J. van de Stadt - Academia.edu (original) (raw)
Papers by J. van de Stadt
in®ltration of large bowel endometriosis along the nerves of the colon
Histology and histopathology, 2005
We report the case of a 49-year-old woman who presented a tailgut cyst lined by a variety of epit... more We report the case of a 49-year-old woman who presented a tailgut cyst lined by a variety of epithelium including squamous, columnar and transitional. Fortuitously a microscopic carcinoid tumor expressing immunohistochemically neuroendocrine markers was identified in the cystic wall. Tailgut cysts are congenital abnormalities located in the presacrococcygeal area occurring usually in adult patients. Clinical diagnosis is difficult because they are often asymptomatic. Patients may present symptoms resulting from local mass effects or complications. The differential diagnoses include rectal duplication cysts, cystic sacrococcygeal teratomas, epidermal cysts, epidermoid cysts, anal duct or gland cysts. Magnetic resonance imaging has recently become the modality of choice to image the cyst. Malignant transformation is rare; 23 cases including 10 carcinoid tumors have been reported in the literature. To our knowledge, this is the eleventh case of carcinoid tumor arising in a tailgut cyst.
Pour un patient presentant une tumeur du rectum, le bilan preoperatoire doit repondre a quatre qu... more Pour un patient presentant une tumeur du rectum, le bilan preoperatoire doit repondre a quatre questions : ○ La tumeur rectale est-elle isolee? ○ Le patient est-il operable? ○ Existe-t-il des metastases a distance? ○ Quelle est l'extension loco-regionale de la tumeur? L'extension loco-regionale de la tumeur rectale est correctement evaluee grâce a l'echoendoscopie rectale. L'atteinte des organes voisins et du mesorectum est mieux detectee par le scanner ou la resonance magnetique.
Le Service de chirurgie digestive est ne en 1977. Il fait partie de l'Unite Medico-Chirurgica... more Le Service de chirurgie digestive est ne en 1977. Il fait partie de l'Unite Medico-Chirurgicale de Gastroenterologie et d'Hepato-Pancreatologie. Les differents secteurs developpes concernent la chirurgie hepatique et de transplantation (traitement des tumeurs hepatiques et de la cirrhose), la chirurgie du pancreas et des voies biliaires (traitement des tumeurs pancreatiques benignes ou malignes, des tumeurs de la voie biliaire principale, de la pancreatite chronique et de la lithiase biliaire), la chirurgie de l'obesite (gastroplastie ou by-pass gastrique), la chirurgie du tube digestif superieur (tumeurs benignes et malignes de l'oesophage ou de l'estomac, traitement du reflux gastro-oesophagien), la chirurgie de la paroi abdominale, la chirurgie colo-rectale et des maladies inflammatoires du tube digestif (cancer colo-rectal, polypose familiale, maladie de Crohn, rectocolite ulcero-hemorragique), la chirurgie proctologique et des troubles anorectaux fonctionnel...
Revue Médicale de Bruxelles, 2009
Colorectal cancer is an important health care problem in Belgium and screening is now widely reco... more Colorectal cancer is an important health care problem in Belgium and screening is now widely recommendend. The French Community has launched in March 2009, a campaign to build public and professional awareness of the importance of screening for colorectal cancer. With the goal of encouraging all persons age 50 to 74 to actively gain information and seek screening with the active participation of their house doctors, the campaign will work to clarify any myths or fears about screening options and ensure that the importance of screening and early detection will be understood. The program in the French Community propose guaiac-based fecal occult blood testing for average risk people and, in case of positivity a colonoscopy must be performed. A high quality colonoscopy should be offered first in case of significant personal and familial history of adenomas, colorectal cancer and some specific extracolonic neoplasia. Several strategies will be used to ensure follow up of this program and...
Journal of Crohn's and Colitis, 2020
Background The current recommendations remain vague as to whether biologics are safe or deleterio... more Background The current recommendations remain vague as to whether biologics are safe or deleterious when surgery is contemplated in patients with Crohn’s disease (CD). Conflicting data do not enable to adopt a definitive position on the time to surgery. The aims of this study were to evaluate the impact of perioperative treatments on the rate of surgical complications and to report surgical recurrence rate of CD after ileo-caecal (IC) resection. Methods This was a retrospective monocentric cohort study of consecutive CD patients who underwent IC resection between 1996 and 2018. An ethical committee has been approved (P2019/376). The overall rate of surgical complications was evaluated within 30 days after surgery. The effect of pre- and postoperative treatments was assessed on overall morbidity, general and infectious complications, anastomotic leakage and risk factors. Statistical analyses were performed using SPSS. Results Demographic data of the 165 CD patients who underwent a pr...
Journal of Clinical Oncology, 2010
3637 Background: Induction chemotherapy has been suggested to impact on preoperative chemoradiati... more 3637 Background: Induction chemotherapy has been suggested to impact on preoperative chemoradiation efficacy in LARC. To evaluate the feasibility and efficacy of a short-intense course of induction...
Update in Intensive Care and Emergency Medicine, 1989
“Fulminant hepatic failure” (FHF) was defined by Trey and Davidson as the development of hepatic ... more “Fulminant hepatic failure” (FHF) was defined by Trey and Davidson as the development of hepatic encephalopathy within 8 weeks of the onset of symptoms in a patients without evidence or history of chronic liver disease [1]. In 1984, Williams added an other entity termed “subacute hepatic failure” (SAHF) when encephalopathy developed within 8 and 26 weeks of the onset of symptoms [2]. Both syndromes are severe conditions leading to a high mortality rate ranging from 60 up to 95% [3, 4]. Although the clinical evolution of FHF or SAHF can be very different from one case to another, the development of encephalopathy with progressive deepening coma and cerebral edema rapidly leads to irreversible neurologic damages. Furthermore, renal failure, arterial hypoxemia resulting from pulmonary dysfunction, hemorrhage due to severe coagulation disturbances, sepsis and at least hemodynamic instability represent the “multiple organ failure” syndrome, that is the final common pathway of the majority of patients with FHF or SAHF.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2014
A modification is described of the J-pouch to facilitate ileoanal anastomosis in the presence of ... more A modification is described of the J-pouch to facilitate ileoanal anastomosis in the presence of an anal or anovaginal fistula. The bowel is divided at the level of the apex of the J-pouch, the distal limb is advanced to project beyond the proximal limb by 3-5 cm. The pouch is constructed by a side-to-side anastomosis to form the H-pouch with a distal ileal segment, which is passed through the anal canal to form an ileoanal anastomosis. The modification allows the treatment of anal and rectal disorders not resolvable by a usual J-pouch construction, as in cases where a rectal resection is needed for concomitant fistulation or destruction of the anal mucosa. The functional results are similar to those of the J-pouch, with no added postoperative morbidity. This technique helps to avoid permanent stoma in selected cases. The modified pouch is relatively simple to perform and can help the surgeon to address complex anorectal disorders.
Hepato-gastroenterology
Partial hepatectomy (PH) or total hepatectomy and orthotopic liver transplantation (OLT) may be c... more Partial hepatectomy (PH) or total hepatectomy and orthotopic liver transplantation (OLT) may be curative in selected patients treated for hepatocellular carcinoma (HCC). The analysis of clinical series may help in the choice of the more appropriate treatment. During the past 11 years, 40 patients with HCC were treated by PH and 16 patients underwent total hepatectomy and OLT. Selection criteria for transplantation were the liver function and the tumor resectability. The actuarial 1-, 3- and 5-year survival rates were 67%, 34% and 18%, respectively, after PH and 62%, 54% and 54% after OLT. The only prognostic factor after PH was the tumor extension to a single or both lobes. Patients with associated cirrhosis had significantly more post-operative complications, but a comparable long-term survival. The proliferative cell nuclear antigen labeling index (PCNA-LI), evaluated on tumoral tissue in 16 patients, showed that an index <30% indicates a better prognosis for HCC developing in ...
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 1984
Synovial sarcoma is a rare tumour. The diagnosis is difficult because of the lack of typical clin... more Synovial sarcoma is a rare tumour. The diagnosis is difficult because of the lack of typical clinical symptoms and microscopy can be controversial. The prognosis is bad. A case is described in a woman aged 63 who presented previously with osteopoikilosis without clinical signs. The sarcoma was situated at the knee and was at first confused with a degenerative arthritis. The patient died despite secondary amputation. After study of the literature the authors conclude that the prognosis may be improved by early diagnosis.
Transplantation proceedings, 1990
In our early experience, orthotopic liver transplantation was found to be successful in fulminant... more In our early experience, orthotopic liver transplantation was found to be successful in fulminant and subacute hepatic failure due to viral hepatitis in adults, with 66% 1-year survival rate. In the future, more accurate prognostic criteria would probably improve overall survival rate in acute hepatic failure, by allowing better and earlier selection of patients requiring liver transplantation.
Acta gastro-enterologica Belgica
The aim of our study was to design simple and practical quantitative scores or indices suitable f... more The aim of our study was to design simple and practical quantitative scores or indices suitable for deciding a pre-liver transplantation work-up in patients with parenchymal cirrhosis. A Pugh score (combining five variables) superior to 8 or a p value inferior to 0.7 of a logistic regression equation containing only two variables (score of ascites and result of 14C aminopyrine breath test) were found to be highly effective for making this decision.
Acta gastro-enterologica Belgica
Cancer in Transplantation: Prevention and Treatment, 1996
From January 1985 to January 1995, 125 adult patients underwent 135 liver transplantations (OLT).... more From January 1985 to January 1995, 125 adult patients underwent 135 liver transplantations (OLT). Hundred of them survived more than 3 months.
Hypertension, 1993
Twenty-four-hour systolic blood pressure, diastolic blood pressure, and heart rate profiles were ... more Twenty-four-hour systolic blood pressure, diastolic blood pressure, and heart rate profiles were recorded in 17 liver-transplanted patients by noninvaslve ambulatory monitoring and were analyzed with the periodogram method. These recordings were compared with those of control subjects matched for age, sex, and daytime ambulatory blood pressure. Abnormal blood pressure patterns were found in seven of the 17 patients, whereas the other 10 patients had circadian blood pressure profiles that were not different from those of control subjects. These two groups of liver-transplanted patients did not differ in age, sex, oral dose of cyclosporine, specific serum cyclosporine level, and proportion of patients receiving azathioprine and antihypertensive medications. In contrast, the daily oral dose of prednisolone was significantly higher (p<0.001) in the seven patients with abnormal circadian blood pressure patterns. Moreover, only the daily oral dose of prednisolone was inversely correlated with the magnitude of the nighttime systolic and diastolic blood pressure decrease (r=-0.64 and r=-0.66,p <0.01). In contrast to blood pressure, patients and control subjects had similar circadian heart rate variations. We conclude that exogenous glucocorticoid administration may have a dose-dependent effect on the nighttime blood pressure fall and may play an important role in the pathogenesis of the abnormal circadian blood pressure profiles observed in liver-transplanted patients. (Hypertension 1993;21:398-405) KEY WORDS • circadian rhythm • blood pressure • heart rate • liver transplantation I n normotensive and essential hypertension patients, 24-hour blood pressure (BP) and heart rate (HR) profiles are characterized by a diurnal increase and nocturnal decrease. 12 Previous studies have reported abnormal circadian patterns of BP and HR in patients with cardiac transplantation. 3 " 5 However, whether immunosuppressive therapy or cardiac denervation is responsible for these alterations is still unclear, 6 because nocturnal BP rises have been reported in patients with endogenous Cushing's syndrome, in subjects treated with exogeneous glucocorticoids, 7-8 and in patients with autonomic dysfunction. 9 Therefore, the exploration of the 24-hour BP and HR patterns of liver-transplanted (LTX) patients who undergo an immunosuppressive therapy similar to that of cardiactransplanted patients but whose heart is not denervated by the surgical procedure may give new insights in the understanding of the circadian BP regulation in organtransplanted patients. The present study was designed to analyze the circadian BP and HR patterns in 17 LTX patients using a mathematical procedure 10 specifically designed for characterizing 24-hour rhythms in normal 11 and pathological 12 conditions. The LTX patients were compared with control subjects matched for age, sex, and daytime BP.
Hepato-gastroenterology, 1989
Between January 1978, and December 1987, 79 patients underwent pancreaticoduodenal resection for ... more Between January 1978, and December 1987, 79 patients underwent pancreaticoduodenal resection for pancreatic (44) or periampullary tumors (ampulla 18, common bile duct 9, duodenum 8). Fifty-five patients were icteric (55/79: 70%); 33 of them underwent preoperative biliary decompression (endoscopic procedures 29, percutaneous transhepatic drainage 3, laparotomy and T-tube placement. 1) After biliary drainage, bilirubin levels decreased from 12.4 +/- 1.3 mg/dl at admission to 5.1 +/- 1.1 mg/dl before surgery. Pancreaticoduodenal resection was performed within a mean of 15 +/- 13 days after biliary decompression. Twenty-seven patients had no complications, others developed one or more complications. The postoperative mortality was 5% (4/79). The influence of various clinical, biological and pathological factors on postoperative complications and long-term survival was studied. Neither jaundice nor preoperative biliary drainage had a statistically significant effect on overall morbidity ...
Revue médicale de Bruxelles, 2001
Significant developments have been occurred in the field of colorectal cancer treatments over the... more Significant developments have been occurred in the field of colorectal cancer treatments over these last years, surgery clearly remaining the only curative therapy. Optimalized surgical approaches, such as total mesorectum excision, aggressive resections of liver metastases and development of innovative techniques of local destruction of hepatic lesions using radiofrequency attempt to prolong survival. New chemotherapeutic and biological agents, associated with a better knowledge of tumor biology open promising perspectives with regards to an increasing of survival, an improvement of quality of life and the possibility to resect curatively liver metastases initially unresectable, after neoadjuvant chemotherapy. The present paper aims to review the therapeutic approaches at the different stages of the disease and strongly insists on the multidisciplinary strategy required for an optimal management and a global view of colorectal cancer, shared by the surgeon, the gastroenterologist a...
in®ltration of large bowel endometriosis along the nerves of the colon
Histology and histopathology, 2005
We report the case of a 49-year-old woman who presented a tailgut cyst lined by a variety of epit... more We report the case of a 49-year-old woman who presented a tailgut cyst lined by a variety of epithelium including squamous, columnar and transitional. Fortuitously a microscopic carcinoid tumor expressing immunohistochemically neuroendocrine markers was identified in the cystic wall. Tailgut cysts are congenital abnormalities located in the presacrococcygeal area occurring usually in adult patients. Clinical diagnosis is difficult because they are often asymptomatic. Patients may present symptoms resulting from local mass effects or complications. The differential diagnoses include rectal duplication cysts, cystic sacrococcygeal teratomas, epidermal cysts, epidermoid cysts, anal duct or gland cysts. Magnetic resonance imaging has recently become the modality of choice to image the cyst. Malignant transformation is rare; 23 cases including 10 carcinoid tumors have been reported in the literature. To our knowledge, this is the eleventh case of carcinoid tumor arising in a tailgut cyst.
Pour un patient presentant une tumeur du rectum, le bilan preoperatoire doit repondre a quatre qu... more Pour un patient presentant une tumeur du rectum, le bilan preoperatoire doit repondre a quatre questions : ○ La tumeur rectale est-elle isolee? ○ Le patient est-il operable? ○ Existe-t-il des metastases a distance? ○ Quelle est l'extension loco-regionale de la tumeur? L'extension loco-regionale de la tumeur rectale est correctement evaluee grâce a l'echoendoscopie rectale. L'atteinte des organes voisins et du mesorectum est mieux detectee par le scanner ou la resonance magnetique.
Le Service de chirurgie digestive est ne en 1977. Il fait partie de l'Unite Medico-Chirurgica... more Le Service de chirurgie digestive est ne en 1977. Il fait partie de l'Unite Medico-Chirurgicale de Gastroenterologie et d'Hepato-Pancreatologie. Les differents secteurs developpes concernent la chirurgie hepatique et de transplantation (traitement des tumeurs hepatiques et de la cirrhose), la chirurgie du pancreas et des voies biliaires (traitement des tumeurs pancreatiques benignes ou malignes, des tumeurs de la voie biliaire principale, de la pancreatite chronique et de la lithiase biliaire), la chirurgie de l'obesite (gastroplastie ou by-pass gastrique), la chirurgie du tube digestif superieur (tumeurs benignes et malignes de l'oesophage ou de l'estomac, traitement du reflux gastro-oesophagien), la chirurgie de la paroi abdominale, la chirurgie colo-rectale et des maladies inflammatoires du tube digestif (cancer colo-rectal, polypose familiale, maladie de Crohn, rectocolite ulcero-hemorragique), la chirurgie proctologique et des troubles anorectaux fonctionnel...
Revue Médicale de Bruxelles, 2009
Colorectal cancer is an important health care problem in Belgium and screening is now widely reco... more Colorectal cancer is an important health care problem in Belgium and screening is now widely recommendend. The French Community has launched in March 2009, a campaign to build public and professional awareness of the importance of screening for colorectal cancer. With the goal of encouraging all persons age 50 to 74 to actively gain information and seek screening with the active participation of their house doctors, the campaign will work to clarify any myths or fears about screening options and ensure that the importance of screening and early detection will be understood. The program in the French Community propose guaiac-based fecal occult blood testing for average risk people and, in case of positivity a colonoscopy must be performed. A high quality colonoscopy should be offered first in case of significant personal and familial history of adenomas, colorectal cancer and some specific extracolonic neoplasia. Several strategies will be used to ensure follow up of this program and...
Journal of Crohn's and Colitis, 2020
Background The current recommendations remain vague as to whether biologics are safe or deleterio... more Background The current recommendations remain vague as to whether biologics are safe or deleterious when surgery is contemplated in patients with Crohn’s disease (CD). Conflicting data do not enable to adopt a definitive position on the time to surgery. The aims of this study were to evaluate the impact of perioperative treatments on the rate of surgical complications and to report surgical recurrence rate of CD after ileo-caecal (IC) resection. Methods This was a retrospective monocentric cohort study of consecutive CD patients who underwent IC resection between 1996 and 2018. An ethical committee has been approved (P2019/376). The overall rate of surgical complications was evaluated within 30 days after surgery. The effect of pre- and postoperative treatments was assessed on overall morbidity, general and infectious complications, anastomotic leakage and risk factors. Statistical analyses were performed using SPSS. Results Demographic data of the 165 CD patients who underwent a pr...
Journal of Clinical Oncology, 2010
3637 Background: Induction chemotherapy has been suggested to impact on preoperative chemoradiati... more 3637 Background: Induction chemotherapy has been suggested to impact on preoperative chemoradiation efficacy in LARC. To evaluate the feasibility and efficacy of a short-intense course of induction...
Update in Intensive Care and Emergency Medicine, 1989
“Fulminant hepatic failure” (FHF) was defined by Trey and Davidson as the development of hepatic ... more “Fulminant hepatic failure” (FHF) was defined by Trey and Davidson as the development of hepatic encephalopathy within 8 weeks of the onset of symptoms in a patients without evidence or history of chronic liver disease [1]. In 1984, Williams added an other entity termed “subacute hepatic failure” (SAHF) when encephalopathy developed within 8 and 26 weeks of the onset of symptoms [2]. Both syndromes are severe conditions leading to a high mortality rate ranging from 60 up to 95% [3, 4]. Although the clinical evolution of FHF or SAHF can be very different from one case to another, the development of encephalopathy with progressive deepening coma and cerebral edema rapidly leads to irreversible neurologic damages. Furthermore, renal failure, arterial hypoxemia resulting from pulmonary dysfunction, hemorrhage due to severe coagulation disturbances, sepsis and at least hemodynamic instability represent the “multiple organ failure” syndrome, that is the final common pathway of the majority of patients with FHF or SAHF.
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2014
A modification is described of the J-pouch to facilitate ileoanal anastomosis in the presence of ... more A modification is described of the J-pouch to facilitate ileoanal anastomosis in the presence of an anal or anovaginal fistula. The bowel is divided at the level of the apex of the J-pouch, the distal limb is advanced to project beyond the proximal limb by 3-5 cm. The pouch is constructed by a side-to-side anastomosis to form the H-pouch with a distal ileal segment, which is passed through the anal canal to form an ileoanal anastomosis. The modification allows the treatment of anal and rectal disorders not resolvable by a usual J-pouch construction, as in cases where a rectal resection is needed for concomitant fistulation or destruction of the anal mucosa. The functional results are similar to those of the J-pouch, with no added postoperative morbidity. This technique helps to avoid permanent stoma in selected cases. The modified pouch is relatively simple to perform and can help the surgeon to address complex anorectal disorders.
Hepato-gastroenterology
Partial hepatectomy (PH) or total hepatectomy and orthotopic liver transplantation (OLT) may be c... more Partial hepatectomy (PH) or total hepatectomy and orthotopic liver transplantation (OLT) may be curative in selected patients treated for hepatocellular carcinoma (HCC). The analysis of clinical series may help in the choice of the more appropriate treatment. During the past 11 years, 40 patients with HCC were treated by PH and 16 patients underwent total hepatectomy and OLT. Selection criteria for transplantation were the liver function and the tumor resectability. The actuarial 1-, 3- and 5-year survival rates were 67%, 34% and 18%, respectively, after PH and 62%, 54% and 54% after OLT. The only prognostic factor after PH was the tumor extension to a single or both lobes. Patients with associated cirrhosis had significantly more post-operative complications, but a comparable long-term survival. The proliferative cell nuclear antigen labeling index (PCNA-LI), evaluated on tumoral tissue in 16 patients, showed that an index <30% indicates a better prognosis for HCC developing in ...
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 1984
Synovial sarcoma is a rare tumour. The diagnosis is difficult because of the lack of typical clin... more Synovial sarcoma is a rare tumour. The diagnosis is difficult because of the lack of typical clinical symptoms and microscopy can be controversial. The prognosis is bad. A case is described in a woman aged 63 who presented previously with osteopoikilosis without clinical signs. The sarcoma was situated at the knee and was at first confused with a degenerative arthritis. The patient died despite secondary amputation. After study of the literature the authors conclude that the prognosis may be improved by early diagnosis.
Transplantation proceedings, 1990
In our early experience, orthotopic liver transplantation was found to be successful in fulminant... more In our early experience, orthotopic liver transplantation was found to be successful in fulminant and subacute hepatic failure due to viral hepatitis in adults, with 66% 1-year survival rate. In the future, more accurate prognostic criteria would probably improve overall survival rate in acute hepatic failure, by allowing better and earlier selection of patients requiring liver transplantation.
Acta gastro-enterologica Belgica
The aim of our study was to design simple and practical quantitative scores or indices suitable f... more The aim of our study was to design simple and practical quantitative scores or indices suitable for deciding a pre-liver transplantation work-up in patients with parenchymal cirrhosis. A Pugh score (combining five variables) superior to 8 or a p value inferior to 0.7 of a logistic regression equation containing only two variables (score of ascites and result of 14C aminopyrine breath test) were found to be highly effective for making this decision.
Acta gastro-enterologica Belgica
Cancer in Transplantation: Prevention and Treatment, 1996
From January 1985 to January 1995, 125 adult patients underwent 135 liver transplantations (OLT).... more From January 1985 to January 1995, 125 adult patients underwent 135 liver transplantations (OLT). Hundred of them survived more than 3 months.
Hypertension, 1993
Twenty-four-hour systolic blood pressure, diastolic blood pressure, and heart rate profiles were ... more Twenty-four-hour systolic blood pressure, diastolic blood pressure, and heart rate profiles were recorded in 17 liver-transplanted patients by noninvaslve ambulatory monitoring and were analyzed with the periodogram method. These recordings were compared with those of control subjects matched for age, sex, and daytime ambulatory blood pressure. Abnormal blood pressure patterns were found in seven of the 17 patients, whereas the other 10 patients had circadian blood pressure profiles that were not different from those of control subjects. These two groups of liver-transplanted patients did not differ in age, sex, oral dose of cyclosporine, specific serum cyclosporine level, and proportion of patients receiving azathioprine and antihypertensive medications. In contrast, the daily oral dose of prednisolone was significantly higher (p<0.001) in the seven patients with abnormal circadian blood pressure patterns. Moreover, only the daily oral dose of prednisolone was inversely correlated with the magnitude of the nighttime systolic and diastolic blood pressure decrease (r=-0.64 and r=-0.66,p <0.01). In contrast to blood pressure, patients and control subjects had similar circadian heart rate variations. We conclude that exogenous glucocorticoid administration may have a dose-dependent effect on the nighttime blood pressure fall and may play an important role in the pathogenesis of the abnormal circadian blood pressure profiles observed in liver-transplanted patients. (Hypertension 1993;21:398-405) KEY WORDS • circadian rhythm • blood pressure • heart rate • liver transplantation I n normotensive and essential hypertension patients, 24-hour blood pressure (BP) and heart rate (HR) profiles are characterized by a diurnal increase and nocturnal decrease. 12 Previous studies have reported abnormal circadian patterns of BP and HR in patients with cardiac transplantation. 3 " 5 However, whether immunosuppressive therapy or cardiac denervation is responsible for these alterations is still unclear, 6 because nocturnal BP rises have been reported in patients with endogenous Cushing's syndrome, in subjects treated with exogeneous glucocorticoids, 7-8 and in patients with autonomic dysfunction. 9 Therefore, the exploration of the 24-hour BP and HR patterns of liver-transplanted (LTX) patients who undergo an immunosuppressive therapy similar to that of cardiactransplanted patients but whose heart is not denervated by the surgical procedure may give new insights in the understanding of the circadian BP regulation in organtransplanted patients. The present study was designed to analyze the circadian BP and HR patterns in 17 LTX patients using a mathematical procedure 10 specifically designed for characterizing 24-hour rhythms in normal 11 and pathological 12 conditions. The LTX patients were compared with control subjects matched for age, sex, and daytime BP.
Hepato-gastroenterology, 1989
Between January 1978, and December 1987, 79 patients underwent pancreaticoduodenal resection for ... more Between January 1978, and December 1987, 79 patients underwent pancreaticoduodenal resection for pancreatic (44) or periampullary tumors (ampulla 18, common bile duct 9, duodenum 8). Fifty-five patients were icteric (55/79: 70%); 33 of them underwent preoperative biliary decompression (endoscopic procedures 29, percutaneous transhepatic drainage 3, laparotomy and T-tube placement. 1) After biliary drainage, bilirubin levels decreased from 12.4 +/- 1.3 mg/dl at admission to 5.1 +/- 1.1 mg/dl before surgery. Pancreaticoduodenal resection was performed within a mean of 15 +/- 13 days after biliary decompression. Twenty-seven patients had no complications, others developed one or more complications. The postoperative mortality was 5% (4/79). The influence of various clinical, biological and pathological factors on postoperative complications and long-term survival was studied. Neither jaundice nor preoperative biliary drainage had a statistically significant effect on overall morbidity ...
Revue médicale de Bruxelles, 2001
Significant developments have been occurred in the field of colorectal cancer treatments over the... more Significant developments have been occurred in the field of colorectal cancer treatments over these last years, surgery clearly remaining the only curative therapy. Optimalized surgical approaches, such as total mesorectum excision, aggressive resections of liver metastases and development of innovative techniques of local destruction of hepatic lesions using radiofrequency attempt to prolong survival. New chemotherapeutic and biological agents, associated with a better knowledge of tumor biology open promising perspectives with regards to an increasing of survival, an improvement of quality of life and the possibility to resect curatively liver metastases initially unresectable, after neoadjuvant chemotherapy. The present paper aims to review the therapeutic approaches at the different stages of the disease and strongly insists on the multidisciplinary strategy required for an optimal management and a global view of colorectal cancer, shared by the surgeon, the gastroenterologist a...