Guy Hubens - Academia.edu (original) (raw)

Papers by Guy Hubens

European Surgical Research, 1992

ABSTRACT The effect of non-absorbable and rapidly absorbable suture material on the cytokinetics ... more ABSTRACT The effect of non-absorbable and rapidly absorbable suture material on the cytokinetics of crypt cells was studied in right and left colonic anastomoses in the rat by using stathmokinetic methods. Forty-five male Sprague-Dawley rats were allocated to three groups. In group A (n = 15), colonic anastomoses were performed in the right and left colon using nonabsorbable, stainless steel sutures. Groups B (n = 15) animals had identically located anastomoses but a rapidly absorbable suture material (Vicryl Rapide) was used. Animals of group C (n = 15) acted as controls. Eight weeks postoperatively, the crypt cell production rate (CCPR) was determined after measuring the slope of the metaphase accumulation line. At this time, no suture material was detected in any of group B (Vicryl Rapide) animals, while in group A rats (stainless steel), 79% of the animals had suture material in place. A steel-sutured anastomosis significantly increased the CCPR in the right colon from 6.2 to 10.6 cells/crypt/h and in the left colon from 5.6 to 9.8 cells/crypt/h compared with controls (p less than 0.05). An anastomosis performed with Vicryl Rapide, whether in the proximal or descending colon, did not influence the CCPR when compared with the control group (right 6.4 vs. 6.2 cells/crypt/h; left 4.2 vs. 5.6 cells/crypt/h). The CCPR at steel-sutured anastomoses was significantly higher than the CCPR at the Vicryl Rapide anastomotic site both in the right (10.6 vs. 6.4 cells/crypt/h) as well as in the left colonic sites (9.8 vs. 4.2 cells/crypt/h) (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical Endoscopy, 1997

Adrenalectomy is not a frequent operation. Therefore the newly developed laparoscopic approach is... more Adrenalectomy is not a frequent operation. Therefore the newly developed laparoscopic approach is sporadically performed by surgeons dealing with endocrine disorders. Some 54 videoendoscopic adrenalectomies performed on 52 patients by five surgical teams between October 1993 and December 1996 were prospectively evaluated. Indications for endoscopic adrenalectomy were pheochromocytoma (n = 17), primary hyperaldosteronism (n = 15), Cushing's adenoma or disease (n = 7), nonsecreting adenoma (n = 7), single metastasis from adenocarcinoma (n = 2), adenoma with dehydroepiandrostenedione (DHEAS) hypersecretion (n = 3), and ACTH-secreting metastases from a thymoma (n = 1). Of the 54 adrenalectomies performed, 31 were of the left gland, 19 of the right and two bilateral. Laparoscopic adrenalectomy was successful in 50 patients (96%). Median tumor size was 4 cm (range 1.5-12), median operation duration was 80 min (range 59-360), and median postoperative stay was 4 days (range 2-13). One patient required blood transfusion. Endoscopic adrenalectomy can safely be performed-even sporadically-by surgeons well versed in adrenalectomy techniques for endocrine disorders and trained in endoscopic surgery.

Surgical …, 1999

Background: In order to investigate the effect of carbon dioxide (CO 2) pneumoperitoneum on solid... more Background: In order to investigate the effect of carbon dioxide (CO 2) pneumoperitoneum on solid colon carcinomas, we used a colon anastomosis tumor model in 30 male syngeneic WAG rats, which were divided, at random into three groups. ...

Background: Vacuum massage is a non-invasive mechanical massage technique invented to treat burns... more Background: Vacuum massage is a non-invasive mechanical massage technique invented to treat burns and scars. To date, no effects of vacuum massage on thickness and density of human scar tissue have been reported. The process in which external stimuli are converted into biochemical responses in the cell is known as mechanotransduction. In the skin endothelial cells, fibroblasts and myofibroblasts embedded in the extracellular matrix (ECM) sense mechanical stimuli (created by vacuum massage) and may promote intracellular processes leading to matrix remodelling. Since mechanotransduction could be a plausible working mechanism for vacuum massage as an anti-scarring therapy, this study aims to investigate the short-term effects of vacuum massage on thickness and density of epidermis and dermis in burn scars in order to find proof of ECM remodelling.

Burns, 2015

Touch pressure threshold Burn Objective measurement Tactile sensation a b s t r a c t Burn scars ... more Touch pressure threshold Burn Objective measurement Tactile sensation a b s t r a c t Burn scars are frequently accompanied with sensory deficits often remaining present months or even years after injury. Clinimetric properties of assessment tools remain understudied within burn literature. Tactile sense of touch can be examined with the touch pressure threshold (TPT) method using the Semmes Weinstein monofilament test (SWMT).

Clinics and research in hepatology and gastroenterology, Jan 20, 2015

The prevalence of non-alcoholic fatty liver disease (NAFLD) and the closely associated metabolic ... more The prevalence of non-alcoholic fatty liver disease (NAFLD) and the closely associated metabolic syndrome is high and is related to risk factors such as obesity and type 2 diabetes. A genetic basis for NAFLD has been suggested, but only few causal genes have been identified. The most significant association reported to date is the robust association of the PNPLA3 I148M variant with susceptibility to NAFLD. We therefore hypothesized that the PNPLA2 gene might also be involved in NAFLD pathogenesis, because of its close sequence similarity with PNPLA3 and its possible involvement in ectopic fat accumulation. In this study, we investigated the association of PNPLA2 polymorphisms with the development of non-alcoholic fatty liver disease in a prospectively recruited Belgian obese population comprising 633 individuals with varying degrees of fatty liver disease. We selected 3 PNPLA2 SNPs for genotyping, including 2 tagSNPs that cover most information on common genetic variation in the sel...

The Faseb Journal, Apr 1, 2010

Acta chirurgica Belgica

In the treatment of diffuse peritonitis, planned relaparotomies with peritoneal lavages using a z... more In the treatment of diffuse peritonitis, planned relaparotomies with peritoneal lavages using a zipper system (EthiZip Ethicon) are sometimes necessary to obtain a complete eradication of the infectious focus. While most reported series are dealing with an adult population, this review focuses on the treatment of peritonitis using a zipper system in a paediatric age group. In a period of 3 years, insertion of a zipper device and peritoneal lavages were considered necessary to control intraabdominal sepsis in 7 children (age varying from 5 days to 13 years). They consequently underwent planned relaparotomies with peritoneal lavages every 24 to 48 hours. The peritonitis was caused by necrotizing enterocolitis (3 patients), postoperative complications (3 patients) and long existing perforated appendicitis (1 patient). Physical status, assessed by the Acute Physiologic Score (A.P.S.), varied from 12 to 22 (mean 17.7). Usually more than one lavage was necessary (1 to 3, mean 1.9) before the abdomen was considered clean and the zipper could be removed. Closure of the abdominal cavity could be achieved primarily in all cases. All patients survived. Although no statistically significant conclusions can be drawn from this small series and although it is unclear whether these children would not have survived without the zipper, this review shows that planned relaparotomies with peritoneal lavages using a zipper system can be performed safely even in very small children.

Acta chirurgica Belgica

A case of a liposarcoma of the stomach in a 27-year old woman is described. Initially the patient... more A case of a liposarcoma of the stomach in a 27-year old woman is described. Initially the patient consulted with epigastric pain. MRI showed a giant tumour of the stomach wall, invading the surrounding organs, as well as the mediastinal region. After surgical 'en-bloc' resection of the tumour, histopathologic examination yielded a diagnosis of pleiomorphic liposarcoma. Because of the bad prognosis of this histologic type, the patient received adjuvant chemotherapy : a combination of doxorubicin and ifosfamide (MAI). Nine months after surgery, she represented with a relapse of the tumour that had become inoperable. Palliative chemotherapy was started with the intent to prolong the young patient's life. However 6 months later, the patient died of the recurrent disease. Although liposarcoma is a very common soft tissue sarcoma, it is rarely seen in the stomach. The standard therapy is surgical excision. Over the last years, adjuvant therapy became more accepted. Drugs of choice are doxorubicin and ifosfamide, although the benefits of this therapy are still largely unknown and doubtful.

Acta chirurgica Belgica

A case is presented of a 72-year old male patient presenting with a massive intestinal blood loss... more A case is presented of a 72-year old male patient presenting with a massive intestinal blood loss due to a solitary jejunal metastasis of a poorly differentiated adenocarcinoma of the right lung resected two years earlier. After diagnostic workup and stabilization a small bowel resection with end to end anastomosis was performed. Patient is alive and well 5 months after operation. Solitary bleeding intestinal metastasis of a primary bronchogenic tumour are extremely rare but should be included in the differential diagnosis of gastrointestinal blood loss in a patient with a known bronchogenic tumour. Resection with end to end anastomosis is the treatment of choice.

Acta chirurgica Belgica

A major problem in the surgical treatment of diffuse peritonitis is to obtain a complete clearanc... more A major problem in the surgical treatment of diffuse peritonitis is to obtain a complete clearance of septic foci in the peritoneal cavity which may lead to persistence of sepsis and multiple organ failure. We describe our experience with staged abdominal re-explorations using a Zipper system in 23 patients with a mean APACHE II score of 20.3 (s.e.m: 1.5). A total of 91 lavages were done in these patients. Overall mortality was 39%. None of the patients having an APACHE II score between 10 and 20 died whereas the predicted mortality was 15%-45%. After successful treatment, primary closure was possible in 8 of the 14 surviving patients. Large incisional hernias developed in 6 patients. One patient eviscerated two years after complete granulation of his laparostoma. Staged abdominal re-explorations using a Zipper system is an useful tool in the treatment of diffuse peritonitis.

Acta chirurgica Belgica

An observation on Pneumatosis Cystoides Intestinalis (PCI) in a 66-year-old man is reported. His ... more An observation on Pneumatosis Cystoides Intestinalis (PCI) in a 66-year-old man is reported. His general condition allowed a thorough clinical and laboratory investigation which resulted in the diagnosis of the disease and the avoidance of an unnecessary laparotomy. PCI is a relatively rare condition characterized by multiple intramural pockets of gas involving any portion of the gastro intestinal tract. Various theories reflect either a mechanical or a bacterial etiology. Most of the patients are asymptomatic although some experience gastrointestinal complaints. The majority of patients require no treatment.

Acta chirurgica Belgica

Although vertical banded gastroplasty is considered as a safe and efficient bariatric procedure, ... more Although vertical banded gastroplasty is considered as a safe and efficient bariatric procedure, reoperation rates either because of failure, or the induction of unacceptable side effects are important. In this study we evaluated 54 obese subjects with a history of vertical banded gastroplasty. One patient (2%) died postoperatively due to pulmonary embolism. Seven patients (13%) underwent a reoperation. A new vertical banded gastroplasty because of dilatation of the pouch with weight regain resulted in a loss of 26% of the initial weight after 3 years (1 patient). The vertical staple line disrupted in 4 patients: restapling failed after 1.5 year (1 patient), conversion into a gastric bypass resulted in a loss of only 12% of the initial weight after 3 years (1 patient), conversion into a biliopancreatic diversion resulted in a loss of 43 and 32% of body weight after 18 and 6 months, respectively (2 patients). In 2 cases a Nissen fundoplication was performed with good result for reflux oesophagitis. Since regastroplasty was not entirely successful in our hands, we consider biliopancreatic diversion as the method of choice for failed vertical banded gastroplasty.

Journal belge de radiologie

Wide-spread abnormalities of the small bowel on CT scan after massive pulmonary embolism and acut... more Wide-spread abnormalities of the small bowel on CT scan after massive pulmonary embolism and acute hemodynamic collapse are described. These small bowel abnormalities are secondary to hypotension with prolonged hypoperfusion. They consist of diffuse thickening of the small-bowel wall, fluid-filled, dilated loops and increased contrast enhancement of the small-bowel wall (shock bowel). These abnormalities are reversible and should be distinguished from acute vascular occlusion.

European Journal of Emergency Medicine

Intussusception is an important cause of intestinal obstruction and bowel necrosis in infants und... more Intussusception is an important cause of intestinal obstruction and bowel necrosis in infants under 2 years. Most frequently the ileocaecal junction is involved. Various aetiologic factors, such as Meckel's diverticulum and lymphoid hyperplasia have been identified. Hydrostatic reduction of the intussusception should be attempted, but delay in diagnosis frequently leads to surgical intervention, because of failing reduction. We report a case of a 4-month-old boy whose ileocaecal junction was intussuscepted into the rectum, and therefore could be palpated by rectal examination. Unsuccessful hydrostatic reduction and bowel necrosis because of delay in diagnosis, made surgical intervention necessary. A terminal ileostomy was performed. A second case report considers a 10-month-old boy whose ileocaecal junction was intussuscepted into the colon sigmoideum. Because there was no delay in diagnosis, this intussusception could be reduced hydrostatically. The procedure however was difficult because of a dolichosigmoideum. Recent literature is also reviewed.

Journal of neonatal surgery

: Impression of the umbilical cord herniation.

Gastroenterology, 2012

Hirschsprung's disease (HD) is a congenital disorder characterized by aganglionosis in the distal... more Hirschsprung's disease (HD) is a congenital disorder characterized by aganglionosis in the distal intestine. The zebrafish mutant, lessen (lsn), has HD phenotypic characteristics. We use the lsn mutant as an experimental model to unravel underlying developmental mechanisms for HD. This study aims to compare the neurochemical content of enteric neurons and gastrointestinal (GI)-motility patterns between wild-type zebrafish and lsn mutants to further validate this mutant as a suitable model for HD research. Immunofluorescence staining was used to detect specific neurochemical markers from 3 to 6 days post-fertilization (dpf) in the proximal (PI), mid (MI) and distal intestine (DI) of both wild-type and mutant embryos. Contractile activity of the GI-tract was filmed and the frequency and direction of contractions in each intestinal region were analyzed. Both mutant and wild-type embryos showed an increase in enteric neuron numbers over time. In mutants, the number of enteric neurons at each embryonic stage was significantly reduced in DI (absent at 3dpf) and MI, but less in PI. The proportion of nitrergic neurons was significantly reduced in all regions at 3dpf, but nearly unaffected in PI and MI at 4 and 5dpf. In mutants, serotonin, calretinin and calbindin showed a delayed expression and a decrease in both number and proportion at all points of time and in each intestinal region. In both mutant and wild-type embryos, galanin, vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating peptide (PACAP) were only detected in nerve fibers. In wild-type, VIP/PACAP-positive and galaninpositive fibers were present at all time points and in each region. Mutants only showed a few immunoreactive fibers at 3dpf in PI, while at 4dpf immunostained fibers appeared in MI and at 5dpf in DI, showing a delayed expression of these neuropeptides. GI-contractility analyses revealed that wild-type animals have defined motility patterns by 4dpf. When comparing motility patterns, the PI showed little change in when comparing wild-type to mutants. In contrast, we observed a decreased contractility in the MI and DI of mutants. The present study reveals abnormalities in the number and proportions of neurons expressing various neurochemical markers in the lsn mutant. These results are similar to previously reported data in the intestine proximal to the aganglionic segment and in the aganglionic segment of the lethal spotted mutant mice, an experimental HD model. Furthermore, in lessen GI-contractility is significantly perturbed in MI and DI. So, this study supports previous studies indicating that the zebrafish mutant lessen is a suitable model for HD research.

Gastroenterology, 2015

The prevalence of non-alcoholic fatty liver disease has increased with the obesity pandemic. We a... more The prevalence of non-alcoholic fatty liver disease has increased with the obesity pandemic. We analyzed the transcriptional profiles of subcutaneous (SAT) and visceral (VAT) adipose tissue, and phenotypes and functional characteristics of adipocyte tissue macrophages (ATM), in obese patients undergoing bariatric surgery. We collected anthropometric data; plasma samples; and SAT, VAT, and liver tissues from 113 obese patients undergoing bariatric surgery at academic hospitals in Europe (Antwerp and Leuven) and South Africa. Based on clinical and histologic features, patients were assigned to the following groups: obese, NAFLD, non-alcoholic steatohepatitis (NASH), or NASH with fibrosis. Microarray analyses were performed to identify genes expressed differentially among groups. We measured levels of cytokines and chemokines in plasma samples and levels of RNAs in adipose tissues by quantitative reverse transcription PCR. ATM were isolated from patients and 13 lean individuals undergoing cholecystectomy (controls), analyzed by flow cytometry, and cultured; immunophenotypes and levels of cytokines and chemokines in supernatants were determined. We observed increased expression of genes that regulate inflammation in adipose tissues from patients with NAFLD and NASH; expression of these genes increased as disease progressed from NAFLD to NASH. We found 111 genes associated with inflammation that were differentially expressed between VAT and SAT. Serum levels of interleukin-8, CCL3, and tumor necrosis factor-αcorrelated with liver inflammation and NAFLD activity score. We developed 2 models that could be used to determine patients' liver histology based on expression of genes in VAT and SAT. Flow cytometry showed increased proportions of CD11c+CD206+ and CCR2+ macrophages in VAT from patients with NASH, and supernatants of cultured macrophages had increased levels of cytokines and chemokines, compared with controls. VAT and SAT from patients with NAFLD and NASH have increased expression of genes that regulate inflammation, and ATM produce increased levels of inflammatory cytokines, compared with adipose tissues from controls. We identified an expression profile of 5 genes in SAT that accurately predict liver histology in these patients.

European Surgical Research, 1992

ABSTRACT The effect of non-absorbable and rapidly absorbable suture material on the cytokinetics ... more ABSTRACT The effect of non-absorbable and rapidly absorbable suture material on the cytokinetics of crypt cells was studied in right and left colonic anastomoses in the rat by using stathmokinetic methods. Forty-five male Sprague-Dawley rats were allocated to three groups. In group A (n = 15), colonic anastomoses were performed in the right and left colon using nonabsorbable, stainless steel sutures. Groups B (n = 15) animals had identically located anastomoses but a rapidly absorbable suture material (Vicryl Rapide) was used. Animals of group C (n = 15) acted as controls. Eight weeks postoperatively, the crypt cell production rate (CCPR) was determined after measuring the slope of the metaphase accumulation line. At this time, no suture material was detected in any of group B (Vicryl Rapide) animals, while in group A rats (stainless steel), 79% of the animals had suture material in place. A steel-sutured anastomosis significantly increased the CCPR in the right colon from 6.2 to 10.6 cells/crypt/h and in the left colon from 5.6 to 9.8 cells/crypt/h compared with controls (p less than 0.05). An anastomosis performed with Vicryl Rapide, whether in the proximal or descending colon, did not influence the CCPR when compared with the control group (right 6.4 vs. 6.2 cells/crypt/h; left 4.2 vs. 5.6 cells/crypt/h). The CCPR at steel-sutured anastomoses was significantly higher than the CCPR at the Vicryl Rapide anastomotic site both in the right (10.6 vs. 6.4 cells/crypt/h) as well as in the left colonic sites (9.8 vs. 4.2 cells/crypt/h) (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Surgical Endoscopy, 1997

Adrenalectomy is not a frequent operation. Therefore the newly developed laparoscopic approach is... more Adrenalectomy is not a frequent operation. Therefore the newly developed laparoscopic approach is sporadically performed by surgeons dealing with endocrine disorders. Some 54 videoendoscopic adrenalectomies performed on 52 patients by five surgical teams between October 1993 and December 1996 were prospectively evaluated. Indications for endoscopic adrenalectomy were pheochromocytoma (n = 17), primary hyperaldosteronism (n = 15), Cushing's adenoma or disease (n = 7), nonsecreting adenoma (n = 7), single metastasis from adenocarcinoma (n = 2), adenoma with dehydroepiandrostenedione (DHEAS) hypersecretion (n = 3), and ACTH-secreting metastases from a thymoma (n = 1). Of the 54 adrenalectomies performed, 31 were of the left gland, 19 of the right and two bilateral. Laparoscopic adrenalectomy was successful in 50 patients (96%). Median tumor size was 4 cm (range 1.5-12), median operation duration was 80 min (range 59-360), and median postoperative stay was 4 days (range 2-13). One patient required blood transfusion. Endoscopic adrenalectomy can safely be performed-even sporadically-by surgeons well versed in adrenalectomy techniques for endocrine disorders and trained in endoscopic surgery.

Surgical …, 1999

Background: In order to investigate the effect of carbon dioxide (CO 2) pneumoperitoneum on solid... more Background: In order to investigate the effect of carbon dioxide (CO 2) pneumoperitoneum on solid colon carcinomas, we used a colon anastomosis tumor model in 30 male syngeneic WAG rats, which were divided, at random into three groups. ...

Background: Vacuum massage is a non-invasive mechanical massage technique invented to treat burns... more Background: Vacuum massage is a non-invasive mechanical massage technique invented to treat burns and scars. To date, no effects of vacuum massage on thickness and density of human scar tissue have been reported. The process in which external stimuli are converted into biochemical responses in the cell is known as mechanotransduction. In the skin endothelial cells, fibroblasts and myofibroblasts embedded in the extracellular matrix (ECM) sense mechanical stimuli (created by vacuum massage) and may promote intracellular processes leading to matrix remodelling. Since mechanotransduction could be a plausible working mechanism for vacuum massage as an anti-scarring therapy, this study aims to investigate the short-term effects of vacuum massage on thickness and density of epidermis and dermis in burn scars in order to find proof of ECM remodelling.

Burns, 2015

Touch pressure threshold Burn Objective measurement Tactile sensation a b s t r a c t Burn scars ... more Touch pressure threshold Burn Objective measurement Tactile sensation a b s t r a c t Burn scars are frequently accompanied with sensory deficits often remaining present months or even years after injury. Clinimetric properties of assessment tools remain understudied within burn literature. Tactile sense of touch can be examined with the touch pressure threshold (TPT) method using the Semmes Weinstein monofilament test (SWMT).

Clinics and research in hepatology and gastroenterology, Jan 20, 2015

The prevalence of non-alcoholic fatty liver disease (NAFLD) and the closely associated metabolic ... more The prevalence of non-alcoholic fatty liver disease (NAFLD) and the closely associated metabolic syndrome is high and is related to risk factors such as obesity and type 2 diabetes. A genetic basis for NAFLD has been suggested, but only few causal genes have been identified. The most significant association reported to date is the robust association of the PNPLA3 I148M variant with susceptibility to NAFLD. We therefore hypothesized that the PNPLA2 gene might also be involved in NAFLD pathogenesis, because of its close sequence similarity with PNPLA3 and its possible involvement in ectopic fat accumulation. In this study, we investigated the association of PNPLA2 polymorphisms with the development of non-alcoholic fatty liver disease in a prospectively recruited Belgian obese population comprising 633 individuals with varying degrees of fatty liver disease. We selected 3 PNPLA2 SNPs for genotyping, including 2 tagSNPs that cover most information on common genetic variation in the sel...

The Faseb Journal, Apr 1, 2010

Acta chirurgica Belgica

In the treatment of diffuse peritonitis, planned relaparotomies with peritoneal lavages using a z... more In the treatment of diffuse peritonitis, planned relaparotomies with peritoneal lavages using a zipper system (EthiZip Ethicon) are sometimes necessary to obtain a complete eradication of the infectious focus. While most reported series are dealing with an adult population, this review focuses on the treatment of peritonitis using a zipper system in a paediatric age group. In a period of 3 years, insertion of a zipper device and peritoneal lavages were considered necessary to control intraabdominal sepsis in 7 children (age varying from 5 days to 13 years). They consequently underwent planned relaparotomies with peritoneal lavages every 24 to 48 hours. The peritonitis was caused by necrotizing enterocolitis (3 patients), postoperative complications (3 patients) and long existing perforated appendicitis (1 patient). Physical status, assessed by the Acute Physiologic Score (A.P.S.), varied from 12 to 22 (mean 17.7). Usually more than one lavage was necessary (1 to 3, mean 1.9) before the abdomen was considered clean and the zipper could be removed. Closure of the abdominal cavity could be achieved primarily in all cases. All patients survived. Although no statistically significant conclusions can be drawn from this small series and although it is unclear whether these children would not have survived without the zipper, this review shows that planned relaparotomies with peritoneal lavages using a zipper system can be performed safely even in very small children.

Acta chirurgica Belgica

A case of a liposarcoma of the stomach in a 27-year old woman is described. Initially the patient... more A case of a liposarcoma of the stomach in a 27-year old woman is described. Initially the patient consulted with epigastric pain. MRI showed a giant tumour of the stomach wall, invading the surrounding organs, as well as the mediastinal region. After surgical 'en-bloc' resection of the tumour, histopathologic examination yielded a diagnosis of pleiomorphic liposarcoma. Because of the bad prognosis of this histologic type, the patient received adjuvant chemotherapy : a combination of doxorubicin and ifosfamide (MAI). Nine months after surgery, she represented with a relapse of the tumour that had become inoperable. Palliative chemotherapy was started with the intent to prolong the young patient's life. However 6 months later, the patient died of the recurrent disease. Although liposarcoma is a very common soft tissue sarcoma, it is rarely seen in the stomach. The standard therapy is surgical excision. Over the last years, adjuvant therapy became more accepted. Drugs of choice are doxorubicin and ifosfamide, although the benefits of this therapy are still largely unknown and doubtful.

Acta chirurgica Belgica

A case is presented of a 72-year old male patient presenting with a massive intestinal blood loss... more A case is presented of a 72-year old male patient presenting with a massive intestinal blood loss due to a solitary jejunal metastasis of a poorly differentiated adenocarcinoma of the right lung resected two years earlier. After diagnostic workup and stabilization a small bowel resection with end to end anastomosis was performed. Patient is alive and well 5 months after operation. Solitary bleeding intestinal metastasis of a primary bronchogenic tumour are extremely rare but should be included in the differential diagnosis of gastrointestinal blood loss in a patient with a known bronchogenic tumour. Resection with end to end anastomosis is the treatment of choice.

Acta chirurgica Belgica

A major problem in the surgical treatment of diffuse peritonitis is to obtain a complete clearanc... more A major problem in the surgical treatment of diffuse peritonitis is to obtain a complete clearance of septic foci in the peritoneal cavity which may lead to persistence of sepsis and multiple organ failure. We describe our experience with staged abdominal re-explorations using a Zipper system in 23 patients with a mean APACHE II score of 20.3 (s.e.m: 1.5). A total of 91 lavages were done in these patients. Overall mortality was 39%. None of the patients having an APACHE II score between 10 and 20 died whereas the predicted mortality was 15%-45%. After successful treatment, primary closure was possible in 8 of the 14 surviving patients. Large incisional hernias developed in 6 patients. One patient eviscerated two years after complete granulation of his laparostoma. Staged abdominal re-explorations using a Zipper system is an useful tool in the treatment of diffuse peritonitis.

Acta chirurgica Belgica

An observation on Pneumatosis Cystoides Intestinalis (PCI) in a 66-year-old man is reported. His ... more An observation on Pneumatosis Cystoides Intestinalis (PCI) in a 66-year-old man is reported. His general condition allowed a thorough clinical and laboratory investigation which resulted in the diagnosis of the disease and the avoidance of an unnecessary laparotomy. PCI is a relatively rare condition characterized by multiple intramural pockets of gas involving any portion of the gastro intestinal tract. Various theories reflect either a mechanical or a bacterial etiology. Most of the patients are asymptomatic although some experience gastrointestinal complaints. The majority of patients require no treatment.

Acta chirurgica Belgica

Although vertical banded gastroplasty is considered as a safe and efficient bariatric procedure, ... more Although vertical banded gastroplasty is considered as a safe and efficient bariatric procedure, reoperation rates either because of failure, or the induction of unacceptable side effects are important. In this study we evaluated 54 obese subjects with a history of vertical banded gastroplasty. One patient (2%) died postoperatively due to pulmonary embolism. Seven patients (13%) underwent a reoperation. A new vertical banded gastroplasty because of dilatation of the pouch with weight regain resulted in a loss of 26% of the initial weight after 3 years (1 patient). The vertical staple line disrupted in 4 patients: restapling failed after 1.5 year (1 patient), conversion into a gastric bypass resulted in a loss of only 12% of the initial weight after 3 years (1 patient), conversion into a biliopancreatic diversion resulted in a loss of 43 and 32% of body weight after 18 and 6 months, respectively (2 patients). In 2 cases a Nissen fundoplication was performed with good result for reflux oesophagitis. Since regastroplasty was not entirely successful in our hands, we consider biliopancreatic diversion as the method of choice for failed vertical banded gastroplasty.

Journal belge de radiologie

Wide-spread abnormalities of the small bowel on CT scan after massive pulmonary embolism and acut... more Wide-spread abnormalities of the small bowel on CT scan after massive pulmonary embolism and acute hemodynamic collapse are described. These small bowel abnormalities are secondary to hypotension with prolonged hypoperfusion. They consist of diffuse thickening of the small-bowel wall, fluid-filled, dilated loops and increased contrast enhancement of the small-bowel wall (shock bowel). These abnormalities are reversible and should be distinguished from acute vascular occlusion.

European Journal of Emergency Medicine

Intussusception is an important cause of intestinal obstruction and bowel necrosis in infants und... more Intussusception is an important cause of intestinal obstruction and bowel necrosis in infants under 2 years. Most frequently the ileocaecal junction is involved. Various aetiologic factors, such as Meckel's diverticulum and lymphoid hyperplasia have been identified. Hydrostatic reduction of the intussusception should be attempted, but delay in diagnosis frequently leads to surgical intervention, because of failing reduction. We report a case of a 4-month-old boy whose ileocaecal junction was intussuscepted into the rectum, and therefore could be palpated by rectal examination. Unsuccessful hydrostatic reduction and bowel necrosis because of delay in diagnosis, made surgical intervention necessary. A terminal ileostomy was performed. A second case report considers a 10-month-old boy whose ileocaecal junction was intussuscepted into the colon sigmoideum. Because there was no delay in diagnosis, this intussusception could be reduced hydrostatically. The procedure however was difficult because of a dolichosigmoideum. Recent literature is also reviewed.

Journal of neonatal surgery

: Impression of the umbilical cord herniation.

Gastroenterology, 2012

Hirschsprung's disease (HD) is a congenital disorder characterized by aganglionosis in the distal... more Hirschsprung's disease (HD) is a congenital disorder characterized by aganglionosis in the distal intestine. The zebrafish mutant, lessen (lsn), has HD phenotypic characteristics. We use the lsn mutant as an experimental model to unravel underlying developmental mechanisms for HD. This study aims to compare the neurochemical content of enteric neurons and gastrointestinal (GI)-motility patterns between wild-type zebrafish and lsn mutants to further validate this mutant as a suitable model for HD research. Immunofluorescence staining was used to detect specific neurochemical markers from 3 to 6 days post-fertilization (dpf) in the proximal (PI), mid (MI) and distal intestine (DI) of both wild-type and mutant embryos. Contractile activity of the GI-tract was filmed and the frequency and direction of contractions in each intestinal region were analyzed. Both mutant and wild-type embryos showed an increase in enteric neuron numbers over time. In mutants, the number of enteric neurons at each embryonic stage was significantly reduced in DI (absent at 3dpf) and MI, but less in PI. The proportion of nitrergic neurons was significantly reduced in all regions at 3dpf, but nearly unaffected in PI and MI at 4 and 5dpf. In mutants, serotonin, calretinin and calbindin showed a delayed expression and a decrease in both number and proportion at all points of time and in each intestinal region. In both mutant and wild-type embryos, galanin, vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase-activating peptide (PACAP) were only detected in nerve fibers. In wild-type, VIP/PACAP-positive and galaninpositive fibers were present at all time points and in each region. Mutants only showed a few immunoreactive fibers at 3dpf in PI, while at 4dpf immunostained fibers appeared in MI and at 5dpf in DI, showing a delayed expression of these neuropeptides. GI-contractility analyses revealed that wild-type animals have defined motility patterns by 4dpf. When comparing motility patterns, the PI showed little change in when comparing wild-type to mutants. In contrast, we observed a decreased contractility in the MI and DI of mutants. The present study reveals abnormalities in the number and proportions of neurons expressing various neurochemical markers in the lsn mutant. These results are similar to previously reported data in the intestine proximal to the aganglionic segment and in the aganglionic segment of the lethal spotted mutant mice, an experimental HD model. Furthermore, in lessen GI-contractility is significantly perturbed in MI and DI. So, this study supports previous studies indicating that the zebrafish mutant lessen is a suitable model for HD research.

Gastroenterology, 2015

The prevalence of non-alcoholic fatty liver disease has increased with the obesity pandemic. We a... more The prevalence of non-alcoholic fatty liver disease has increased with the obesity pandemic. We analyzed the transcriptional profiles of subcutaneous (SAT) and visceral (VAT) adipose tissue, and phenotypes and functional characteristics of adipocyte tissue macrophages (ATM), in obese patients undergoing bariatric surgery. We collected anthropometric data; plasma samples; and SAT, VAT, and liver tissues from 113 obese patients undergoing bariatric surgery at academic hospitals in Europe (Antwerp and Leuven) and South Africa. Based on clinical and histologic features, patients were assigned to the following groups: obese, NAFLD, non-alcoholic steatohepatitis (NASH), or NASH with fibrosis. Microarray analyses were performed to identify genes expressed differentially among groups. We measured levels of cytokines and chemokines in plasma samples and levels of RNAs in adipose tissues by quantitative reverse transcription PCR. ATM were isolated from patients and 13 lean individuals undergoing cholecystectomy (controls), analyzed by flow cytometry, and cultured; immunophenotypes and levels of cytokines and chemokines in supernatants were determined. We observed increased expression of genes that regulate inflammation in adipose tissues from patients with NAFLD and NASH; expression of these genes increased as disease progressed from NAFLD to NASH. We found 111 genes associated with inflammation that were differentially expressed between VAT and SAT. Serum levels of interleukin-8, CCL3, and tumor necrosis factor-αcorrelated with liver inflammation and NAFLD activity score. We developed 2 models that could be used to determine patients' liver histology based on expression of genes in VAT and SAT. Flow cytometry showed increased proportions of CD11c+CD206+ and CCR2+ macrophages in VAT from patients with NASH, and supernatants of cultured macrophages had increased levels of cytokines and chemokines, compared with controls. VAT and SAT from patients with NAFLD and NASH have increased expression of genes that regulate inflammation, and ATM produce increased levels of inflammatory cytokines, compared with adipose tissues from controls. We identified an expression profile of 5 genes in SAT that accurately predict liver histology in these patients.