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Vaesen Bentein H, De Roeck L, Pirenne Y, Vissers G, Tondu T, Thiessen F, Willemsen P. Perineal bowel evisceration after extralevator abdominoperineal excision and vertical rectus abdominis myocutaneous flap closure. Acta Chir Belg 2023; 123:673-678. [PMID: 35786301 DOI: 10.1080/00015458.2022.2097991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/30/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Perineal bowel evisceration is a rare complication after extralevator abdominoperineal excision (ELAPE). This surgical technique is used to resect low rectal and anal cancer, with a lower likelihood of positive surgical margins, but resulting in a larger perineal defect. A vertical rectus abdominis myocutaneous (VRAM) flap allows filling of the empty pelvic space and closure of the defect in the pelvic floor. CASE PRESENTATION A 77-year-old woman, with a hysterectomy in her medical history, underwent an ELAPE followed by reconstruction of the perineal defect with a VRAM flap after neoadjuvant radiotherapy for a moderately differentiated invasive adenocarcinoma of the distal rectum. The postoperative course was complicated with a herniation of the perineal wound and evisceration of a bowel loop. CONCLUSION Closure of the perineal defect after ELAPE remains a challenge, especially in cases where several risk factors for delayed wound healing, flap failure and perineal herniation are present.
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Affiliation(s)
| | - Lynn De Roeck
- Department of Plastic, Reconstructive and Aesthetic Surgery, ZNA Middelheim and University Hospital Antwerp, Antwerp, Belgium
| | - Yves Pirenne
- Department of General and Abdominal Surgery, ZNA Middelheim, Antwerp, Belgium
| | - Gino Vissers
- Department of Plastic, Reconstructive and Aesthetic Surgery, ZNA Middelheim and University Hospital Antwerp, Antwerp, Belgium
| | - Thierry Tondu
- Department of Plastic, Reconstructive and Aesthetic Surgery, ZNA Middelheim and University Hospital Antwerp, Antwerp, Belgium
| | - Filip Thiessen
- Department of Plastic, Reconstructive and Aesthetic Surgery, ZNA Middelheim and University Hospital Antwerp, Antwerp, Belgium
| | - Paul Willemsen
- Department of General and Abdominal Surgery, ZNA Middelheim, Antwerp, Belgium
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Adriaenssens J, Vaesen Bentein H, Jacobs R, Politis C, Van der Cruyssen F. Prospective orofacial quantitative sensory testing data of the human face and mouth. Data Brief 2023; 49:109316. [PMID: 37360670 PMCID: PMC10285537 DOI: 10.1016/j.dib.2023.109316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
Quantitative sensory testing (QST) is a valuable tool in the assessment of orofacial somatosensory function and dysfunction. QST is a method where thermal and mechanical stimuli are applied to the area of interest in a noninvasive way. The QST technique can detect patterns of loss of sensation that may happen in case of hypoesthesia, hypoalgesia, anesthesia, or gain of sensation in the context of allodynia, hyperalgesia or spontaneous pain. Normal values have already been recorded for some parts of the face and mouth, but not for the complete innervation area of the trigeminal nerve. This dataset involves orofacial QST gathered from ten healthy volunteers, a standardized QST battery was applied to 24 regions (14 extraoral and 10 intraoral) innervated by the trigeminal nerve. Descriptive statistics were applied to compare the different regions. This dataset can be used to inform future studies involving orofacial sensory function, pain studies and pharmacological trials.
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Affiliation(s)
- Julie Adriaenssens
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Hannah Vaesen Bentein
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
- Department of Oral Health Sciences, KU Leuven and Department of Dentistry, University Hospitals, Leuven, Belgium
- Department of Dental Medicine, Karolinksa Institutet, Stockholm, Sweden
| | - Constantinus Politis
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
| | - Fréderic Van der Cruyssen
- Department of Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, University Leuven, Leuven, Belgium
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Van den Eynde J, Vaesen Bentein H, Decaluwé T, De Praetere H, Wertan MC, Sutter FP, Balkhy HH, Oosterlinck W. Safe implementation of robotic-assisted minimally invasive direct coronary artery bypass: application of learning curves and cumulative sum analysis. J Thorac Dis 2021; 13:4260-4270. [PMID: 34422354 PMCID: PMC8339757 DOI: 10.21037/jtd-21-775] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/11/2021] [Indexed: 12/07/2022]
Abstract
Background Learning curves are inevitably encountered when first implementing an innovative and complex surgical technique. Nevertheless, a cluster of failures or complications should be detected early, but not deter learning, to ensure safe implementation. Here, we aimed to examine the presence and impact of learning curves on outcome after robotic-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB). Methods A retrospective analysis of the first 300 RA-MIDCAB surgeries between July 2015 and December 2020 was performed. Learning curves were obtained via logarithmic regression for surgical time. Cumulative sum (CUSUM) analysis was performed for (I) major complications including MI, stroke, repeat revascularization, and mortality, and (II) other complications, including prolonged ventilation, pneumonia, pleura puncture, lung herniation, pericarditis, pleuritis, arrhythmia, wound complications, and delirium. Expected and unacceptable rates were set at 12% and 20%, respectively, for major complications, and at 40% and 60% for other complications, based on historical data in conventional coronary artery bypass grafting (CABG). Results Demographic characteristics did not differ between terciles, except for more smokers in the first tercile, and less hypercholesterolemia and more complex procedures in the third tercile. The mean surgical time for all operations was 258±81 minutes, ranging from 127 to 821 minutes. A learning curve was only observed in the first tercile. Subgroup analysis revealed that this learning curve was only observed for procedures consisting of single internal mammary artery (SIMA) with 1 or 2 distal anastomoses but not with bilateral internal mammary arteries (BIMA) or more than 2 distal anastomoses. CUSUM analysis showed that the cumulative rate of major and other complications never crossed the lines for unacceptable rates. Rather, the lower 95% confidence boundary was crossed after 50 cases, indicating improvement in safety. Conclusions These results suggest that integration of RA-MIDCAB in the surgical landscape can be safely achieved and complication rates can quickly be reduced below those expected in traditional CABG. Collective experience plays a key role in overcoming the learning curve when more complex procedures and cases are introduced.
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Affiliation(s)
- Jef Van den Eynde
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.,Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Hannah Vaesen Bentein
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Tom Decaluwé
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Herbert De Praetere
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - MaryAnn C Wertan
- Division of Cardiac Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Francis P Sutter
- Division of Cardiac Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Husam H Balkhy
- Division of Cardiac Surgery, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Wouter Oosterlinck
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Masrori P, Vaesen Bentein H, Raskin J, Montagna M, De Picker L, De Volder I, Van Schil PE, Janssens A, Mercelis R. Caspr2 autoantibody-associated Morvan syndrome predating thymoma relapse by 30 months. Lung Cancer 2021; 153:117-119. [PMID: 33485137 DOI: 10.1016/j.lungcan.2021.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/10/2021] [Indexed: 11/30/2022]
Abstract
Morvan's syndrome (MoS) is a rare autoimmune disorder characterized by central nervous system involvement, autonomic dysfunction and peripheral nerve hyperexcitability. MoS is believed to be caused by autoantibodies targeting contactin-associated protein 2 (Caspr2), a subunit of the neuronal voltage-gated potassium channel (VGKC) complex, usually in association with thymoma, less commonly with other malignancies. This case highlights an exceptional case of severe sleep disturbances and behavioural changes due to MoS, in a patient who would present with and be treated successfully for a second relapse of thymoma 30 months later. Originally he suffered from ocular myasthenia, another autoimmune disorder, which led to diagnosis of his original thymoma and first relapse.
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Affiliation(s)
- Pegah Masrori
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
| | | | - Jo Raskin
- Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium.
| | | | - Livia De Picker
- Department of Psychiatry, Antwerp University Hospital, Edegem, Belgium
| | - Ilse De Volder
- Department of Psychiatry, Antwerp University Hospital, Edegem, Belgium; Centre for Sleep, Antwerp University Hospital, Edegem, Belgium
| | - Paul E Van Schil
- Department of Thoracovascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Annelies Janssens
- Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Rudy Mercelis
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium
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