Marleen Craessaerts - Academia.edu (original) (raw)
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Papers by Marleen Craessaerts
Human Reproduction, 2008
BACKGROUND: Endometriosis is associated with an inflammatory response. Hence infliximab, an anti-... more BACKGROUND: Endometriosis is associated with an inflammatory response. Hence infliximab, an anti-TNF-a monoclonal antibody, might relieve pain. METHODS: A randomized placebo-controlled trial was designed with 21 women with severe pain and a rectovaginal nodule of at least 1 cm. After 1 month of observation, three infusions of infliximab (5 mg/kg) or placebo were given. Surgery was performed 3 months later and follow-up continued for 6 months. The primary end-point was pain (dysmenorrhea, deep dyspareunia and non-menstrual pain) rated at each visit by the clinician and on a daily basis by the patient who in addition scored pain by visual analog pain scale and analgesia intake. Secondary end-points included the volume of the endometriotic nodule, pelvic tenderness and the visual appearance of endometriotic lesions at laparoscopy. RESULTS: Pain severity decreased during the treatment by 30% in both the placebo (P < 0.001) and infliximab groups (P < 0.001). However, no effect of infliximab was observed for any of the outcome measures. After surgery, pain scores decreased in both groups to less than 20% of the initial value. CONCLUSIONS: Infliximab appears not to affect pain associated with deep endometriosis. Treatment is associated with an important placebo effect. After surgery, pain decreases to less than 20%. Trials registration number ClinicalTrials.gov: NCT00604864.
Fertility and Sterility, 2009
Objective: To investigate the outcome of laparoscopic repair of ureteral injury in laparoscopic g... more Objective: To investigate the outcome of laparoscopic repair of ureteral injury in laparoscopic gynecologic surgery. Design: Prospective trial. Setting: University hospital. Patient(s): Forty patients with a ureteral lesion in laparoscopic surgery between 1991 and 2007. Intervention(s): Laparoscopic ureteral repair, laparoscopic-assisted or blind stent insertion. Main outcome measure(s): Treatment outcome of ureteral lesion analyzed by type of injury, time of diagnosis, and management. Result(s): In 4,350 consecutive laparoscopic gynecologic interventions, 42 lesions occurred, 5 during hysterectomy, 1 during adnexectomy, and 36 during deep endometriosis surgery. In the latter group (n ¼ 1,427), the incidence was 1.5% and 21% in women without and with hydronephrosis, respectively. In eight women in whom a stent was inserted after surgery without laparoscopic guidance, five were uneventful and three needed a second intervention. In all 34 women in whom a laparoscopic repair over a stent was performed, the outcome was uneventful, whether diagnosed and treated during surgery (n ¼ 25) or after surgery (n ¼ 9). Conclusion(s): Laparoscopic repair over a stent was uneventful for all lacerations, transections, and fistulas, whether performed during or after surgery, and was superior to blind stent insertion. In women with hydronephrosis and deep endometriosis, a preoperative stent insertion seems to be mandatory. (Fertil Steril Ò 2008;-:---.
Journal of Gynecologic Surgery, 2015
ABSTRACT Background: Instillation of crystalloid flotation agents, such as Ringer's lacta... more ABSTRACT Background: Instillation of crystalloid flotation agents, such as Ringer's lactate has been suggested for preventing adhesion formation after abdominal surgery, but the efficacy of this approach remains controversial. Objective: The aim of this pilot study was to evaluate the resorption rates of Ringer's lactate and icodextrin 4% following a pneumoperitoneum with CO2 and humidification (control) in comparison with a pneumoperitoneum with 86%CO2+10%N2O+4%O2 together with cooling and humidification (full conditioning). Materials and Methods: Twenty women undergoing laparoscopic hysterectomy were prospectively randomized to have during surgery with a control or a full-conditioned pneumoperitoneum as well as the instillation of 1000 mL of Ringer's lactate or icodextrin 4% at the end of surgery. Fluid volumes remaining after 24, 48, and 72 hours were measured by ultrasound testing. Results: The peritoneal volumes of Ringer's lactate and icodextrin 4% both decreased exponentially over time. Following a pneumoperitoneum with CO2, the resorption rate of Ringer's lactate was faster than for icodextrin 4%. After 24, 48, and 72 hours 11.7±1.0% versus 38.2±9.5% (p=0.009), 5.3±0.6% versus 14.9±4.8% (NS), and 4.2±0.7% versus 12.1±4% (p=0.03), respectively of the initial 1 L remained. Conditioning decreased the resorption rate of Ringer's lactate and after 24, 48, and 72 hours 25.2±3.4, 13.2±1.3 and 6.0±0.5% remained (p=0.03, 0.009, and NS versus the control group), respectively Conditioning did not affect the resorption rate of icodextrin. Conclusions: The absorption of both Ringer's lactate and of icodextrin 4% from the peritoneal cavity was fast and exponential in this pilot study. In the control group, the resorption rate of icodextrin 4% was slightly slower than that of Ringer's lactate. After conditioning, the resorption rate of Ringer's was slower and became comparable to that of icodextrin 4%. (J GYNECOL SURG 31:1)
Human Reproduction, 2008
BACKGROUND: Endometriosis is associated with an inflammatory response. Hence infliximab, an anti-... more BACKGROUND: Endometriosis is associated with an inflammatory response. Hence infliximab, an anti-TNF-a monoclonal antibody, might relieve pain. METHODS: A randomized placebo-controlled trial was designed with 21 women with severe pain and a rectovaginal nodule of at least 1 cm. After 1 month of observation, three infusions of infliximab (5 mg/kg) or placebo were given. Surgery was performed 3 months later and follow-up continued for 6 months. The primary end-point was pain (dysmenorrhea, deep dyspareunia and non-menstrual pain) rated at each visit by the clinician and on a daily basis by the patient who in addition scored pain by visual analog pain scale and analgesia intake. Secondary end-points included the volume of the endometriotic nodule, pelvic tenderness and the visual appearance of endometriotic lesions at laparoscopy. RESULTS: Pain severity decreased during the treatment by 30% in both the placebo (P < 0.001) and infliximab groups (P < 0.001). However, no effect of infliximab was observed for any of the outcome measures. After surgery, pain scores decreased in both groups to less than 20% of the initial value. CONCLUSIONS: Infliximab appears not to affect pain associated with deep endometriosis. Treatment is associated with an important placebo effect. After surgery, pain decreases to less than 20%. Trials registration number ClinicalTrials.gov: NCT00604864.
Fertility and Sterility, 2009
Objective: To investigate the outcome of laparoscopic repair of ureteral injury in laparoscopic g... more Objective: To investigate the outcome of laparoscopic repair of ureteral injury in laparoscopic gynecologic surgery. Design: Prospective trial. Setting: University hospital. Patient(s): Forty patients with a ureteral lesion in laparoscopic surgery between 1991 and 2007. Intervention(s): Laparoscopic ureteral repair, laparoscopic-assisted or blind stent insertion. Main outcome measure(s): Treatment outcome of ureteral lesion analyzed by type of injury, time of diagnosis, and management. Result(s): In 4,350 consecutive laparoscopic gynecologic interventions, 42 lesions occurred, 5 during hysterectomy, 1 during adnexectomy, and 36 during deep endometriosis surgery. In the latter group (n ¼ 1,427), the incidence was 1.5% and 21% in women without and with hydronephrosis, respectively. In eight women in whom a stent was inserted after surgery without laparoscopic guidance, five were uneventful and three needed a second intervention. In all 34 women in whom a laparoscopic repair over a stent was performed, the outcome was uneventful, whether diagnosed and treated during surgery (n ¼ 25) or after surgery (n ¼ 9). Conclusion(s): Laparoscopic repair over a stent was uneventful for all lacerations, transections, and fistulas, whether performed during or after surgery, and was superior to blind stent insertion. In women with hydronephrosis and deep endometriosis, a preoperative stent insertion seems to be mandatory. (Fertil Steril Ò 2008;-:---.
Journal of Gynecologic Surgery, 2015
ABSTRACT Background: Instillation of crystalloid flotation agents, such as Ringer's lacta... more ABSTRACT Background: Instillation of crystalloid flotation agents, such as Ringer's lactate has been suggested for preventing adhesion formation after abdominal surgery, but the efficacy of this approach remains controversial. Objective: The aim of this pilot study was to evaluate the resorption rates of Ringer's lactate and icodextrin 4% following a pneumoperitoneum with CO2 and humidification (control) in comparison with a pneumoperitoneum with 86%CO2+10%N2O+4%O2 together with cooling and humidification (full conditioning). Materials and Methods: Twenty women undergoing laparoscopic hysterectomy were prospectively randomized to have during surgery with a control or a full-conditioned pneumoperitoneum as well as the instillation of 1000 mL of Ringer's lactate or icodextrin 4% at the end of surgery. Fluid volumes remaining after 24, 48, and 72 hours were measured by ultrasound testing. Results: The peritoneal volumes of Ringer's lactate and icodextrin 4% both decreased exponentially over time. Following a pneumoperitoneum with CO2, the resorption rate of Ringer's lactate was faster than for icodextrin 4%. After 24, 48, and 72 hours 11.7±1.0% versus 38.2±9.5% (p=0.009), 5.3±0.6% versus 14.9±4.8% (NS), and 4.2±0.7% versus 12.1±4% (p=0.03), respectively of the initial 1 L remained. Conditioning decreased the resorption rate of Ringer's lactate and after 24, 48, and 72 hours 25.2±3.4, 13.2±1.3 and 6.0±0.5% remained (p=0.03, 0.009, and NS versus the control group), respectively Conditioning did not affect the resorption rate of icodextrin. Conclusions: The absorption of both Ringer's lactate and of icodextrin 4% from the peritoneal cavity was fast and exponential in this pilot study. In the control group, the resorption rate of icodextrin 4% was slightly slower than that of Ringer's lactate. After conditioning, the resorption rate of Ringer's was slower and became comparable to that of icodextrin 4%. (J GYNECOL SURG 31:1)