sclerostin level. Serum DKK1 levels are lower in CKD patients than in controls and are not associated with laboratory parameters of mineral metabolism. Interestingly, a direct association between DKK1 and platelet count was observed.
CONCLUSION In CKD, serum levels of the Wnt inhibitors DKK1 and sclerostin are unrelated, indicating different sites of origin and/ or different regulatory mechanisms. Sclerostin, as opposed to DKK1, may qualify as a biomarker of CKD-MBD, particularly in dialysis patients. DKK1 serum levels, remark ably, correlate almost uniquely with blood platelet counts.
NEFROLOGIE
39
CENTRUM
NEUROLOGIE ARTIKELS ABSTRACT 1 An individualized coaching program for patients with acute ischemic stroke: feasibility study. Vanacker P, Standaert D, Libbrecht N, Vansteenkiste I, Bernard D, Yperzeele L, Vanhooren G. Clinical Neurology and Neurosurgery, 2017,154,89-93
ABSTRACT 2 Risk for major bleeding in patients receiving ticagrelor compared with aspirin after transient ischemic attack or acute ischemic stroke in the SOCRATES Study (acute stroke or transient ischemic attack treated with aspirin or ticagrelor and patient outcomes). Easton JD, Aunes M, Albers GW, Amarenco P, Bokelund-Singh S, et al. Circulation, 136(10), 907-916
OBJECTIVES An individualized stroke care program was developed to match patients' education with their needs regarding strokeknowledge, secondary prevention and rehabili tation. Our purpose was to assess feasibility of in-hospital and post-discharge, personalized stroke coaching service.
METHODS Acute ischemic stroke patients enrolled in ASTRAL-B stroke registry (Sint-Lucashospital, Bruges Belgium) with: (a) hospitalization between 12/2014-12/2015, (b) hospital-to-home discharge, and (c) without cognitive decline, were selected. The stroke coach contacted patients individually twice during hospitalization (2×20min) and post-discharge via phone calls using the standardized WSO Post-Strokechecklist. Risk factor management, review of therapy and clinical evolution were discussed. P articipants were contacted at 2 weeks, followed by repeat calls if necessary and ambulatory with the vascular neurologist at 1, 3, 6 and 12 months.
INTRODUCTION/BACKGROUND Patients with minor acute ischemic stroke or transient ischemic attack are at high risk for subsequent stroke, and more potent antiplatelet therapy in the acute setting is needed. However, the potential benefit of more intense antiplatelet therapy must be assessed in relation to the risk for major bleeding. The SOCRATES trial (Acute Stroke or Transient Ischemic Attack Treated With Aspirin or Ticagrelor and Patient Outcomes) was the first trial with ticagrelor in patients with acute ischemic stroke or transient ischemic attack in which the efficacy and safety of ticagrelor were compared with those of aspirin.
OBJECTIVE The main safety objective was assessment of PLATO (Pla telet Inhibition and Patient Outcomes)-defined major bleeds on treatment, with special focus on intracranial hemorrhage (ICrH).
MATERIALS/METHODS RESULTS Of all 255 patients meeting the inclusion criteria, 152 (59.7%) received individualized education during hospitali zation by the stroke coach. Median age of our population was 74 years and median NIHSS 5. Majority of patients had at least two cardiovascular risk factors. Patients were not coached because of palliative care/decease (10%), unfa vorable life expectancy (2%), dementia (8.5%) and lack of time due to short hospitalization (22%). A quarter of all patients were contacted at least once by phone, 12% were contacted at least twice after discharge. At three months, low stroke recurrence (5%) and mortality rates (4%) were identified, probably linked to improved adherence.
CONCLUSIONS We demonstrated feasibility of an individualized coaching service executed by well-trained stroke nurse. Future research will focus on developing an online portal deliv ering post-discharge services to patients and caregivers.
40
ABSTRACTBOEK | 2017
An independent adjudication committee blinded to study treatment classified bleeds according to the PLATO, TIMI (Thrombolysis in Myocardial Infarction), and GUSTO (Glo bal Use of Strategies to Open Occluded Coronary Arte ries) d efinitions. The definitions of ICrH and major blee ding excluded cerebral microbleeds and asymptomatic hemorrhagic transformations of cerebral infarctions so that the definitions better discriminated important events in the acute stroke population.
RESULTS A total of 13 130 of 13 199 randomized patients received at least 1 dose of study drug and were included in the safety analysis set. PLATO major bleeds occurred in 31 patients (0.5%) on ticagrelor and 38 patients (0.6%) on aspirin (ha zard ratio, 0.83; 95% confidence interval, 0.52-1.34). The most common locations of major bleeds were intracranial and gastrointestinal. ICrH was reported in 12 patients (0.2%) on ticagrelor and 18 patients (0.3%) on aspirin. Thir teen of all 30 ICrHs (4 on ticagrelor and 9 on aspirin) were hemorrhagic strokes, and 4 (2 in each group) were symp
tomatic hemorrhagic transformations of brain infarctions. The ICrHs were spontaneous in 6 and 13, traumatic in 3 and 3, and procedural in 3 and 2 patients on ticagrelor and aspirin, respectively. In total, 9 fatal bleeds occurred on ti cagrelor and 4 on aspirin. The composite of ICrH or fatal bleeding included 15 patients on ticagrelor and 18 on aspi rin. Independently of bleeding classification, PLATO, TIMI, or GUSTO, the relative difference between treatments for major/severe bleeds was similar. Nonmajor bleeds were more common on ticagrelor.
CONCLUSION Antiplatelet therapy with ticagrelor in patients with acute ischemic stroke or transient ischemic attack showed a bleeding profile similar to that of aspirin for major bleeds. There were few ICrHs.
ABSTRACT 3 Distinction between contrast staining and hemorrhage after endovascular stroke treatment: one CT is not enough Dekeyzer S, Nikoubashman O, Lutin B, De Groote J, Vancaester E, et al. Journal of neurointerventional surgery, 2017, 9(4) ,394-398
PCHDs correlated with hemorrhage with a specificity of 93.3% and a sensitivity of 62.5%. When follow-up CT was performed at least 19 h after the first CT, persisting PCHDs correlated with hemorrhage with a specificity of 100% and a sensitivity of 62.5%.
CONCLUSION There are no density thresholds for PCHDs that allow predicting the absence or presence of hemorrhage with 100% specificity and acceptable sensitivity. A CT scan performed at least 19-24 h after endovascular therapy is the only reliable method to differentiate contrast staining from hemorrhage.
ABSTRACT 4 Prestroke CHA2DS2-VASc score and severity of acute stroke in patients with atrial fibrillation: findings from RAF study. Acciarresi M, Paciaroni M, Agnelli G, Falocci N, Caso V, et al. Journal of Stroke and Cerebrovascular Diseases, 2017,26(6),1363-1368
INTRODUCTION/BACKGROUND INTRODUCTION/BACKGROUND Postinterventional cerebral hyperdensities (PCHDs) are a common finding after endovascular stroke treatment. There is uncertainty about the extent to which PCHDs correspond to hemorrhage or contrast staining.
The aim of this study was to investigate for a possible asso ciation between both prestroke CHA2DS2-VASc score and the severity of stroke at presentation, as well as disability and mortality at 90 days, in patients with acute stroke and atrial fibrillation (AF).
OBJECTIVE
MATERIALS/METHODS
Our aim was to evaluate the use of PCHD density on immediate postinterventional CT, and PCHD evolution on follow-up CT for differentiating contrast staining from hemorrhage after endovascular treatment.
This prospective study enrolled consecutive patients with acute ischemic stroke, AF, and assessment of prestroke CHA2DS2-VASc score. Severity of stroke was assessed on admission using the National Institutes of Health Stroke Scale (NIHSS) score (severe stroke: NIHSS ≥10). Disability and mortality at 90 days were assessed by the modified Rankin Scale (mRS <3 or ≥3). Multiple logistic regression was used to correlate prestroke CHA2DS2-VASc and severity of stroke, as well as disability and mortality at 90 days.
MATERIALS/METHODS We retrospectively reviewed the imaging data of 84 p atients who underwent endovascular treatment for acute arterial ischemic stroke in the anterior circulation and who received an immediate postinterventional CT, a follow-up CT within 36 h, and a follow-up MRI within 10 days.
RESULTS PCHDs were seen in 62 of 84 patients in a total of 130 Alberta Stroke Program Early CT Score (ASPECTS) areas. A specificity of 100% to predict hemorrhage was only seen for PCHDs with densities <40 HU (for ruling hemorrhage out) and ≥140 HU (for ruling hemorrhage in), at the cost of a low sensitivity of 1.1% and 2.4%, respectively. Persisting
RESULTS Of the 1020 patients included in the analysis, 606 patients had an admission NIHSS score lower and 414 patients higher than 10. At 90 days, 510 patients had mRS ≥3. A linear correlation was found between the prestroke CHA2DS2-VASc score and severity of stroke (P = .001). On multivariate analysis, CHA2DS2-VASc score correlated with severity of stroke (P = .041) and adverse functional outcome (mRS ≥3) (P = .001). A logistic regression with the r eceiver
NEUROLOGIE
41
operating characteristic graph procedure (C-statistics) evidenced an area under the curve of .60 (P = .0001) for severe stroke. Furthermore, a correlation was found between prestroke CHA2DS2-VASc score and lesion size.
CONCLUSION In patients with AF, in addition to the risk of stroke, a high CHA2DS2-VASc score was independently associated with both stroke severity at onset and disability and mortality at 90 days.
ABSTRACT 5 The changing landscape for stroke prevention in AF: findings from the GLORIA-AF registry phase 2. Huisman MV, Rothman KJ, Paquette M, Teutsch C, Diener HC, et al. Journal of American College of Cardiology, 2017, 69(7) 777-785
INTRODUCTION/BACKGROUND GLORIA-AF (Global Registry on Long-Term Oral Antithrom botic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrom botic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non-vitamin K antagonist oral anticoagulant (NOAC), became available.
(CHA2DS2-VASc = 1). Overall, 79.9% received oral antico agulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For com parison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treat ment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received anti platelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment.
CONCLUSION The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation pa tients, NOAC have been highly adopted into practice, be coming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large propor tion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]
ABSTRACT 6 OBJECTIVE This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1.
MATERIALS/METHODS During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients' baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant di seases and medications were collected. Data were analyzed using descriptive statistics.
Prediction of early recurrent thromboembolic event and major bleeding in patients with acute stroke and atrial fibrillation by a risk stratification schema: the ALESSA score study. Paciaroni M, Agnelli G, Caso V, Tsivgoulis G, Furie KL, et al. Stroke, 2017, 48(3), 726-732
INTRODUCTION/BACKGROUND This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation.
MATERIALS/METHODS RESULTS Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score ≥2; 86.1%); 13.9% had moderate risk 42
ABSTRACTBOEK | 2017
The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00-1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08-2.87) were pre dictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (≤1.5 cm) were inversely corre
lated with both major bleeding (hazard ratio, 0.39; P=0.03) and ischemic outcome events (hazard ratio, 0.55; 95% con fidence interval, 0.30-1.00). We assigned to age ≥80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiveroperating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632-0.763; P=0.0001) for ischemic outcome events and 0.585 (0.4930.678; P=0.10) for major bleedings.
RESULTS The validation cohort consisted of 994 patients inclu ded in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529-0.763; P=0.009) for ischemic outcome events and 0.407 (0.275-0.540; P=0.14) for hemorrhagic outcome events.
CONCLUSION In acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings..
PRESENTATIES / CONGRESSEN
conducted in fourBelgian stroke centers. Recruitment of eligible inpatients (175) will be allowed between February-August2017and patients will be coached during 6 months’ post-discharge. Baseline,risk factorsfollow-up, and video consultancy (at 0.5-1-3-6months)are guidedby the mobile health applicationspecifically designed.
RESULTS The primary outcome is risk factor control. Asummary score of four objective measures of risk factor control (systolic blood pressure, LDLcholesterol, fasted glucose level, and antiplateletadherence selfreport)will be used. Goals for the different risk factors were described in detail.In addition, secondaryendpoints are (a) quality-of-life (EQ-5D); (b) impact onlong term clinicaloutcome (mRS)and (c) stroke recurrence rateat 6 months. A detailed health-economic evaluation will also be conducted.
CONCLUSION If proven effective and feasible, implementation of this innovative model executed by a personal stroke coach, initiated during hospitalization and using a web-based intervention program, can easily be unrolled in other stroke units. The program can be cost-effective in case of improved recurrence rates, self-care and adherence.
ABSTRACT 2 A transient ischemic attack mimic.
ABSTRACT 1 Multicenter study of a personalized, digital c oaching Glibert N, De Keyser J. program after stroke: design & rationale. Poster- Acta Neurologica Belgica, 117(4),919-920 presentation Vanacker P, Standaert D, Mahieu D, Libbrecht N, Maqueda V, et al. May 2017, European Stroke Organisation Conference, Prague, Czech Republic
INTRODUCTION/BACKGROUND Increasing number of patients, caregivers and medical professionals are using online applications or web-based portals to optimize the post-stroke care. Focus on better supported discharge, regular patient coaching by telemedicine and mobile health solutions show promise to augment therapeutic adherence, reduce length of stay and readmissions. We aimed to assess feasibility of in-hospital initiated and post-discharge, personalized coaching program and its impact on self-reported adherence to risk factor management.
MATERIALS/METHODS This prospective, multi-center cohort study is being NEUROLOGIE
43
CENTRUM
NUCLEAIRE GENEESKUNDE ARTIKELS
CT and Tc-99m PSMA SPECT/CT in patients with prostate cancer.
ABSTRACT 1 Negative 18F-FDG PET and positive CT and MRI findings in multifocal splenic hamartoma. Van de Wiele C, Verstraete K, Bourgeois S, Maes A. Hellenic Journal of Nuclear Medicine, 2017, 20(2),182-183
INTRODUCTION/BACKGROUND We report our fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18FFDG PET/CT) findings in a 51 years old female presenting with B symptoms, respectively fever, night sweats and malaise, that underwent an 18F-FDG PET/CT examination to exclude underlying lymphomatous disease. Whereas 18F-FDG PET scan findings were negative, CT put to evidence the presence of multiple small lesions suggestive for multifocal hamartoma. On a subsequently performed magnetic resonance imaging (MRI) of the spleen, multiple infracentimetric foci were visualized displaying characte ristic findings for hamartoma. During a follow-up period of two years no change in size or characteristics of these lesions occurred.
CONCLUSION The normal 18F-FDG PET/CT findings suggested that, at least in this patient, splenic hamartoma may display a similar 18F-FDG avidity when compared to normal splenic tissue. Alternatively, due to the infra-centrimeric size of the hamartoma and spill-over from 18F-FDG activity from neighbouring normal tissue, the true 18F-FDG avidity of the hamartomas present might also be overestimated.
ABSTRACT 2 Diagnostic sensitivity of Tc-99m HYNIC PSMA SPECT/CT in prostate carcinoma: A comparative analysis with Ga-68 PSMA PET/CT. Lawal I, Ankrah A, Mokgoro N, Vorster M, Maes A, Sathekge M. Prostate, 2017, 77(11),1205-1212
MATERIALS/METHODS A total of 14 patients with histologically confirmed prostate cancer were prospectively recruited to undergo Ga-68 PSMA PET/CT and Tc-99m HYNIC PSMA SPECT/CT. The mean age of patients was 67.21 ± 8.15 years and the m edian PSA level was 45.18 ng/mL (range = 1.51-687 ng/mL). SUV max of all lesions and the size of lymph nodes with PSMA avidity on Ga-68 PSMA PET/CT were determined. Propor tions of these lesions detected on Tc-99m HYNIC PSMA SPECT/CT read independent of PET/CT findings were de termined.
RESULTS A total of 46 lesions were seen on Ga-68 PSMA PET/CT localized to the prostate (n = 10), lymph nodes (n = 24), and bones (n = 12). Of these, Tc-99m HYNIC PSMA SPECT/ CT detected 36 lesions: Prostate = 10/10 (100%), lymph nodes = 15/24 (62.5%), and bones = 11/12 (91.7%) with an overall sensitivity of 78.3%. Lesions detected on Tc-99m HYNIC PSMA SPECT/CT were bigger in size (P < 0.001) and had higher SUVmax (P < 0.001) as measured on Ga-68 PSMA PET/CT compared to those lesions that were not detected. All lymph nodes greater than 10 mm in size were detected while only 28% of nodes less than 10 mm were detected by Tc-99m HYNIC PSMA SPECT/CT. In a univariate analysis, Lymph node size (P = 0.033) and the SUVmax of all lesions (P = 0.007) were significant predictors of lesion detection on Tc-99m HYNIC PSMA SPECT/CT.
CONCLUSION Tc-99m HYNIC PSMA may be a useful in imaging of prostate cancer although with a lower sensitivity for lesion detection compared to Ga-68 PSMA PET/CT. Its use is recommended when Ga-68 PSMA is not readily available, in planning ra dio-guided surgery or the patient is being considered for radio-ligand therapy with Lu-177 PSMA. It performs poorly in detecting small-sized lesions hence its use is not recom mended in patients with small volume disease.
ABSTRACT 3 INTRODUCTION/BACKGROUND Emerging data from published studies are d emonstrating the superiority of Ga-68 PSMA PET/CT imaging in prostate cancer. However, the low yield of the Ge-68/Ga-68 from which Gallium-68 is obtained and fewer installed PET/CT systems compared to the SPECT imaging systems may limit its availability. We, therefore, evaluated in a head-to-head comparison, the diagnostic sensitivity of Ga-68 PSMA PET/
44
ABSTRACTBOEK | 2017
In vitro functional quality characterization of NOTA- modified somatropins. Bracke N, Yao H, Wynendaele E, Verbeke E, Xu X, Gevaert B, Maes A, Van de Wiele C, Sathekge M, De Saeger S, De Spiegeleer B. Analytical Chemistry, 2017, 89(5),2764-2772
INTRODUCTION/BACKGROUND Chemical modifications on protein biopharmaceuticals introduce extra variability in addition to their inherent complexity, hence require more comprehensive analytical and functional characterization during their discovery, development, and manufacturing. Somatropin (i.e., recom binant human growth hormone, rhGH) modified with the chelating agent S-2-(4-isothiocyanatobenzyl)-1,4,7-triaza cyclononane-1,4,7-triacetic acid (p-SCN-Bn-NOTA) allows the incorporation of radiometals for research and possible theranostic purposes. We previously demonstrated that this conjugation leads to multiple substitution degrees and positional isomers within the product. In vitro techniques at the molecular and cellular levels were now applied to assess their functional quality: (i) size exclusion chromatography (SEC) demonstrated functional complexation with human growth hormone binding protein (hGHBp) to the different NOTA-modified somatropins as well as to gallium chelated NOTA-functionalities (Ga-10:1 NOTA-somatropin); (ii) native mass spectrometry (MS) offered in-depth information, a substitution degree up to four NOTAs was still functional; (iii) circular dichroism (CD) analysis confirmed the com plexation of unmodified and NOTA-modified somatropin to hGHBp; and (iv) a hGHR bioassay demonstrated initia tion of the signal transduction cascade, after binding of all investigated products to the receptor presented on cells with a similar potency (pEC50 values between 9.53 and 9.78) and efficacy (Emax values between 130 and 160%). We conclude that the NOTA-modified somatropins do not possess a significantly different in vitro functionality profile compared to unmodified somatropin. Techniques such as SEC, MS, and CD, traditionally used in the physicochemical characterization of proteins have a demonstrated poten tial use in the functionality evaluation not only in drug dis covery and development but also in quality control settings.
compared to routinely performed staging examinations and analyzed as to lesion location and progesterone receptor status.
RESULTS Out of 81 tumor lesions identified, 84% were identified on 68Ga-PSMA-HBED-CC PET. 68Ga-PSMA-HBED-CC SUVmean values of distant metastases proved significantly higher (mean, 6.86, SD, 5.68) when compared to those of primary or local recurrences (mean, 2.45, SD, 2.55, p = 0.04) or involved lymph nodes (mean, 3.18, SD, 1.79, p = 0.011). SUVmean values of progesterone receptor-positive lesions proved not significantly different from progesterone recep tor-negative lesions. SUV values derived from FDG PET/CT, available in seven patients, and 68Ga-PSMA-HBED-CC PET/ CT imaging proved weakly correlated (r = 0.407, p = 0.015).
CONCLUSION 68Ga-PSMA-HBED-CC PET/CT imaging in breast carci noma confirms the reported considerable variation of PSMA expression on human solid tumors using immuno histochemistry.
ABSTRACT 5 Metabolic and morphological measurements of subcutaneous and visceral fat and their relationship with disease stage and overall survival in newly diagnosed pancreatic adenocarcinoma : Metabolic and morphological fat measurements in pancreatic adenocarcinoma. Van de Wiele C, Van Vlaenderen M, D'Hulst L, Delcourt A, Copin D, De Spiegeleer B, Maes A. European Journal of Nuclear Medicine and Molecular Imaging, 2017, 44(1),110-116
OBJECTIVE ABSTRACT 4 68Ga-PSMA-HBED-CC PET imaging in breast carcinoma patients. Sathekge M, Lengana T, Modiselle M, Vorster M, Zeevaart J, Maes A, Ebenhan T, Van de Wiele C. European Journal of Nuclear Medicine and Molecular Imaging, 2017, 44(4),689-694
INTRODUCTION/BACKGROUND To report on imaging findings using 68Ga-PSMA-HBED-CC PET in a series of 19 breast carcinoma patients.
MATERIALS/METHODS
The relationship between tumor metabolism and stage, subcutaneous and visceral fat thickness, and their glucose metabolism and overall survival in patients recently diagnosed with pancreatic carcinoma was assessed.
MATERIALS/METHODS Thirty-eight consecutive patients were studied. Subcuta neous fat thickness (SFT), visceral fat thickness (VFT), and their corresponding FDG SUVmean, as well as SUVmean and SUVmax values of the primary tumor (PT) were de rived from FDG-PET CT imaging. Results obtained as well as clinical variables obtained, including gender and BMI, were related to patient outcome. Median follow-up was 382 days (range: 36-917 days).
68Ga-PSMA-HBED-CC PET imaging results obtained were
NUCLEAIRE GENEESKUNDE
45
RESULTS Median age was 66 years (13 women). Mean BMI was 24.6 (SD: 4.5). Lymph node (LN) involvement was diagnosed in 17 patients and 14 patients presented with distant metastases. Mean SUV max and SUVmean values of the PT were 9.0 (SD 5.9) and 4.2 (SD 2.1). Mean values of SFT and VFT were, respectively, 11.9 mm (range 1-31.7 mm) and 11.5 mm (range 0-49.8 mm). The corresponding SUVmean values were 0.4 (range 0-1.0) and 0.6 (range 0.0-1.6). SUVmean values of SFT proved significantly lower in LNpositive versus LNnegative patients (p = 0.021), in patients with and without metastatic disease (p = 0.017) and in stage III+IV patients versus stage I+II patients (p = 0.03). An inverse logarithmic relationship was found between SUVmean values of subcu taneous fat and SUVmean values of the PT (p = 0.02). Only disease stage dichotomized according to stage I+IIA versus stage IIB+III+IV was predictive of overall survival (p = 0.05).
CONCLUSION Glucose metabolism of subcutaneous fat in de novo diagnosed pancreas carcinoma patients presenting with lymph node involvement and metastatic disease is signi ficantly reduced and inversely correlated to the primary tumor metabolism. Of the various fat-related variables studied, none proved significantly related to outcome.
kidney donors was used to validate the new formulae that define the reference interval.
RESULTS The reference limits for estimated GFR (eGFR), calculated by entering the reference limits for SCr into the FAS equation closely correspond with published reference limits for mGFR. Of the mGFRs of potential living kidney donors, 97.2% lie between the newly defined reference limits for GFR.
CONCLUSION SCr reference limits may serve to define age-dependent reference limits for eGFR and mGFR.
ABSTRACT 7 Cardiac 123I-mIBG scintigraphy is associated with freedom of appropriate ICD therapy in stable chronic heart failure patients. Verschure D, de Groot J, Mizraei S, Gheysens O, Nakajima K, van Eck-Smit B, Aernout Somsen G, Verberne H. International Journal of Cardiology, 2017, 403-408
OBJECTIVE ABSTRACT 6 Age-dependent reference intervals for estimated and measured glomerular filtration rate. Pottel H, Delanaye P, Weekers L, Selistre L, Goffin K, Gheysens O, Dubourg L. Clinical Kidney Journal, 2017, 10(4),545-551
Chronic heart failure (CHF) is a life-threatening clinical syndrome, partly due to sudden cardiac death (SCD). Implantable cardioverter defibrillators (ICD) for primary prevention of SCD have improved overall survival of CHF patients. However, a high percentage of patients never receives appropriate ICD therapy. This prospective mul ticentre study evaluated whether cardiac sympathetic activity assessed by 123I-mIBG scintigraphy could be helpful in selecting patients for ICD implantation.
INTRODUCTION/BACKGROUND Defining mean and reference intervals for glomerular fil tration rate (GFR) has been the subject of only a limited number of studies and review articles, with contradicting statements about the mean. Normal measured GFR (mGFR) values of ~120-130 mL/min/1.73 m2 have long been the referenced values for young adults but seem to be too high according to recent studies. Reference intervals are difficult to define because of the age decline of GFR, which is also observed in healthy subjects. Little data are available for subjects >70 years of age.
MATERIALS/METHODS 135 stable CHF subjects (age 64.5±9.3years, 79% male, LVEF 25±6%) referred for prophylactic ICD implantation were enrolled in 13 institutions. All subjects underwent planar and SPECT 123I-mIBG scintigraphy. Early and late heart-to-mediastinum (H/M) ratio, 123I-mIBG washout (WO) and late summed scores were calculated. The prima ry endpoint was appropriate ICD therapy. The secondary endpoint was defined as the combined endpoint of all first cardiac events: appropriate ICD therapy, progression of heart failure (HF) and cardiac death.
MATERIALS/METHODS Based on the reference intervals for serum creatinine (SCr) and the recently published full-age spectrum (FAS) equa tion, we define simple age-dependent equations for the reference limits of GFR. The mGFR of 633 living potential
46
ABSTRACTBOEK | 2017
RESULTS During a median follow-up of 30months (6-68months), 24 subjects (17.8%) experienced a first cardiac event (appro priate ICD therapy [12], HF progression [6], cardiac death
[6]). Late H/M ratio and defect size of 123I-mIBG SPECT were not associated with appropriate ICD therapy. How ever, late H/M ratio was independently associated with the combined endpoint (HR 0.135 [0.035-0.517], p=0.001). Post-hoc analysis showed that the combination of late H/M ratio (HR 0.461 [0.281-0.757]) and LVEF (HR 1.052 [1.021-1.084]) was significantly associated with freedom of appropriate ICD therapy (p<0.001).
clusion, cholesterol-lowering gene therapy potently coun teracts structural and metabolic remodeling, and enhances cardiac function.
CONCLUSION
Mathuramu I, Amin R, Postnov A, Mishra M, Jacobs F, Gheysens O, Van Veldhoven P, De Geest B. International Journal of Molecular Sciences, 2017, 18(7),E1565
123I-mIBG scintigraphy seems to be helpful in selecting CHF subjects who might not benefit from ICD implantation.
ABSTRACT 9 Coconut oil aggravates pressure overload-induced cardiomyopathy without inducing obesity, systemic insulin resistance, or cardiac steatosis.
ABSTRACT 8
INTRODUCTION/BACKGROUND
Cholesterol-lowering gene therapy counteracts the development of non-ischemic cardiomyopathy in mice.
Studies evaluating the effects of high-saturated fat diets on cardiac function are most often confounded by diet-in duced obesity and by systemic insulin resistance. We eva luated whether coconut oil, containing C12:0 and C14:0 as main fatty acids, aggravates pressure overload-induced cardiomyopathy induced by transverse aortic constriction (TAC) in C57BL/6 mice. Mortality rate after TAC was high er (p < 0.05) in 0.2% cholesterol 10% coconut oil diet-fed mice than in standard chow-fed mice (hazard ratio 2.32, 95% confidence interval 1.16 to 4.64) during eight weeks of follow-up. The effects of coconut oil on cardiac remode ling occurred in the absence of weight gain and of systemic insulin resistance. Wet lung weight was 1.76-fold (p < 0.01) higher in coconut oil mice than in standard chow mice. My ocardial capillary density (p < 0.001) was decreased, inter stitial fibrosis was 1.88-fold (p < 0.001) higher, and systolic and diastolic function was worse in coconut oil mice than in standard chow mice. Myocardial glucose uptake was 1.86fold (p < 0.001) higher in coconut oil mice and was accom panied by higher myocardial pyruvate dehydrogenase levels and higher acetyl-CoA carboxylase levels. The coconut oil diet increased oxidative stress. Myocardial triglycerides and free fatty acids were lower (p < 0.05) in coconut oil mice. In conclusion, coconut oil aggravates pressure overload- induced cardiomyopathy.
Muthuramu I, Amin R, Postnov A, Mishra M, Aboumsallem J, Dresselaers T, Himmelreich U, Van Veldhoven P, Gheysens O, Jacobs F, De Geest B. Molecular Therapy: the Journal of the American Society of Gene Therapy, 2017, 25(11),2513-2525
INTRODUCTION/BACKGROUND A causal role of hypercholesterolemia in non-ischemic heart failure has never been demonstrated. Adeno-associated viral serotype 8 (AAV8)-low-density lipoprotein receptor (AAV8-LDLr) gene transfer was performed in LDLr-de ficient mice without and with pressure overload induced by transverse aortic constriction (TAC). AAV8-LDLr gene therapy resulted in an 82.8% (p < 0.0001) reduction of plasma cholesterol compared with controls. Mortality rate was lower (p < 0.05) in AAV8-LDLr TAC mice compared with control TAC mice (hazard ratio for mortality 0.457, 95% confidence interval [CI] 0.237-0.882) during 8 weeks of follow-up. AAV8-LDLr gene therapy attenuated cardiac hy pertrophy, reduced interstitial and perivascular fibrosis, and decreased lung congestion in TAC mice. Cardiac function, quantified by invasive hemodynamic measurements and magnetic resonance imaging, was significantly improved 8 weeks after sham operation or after TAC in AAV8-LDLr mice compared with respective control groups. Myocardial protein levels of mammalian target of rapamycin and of acetyl-coenzyme A carboxylase were strikingly decreased following cholesterol lowering in mice without and with pressure overload. AAV8-LDLr therapy potently reduced cardiac glucose uptake and counteracted metabolic remo deling following pressure overload. Furthermore, oxidative stress and myocardial apoptosis were decreased following AAV8-LDLr therapy in mice with pressure overload. In con
ABSTRACT 10 Fibrous dysplasia mimicking bone metastasis on 68GA-PSMA PET/MRI. De Coster L, Sciot R, Everaerts W, Gheysens O, Verscuren R, Deroose C, Pans S, Van Laere K, Goffin K. European Journal of Nuclear Medicine and Molecular Imaging, 2017, 44(9),1607-1608
NUCLEAIRE GENEESKUNDE
47
ABSTRACT 11
INTRODUCTION/BACKGROUND
Nuclear medicine imaging in pediatric infection or chronic inflammatory diseases.
Post-transplantation lymphoproliferative disorder is an aggressive complication of transplantation, most frequently of diffuse large B-cell lymphoma morphology and associa ted with Epstein-Barr virus (EBV) infection/reactivation. In this study the microenvironment of EBV+ (n=23) and EBV(n=9) post-transplant non-germinal center B-cell diffuse large B-cell lymphoma was characterized. Of EBV+ cases somatic hypermutation analysis, gene expression profiling, and extensive phenotyping were performed. Our results demonstrated variable cytotoxic T-cell infiltration and sig nificantly increased CD163+ M2 macrophage infiltration in EBV+ compared with EBV- post-transplant diffuse large B-cell lymphoma. On the basis of IgM staining and hyper mutation analysis, two EBV+ post-transplant diffuse large B-cell lymphoma subgroups were identified: IgM+ tumors lacking somatic hypermutations and IgM- tumors harboring somatic hypermutations. IgM- tumors arose late follow ing transplantation (median interval: 16 months), mainly in kidney recipients. IgM+ tumors on the other hand arose early (median interval: 3 months, P-value=0.0032), almost exclusively following stem cell transplantation and were associated with worse outcome (median survival 1 month for IgM+ versus 41 months for IgM- tumors, log-rank/ Wilcoxon P-value 0.07/0.04). Notably, IgM+ tumors were characterized by plasma cell features (monotypic kappa/ lambda expression, high MUM1 expression, and partial CD138 expression) and a high proliferation index. Consis tent with the plasma cell phenotype, unfolded protein re sponse signaling was upregulated. In contrast, IgM- EBV+ post-transplant diffuse large B-cell lymphoma did not ex press kappa, lambda, IgD, or CD138 and expressed limited MUM1. In these tumors T-cell signaling was enhanced asso ciated with increased T-cell infiltration compared with IgM+ cases. Overall, our results allow further molecular classi fication of EBV+ post-transplant diffuse large B-cell lym phoma and provide a rationale for the use of subtype-spe cific-targeted therapies (eg, bortezomib in IgM+ tumors). Our findings also provide a biological basis for the clinical differences between post-transplant lymphoproliferative disorder following solid organ and stem cell transplantation, which are regarded as different disorders.
DSignore A, Glaudemans A, Gheysens O, Lauri C, Catalano O. Seminars in Nuclear Medicine, 2017, 47(3),286-303
INTRODUCTION/BACKGROUND In this review article, we focus on the most recent applica tions of nuclear medicine techniques (mainly 99mTc/111In white blood cells (WBC) scan, [18F]-FDG-PET/CT, [18F]FDG-PET/MRI, and 99mTc-IL-2 scintigraphy) in the study of children affected by peripheral bone osteomyelitis, fungal infections, inflammatory bowel diseases, and type 1 diabetes, owing to recent important published eviden ces of their role in the management of these diseases. For osteomyelitis in children, both bone scintigraphy and [18F]-FDG-PET have a major advantage of assessing the whole body in one imaging session to confirm or exclude multifocal involvement, whereas WBC scan has a limited role. In children with fungal infections, [18F]-FDG-PET can help in defining the best location for biopsy and can help in evaluating the extent of the infection and organs involved (also sites that were not yet clinically apparent), although its main role is for therapy monitoring. In inflammatory bowel diseases, and Crohn disease in particular, WBC scan has been successfully used for many years, but it is now used only in case of doubtful magnetic resonance (MR) or when MR cannot be performed and endoscopy is inconclusive. By contrast, there is an accumulating evidence of the role of [18F]-FDG-PET in management of children with Crohn disease, and PET/MR could be a versatile and innovative hybrid imaging technique that combines the metabolic information of PET with the high soft tissue resolution of MR, particularly for distinguishing fibrotic from active stric tures. Finally, there are several new radiopharmaceuticals that specifically target inflammatory cells involved in the pathogenesis of insulitis aiming at developing new specific immunotherapies and to select children candidates to these treatments for improving their quality of life.
ABSTRACT 12 Identification of distinct subgroups of EBV-positive post-transplant diffuse large B-cell lymphoma. Morscio J, Finalet Ferreiro J, Vander Borght S, Bittoun E, Gheysens O, Dierickx D, Verhoef G, Wodarska I, Tousseyn T. Modern Pathology: an official journal of the united states and canadian academy of pathology, 2017, 30(3),370-381
48
ABSTRACTBOEK | 2017
ABSTRACT 13 Carbon-11 and fluorine-18 radiolabeled pyridopyrazinone derivatives for positron emission tomography (PET) imaging of phosphodiesterase-5 (PDE5). E Chekol R, Gheysens O, Ahamed M, Cleynhens J, Pokreisz P,
Vanhoof G, Janssens S, Verbruggen A, Bormans G. Journal of Medicinal Chemistry, 2017, 60(1),486-496
INTRODUCTION/BACKGROUND The cyclic guanosine monophosphate (cGMP) specific phos phodiesterase type 5 (PDE5) plays an important role in va rious pathologies including pulmonary arterial hypertension and cardiomyopathy. PDE5 represents an important thera peutic and/or prognostic target, but noninvasive assessment of PDE5 expression is lacking. The purpose of this study was to develop and evaluate pyridopyrazinone derivatives labeled with carbon-11 or fluorine-18 as PDE5-specific PET tracers. In biodistribution studies, highest PDE5-specific retention was observed for [11C]-12 and [18F]-17 in the lungs of wildtype mice and in the myocardium of transgenic mice with cardiomyocyte-specific PDE5 overexpression at 30 min post injection. In vivo dynamic microPET images in rats revealed that both tracers crossed the blood-brain barrier but brain retention was not PDE5-specific. Both [11C]-12 and [18F]17 showed specific binding to PDE5 in myocardium of trans genic mice; however [18F]-17 showed significantly higher PDE5-specific inhibitable binding than [11C]-12.
duction, were treated with four weekly doses of rituximab induction. After restaging, complete responders continued with four courses of rituximab consolidation every 21 days; all others received four courses of rituximab plus CHOP chemotherapy every 21 days. The primary end point was treatment efficacy measured as the response rate in pa tients who completed therapy and the response duration in those who completed therapy and responded. Secondary end points were frequency of infections, treatment-related mortality, and overall survival in the intention-to-treat pop ulation.
RESULTS One hundred eleven of 126 patients had a complete or partial response (88%; 95% CI, 81% to 93%), of whom 88 had a complete response (70%; 95% CI, 61% to 77%). Median response duration was not reached. The 3-year estimate was 82% (95% CI, 74% to 90%). Median overall survival was 6.6 years (95% CI, 5.5 to 7.6 years). The fre quency of grade 3 or 4 infections and of treatment-related mortality was 34% (95% CI, 27% to 42%) and 8% (95% CI, 5% to 14%), respectively. Response to rituximab induction remained a prognostic factor for overall survival despite treatment stratification.
ABSTRACT 14 CONCLUSION
Response to rituximab induction is a predictive marker in b-cell post-transplant lymphoproliferative disorder and allows successful stratification into rituximab or R-CHOP consolidation in an international, prospective, multicenter phase II trial.
In B-cell PTLD, treatment stratification into rituximab or rituximab plus CHOP consolidation on the basis of response to rituximab induction is feasible, safe, and effective.
Trappe R, Dierickx D, Zimmermann H, Morschlauser F, Mollee P, et al. Journal of Clinical Oncology: official journal of the American Society of clinical oncology, 2017, 35(5),536-543
Peptides as quorum sensing molecules: measurement techniques and obtained levels in vitro and In vivo.
OBJECTIVE
Verbeke F, De Craemer S, Debunne N, Janssens Y, Wynendaele E, Van de Wiele C, De Spiegeleer B. Frontiers in Neuroscience, 2017, 11,183
The Sequential Treatment of CD20-Positive Posttransplant Lymphoproliferative Disorder (PTLD-1) trial ( ClinicalTrials. gov identifier, NCT01458548) established sequential treat ment with four cycles of rituximab followed by four cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy as a standard in the management of post-transplant lymphoproliferative disorder (PTLD) and identified response to rituximab induction as a prognostic factor for overall survival. We hypothesized that rituximab consolidation might be sufficient treatment for patients with a complete response after rituximab induction.
MATERIALS/METHODS In this prospective, international, multicenter phase II trial, 152 treatment-naive adult solid organ transplant recipients, with CD20+ PTLD unresponsive to immunosuppression re
ABSTRACT 15
INTRODUCTION/BACKGROUND The expression of certain bacterial genes is regulated in a cell-density dependent way, a phenomenon called quo rum sensing. Both Gram-negative and Gram-positive bac teria use this type of communication, though the signal molecules (auto-inducers) used by them differ between both groups: Gram-negative bacteria use predominantly N-acyl homoserine lacton (AHL) molecules (autoinducer-1, AI-1) while Gram-positive bacteria use mainly peptides (autoinducer peptides, AIP or quorum sensing peptides). These quorum sensing molecules are not only involved in the inter-microbial communication, but can also possibly cross-talk directly or indirectly with their host. This review
NUCLEAIRE GENEESKUNDE
49
summarizes the currently applied analytical approaches for quorum sensing identification and quantification with additionally summarizing the experimentally found in vivo concentrations of these molecules in humans.
an independent predictor of therapy outcome in the pre sence of other factors such as SUVmax, MTV, TLG and the Ann Arbor stage of the disease.
CONCLUSION ABSTRACT 16 The role of F-18 FDG PET/CT in evaluating the impact of HIV infection on tumor burden and therapy outcome in patients with Hodgkin lymphoma. Lawal I, Nyakale N, Harry L, Modiselle M, Ankrah A, Msomi A, Mokgoro N, Boshomane T, Van de Wiele C, Sathekge M. European Journal of Nuclear Medicine and Molecular Imaging, 2017, 44(12),2025-2033
OBJECTIVE To evaluate the impact of HIV infection on tumor burden and therapy outcome following treatment with chemo therapy in patients with Hodgkin lymphoma.
MATERIALS/METHODS A total of 136 patients with classical Hodgkin lymphoma were studied (mean age ± SD = 32.31 ± 1.39 years, male = 86, female = 50). Advanced disease (stage III and IV) was present in 64% of patients. HIV infection was present in 57 patients while 79 patients were HIV-negative. Baseline F-18 FDG PET/CT was obtained in all patients. SUVmax, MTV and TLG were determined on the baseline scan to evaluate for tumor burden. All patients completed a standard re gimen of adriamycin, bleomycin, vinblastine and dacarba zine (ABVD). After a median period of 8 weeks (range = 6 to 17 weeks), a repeat F-18 FDG PET/CT scan was obtained to evaluate response to therapy using Deauville 5-point scoring system.
50
ABSTRACTBOEK | 2017
HIV infection is not associated with a higher tumor burden in patients with Hodgkin lymphoma. HIV infection is, how ever, a strong predictor of poor therapy outcome in patients treated with standard regimen of ABVD.
ABSTRACT 17 Stable metabolic disease on FDG-PET provides information on response to endocrine therapy for breast cancer. Kruse V, Van de Wiele C, Maes A, Borms M, Pottel H, Van Belle S, Cocquyt V. Quarterly Journal of Nuclear Medicine and Molecular Imaging, 2017,61(1),108-114
INTRODUCTION/BACKGROUND The aim of this study was to assess whether outcome in advanced breast cancer patients is related to metabol ic response to endocrine therapy determined by fluoro deoxyglucose positron-emission tomography (FDG-PET).
MATERIALS/METHODS We retrospectively identified 21 consecutive breast cancer patients receiving endocrine therapy for metastatic disease (mean number of previous therapies 3.6±3.5). All patients had been evaluated with at least 2 FDG-PETs. The first scan was performed by initiation of endocrine therapy. The se cond scan was performed after a mean of 3.8±1.14 months. Seventy-two FDG-avid lesions were identified and followed. The mean change in SUVmax (ΔSUVmax) was calculated per patient.
RESULTS
RESULTS
The HIV-positive and HIV-negative groups were similar with regards to age and disease stage. The groups were heterogeneous with respect to gender (p = 0.029). The SUV max, MTV and TLG of lesions were not significant different between the two groups. Complete response was seen in 72.8% of the study population. Presence of HIV infection was associated with higher rate of treatment failure with 40.4% of the HIV-positive patients having treatment failure while only 17.7% of the HIV-negative patients had treatment failure (p = 0.0034). HIV infection was a significant predictor of response to chemotherapy. Effects of SUVmax, MTV, TLG and Ann Arbor stage of the disease were not statistically significant as predictors of therapy outcome. In a multiple logistic regression, presence of HIV infection still remained
ΔSUVmax dichotomized using the group median as cut-off (8.6%) was predictive of progression-free survival (PFS). The median PFS for the response-group (N.=10, median ΔSUVmax -20.9%) was 10.1 months. The median PFS for the progressive disease-group (N.=11, median ΔSUVmax 40.6%) was 6.7 months (log-rank testing P=0.033).
CONCLUSION Our data suggest that breast cancer patients under hormo nal therapy with stable disease on FDG-PET have a longer PFS when compared to non-responders. This finding is new, supporting the value of endocrine therapy among patients with advanced breast cancer.
of the acquisition.
ABSTRACT 18 Fluorodeoxyglucose-positron emission tomography/ computed tomography after concurrent chemoradio therapy in locally advanced head-and-neck squamous cell cancer: The ECLYPS study Van den Wyngaert T, Helsen N, Carp L, Hakim S, Martens MJ, et al. Journal of Clinical Oncology, 35(30),3458-3464 De tekst van het abstract is terug te vinden op pagina 53.
PRESENTATIES/ CONGRESSEN
RESULTS The phantom reconstructed with the GE Xeleris Volumetrix resulted in a mean CF of 7.93 cpm/kBq (counts per minute per kilo Bequerel) for the 4 different acquisition protocols (CV: 0.04). Repeating this experiment resulted in a mean CF of 7.98 cpm/kBq (CV: 0.06) which only deviates 0.61% to the CF obtained during the first experiment. The phantom reconstructed with the GE Xeleris Volumetrix Evolution for Bone resulted in a mean CF of 40.51 cpm/kBq (counts per minute per kilo Bequerel) for the 4 different acquisition protocols (CV: 0.02). Repeating this experiment resulted in a mean CF of 41.29 cpm/kBq (CV: 0.02) which only deviates 1.93% to the CF obtained during the first ex periment.
ABSTRACT 1
CONCLUSION
Determining the calibration factor of a SPECT/CT camera
The CF is not influenced by acquisition time, matrix size or zoom factor, but is highly influenced by the recon struction parameters, more specifically resolution recovery (used in the GE Xeleris Volumetrix Evolution for Bone software). Therefore it is highly important when using a CF clinically to reconstruct the phantom data with the same reconstruction parameters as patient data.
Beels L. October 2017, Annual Congress of the European Association of Nuclear Medicine, Vienna, Austria
OBJECTIVE Quantitative single-photon emission computed tomo graphy (SPECT) has several important applications inclu ding monitoring tumor response after treatment and dose estimation for targeted radionuclide therapy treatment planning. The use of a calibration factor is required to ob tain quantitative SPECT images. In this study, the calibration factor (CF) was determined for different acquisition and re construction protocols.
MATERIALS/METHODS A cylindrical phantom (height: 19.5 cm , diameter: 19.5 cm) was used for the SPECT/CT acquisitions (GE Discovery NM/CT 670). The phantom was filled with 99mTc, approximately 320 MBq for the first measurements and ap proximately 230 MBq for the second measurement that was performed to check the reproducibility of the calibration factor. The phantom was acquired four times using different acquisition parameters (change of acquisition time, matrix size, zoom factor) and the phantom was reconstructed us ing the GE Xeleris Volumetrix and GE Xeleris Volumetrix Evolution for Bone software. A volume of interest (VOI) (height: 15 cm, diameter: 17 cm) was drawn on the acquired images. Knowing the counts in the VOI, the volume of the VOI and the acquisition time, the count rate per unit volume was calculated. The CF was then determined by dividing the count rate per unit volume by the activity concentration decay corrected at the beginning
NUCLEAIRE GENEESKUNDE
51
CENTRUM
ONCOLOGIE ARTIKELS
ABSTRACT 2
ABSTRACT 1
The distress thermometer predicts subjective, but not o bjective, cognitive complaints six months after treatment initiation in cancer patients.
Incidence of medication-related osteonecrosis of the jaw in patients treated with both bone resorption inhibitors and vascular endothelial growth factor receptor tyrosine kinase inhibitors. Van Cann T, Loyson T, Verbiest A, Clement PM, Bechter O, et al. Supportive Care in Cancer, 26(3),869-878
INTRODUCTION/BACKGROUND Several case reports and small case series have suggested a higher incidence of medication-related osteonecrosis of the jaw (MRONJ) in patients treated concomitantly with bone resorption inhibitors (BRIs) and vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs), as compared to patients treated with BRIs alone. We aimed to assess ONJ-incidence in patients exposed concomitantly to BRIs and VEGFR-TKIs.
MATERIALS/METHODS We reviewed the records of all patients who received VEG FR-TKIs concomitantly with BRIs. Patients, who were treated with BRIs without VEGFR-TKI, served as a control group. End points of the study were total MRONJ-incidence, MRONJ- incidence during the first and second year of exposure, and time-to-ONJ-incidence.
Lycke M, Lefebvre T, Pottel L, Pottel H, Ketelaars L, et al. Journal of Psychosocial Oncology, 35(6),741-757
OBJECTIVE Research has indicated that cancer-related cognitive impairments (CRCI) may be influenced by psychosocial factors such as distress, worry and fatigue. Therefore, we aimed to validate the distress thermometer (DT) as a scree ning tool to detect CRCI six months post-treatment-initiation in a group of general cancer patients.
MATERIALS/METHODS Patients (≥18 years, n = 125) with a histologically confirmed diagnosis of a solid cancer or hematological malignan cy, scheduled for a curative treatment, were evaluated at baseline (T0) and six months post-treatment-initiation (T1) for CRCI by a neuropsychological assessment, including patient-reported outcome measures (PROMs). Assessed cognitive domains included premorbid intelligence, atten tion, processing speed, flexibility, verbal and visual episodic memory and verbal fluency. PROMs entailed distress (DT, cut-off ≥4, range 0-10), anxiety and depression, fatigue (FACIT-fatigue scale) and subjective cognitive complaints.
RESULTS RESULTS Ninety patients were treated concomitantly with BRIs and VEGFR-TKIs with a median BRI-exposure of 5.0 months. Total MRONJ-incidence was 11.1%. During the first year of BRI-exposure (with a median concomitant exposure of 4.0 months), 6 out of 90 patients (6.7%) developed a MRONJ, compared to 1.1% in the control group (odds ratio 5.9; 95%CI 2.0-18.0; p = 0.0035). In Kaplan-Meier estimates, time-toONJ-incidence was significantly shorter in patients treated with BRIs and VEGFR-TKIs compared to BRIs alone (hazard ratio 9.5; 95%CI 3.1-29.6; p < 0.0001). MRONJs occurred ear lier in patients treated concomitantly compared to patients treated with BRIs only (after a median exposure of 4.5 and 25.0 months, respectively; p = 0.0033).
CONCLUSION With a global MRONJ-incidence of 11%, patients receiving concomitant treatment with VEGFR-TKIs and BRIs have a five to ten times higher risk for development of MRONJ com pared to patients treated with BRIs alone.
52
ABSTRACTBOEK | 2017
At T0, 60.4% of patients showed a DT score of ≥4, whereas 50% met this criterion at T1. According to the definition of the International Cognition and Cancer Task Force, 25.5% and 28.3% of patients presented with a CRCI at T0 and T1, respectively. When evaluating the DT as a screening tool for CRCI at T1, data showed an inverse relationship between the DT and CRCI. ROC-curve analysis revealed an AUC <0.5. ROCcurve analyses evaluating the DT and FACIT-fatigue scale as screening tools for subjective cognitive complaints showed an AUC ± SE of, respectively, 0.642 ± 0.067 and 0.794 ± 0.057.
CONCLUSION The DT at T0 cannot be used to screen for objective CRCI at T1, but both the DT and FACIT-fatigue scale at T0 showed po tential as screening tools for subjective cognitive complaints at T1.
ABSTRACT 3 Predictors of baseline cancer-related cognitive impairment in cancer patients scheduled for curative treatment.
Lycke M, Pottel L, Pottel H, Ketelaars L, Stellamans K, Van Eygen K, Vergauwe P, Werbrouck P, Goethals L, Schofield P, Boterberg T, Debruyne PR. Psychooncology, 26(5), 632-639
INTRODUCTION/BACKGROUND Recent 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 influ ence of age, IQ, and other psychosocial and medical factors.
MATERIALS/METHODS Recent 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 influ ence of age, IQ, and other psychosocial and medical factors.
OBJECTIVE To assess the standardized implementation and reporting of surveillance [18F]fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scan of the neck in locoregionally advanced head-and-neck squa mous cell carcinoma (LAHNSCC) after concurrent chemo radiotherapy (CCRT).
MATERIALS/METHODS We performed a prospective multicenter study of FDG-PET/ CT scanning 12 weeks after CCRT in newly diagnosed pa tients with LAHNSCC (stage IVa/b) that used standardized reconstruction and Hopkins reporting criteria. The reference standard was histology or > 12 months of clinical follow-up. The primary outcome measure was the negative predictive value (NPV) of FDG-PET/CT scans and other supporting diagnostic test characteristics, including time dependency with increasing follow-up time.
RESULTS
RESULTS
Cross-sectional data of 125 patients were collected. Pa tients 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 pa tients, a CRCI was detected. Binary logistic regression analy ses showed that a lower premorbid IQ (β = -.084, P < .01) and a higher level of fatigue (β = -.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.
Of 152 patients, 125 had adequate primary tumor control after CCRT and entered follow-up (median, 20.4 months). Twenty-three (18.4%) had residual neck disease. Over all, NPV was 92.1% (95% CI, 86.9% to 95.3%; null hypo thesis: NPV = 85%; P = .012) with sensitivity of 65.2% (95% CI, 44.9% to 81.2%), specificity of 91.2% (95% CI, 84.1% to 95.3%), positive predictive value of 62.5% (95% CI, 45.5% to 76.9%), and accuracy of 86.4% (95% CI, 79.3% to 91.3%). Sensitivity was time dependent and high for residual disease manifesting up to 9 months after imaging but lower (59.7%) for disease detected up to 12 months after imaging. Standardized reporting criteria reduced the num ber of equivocal reports (95% CI for the difference, 2.6% to 15.0%; P = .003). Test characteristics were not improved with the addition of lymph node CT morphology criteria.
CONCLUSION Premorbid IQ and fatigue are important predictors of baseline CRCI. Therefore, we advise researchers to implement a short IQ test when conducting clinical trials on CRCI.
COMMENTS FDG-PET/CT surveillance using Hopkins criteria 12 weeks after CCRT is reliable in LAHNSCC except for late manifest ing residual disease, which may require an additional sur veillance scan at 1 year after CCRT to be detected.
ABSTRACT 4 Fluorodeoxyglucose-positron emission tomography/ computed tomography after concurrent chemoradio- ABSTRACT 5 therapy in locally advanced head-and-neck squamous Lenalidomide maintenance compared with placebo in responding elderly patients with diffuse large B-cell cell cancer: The ECLYPS study lymphoma treated with first-line rituximab plus cycloVan den Wyngaert T, Helsen N, Carp L, Hakim S, Martens MJ, phosphamide, doxorubicin, vincristine, and prednisone. et al. Gomes da Silva M, van Eygen K, Cohen AM, Van Hoof A, Journal of Clinical Oncology, 35(30) ,3458-3464 Briere J, et al. Journal Of Clinical Oncology, 2017,35(22),22,2473-2481
ONCOLOGIE
53
INTRODUCTION/BACKGROUND
INTRODUCTION/BACKGROUND
The standard treatment of patients with diffuse large B-cell lymphoma (DLBCL) is rituximab in combination with cy clophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). Lenalidomide, an immunomodulatory agent, has shown activity in DLBCL.
Mantle cell lymphoma is a B-cell non-Hodgkin's lymphoma characterized by a t(11;14), resulting in overexpression of cyclin D1. Conventional chemotherapy obtains frequent (but short) remissions, leading to a poor median overall survival (OS) of 3-5 years. To obtain more information about the prevalence and current treatment of Mantle cell lymphoma (MCL) in Belgium, we collected data in a Belgian registry of MCL.
OBJECTIVE This randomized phase III trial compared lenalidomide as maintenance therapy with placebo in elderly patients with DLBCL who achieved a complete response (CR) or partial response (PR) to R-CHOP induction.
MATERIALS/METHODS Patients with previously untreated DLBCL or other aggressive B-cell lymphoma were 60 to 80 years old, had CR or PR after six or eight cycles of R-CHOP, and were randomly assigned to lenalidomide maintenance 25 mg/d or placebo for 21 days of every 28-day cycle for 24 months. The primary end point was progression-free survival (PFS).
RESULTS A total of 650 patients were randomly assigned. At the time of the primary analysis (December 2015), with a median follow-up of 39 months from random assignment, median PFS was not reached for lenalidomide maintenance versus 58.9 months for placebo (hazard ratio, 0.708; 95% CI, 0.537 to 0.933; P = .01). The result was consistent among analyzed subgroups (eg, male v female, age-adjusted International Prognostic Index 0 or 1 v 2 or 3, age younger than 70 v ≥ 70 years), response (PR v CR) after R-CHOP, and positron emission tomography status at assignment (negative v positive). With longer median follow-up of 52 months (Octo ber 2016), overall survival was similar between arms (hazard ratio, 1.218; 95% CI, 0.861 to 1.721; P = .26). Most common grade 3 or 4 adverse events associated with lenalidomide versus placebo maintenance were neutropenia (56% v 22%) and cutaneous reactions (5% v 1%), respectively.
MATERIALS/METHODS All Belgian MCL patients, t(11;14) and/or cyclin D1 positive, seen in hematology departments over a one-year period (April 2013-March 2014) were included. Data about patient characteristics, histology, treatment lines, and response were compiled and retrospectively analyzed.
COMMENTS Four hundred and four patients were included with a median age at diagnosis of 64 years (range 23-96 years) and a male predominance (72%). For 2013, we calculated a prevalence of at least 36.2 per million and an incidence of at least 7.0 per million in the Belgian population. C haracteristics at diagnosis involved lymphadenopathy (82%), sple nomegaly (44%), B-symptoms (39%), and hepatomegaly (10%). Bone marrow invasion was present at diagnosis in 77%. Stage at diagnosis was advanced in the majority of cases. The median number of treatment lines was 1. Type of first line treatment included a combination of anthracyclin and cytarabine-based regimen (34%), anthracyclin (39%), and other. Rituximab was used in 88% of first line treatments. In 44% first line treatment was followed by autologous stem cell transplantation.
CONCLUSION The analysis of this Belgian MCL registry provides insight in the epidemiology, demographics, and current treatment of our Belgian MCL population;
CONCLUSION Lenalidomide maintenance for 24 months after obtaining a CR or PR to R-CHOP significantly prolonged PFS in elderly patients with DLBCL.
ABSTRACT 6 Results from the Belgian mantle cell lymphoma registry. Vergote V, Janssens A, André M, Bonnet C, Van Hende V, Van Den Neste E, Van Eygen K, et al. Acta Clinica Belgica, 2017,72(3),172-178
54
ABSTRACTBOEK | 2017
ABSTRACT 7 The use of uHear™ to screen for hearing loss in older patients with cancer as part of a comprehensive geriatric assessment. Lycke M, Debruyne PR, Lefebvre T, Martens E, Ketelaars L, et al. Acta Clinica Belgica, 73(2) ,132-138
OBJECTIVE We previously validated uHear™ to screen for hearing loss in older patients with cancer without a known hearing loss,
as part of a comprehensive geriatric assessment (CGA). In view of low specificity, we tested a new modified uHear™ scoring system as described by Handzel.
MATERIALS/METHODS Patients, aged ≥70 years, were evaluated by uHear™ and conventional audiometry, which is considered the gold standard, as part of a CGA. The pass or fail screening cut-off for uHear™ was defined as having ≥2 consecutive hearing grades starting from the moderate-severe threshold zone ranging from 0.5 to 2.0 kHz (modified Handzel-uHear™ scoring system). To accept the modified Handzel-uHear™ as screening tool, it was predefined that the combined sen sitivity (S) and specificity (Sp) of the test (S + Sp/2) was at least 80% and that an actual combined (S + Sp)/2 of 90% would be found.
RESULTS Ninety ears (45 subjects) were tested. Of those ears, 24.4% were identified as impaired by conventional audiometry. Modified Handzel-uHear™ identified 26.7% of tested ears as impaired. The combined (S + Sp)/2 of the modified Handzel-uHear™ was calculated as 77.5%, while in previ ous cohort, this was retrospectively calculated as 94.6%. A new uHear™ scoring system was proposed and tested in current and previous cohort. A (S + Sp)/2 of 80.2 and 78.8%, respectively, were obtained.
CONCLUSION uHear™ is a feasible tool for use within the CGA and shows promising results. However, further research is warranted to optimize the cut-off method before it could be routinely implemented within geriatric oncology.
ONCOLOGIE
55
CENTRUM
ORTHOPEDIE / HANDGROEP ARTIKELS ABSTRACT 1 External rotation of the femoral component increases asymmetry of the posterior condyles. Bonnin MP, Saffarini M, van der Maas J, Hannink G, Victor J, et al. The Bone & Joint Journal, 2017, 99-B(7),894-903
OBJECTIVE The morphometry of the distal femur was largely studied to improve bone-implant fit in total knee arthroplasty (TKA), but little is known about the asymmetry of the posterior condyles. This study aimed to investigate the dimensions of the posterior condyles and the influence of externally rotating the femoral component on potential prosthetic overhang or under-coverage.
MATERIALS/METHODS We analysed the shape of 110 arthritic knees at the time of primary TKA using pre-operative CT scans. The height and width of each condyle were measured at the posterior femoral cut in neutral position, and in 3º and 5º of external rotation, using both central and medial referencing systems. We compared the morphological characteristics with those of 14 TKA models.
RESULTS In the neutral position, the dimensions of the condyles were nearly equal. Externally rotating the femoral cut by 3º and 5º with 'central referencing' induced width asymmetry > 3 mm in 23 (21%) and 33 (30%) knees respectively, while with 'medial referencing' it induced width asymmetry > 3 mm in 43 (39%) and 75 (68%) knees respectively. The asymmetries induced by rotations were not associated with gender, aetiology or varus-valgus alignment.
CONCLUSION External rotation may amplify the asymmetry between the medial and lateral condyles, and exacerbate prosthetic overhang, particularly in the superolateral zone. 'Central referencing' guides result in less potential prosthetic over hang than 'medial referencing’ guides.
56
ABSTRACTBOEK | 2017
CENTRUM
PSYCHIATRIE ARTIKELS ABSTRACT 1 Acute ingrijpmedicatie bij de geagiteerde patiënt met intoxicatie met psychostimulantia
en het psychiatrische toestandsbeeld van een 31-jarige patiënt met pws, die op 14-jarige leeftijd een eerste psy chotische episode doormaakte, gevolgd door een sterk wisselend beloop van herstel en terugval.
Geerts P, Titeca K, Lemmens MD G, De Fruyt J. Tijdschrift voor Psychiatrie, 2017, 59(6)360-365
INTRODUCTION/BACKGROUND Intoxicatie met psychostimulantia gaat vaak gepaard met agressie of agitatie. Aangezien een intoxicatie ernstige gezondheidsrisico’s inhoudt, zijn een adequate observatie en behandeling met acute ingrijpmedicatie vaak nood zakelijk.
OBJECTIVE Is er wetenschappelijke evidentie omtrent veilige en doel treffende acute ingrijpmedicatie specifiek voor patiënten met intoxicatie met psychostimulantia?
MATERIALS/METHODS Systematisch literatuuronderzoek.
RESULTS In één studie bleek intraveneuze toediening van droperidol sneller en effectiever in het induceren van sedatie dan intra veneuze toediening van lorazepam. In andere studies was het aantal patiënten met intoxicatie met psychostimulantia te klein of te weinig omschreven om eenduidige conclusies te trekken.
CONCLUSION Er is te weinig onderzoek voorhanden om clinici te a dviseren welke acute ingrijpmedicatie men dient te gebruiken bij patiënten met acute intoxicatie met psychostimulantia.
ABSTRACT 2 Psychose bij een patient met het syndroom van Prader-Willi Merckx W, Lecot W, Titeca K. Tijdschrift voor Psychiatrie, 2017, 59(12),784-787
INTRODUCTION/BACKGROUND Het syndroom van Prader-Willi (PWS) is een genetische aandoening, gekenmerkt door specifieke lichamelijke en gedragsmatige afwijkingen. Recente studies wijzen op een verhoogd voorkomen van psychiatrische stoornissen, waar onder psychose. Wij beschrijven het ontwikkelingsverloop
PSYCHIATRIE
57
CENTRUM
RADIOTHERAPIE ARTIKELS ABSTRACT 1 Predictors of baseline cancer-related cognitive impairment in cancer patients scheduled for a curative treatment Lycke M, Pottel L, Pottel H, Ketelaars L, Stellamans K, Van Eygen K, Vergauwe P, Werbrouck P, et al. Psychooncology, 2017,26(5),632-639 De tekst van het abstract is terug te vinden op pagina 52.
and 11.59, respectively). A bounce developed in 70 patients (36%). Younger patients and those treated with a lower activity per volume had a higher chance of developing a bounce in the Cox model (HR 0.99 and 0.04, respectively).
CONCLUSION For younger men, LDR BT is a valid primary curative treat ment option in low-risk and is to consider in intermediaterisk localized prostate cancer.
ABSTRACT 3 Radiotherapy access in Belgium: How far are we from evidence-based utilisation?
ABSTRACT 2 125I brachytherapy in younger prostate cancer patients : Outcomes in low- and intermediate-risk disease. Kindts I, Stellamans K, Billiet I, Pottel H, Lambrecht A. Strahlentherapie und Onkologie, 2017, 193(9), 707-713
INTRODUCTION To evaluate local recurrence in younger men treated with low-dose-rate (LDR) 125I brachytherapy (BT) for localized prostate cancer.
MATERIALS AND METHODS A total of 192 patients (≤65-years-old) were treated with LDR 125I-BT ± hormone therapy. Local failure was defined as any prostate-specific antigen (PSA) rise leading to salvage treatment or biochemical failure according to the Phoenix definition. A bounce was defined as a rise in the nadir of ≥0.2 ng/mL followed by spontaneous return. Proportions were compared using Fisher's exact tests; continuous variables using the unpaired t-test or its non-parametric equivalent. Cox proportional hazards models were applied for multivariable survival analysis.
RESULTS Median follow-up was 66 months. The 5‑year local recurrence-free survival was 96.1%. Biopsy-proven local re currence developed in 13 patients, 4 had a Phoenix-defined recurrence at the last follow-up. Androgen deprivation the rapy was started in 1 patient without proven recurrence. Univariable risk factors for local recurrence were: at least 50% positive biopsies, intermediate risk, treatment with neoadjuvant hormone therapy, low preimplantation volume receiving 100% of the prescribed dose, and no bounce de velopment. Hormone-naïve patients not attaining a PSA value <0.5 ng/mL during follow-up also had a higher risk of local recurrences. Cox regression demonstrated that the variables "at least 50% positive biopsies" and "bounce" significantly impacted local failure (hazard ratio, HR 1.02 58
ABSTRACTBOEK | 2017
Lievens Y, De Schutter H, Stellamans K, Rosskamp M, Van Eycken L. European Journal of Cancer, 2017, 84,102-113
INTRODUCTION Underutilisation of radiotherapy has been observed world wide. To evaluate the current situation in Belgium, optimal utilisation proportions (OUPs) adopted from the Europe an SocieTy for Radiotherapy and Oncology - Health Eco nomics in Radiation Oncology (ESTRO-HERO) project were compared to actual utilisation proportions (AUPs) and with radiotherapy advised during the multidisciplinary cancer team (MDT) meetings. In addition, the impact of independent variables was analysed.
MATERIALS AND METHODS AUPs and advised radiotherapy were calculated overall and by cancer type for 110,810 unique cancer diagnoses in 2009-2010. Radiotherapy utilisation was derived from reimbursement data and distinguished between palliative and curative intent external beam radiotherapy (EBRT) and/ or brachytherapy (BT). Sensitivity analyses regarding the influence of the follow-up period, the survival length and patient's age were performed. Advised radiotherapy was calculated based on broad treatment categories as reported at MDT meetings.
RESULTS The overall AUP of 37% (39% including BT) was lower than the OUP of 53%, but in line with advised radiotherapy (35%). Large variations by tumour type were observed: in some tumours (e.g. lung and prostate cancer) AUP was considera bly lower than OUP, whereas in others there was reasonable concordance (e.g. breast and rectal cancer). Overall, 84% of treatments started within 9 months following diagnosis. Survival time influenced AUP in a cancer type-dependent way. Elderly patients received less radiotherapy.
CONCLUSION Although the actually delivered radiotherapy in Belgium aligns well to MDT advices, it is lower than the evi dence-based optimum. Further analysis of potential barriers is needed for radiotherapy forecasting and planning, and in order to promote adequate access to radiotherapy.
ABSTRACT 4 The use of uHear™ to screen for hearing loss in older patients with cancer as part of a comprehensive geriatric assessment Lycke M, Debruyne PR, Lefebvre T, Martens E, Ketelaars L, Pottel H, Van Eygen K, Derijcke S, Werbrouck P, Vergauwe P, Stellamans K, Clarysse P, Dhooge I, Schofield P, Boterberg T. Acta Clinica Belgica, 2017, 24,1-7 De tekst van het abstract is terug te vinden op pagina 59.
ABSTRACT 5 The distress thermometer predicts subjective, but not objective, cognitive complaints six months after treatment initiation in cancer patients. Lycke M, Lefebvre T, Pottel L, Pottel H, Ketelaars L, et al. Journal of Psychosocial Oncology, 35(6),741-757 De tekst van het abstract is te vinden op pagina 54.
RADIOTHERAPIE
59
CENTRUM
UROLOGIE ARTIKELS ABSTRACT 1 Efficacy and safety of enzalutamide (ENZA) in patients with metastatic castration-resistant prostate cancer (mCRPC) previously treated with abiraterone acetate (Abi): A multicenter, single-arm, open-label study De Bono JS, Chowdhury S, Feyerabend S, Elliot T, Werbrouck P, et al. Journal of Clinical Oncology, 2017, 35(6)165-165
INTRODUCTION/BACKGROUND This phase 4, multicenter, single-arm, open-label study evaluated the efficacy and safety of ENZA in patients (pts) with progressing mCRPC previously treated with Abi.
CONCLUSION In this study, ENZA remained active in pts with mCRPC previously treated with Abi. Median rPFS in pts with prior chemotherapy was consistent with previously reported data of ENZA in pts with mCRPC and prior chemotherapy/Abi therapy.Reported TEAEs were consistent with the known safety profile of ENZA.
ABSTRACT 2 Long-term efficacy and safety of enzalutamide (ENZ) monotherapy in hormone-naïve prostate cancer (HNPC): 3-year, open-label, follow-up results. Tombal BF, Borre M, Rathenborg P, Werbrouck P, Van Poppel H, et al. Journal of Clinical Oncology, 2017, 35(6),220-220
MATERIALS/METHODS All pts maintained castration therapy with luteinizing hormone-releasing hormone for the duration of the trial or had a bilateral orchiectomy. Pts were required to have progressive disease at study entry and ≥ 24 weeks of Abi treatment prior to receiving 160 mg/day ENZA. Prior chemotherapy was allowed. The primary end point was radiographic progression-free survival (rPFS). The secon dary end points were overall survival (OS), prostate-specific antigen (PSA) response, and time to PSA progression. Safety was also assessed.
INTRODUCTION/BACKGROUND A phase 2 study of the androgen receptor inhibitor ENZ as monotherapy in patients with HNPC [NCT01302041] showed a high prostate-specific antigen (PSA) response rate, regardless of baseline metastases, and favorable tolerability. In a 1- and 2-year follow-up, ENZ maintained long-term reductions from baseline in PSA, with minimal impact on total-body bone mineral density (BMD). Herein, results from a pre-specified 3-year follow-up are reported.
MATERIALS/METHODS RESULTS A total of 215 pts were enrolled; 214 were treated with ENZA (median age, 73 years). The analysis was performed on data up to 48 weeks after the last pt started ENZA treatment. Median duration of prior Abi therapy was 54 weeks. The median duration of ENZA treatment was 5.7 months: 12 months in PSA responders and 4.6 months in non-PSA responders. 16% of pts received treatment for ≥ 1 year. The most common reason for treatment discontinuation was disease progression (65%). Median rPFS was 8.1 months (95% CI 6.1, 8.3). Median OS was not reached in the overall population and 75% of pts were alive 1 year after treatment initiation. PSA response (confirmed or unconfirmed) rate was 26.5% (48/181). The median time to PSA progression was 5.7 months (95% CI 5.6, 5.8). The overall objective response rate in pts with measurable di sease at study entry was 12%. The most common treatment emergent adverse events (TEAEs) were fatigue (32%), de creased appetite (25%), asthenia (18%), back pain (17%), and arthralgia (16%). ENZA was primarily discontinued due to TEAEs in 8% of pts. No seizures were reported.
60
ABSTRACTBOEK | 2017
A total of67 patients with HNPC and non-castrate testoste rone ( ≥ 230 ng/dL) received ENZ 160 mg/day until d isease progression or unacceptable toxicity. The primary end point of PSA response ( ≥ 80% decline from baseline) was ana lyzed at week 25 and 1, 2, and 3 years. Other end points were best overall tumor response, BMD, body composition, quality of life, and safety.
RESULTS At the 3-year visit, 42 (62.7%) patients remained on the study medication. Of those, 38 (90.5%; 95% confidence interval 77.4%, 97.3%) maintained a PSA response. Of the 26 patients with metastases at baseline, 17 (65.4%) had a complete or partial response as best overall response at 3 years. In patients who completed the 3-year v isit, minimal changes from baseline were observed in total-body BMD or in BMD of the femoral neck, t rochanter, spine L1–L4, or forearm (median and mean changes ranged from –3.6% to 1.3% and –2.7% to –0.1%, respectively). The EORTC QLQ-C30 global health status results showed a small decrease at 3 years versus baseline (–3.96 points), consistent with the 2-year results. At 3 years, measurements for total body fat increased (median, 14.7%;
mean, 16.5%) and total body lean decreased (median, –6.3%; mean, –6.5%) from baseline. Physical functioning, fatigue, and dyspnea worsened ( > 10 points) at 3 years, similar to results at 2 years. The most frequently reported adverse events ( > 10%) were gynecomastia, fatigue, hot flush, nipple pain, hypertension, diarrhea, nausea, pain in extremity, back pain, and constipation.
CONCLUSION In patients with HNPC treated with ENZ for 3 years, the efficacy of ENZ as monotherapy was maintained. Overall, BMD, global health status, and safety results were similar to those at 2 years.
health status minimally decreased from baseline. Common adverse events were gynecomastia, fatigue, hot flush and nipple pain.
CONCLUSION Enzalutamide anti-tumor activity was maintained in pa tients with hormone-naïve prostate cancer at 3 years. Over all, bone mineral density, global health status and safety results were similar to those at 2 years.
ABSTRACT 4 Which factors predict overall survival in patients with metastatic castration-resistant prostate cancer treated with abiraterone acetate post-docetaxel?
ABSTRACT 3 Long-term anti-tumor activity and safety of enzalutamide monotherapy in hormone-naïve prostate cancer: 3-year, open-label, follow-up results Tombal B, Borre M, Rathenborg P, Werbrouck P, et al. The Journal of Urology 199(2), 2018,199(2),459-464
INTRODUCTION/BACKGROUND A phase 2 study of enzalutamide monotherapy in patients with hormone-naïve prostate cancer demonstrated high prostate-specific antigen response rates at 25 weeks, 1 year and 2 years, with minimal effects on total body bone mineral density and favorable safety. This follow-up analysis evaluated enzalutamide's anti-tumor activity and safety at 3 years.
MATERIALS/METHODS Sixty-seven patients with hormone-naïve prostate cancer and non-castrate testosterone (≥230 ng/dL) received en zalutamide 160 mg/day orally until disease progression or unacceptable toxicity in a single-arm analysis. The primary end point was prostate-specific antigen response (≥80% decline from baseline).
RESULTS No patients discontinued treatment during year 3. Of 42 patients with prostate-specific antigen assessments at 3 years, 38 (90.5%; 95% confidence interval 77.4, 97.3) main tained a prostate-specific antigen response. Of 26 patients with metastases at baseline, 17 (65.4%) had complete or partial response as the best overall response over 3 years. In patients who completed the 3-year visit, minimal mean changes from baseline were observed in total body bone mineral density or bone mineral density of the femoral neck, trochanter, spine L1-L4 or forearm (range, -2.7% to -0.1%). At 3 years, total body fat increased (mean, 16.5%), total lean body mass decreased (mean, -6.5%) and global
Van Praet C, Rottey S, Van Hende F, Pelgrims G, Werbrouck P, et al. Clinical Genitourinary Cancer, 2017, 15(4),502-508
INTRODUCTION/BACKGROUND Abiraterone acetate (AA) increases overall survival (OS) in patients with metastatic castration-resistant prostate cancer (mCRPC) previously treated with docetaxel. However, sur vival time varies substantially between individuals. Our goal was to identify prognostic factors that better estimate OS.
MATERIALS/METHODS This is a retrospective multicentric analysis of 368 patients with mCRPC starting AA with prednisone after docetaxel. Cox proportional hazards statistics were applied. A multi variate model was constructed based on significant uni variate predictors by using a manual stepwise forward and backward selection strategy. Model performance was determined by using receiver operating characteristic (ROC) curves.
RESULTS Univariate analysis identified 20 significant OS predictors. A multivariate model was constructed, based on 220 patients, incorporating 5 independent risk factors for decreased OS at the time of AA initiation: hemoglobin < 12 g/dL (hazard ratio [HR] 2.02), > 10 metastases (HR 1.80), ECOG perfor mance status ≥ 2 (HR 1.88), radiographic progression (HR 1.50), and time since diagnosis < 90 months (HR 1.66, all P < .05). Patients were stratified into 3 groups: good (0-2 risk factors, median OS 22.6 months), intermediate (3 risk fac tors, median OS 13.9 months), and poor prognosis (4-5 risk factors, median OS 6.2 months). The area under the ROC curve based on the event "death by the time of median OS (13.3 months)" was 0.736 (95% confidence interval 0.6700.803).
UROLOGIE
61
CONCLUSION We identified 5 readily available risk factors independently associated with decreased OS. The resulting model may be used for patient counseling in daily clinical practice, as well as patient stratification in clinical trials.
PRESENTATIES/ CONGRESSEN ABSTRACT 1 The use of MRI after the PROMIS trial. De Prycker S, Veys R, Seynaeve P, Werbrouck P, Billiet I, Lesage K, Vanneste A, Van Bruwaene S October 2017, Annual Congress of the Société Internationale d'Urologie, Lisbon, Portugal
INTRODUCTION/BACKGROUND PROMIS suggested avoiding prostate biopsies (PB) in the 27% of patients presenting with PIRADS score 1-2 irrespective of clinical findings.
OBJECTIVE We investigated the use of MRI versus clinical parameters as triage tests for performing biopsies at our center.
MATERIALS/METHODS Between 03-2015 and 09-2016, a total of 358 patients underwent prostate MRI for clinical suspicion of prostate cancer (PCa). PSA density (PSAd), digital rectal examina tion (DRE), MRI and pathology results were retrospectively collected.
RESULTS PIRADS 1-2, 3, 4-5 was found in 10%, 16% and 74% of the population respectively with 44%, 76% and 94% of these patients underoing prostate biopsies (p < 0.001). In 25%, 9% and 66% there was significant cancer (p < 0.001)while in 31%, 22% and 15% insignificant.
CONCLUSION At our center the results of MRI are used in conjunction with clinical parameters to make the decision about performing prostate biopsies. The clinical implication of a PIRADS 3 lae sion most likely differs per center/radiologist.
62
ABSTRACTBOEK | 2017
CENTRUM
VASCULAIRE EN THORACALE CHIRURGIE ARTIKELS
cardiovascular outcomes than aspirin alone and resulted in more major bleeding events.
ABSTRACT 1 Rivaroxaban with or without aspirin in stable cardio vascular disease. including Elegeert I and Lerut P Eikelboom J, Connolly S, Bosch J, Dagenais G, COMPASS Investigators et al.* The New England Journal of Medicine, 2017, 377,1319-1330
INTRODUCTION/BACKGROUND We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention.
MATERIALS/METHODS In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months.
ABSTRACT 2 Choices of stent and cerebral protection in the ongoing ACST-2 trial: A descriptive study including Dormal P, Lerut P de Waard D, Halliday A, de Borst G, Bulbulia R. ACST-2 Collaborative Group* et al European Journal of Endovascular Surgery, 53(5),617-625
INTRODUCTION/BACKGROUND Several plaque and lesion characteristics have been associated with an increased risk for procedural stroke during or shortly after carotid artery stenting (CAS). While technical advancements in stent design and cerebral protection devices (CPD) may help reduce the procedural stroke risk, and anatomy remains important, tailoring stenting procedures according to plaque and lesion characteristics might be a useful strategy in reducing stroke associated with CAS. In this descriptive report of the on going Asymptomatic Carotid Surgery Trial-2 (ACST-2), it was assessed whether choice for stent and use or type of CPD was influenced by plaque and lesion characteristics.
RESULTS
MATERIALS/METHODS
The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=-4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no signi ficant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group.
Trial patients who underwent CAS between 2008 and 2015 were included in this study. Chi-square statistics were used to study the effects of plaque echolucency, ipsilateral pre occlusive disease (90-99%), and contralateral high-grade stenosis (>50%) or occlusion of the carotid artery on inter ventionalists' choice for stent and CPD. Differences in treat ment preference between specialties were also analysed.
CONCLUSION Among patients with stable atherosclerotic vascular di sease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better
RESULTS In this study, 831 patients from 88 ACST-2 centres were included. Almost all procedures were performed by either interventional radiologists (50%) or vascular surgeons (45%). Plaque echolucency, ipsilateral preocclusive disease (90-99%), and significant contralateral stenosis (>50%) or occlusion did not affect the choice of stent or either the use of cerebral protection and type of CPD employed (i.e., filter/flow reversal). Vascular surgeons used a CPD signifi cantly more often than interventional radiologists (98.6% vs. 76.3%; p < .001), but this choice did not appear to be dependent on patient characteristics.
CONCLUSION In ACST-2, plaque characteristics and severity of steno sis did not primarily determine interventionalists' choice
VASCULAIRE EN THORACALE CHIRURGIE
63
of stent or use or type of CPD, suggesting that other fac足 tors, such as vascular anatomy or personal and centre prefe足rence, may be more important. Stent and CPD use was h 足 ighly heterogeneous among participating European 足centres.
64
ABSTRACTBOEK | 2017
az groeninge is internationaal erkend door jci voor veilige zorg en kwaliteit. www.azgroeninge.be/kwaliteit
65
NOTITIES
66
ABSTRACTBOEK | 2017
67
68
ABSTRACTBOEK | 2017