THORAXHEELKUNDE ARTS J., LERUT T., RUTGEERTS P., SIFRIM D., JANSSENS J., TACK J.: A one-year follow-up study of endoluminal gastroplication (Endocinch) in GERD patients refractory to proton pump inhibitor therapy. Dig. Dis. Sci., 2005; 50(2): 351-356. In a subset of patients with gastroesophageal reflux disease (GERD), symptoms persist in spite of proton pump inhibitor (PPI) therapy. Endoscopic gastroplication (EG) was reported to provide a novel therapeutic option in GERD. To evaluate symptomatic and objective outcome of EG in PPI refractory GERD, consecutive GERD patients with persisting reflux symptoms during at least 2 months double dose PPI were recruited for EG (Endocinch). Exclusion criteria were high-grade esophagitis, Barrett's esophagus, and hiatal hernia > 3 cm. Symptoms and PPI use were evaluated before and 1, 3, and 12 months after the EG; 24-hr pH monitoring off PPI was performed before and after 3 and 12 months. All data are given as mean +/- SD and were analyzed by Student's t test. Twenty patients (10 females; mean age, 45 +/- 11 years) were recruited. Under conscious sedation with midazolam (6 +/- 2 mg) and pethidine (53 +/- 5 mg), a mean of 2.0 +/- 0.2 sutures was applied during a procedure time of 33 +/- 6 min. Throat ache and mild epigastric pain for up to 3 days after the procedure were the only adverse events. At 3 and 12 months symptom score (11.6 +/- 6 vs. 6.4 +/- 3.7 [P < 0.01] and 7.1 +/- 4.5 [P < 0.05]) as well as pH monitoring (% time pH < 4: 17.0 +/- 11.1 vs. 8.1 +/- 5.7% [P < 0.01] and 9.8 +/- 4.1% [P < 0.01]) significantly improved. Ph monitoring was normalized (< 4% of time) in seven patients after 3 months. PPIs could be stopped in 13 patients, with 2 patients still using H2-blockers and 1 using cisapride after 3 months. After 12 months only six patients were free of PPI use and pH monitoring was normalized in six patients. We conclude that EG provides short- and medium-term symptomatic and objective relief to a subset of GERD patients refractory to high-dose PPI.
CHRISTIE J.D., VAN RAEMDONCK D., DE PERROT M., BARR M., KESHAVJEE S., ARCASOY S., ORENS J. and the working group on primary lung graft dysfunction: Report of the ISHLT working group on primary lung graft dysfunction. Part I: Introduction and methods. J. Heart Lung Transplant, 2005; 24(10): 1451-1453.
Primary graft dysfunction is a form of acute lung injury that follows the sequence of events inherent in the lung transplantation process, beginning with the brain death of the donor, pulmonary ischemia, preservation of donor tissue, transplantation, and reperfusion of donor tissue in the recipient. Despite numerous recent advances in organ preservation, surgical technique and perioperative care, post-transplant allograft dysfunction is sufficiently common to warrant the use of a wide range of synonyms. These include ischemia–reperfusion injury, re-implantation response, re-implantation edema, reperfusion edema, non-cardiogenic pulmonary edema, early graft dysfunction, primary graft dysfunction (PGD), primary graft failure (PGF) and post-transplant acute respiratory distress syndrome (ARDS) or acute lung injury (ALI). The expressions used to describe this condition are not perfectly synonymous, with some representing the most severe end of the spectrum of lung allograft ischemia–reperfusion injury and others representing less severe clinical syndromes. Despite variation in studies, it is clear that PGD is responsible for significant morbidity and mortality after lung transplantation. Furthermore, with efforts in place to expand the donor pool, the expectation is that efforts to treat and/or prevent PGD will remain important to the field of lung transplantation. The International Society of Heart and Lung Transplantation (ISHLT) Working Group on Primary Lung Graft Dysfunction was formed at the suggestion of the ISHLT Pulmonary Council in 2003. The purpose of this group was to review the available literature to provide a state-of-the-art, comprehensive series of documents to serve as a resource for clinicians and researchers. In addition, a major goal was to standardize consensus-defining criteria to facilitate future studies of PGD.
DEKETELAERE A., KELCHTERMANS G., STRUYF E., DE LEYN P.: Een beter begrip van ervaringsleren tijdens de stage (co-assistentschap) in het derde jaar van de artsopleiding. TMO, 2005; 24(1): 46-47. De kwaliteit van de leerervaringen tijdens de verschillende stagemomenten wisselt sterk. Dikwijls is er een groot accent op werken, ten koste van leren. Als theoretisch referentiekader werd gebruik gemaakt van het concept ‘Breed en Diep Ervaringsleren’, ontwikkeld binnen de Lerarenopleiding. Dit concept maakt een onderscheid tussen vorm en inhoud: naar vorm betekent ervaringsleren het expliciet terugblikken op ervaringen
om er leerinzichten en conclusies uit te trekken voor toekomstig handelen. Naar inhoud houdt breed ervaringsleren in dat de reflecties niet alleen de technische aspecten, maar ook de more, ethische en politieke dimensies van de ervaring betreffen. Diep ervaringsleren betekent dat er ook stil gestaan wordt bij de achterliggende opvattingen die aan de basis liggen van het handelen. Diep ervaringsleren heeft dus niet alleen een grotere effectiviteit van handelen maar ook een grotere geldigheid van de denkkaders tot gevolg.
DEKETELAERE A., KELCHTERMANS G., STRUYF E., DE LEYN P.: Spanningsvelden in de klinische leeromgeving. Een exploratieve studie van stage-ervaringen. TMO, 2005; 24(3): 103-112. Probleemstelling: De stage (het co-assistentschap) is een essentieel onderdeel van de opleiding tot arts, maar niet alle stages leiden tot de verhoopte leerresultaten. In dit artikel rapporteren we over een exploratief onderzoek naar de determinanten van de stage-ervaringen. Uitgangspunt is de idee dat die ervaring in belangrijke mate bepaald wordt door de betekenisvolle interactie tussen stagiair en stage-omgeving (in het bijzonder de stageleiders). Onderzoeksopzet en methodologie: Door middel van interpretatieve methodieken (student shadowing, interviews) werden gegevens verzameld bij acht stagiairs en hun stageleiders in twee perifere ziekenhuizen. De interpretatieve analyse van de gegevens werd ter validering voorgelegd aan focusgroepen van stagiairs en stageleiders. Resultaten: De analyse resulteerde in het identificeren van vijf componenten die toelaten de stage-ervaringen in kaart te brengen en te begrijpen. Elke component blijkt beschreven te kunnen worden in termen van een spanningsveld. Deze componenten zijn: 1) de stageagenda (werken versus leren), 2) de begeleidershouding (evaluator versus coach), 3) de stage-cultuur (beroepsgericht versus opleidingsgericht), 4) de leerhouding van de stagiair (receptief versus pro-actief), 5) de aard van het leerproces (informeel versus formeel). De spanningsvelden in de respectievelijke componenten dienen niet gezien te worden als op te lossen tegenstellingen, maar zijn als zodanig constitutief voor de stage-ervaring. De stagiairs bevinden zich onvermijdelijk en voortdurend in de dynamiek van die spanningsvelden en dit bepaalt de impact van de stage. Relevantie en besluit: De componenten en spanningsvelden vormen een conceptueel kader dat toelaat de stage-ervaringen systematischer in kaart te brengen en te analyseren. Voor de stagiairs helpt het om de ervaringen te duiden en het eigen leren te sturen. Aan stageleiders en opleidingsverantwoordelijken biedt het een begrippenkader om analytisch meer inzicht te verwerven in de betekenis van stage-ervaringen en om de kwaliteit van stageplaatsen als klinische leeromgeving te evalueren.
DE LEYN P., LISMONDE M., NINANE V., NOPPEN M., SLABBYNCK H., VAN MEERHAEGHE A., VAN SCHIL P., VERMASSEN F.: Belgian Society of Pneumology. Guidelines on the management of spontaneous pneumothorax. Acta Chir. Belg., 2005; 105: 265-267.
DEPREST J., JANI J., GRATACOS E., VANDECRUYS H., NAULAERS G., DELGADO J., GREENOUGH A., NICOLAIDES K. and the FETO Tast Group (VAN SCHOUBROECK D., VANDEVELDE M., DEVLIEGER H., CANNIE M., DYMARKOWSKI S., LERUT T., CARRERAS E., SALCEDO S., TORAN N., PEIRO J.L., MARTINEZ-IBANEZ V., COCKELL A., PATEL S., DAVENPORT M.: Fetal intervention for congenital diaphragmatic hernia: The European Experience. Semin. Perinatol., 2005; 29(2): 94-103. Fetuses with CDH presenting with liver herniation and a lung area-to-head circumference ratio of less than 1.0 have a high chance for neonatal death due to pulmonary hypoplasia. Fetal tracheal occlusion (TO) prevents egress of lung liquid, which triggers lung growth. In animal experiments, we were able to develop a minimally invasive technique for Fetoscopic Endoluminal Tracheal Occlusion (FETO) with a detachable balloon. In 2001, we demonstrated feasibility of FETO by percutaneous access in fetuses with severe CDH. In a retrospective multicenter review, we obtained LHR measurements and position of the liver in 134 cases of isolated left-sided CDH between 24 and 28 weeks. Eleven patients (8%) with LHR < 1.4 opted for termination. Overall survival of liveborn babies was 47% (58/123). LHR and position of the liver correlated both to survival. Combination of both variables predicted neonatal outcome better: liver up and LHR < 1.0 predicted a survival of 9%. When LHR < 0.6, there were no survivors irrespective of liver position. We could successfully perform endotracheal placement of the balloon in 20 cases at a median gestational age of 26 weeks. The mean duration of the operation was 22 (range 5-54) minutes. In 11 (55%) of these patients, there was postoperative prelabor (ie, <37 weeks) amniorrhexis. Membranes ruptured before 32 weeks in 35%, with a decreasing trend as experience increased. Ultrasound scans after FETO demonstrated an increase in the echogenicity of the lungs within 48 hours and improvement in the LHR from a median 0.7 (range 0.40.9) before FETO to 1.8 (range 1.1-2.9) within 2 weeks after surgery. The median gestation at delivery was 33.2 (range 27-38) weeks, and in 14 (70%) this occurred after 32 weeks. Surgical repair of the diaphragmatic hernia could be done in 13 babies, and in all but 1 the defect was extensive and required the insertion of a patch. Survival to discharge was 50%. These 10 long-term surviving babies are now aged 7 to 26 (median 19) months without known neurologic morbidity. Eight babies
died in the neonatal period due to complications of the underlying disease. Two nonsurvivors died from other causes but with appropriately developed lungs. Improved survival coincided with increasing experience, in turn related to reduced incidence of postoperative amniorrhexis, later delivery, and a change in the policy on the timing of removal of the balloon from intrapartum to the prenatal period. Survival in eligible contemporary controls was 1/12 (8%). The presence of liver herniation and a low lung-to-head ratio (LHR <1.0) is a good predictor of poor prognosis at different tertiary centers around the world. Severe CDH may be successfully treated with FETO, which is minimally invasive and may improve postnatal survival.
ECTORS N., DRIESSEN A., DE HERTOG G., LERUT T., GEBOES K.: Is adenocarcinoma of the esophagogastric junction or cardia different from Barrett adenocarcinoma? Arch. Pathol. Lab Med., 2005; 129(2): 183-185. Over time the relative distribution of cancers of the proximal digestive tract has changed. Squamous cell carcinomas of the esophagus have become less common, while numbers of adenocarcinomas have greatly increased. This shift most likely reflects an increase in the incidence of gastroesophageal reflux. Moreover, there is a decline in the incidence of distal gastric cancer, which in turn may be related to Heliobacter pylori eradication. Simultaneously, there is a time trend toward a more proximal localization of gastric cancer. If the above-mentioned etiopathologic links are correct, this could indicate that the so-called cardia adenocarcinomas are not related to H pylori infection and that they may instead be related to gastroesophageal reflux and eventually may not be considered to be "gastric" cancers. The rapidly growing quantity of literature on this subject is, however, confounding. A major source of discordance would seem to be a Babylonian confusion of tongues concerning the terms cardia and cardiac carcinomas. Unfortunately, this confusion is also apparent in the classification systems available for staging of cancer, thus closing the "vicious" circle.
GOVAERE E., VAN RAEMDONCK D., DEVLIEGER H., SMET M.H., VERBEKEN E., PROESMANS M., DE BOECK K.: Massive lung collapse with partial resolution after several years: a case report. BMC Pediatrics, 2005; 5: 39. Bacground: Bronchitis obliterans is a severe and extremely rare complication of respiratory tract infections in children and is characterized by massive atelectasis and collapse of the affected lung. Of the rare cases reported in the literature all surviving children underwent surgical resection of the collapsed lung.
Case presentation: We report an infant with bronchitis obliterans that was treated conservatively. 5 years after the initial event, partial lung re-expansion was documented. Conclusion: This case therefore supports a conservative treatment whenever possible with pneumonectomy only as a last treatment option.
LERUT T., CEULEMANS P., COOSEMANS W., DECKER G., DE LEYN P., NAFTEUX P., VAN RAEMDONCK D., DEJAEGER E.: De divertikel van Zenker. Tijdschr. voor Geneeskunde, 2005; 61(6): 464-476. De divertikel van Zenker is een aandoening die voornamelijk voorkomt in de geriatrische leeftijdsgroep. De symptomatologie behelst zowel de slokdarm als de luchtwegen en kan levensbedreigend zijn, zeker in aanwezigheid van belangrijke comorbiditeit. Hierbij moet men steeds bedacht zijn op de regelmatig voorkomende associatie met gastro-oesofagale reflux. De behandeling van de divertikel van Zenker kan gebeuren op verschillende manieren: via een open toegangsweg onder vorm van extramuceuze myotomie van de m. cricopharyngeus en de proximale gestreepte slokdarmspier gecombineerd met een resectie van de divertikel of een ophanging (diverticulopexie), of via een endoscopische weg onder vorm van cauterisatie of CO2 lasering van de zogenaamde “cricofaryngale baar” of een “staple”-oesofagodiverticulostomie. Deze diverse methoden kunnen heden ten dage op een veilige manier met een zeer laag mortaliteitsrisico worden uitgevoerd. De morbiditeit is over het algemeen laag met een korte hospitalisatieduur als resultaat. Het komt er bijgevolg op neer, mede het gegeven van een geriatrische populatie in acht nemend, om de behandelingsmethode te kiezen die het beste uitzicht biedt op een definitief resultaat waarbij de patiënt volledig klachtenvrij is. De open extramuceuze myotomie en de diverticulopexie lijken hiertoe de beste waarborgen te bieden.
LERUT T., COOSEMANS W., DECKER G., DE LEYN P., MOONS J., NAFTEUX P.: VAN RAEMDONCK D.: Surgical Techniques. J. Surg. Oncol., 2005. 92(3): 218-229. Adenocarcinoma of the esophagus and gastroesophageal junction (GEJ) has shown a remarkable increase during recent decades. Most patients are present with advanced stage disease, reflecting transmural growth and metastasis to lymph nodes at the time of diagnosis. Moreover, the pattern of lymph node dissemination is chaotic and difficult to predict, and despite the use of modern technology (e.g., spiral CT, EUS, FDG-PET), clinical staging remains suboptimal. These shortcomings in staging, as well as in different attitudes toward extent of resection and
lymphadenectomy, are reflected by a great variation in surgical techniques, which are discussed in this review. As to the results, primary surgery can currently be performed with low mortality, below 5% in high volume centers. Hospital mortality and morbidity are mainly related to pulmonary complications and anastomotic leaks, the latter mostly resolving under conservative treatment. Overall 5-year survival varies between 10% and 59%. As expected the most important prognostic determinants are completeness of resection (R0 vs. R1R2) and lymph node status (N0, N1). R0 resection currently offers 5-year survival rates of over 40%. Fiveyear survival figures for node-negative (N0) patients exceed 70%, and even for node-positive (N1), patients reach 25%. It is not known whether performing a threefield lymph node dissection is beneficial for patients with adenocarcinoma of the distal esophagus. With overall 5year survival currently exceeding 30%-40%, these figures should be the gold standard against which all other therapeutic modalities are compared.
LERUT T., NAFTEUX Ph., MOONS J., COOSEMANS W., DECKER G., DE LEYN P., VAN RAEMDONCK D.: Quality in the surgical treatment of cancer of the esophagus and gastroesophageal junction. Eur. J. Surg. Oncol., 2005; 31: 587-594. Surgical treatment of cancer of the esophagus and gastroesophageal junction (GEJ) remains a complex and challenging task. Quality of care may be improved by concentrating these patients in high volume centres in order to decrease post-operative mortality. However, it appears that hospital mortality is a poor tool to measure the quality. More likely specialisation as well as appropriate hospital environment supporting a dedicated multidisciplinary team are key elements in improving both the short term and long term results. The dedicated specialist surgeon has a key role in improving these results through surgical quality. The most important goal in the surgical treatment of these cancers is to perform a complete resection (R0). Data from literature seem to indicate that R0 resection combined with extensive lymphadenectomy are resulting in improved disease free survival and possibly in improved 5 year survival, often reported to exceed 35% after such interventions. These results suggest that there is a great need for standardisation of surgery. Such a standardisation and the resulting improved quality most likely will result in a significant improvement of outcome of esophagectomy for cancer of the esophagus and GEJ. These improvements in outcome should become the gold standard to which all other therapeutic regimens should be compared. Poor surgical quality and related poor results should not be a justification for multimodality regimen.
LERUT T., STAMENKOVIC S., NAFTEUX P., COOSEMANS W., DECKER G., DE LEYN P., MOONS J., VAN RAEMDONCK D.: Oesophageal cancer and cancer of the cardia. Staging: the role of endosonography, CT/MRI and PET. In: Gl Oncology and Innovative Aspects in Gastroenterology. Eds.: R. Arnold, P. Malfertheiner, D.J. Gouma, John Libbey Eurotext, Paris, 2005: pp.33-37. The vast majority of invasive esophageal tumours are detected by endoscopy or by a contrast study. Endoscopy with biopsy is required in all patients for histological confirmation. Vital staining using Lugol or Toluidin blue may be helpful to guide biopsy in cases of early carcinoma thus increasing diagnostic accuracy. Barium swallow will usually show an irregularly lined esophageal wall and is helpful mainly for topographic assessment of tumour extension and its relationship to the carina, as this may have therapeutic implications concerning the surgical access route.
SCHILDERMANS R., VANSTEENKISTE J., DE LEYN P., LIEVENS Y., NACKAERTS K., DOOMS C., VAN RAEMDONCK D., namens de Leuven Lung Cancer Group. Multimodale behandeling bij vroegtijdige stadia van nietkleincellig longcarcinoom: heden of toekomst. Tijdschr. voor Geneeskunde, 2005; 61(10): 783-790. Het niet-kleincellige longcarcinoom (NKCLC) komt veel voor. Slechts 20 tot 30% van de patiënten komt primair in aanmerking voor radicale chirurgie, maar zelfs hiervan is slechts 40 tot 50% nog in leven na 5 jaar. Er werd niet aangetoond dat adjuvante radiotherapie de overleving van deze patiënten verbetert. Talrijke recente grote studies wijzen wel op het nut van adjuvante, op cisplatine gebaseerde chemotherapie. Beperkte gegevens suggereren ook een voordeel wanneer dezelfde chemotherapie preoperatief of neoadjuvant wordt gegeven. Dit artikel omvat een beschrijving van de historische en meer recente gegevens betreffende adjuvante en neo adjuvante therapie bij vroegtijdige stadia van NKCLC, en de implicatie hiervan op de huidige dagdagelijkse praktijk.
TILANUS H.W., KOPPERT L.B., LERUT L.T.: Oesophaguscarcinoom. In: Oncology. Editors: Tilanus H.W., Kopper L.B., Lerut L.T., 2005, 7de herziene druk: 275-280. Wereldwijd stijgt de incidentie van het adenocarcinoom van de (Barrett-) oesophagus, bij een gelijkblijvende incidentie van het plaveiselcelcarcinoom. De diagnose wordt eenvoudig gesteld door oesofagoscopie en een biopsie, waarna op niet-invasieve wijze met endoscopische ultrasonografie, computertomografie en uitwendige echografie de prognose goed kan worden bepaald en een behandelplan kan worden opgesteld.
Een op curatie gerichte behandeling bestaat uit operatieve resectie, eventueel gecombineerd met neoadjuvante therapie. Een zelfontplooibare stent of brachytherapie is op dit moment in Nederland de meest gebruikte palliatieve behandeling. Gezien de diversiteit aan diagnostische mogelijkheden en het grote aantal, deels curatieve en deels palliatieve, behandelingsopties moet iedere patient met een oesophagocarcinoom worden behandeld door een multidisciplinair team van specialisten, zodat een optimaal behandelingsplan kan worden opgesteld.
VAN RAEMDONCK D., KLEPETKO W., VERLEDEN G.M., DAENEN W., COOSEMANS W., DECKER G., DE LEYN P., NAFTEUX P., LERUT T.: Surgical aspects of (cardio) pulmonary transplantation. Rev. Mal. Respir., 2005; 22(5): 785-795. Introduction and state of the art: Both short and longterm outcomes following lung transplantation have improved substantially in recent years as a result of advances in the selection and management of donors, organ preservation, immunosuppressive therapy, and the treatment of infectious and malignant complications. In addition surgical techniques have evolved over time and have contributed to this increase in success rates. Perspectives and conclusions: This review outlines surgical aspects of lung transplantation including a historical note, techniques of lung harvesting, some anaesthetic considerations, the different transplant types and incisions, as well as anastomotic techniques and their pitfalls.
VERLEDEN G.M., DUPONT L.J., VANHAECKE J., DAENEN W., VAN RAEMDONCK D.E.M.: Effect of Azithromycin on bronchiectasis and pulmonary function in a heart-lung transplant patient with severe chronic allograft dysfunction: a case report. J. Heart Lung Transplant, 2005; 24: 1155-1158. Azithromycin has been shown to be beneficial in several diseases with chronic neutrophilic inflammation of the airways, such as cystic fibrosis and bronchiolitis obliterans syndrome (BOS) after lung transplantation. Up to now, however, its healing effect on bronchiectasis has never been demonstrated. We report a heart-lung transplant patient who developed chronic rejection (BOS stage 3) with the appearance of gross bronchiectasis on a spiral computed tomography (CT) chest scan. Within 2 weeks after starting azithromycin, the patient's forced expiratory volume in 1 second increased significantly and a repeat spiral CT chest scan 5 months later, showed a major improvement of the bronchiectasis. This case report illustrates that bronchiectasis may greatly improve after treatment with azithromycin and no longer
needs to be considered an endstage finding in patients with severe BOS.
VERLEDEN G.M., DUPONT L.J., VAN RAEMDONCK D.E.M.: Bronchiolitis obliterans syndrome after lung transplantation. Minerva Pneumol., 2005; 44: 123-133 Lung and heart-lung transplantation are currently recognized as effective treatment modalities for selected patients with end-stage lung or heart-lung disease. Although the survival rates have improved in recent years, long-term survival remains inferior compared to other solid organ transplantations, such as kidney, heart and liver. The main reason is the development of chronic rejection, which histologically manifests as obliterative bronchiolitis (OB), a process that leads to airways obstruction, with a gradual decline in pulmonary function tests. Because of the difficulties in obtaining good pathological specimens, a clinical grading system, called bronchiolitis obliterans syndrome (BOS) has been introduced, divided into 4 and, more recently, 5 categories, depending on the severity of airflow obstruction. Extensive research efforts have attempted to unravel the pathophysiology of OB and identify key process; Once established, the response to treatment is very poor, although recently treatment with azithromycine, a neomacrolide antibiotic with extensive anti-inflammatory effects, has proven to be effective in at least some of these patients. This paper intends to review the current knowledge of BOS and OB after heart-lung and lung transplantation.
VERLEDEN G.M., DUPONT L.J., VAN RAEMDONCK D.E.: Is it bronchiolitis obliterans syndrome or is it chronic rejection : a reappraisal? Eur. Respir. J., 2005; 25(2): 221224. Chronic rejection (obliterative bronchiolitis) is the single most important cause of chronic allograft dysfunction and late mortality after lung transplantation. As this condition is difficult to prove using biopsy specimens, a clinical term, bronchiolitis obliterans syndrome (BOS) has been in use for >10 yrs to describe the progressive decrease of pulmonary function. However, before diagnosing a patient as having BOS, based on a sustained and progressive decrease in forced expiratory volume in one second and/or forced mid-expiratory flow between 25-75% of forced vital capacity, different confounding factors have to be eliminated. Treatment of BOS mainly consists of an increase or a change in the immunosuppressive drug regimen, which may lead to more pronounced infectious complications. Recently, two new options have become available to treat patients with BOS, treatment of gastro-oesophageal reflux and azithromycin. In the present paper, the authors give an overview of the current data on these two modalities, which may lead to a restoration of the pulmonary
function in some of the patients, illustrating once more the fact that bronchitis obliterans syndrome is not always a manifestation of chronic rejection.
VERLEDEN G.M., DUPONT U., VAN RAEMDONCK D.E.M.: Current issues in lung transplantation. Int. J. Resp. Care, 2005; 99-105. Over two decades have passed since long-term survival was first achieved following heart-lung and lung transplantation in humans. Since the beginning of the successful lung transplantation era, survival has improved dramatically, but this has been almost entirely due to reduction in early (90-day) mortality. This is the result of better surgical techniques and improvements to anaesthetic and perioperative management using very effective immunosuppressive drugs and extensive antibacterial, antifungal and antiviral prophylaxis. Nowadays, a mean actuarial five-year survival of 40-50% can be achieved, even increasing to over 60-70% for selected indications such as cystic fibrosis and emphysema in some high volume centres. Figure 1 describes the evolution of survival in the Leuven lung transplant programma, clearly indicating that early postoperative mortality has decreased, but also showing better long-term survival, which is mainly due to early recognition and treatment of chronic allograft dysfunction. Although the results seem to improve, there are still some issues that need resolving before survival will match the success of other solid organ transplantations. The aim of this paper is to summarise these ongoing problems in lung transplantation.
VERLEDEN G.M., DUPONT U., VAN RAEMDONCK D., DELCROIX M., VANHAECKE J., DAENEN W. en de Leuvense Longtransplantgroep: Long- an hart-longtransplantaties in de Universitaire Ziekenhuizen Leuven: indicaties en resultaten. Tijdschr. voor Geneeskunde, 2005; 61(17): 12301235. In dit artikel presenteren we een overzicht van de indicaties en resultaten van 245 hart-long en longtransplantaties bij 241 patiënten in het Universitair Ziekenhuis Gasthuisberg (U.Z. Leuven). We benadrukken de duidelijke verbetering van de overlevingsresultaten naarmate de ervaring is toegenomen. Hoewel nog een aantal belangrijke problemen blijven bestaan, zijn er de laatste jaren toch meer mogelijkheden beschikbaar geworden om bv. chronische rejectie vroeger te diagnosticeren en beter te behandelen. Samen met een belangrijke vermindering van de perioperatieve mortaliteit, heeft dit ongetwijfeld bijgedragen tot een betere overleving op lange termijn.
