Wilhelm P. Mistiaen

Maternal Position and Other Variables: Effects on Perineal Outcomes in 557 Births

BACKGROUND Damage to the perineum is common after vaginal delivery, and it can be caused by laceration, episiotomy, or both. This study investigated the effects of maternal position (lateral vs lithotomy) and other variables on the occurrence of perineal damage. METHODS A retrospective study included the examination of hospital records from 557 women. The effects of demographic characteristics, gravidity, parity, duration of pregnancy, reason for admission, and mode of labor on perineal outcomes were investigated through univariate (independent sample t test, chi-square test) and multivariate analysis (logistic regression analysis). RESULTS Considering episiotomy as perineal damage, univariate analysis showed a protective effect of the lateral position (45.9% vs 27.9%, p > 0.001), and fewer episiotomies were performed (6.7% vs 38.2%) with this position. This protective effect for perineal damage disappeared on excluding women undergoing episiotomy from analysis. Multivariate analysis including all participants showed an increase of 47 percent in the likelihood of an intact perineum for the lateral position when compared with the lithotomy position (OR: 0.53; 95% CI: 0.36-0.78). Parity was associated with a reduction of 44 percent in perineal damage (OR: 0.56; 95% CI: 0.47-0.78, p < 0.001). Moreover, the lithotomy position was associated with significantly more episiotomies than the lateral position (7% vs 38%, p < 0.001). The odds of perineal damage increased in deliveries performed by physicians (OR: 2.92; 95% CI: 1.79-4.78). CONCLUSIONS Childbirth in the lateral position resulted in less perineal trauma when compared with childbirth in the lithotomy position, even after correcting for parity and birth attendant. The probability of an intact perineum increased in deliveries performed by midwives. (BIRTH 39:2 June 2012).

Gastric Emptying Rate Measurement after Vertical Banded Gastroplasty

Background: In vertical banded gastroplasty (VBG), a small proximal gastric pouch is created, which is believed to fill rapidly and to empty slowly. Methods: In 13 patients who underwent VBG, gastric emptying rate was measured. A radiolabelled solid test meal was used before and 2 weeks after operation. From a region of interest above the whole stomach, the proximal pouch and the distal stomach, half emptying time as well as retention percentage were derived. Results: All patients experienced early satiety and gastric fullness after ingestion of a small test meal. The proximal pouch emptied rapidly.The evacuation of the test meal from the whole gastric region as well as the distal stomach were not altered significantly by the operation. Conclusion: VBG is a safe operation which reduced weight significantly. Early satiety, however, induced by this technique, cannot be explained alone by slow emptying of the proximal pouch. The nature of the outlet of the pouch as well as the behavior of its wall must be considered.

Gastric emptying for solids in patients with duodenal ulcer before and after highly selective vagotomy

In a series of 31 duodenal ulcer patients (23 males and 8 females), who underwent a highly selective vagotomy, gastric emptying characteristics of a solid meal, labeled with [su99mTc]stannous colloid, were assessed before, two weeks and six months after operation. The clinical diagnosis was confirmed by endoscopy and x-ray; failure of treatment with H2 antagonists or antacids during 1–18 (mean 5) years was the direct indication for operative treatment. A temporary delay in gastric emptying is noted two weeks after operation (T 1/2: 124 vs 57 min). After six months, gastric emptying time has practically normalized. It appears that this is the result of the preservation of the antropyloric vagal nerve supply. In these patients, a 10% recurrence rate is noted, comparable to the results in the literature. Highly selective vagotomy proves to be a safe and effective procedure with few side effects. It does not impair gastric motility.

The risk of postoperative pulmonary or pleural complications after aortic valve replacement is low in elderly patients: an observational study

QUESTION What factors predict postoperative pulmonary and pleural complications following aortic valve replacement? DESIGN Retrospective study. PARTICIPANTS One thousand consecutive patients who underwent aortic valve replacement with a pericardial valve between 1986 and 2006. Of these, 610 underwent also coronary artery surgery. OUTCOME MEASURES Thirty putative predictors were investigated. Postoperative pulmonary complications (defined as respiratory failure, pneumonia, atelectasis) and postoperative pleural complications (defined as pleural effusion, pneumothorax, haemothorax, empyema) within 30 days of surgery were identified. RESULTS 58 (6%) patients developed pulmonary complications and 45 (5%) developed pleural complications. None of the pleural and only 3 of the pulmonary complications were fatal if they occurred alone. Postoperative heart failure (OR 4.7, 95% CI 1.8 to 11.9), previous pacemaker implant (OR 4.4, 95% CI 1.8 to 11.2) and chronic obstructive pulmonary disease (OR 1.7, 95% CI 1.0 to 3.1) independently predicted postoperative pulmonary complications. Postoperative bleeding (OR 7.4, 95% CI 1.8 to 29.9), carotid artery disease (OR 2.8, 95% CI 1.4 to 5.5), previous coronary artery surgery (OR 2.7, 95% CI 1.1 to 6.4), chronic obstructive pulmonary disease (OR 1.9, 95% CI 1.0 to 3.8) and cardiac conduction defect (OR 1.9, 95% CI 1.0 to 3.7) independently predicted postoperative pleural complications. CONCLUSIONS Postoperative pulmonary and pleural complications were rare. A history of cardiac and/or pulmonary problems are risk factors for pulmonary complications after aortic valve replacement. Further study is needed to reveal if preventive physiotherapeutic intervention in these patients is effective.

Autophagy as Mechanism for Cell Death in Degenerative Aortic Valve Disease: An Underestimated Phenomenon in Cardiovascular Diseases

Once degenerative aortic valve disease becomes symptomatic, valve replacement is necessary for prognostic and symptomatic reasons. In elderly patients, symptoms of degenerative aortic valve can often be doubtful. Therefore, it is difficult but important to distinguish patients who need surgery from those who do not. Estimation of the rate of the progression of this disease can be helpful herein because one needs to bear in mind that aortic valve degeneration is an active process, which can influence the rate of progression. Recently, autophagy was discovered as a mechanism of cell death in different cardiovascular diseases such as atherosclerosis, aortic valve degeneration, heart failure and at regions around heart infarctions. Thus understanding autophagy in all its details can be helpful to contribute insights into the cell death machinery of cardiovascular diseases. This could open ways for inhibition of cell death in cardiovascular disease and possibly define targets for future drug design. Addendum to: Histological Evaluation of Autophagic Cell Death in Calcified Aortic Valve Stenosis P. Somers, M. Knaapen, M. Kockx, H. Bortier and W. Mistiaen W J Heart Valve Dis 2006;15:43-8

Comparison of the Effect of Conventional Highly Selective Vagotomy and Anterior Gastric Wall Stapling with Posterior Truncal Vagotomy on the Gastric Emptying Rate for Solid Meals in Beagle Dogs

Anterior gastric wall stapling combined with posterior truncal vagotomy has been used as a new and adequate gastric acid output-reducing procedure. Severing the posterior vagal trunk as well as stapling the anterior gastric wall could impair gastric emptying. In this study, the gastric emptying rate for solid food, using a radionuclide technique, has been evaluated in 2 series of canine experiments. Compared to the results after conventional highly selective vagotomy, a temporary delay in the gastric emptying rate could be found after this new procedure, however, completely normalizing 1 year later.

Can a submaximal exercise test predict peak exercise performance in dancers

Abstract Professional dancers are artistic athletes who require high aerobic conditioning to perform at their best. Moreover, high aerobic conditioning may control overtraining and prevent injuries. A submaximal exercise test that is easy to administer and allows prediction of maximal oxygen consumption in dancers would be a powerful tool for coaches, physiotherapists, and sports medicine physicians to screen physical fitness and evaluate the effects of aerobic exercise training. In the present study, the values recorded for a submaximal exercise test called the Aerobic Power Index were compared with peak aerobic power values in 44 dance students. The Aerobic Power Index proved to be an acceptable submaximal field test for evaluating aerobic power and predicting peak oxygen consumption in dancers.

Histopathology of calcific aortic valve stenosis.

Calcific aortic valve stenosis is the most common and increasing heart valve disease in the western world. In the last 30 years, diagnosis and management were revolutionized by the development of cardiac catheterisation, echocardiography, cardiac surgery, and medication. Recently, new strategies were introduced for aortic valve replacement using more sophisticated bioprosthetic heart valves. Moreover, tissue-engineered heart valves are under development to improve management strategies. In this article we review the current morphological and histopathological findings in the progression of calcific aortic valve stenosis.This is, to our understanding, important to contribute to the knowledge of fundamental management strategies of this disease.

Evaluation of cell death markers in severe calcified aortic valves.

Degenerative aortic valve disease is the most frequent acquired valve disease. Especially in the elderly, its prevalence is increasing. Once the disease becomes symptomatic, it is rapidly fatal. The disease cannot be considered a result of aging alone. The condition is an active process, which occurs with rapid progression, especially when calcification can be documented. This calcification can be the end result of cellular mechanisms involving cell death pathways (such as autophagy) and cellular matrix remodeling. These processes are beginning to be unraveled in the initiation and propagation of the disease. Autophagy could be the common step through which these mechanisms lead to this pathway of cell death in this disease. Autophagy can be detected by procedures described hereafter.

Cancer in heart disease patients: what are the limitations in the treatment strategy?

Cardiovascular disease and cancer are leading causes of morbidity and mortality, and can both be present in one patient. In patients with simultaneous disease, the most threatening disease should be treated first. This is usually heart disease, but this can pose specific problems. If percutaneous coronary intervention is preferred, bleeding and thrombotic tendencies have to be taken into account in the subsequent treatment of the malignancy. With coronary artery bypass grafting, the advantages and disadvantages of one- or two-stage procedures, and the use of extracorporeal circulation have to be balanced. Development of heart disease after treatment of malignancy could be due to radiotherapy and chemotherapy. The effects of these cancer treatments have to be taken into account for the treatment options of the heart disease and the postoperative prognosis.