Papers by Wilhelm Mistiaen
Journal of Cancer Science & Therapy, Nov 27, 2014
A history of malignancy can be considered as a contraindication for heart transplantation in pati... more A history of malignancy can be considered as a contraindication for heart transplantation in patients with end-stage heart failure. A systematic search of the available literature about this theme resulted in some older case reports (n=3) and small series. More recent series are larger (n=10), have a specific design or rely on nationwide databases (n=2). All reports are retrospective in nature. Entirely pediatric series are excluded. The preoperative profile of the patients include demographics, time interval between malignancy and transplantation (if available), indication of transplantation and co-morbid conditions. Postoperative results include hospital mortality, long-term survival, recurrence of malignancy, infection and rejection rate. Findings: 1) 10 to 27% of cancer survivors suffer from chemotherapy-related cardiomyopathy. Moreover, two series show that the number of surviving cancer patients, needing transplantation is increasing; chemotherapy related end-stage heart failure almost doubled as indication for transplantation between the periods 2000-2004 and 2004-2008. 2) Hospital mortality varied between 0-10% in small series and seems comparable to patients without malignancy. 3) The same is true for 5-year survival, being 55-75%. The disease free interval between malignancy and transplantation has an important effect on postoperative survival and on recurrence rate of cancer: 5-year survival decreases from 80% to 55% if the interval decreases from 5 to 1 year. Recurrence rate of cancer increases from 6% to 63%. Although the published series are not comparable, it can be concluded that transplantation in patients with prior malignancy can be justified when the interval between malignancy and transplantation exceeds 5 years.
Journal of Cancer Science & Therapy, Nov 27, 2014
C ardiovascular disease and cancer are leading causes of mortality. Due to common risk factors, b... more C ardiovascular disease and cancer are leading causes of mortality. Due to common risk factors, both conditionscan be present simultaneously or subsequently in one patient. A systematic literature search reveals that the presence of malignancy in cardiac patients series varies between 1.9 and 4.2%. In patients with simultaneous disease, the most threatening disease should be treated first. This is usually the heart disease. If percutaneous coronary intervention is preferred, an antithrombotic treatment protocol has to be observed. Resulting bleeding and thrombotic tendencies have to be taken into account in the subsequent treatment of the malignancy.Using coronary artery bypass grafting, combined or two-staged procedures are possible. A combinedoperation has the advantage of one admission and one anesthesia. It also avoids tumor progression during while waiting for a second operation in a staged procedure. Thirty-day mortality (between 4-7% in most series) and 5-year survival (up to 60%) after the combined procedure are comparable to results in patients without malignancy. Postoperative infection is problematic in patients with hematologic malignancies.In patients with heart disease after malignancy treated with curative intent,postoperative hospital mortality seems comparable to patients without prior malignancy. Five-year survival can be up to 80%, but the only existing large series with sufficiently long-term follow-up indicates that the time interval between cancer treatment and cardiac surgery plays a dominant role: if this is below 2 years, 5-year mortality, especially due to metastasis, rises from 11 to 58%. In conclusion, aggressive treatment of both conditions in selected patients is worthwhile. Wilhelm P. Mistiaen graduated as MD at the University of Antwerp in 1984. In 1994, he completed a surgical training and registered as surgeon. He completed his first PhDin 1999 and a second one in 2009 at the same university. Currently, he is lecturer and associate professor of Anatomy and of Pathology at the University of Antwerp / Artesis-Plantijn University College.The focus of interest is complications after aortic valve replacement. Another focus is heart disease in patients with (prior) malignancy. Several manuscripts appeared on these topics. He is a regular reviewer for the European Journal of Cancer Prevention.
Acta Chirurgica Belgica, 2012
Aortic valve replacement has some major adverse outcomes. For these, the predictors need identifi... more Aortic valve replacement has some major adverse outcomes. For these, the predictors need identification. This was a retrospective file study of 1000 consecutive patients who underwent AVR for degenerative aortic valve disease. Twenty-five preoperative and 5 peroperative factors were screened by a univariate Fisher-exact analysis. The predictors were identified in a second step by logistic regression multivariate analysis. Five hundred thirty patients were male. The mean age was 75 (71-77) years and 610 also underwent CABG. For hospital mortality, need for urgent aortic valve replacement (p < 0.001) was the dominant predictor. Need for digitalis (p = 0.002) and age > 80 (p = 0.005) followed. For postoperative congestive heart failure, need for urgent aortic valve replacement was also dominant (p <0.001). Atrial fibrillation (p = 0.001,) and ejection fraction < 50% (p = 0.055) were less important. For ventricular arrhythmia, previous infarction (p = 0.025) and ejection fraction < 50% (p = 0.032) were identified. For bleeding, concomitant CABG (p = 0.046) and chronic obstructive pulmonary disease were identified. For thromboembolic events only an ejection fraction < 50% (p = 0.027) was identified. Need for urgent aortic valve replacement is the dominant predictor for postoperative mortality and congestive heart failure. Once a degenerative aortic valve disease becomes symptomatic, prompt referral could prevent the development for need for urgent surgery, with all its adverse postoperative consequences.
Journal of nursing management, Jan 30, 2016
This study investigated whether Nigerian nurses' emotional exhaustion and active learning wer... more This study investigated whether Nigerian nurses' emotional exhaustion and active learning were predicted by job demands, control and social support. Limited research has been conducted concerning nurses' work stress in developing countries, such as Nigeria. Accordingly, it is not clear whether work interventions for improving nurses' well-being in these countries can be based on work stress models that are developed in Western countries, such as the job demand control support model, as well as on empirical findings of job demand control support research. Nurses from Nurses Across the Borders Nigeria were invited to complete an online questionnaire containing validated scales; 210 questionnaires were fully completed and analysed. Multiple regression analysis was used to test the hypotheses. Emotional exhaustion was higher for nurses who experienced high demands and low supervisor support. Active learning occurred when nurses worked under conditions of high control and hig...
The Journal of Thoracic and Cardiovascular Surgery, 2007
Anticancer research, 2009
Cancer and chronic fatigue syndrome (CFS) are both characterised by fatigue and severe disability... more Cancer and chronic fatigue syndrome (CFS) are both characterised by fatigue and severe disability. Besides fatigue, certain aspects of immune dysfunctions appear to be present in both illnesses. In this regard, a literature review of overlapping immune dysfunctions in CFS and cancer is provided. Special emphasis is given to the relationship between immune dysfunctions and fatigue. Abnormalities in ribonuclease (RNase) L and hyperactivation of nuclear factor kappa beta (NF-kappaB) are present in CFS and in prostate cancer. Malfunctioning of natural killer (NK) cells has long been recognised as an important factor in the development and reoccurrence of cancer, and has been documented repeatedly in CFS patients. The dysregulation of the RNase L pathway, hyperactive NF-kappaB leading to disturbed apoptotic mechanisms and oxidative stress or excessive nitric oxide, and low NK activity may play a role in the two diseases and in the physiopathology of the common symptom fatigue. However, i...
The Journal of heart valve disease, 2007
The number of patients undergoing valve repair and replacement or catheter-based interventions ha... more The number of patients undergoing valve repair and replacement or catheter-based interventions has continuously increased during recent decades, such that today in Europe approximately 50,000 cases are reported each year (1). Despite substantial progress ...
The Journal of heart valve disease, 2005
Prosthetic valve thrombosis (PVT) is a life-threatening disease, for which treatment strategies h... more Prosthetic valve thrombosis (PVT) is a life-threatening disease, for which treatment strategies have been controversial. Herein, existing data on management options are reviewed, and conclusions drawn as to the choice and use of treatment strategies for PVT. The use of transesophageal echocardiography (TEE) allows distinction to be made between obstructive and non-obstructive PVT by the presence or absence of occluder motion limitation. The differentiation of PVT from pannus and vegetation is, however, still limited by TEE. The incidence of PVT has been underestimated by not taking into account a large percentage of non-obstructive PVT. Although the standard treatment for PVT has been surgery, thrombolysis has lower mortality rates, particularly in patients in NYHA functional classes III-IV. The lowest complication rates with thrombolysis have been achieved in patients with non-obstructive PVT. Pregnancy, left atrial appendage thrombi and large PVT are not contraindications to throm...
The Journal of heart valve disease, 2005
Major reasons for the considerable heterogeneity among published results of heart valve surgery a... more Major reasons for the considerable heterogeneity among published results of heart valve surgery are inconsistency in follow up techniques, reporting systems and classification of adverse events. The present recommendations are intended to harmonize the presentation of clinical material in order to improve comparison of data from different sources for the analysis of pooled data. The quality of an observational study is largely, if not entirely, due to the follow up technique, which may be graded according to six categories: Self-reporting of adverse events/well-being by the patients may be classified 'excellent'; if the information is gathered and re-checked at short-term intervals. Data obtained from in-hospital or outpatient examinations by qualified examiners at least twice a year or other personal contact through qualified examiners may be regarded as 'sufficient', if the results are re-checked by contacting the treating home physician. All other follow up techni...
Journal of Manipulative and Physiological Therapeutics, 2012
The purpose of this study was to evaluate musculoskeletal injury rate and physical fitness before... more The purpose of this study was to evaluate musculoskeletal injury rate and physical fitness before and 6 months after an endurance, strength, and motor control exercise program in preprofessional dancers. This uncontrolled trial was completed at a college offering a professional bachelor degree in dance. Forty preprofessional dancers underwent a test battery before and after a 6-month lasting exercise program in addition to their regular dance lessons. Physical fitness was evaluated by means of a submaximal exercise test with continuous physiological monitoring and by a field test for explosive strength. Anthropometric measurements were taken to analyze the influence of fitness training on body composition. Musculoskeletal injury incidence and quality of life were recorded during the 6-month lasting intervention. An intention-to-treat analysis ("last observation carried forward" method) was used with a Student t test for normally distributed variables. The Wilcoxon signed rank and Mann-Whitney U tests were used as nonparametric tests. Physical fitness improved after the 6 months of additional training program (P<.05). The waist:hip ratio (P=.036) and the sum of the measured subcutaneous skin thickness (P=.001) significantly decreased. Twelve dancers developed musculoskeletal complaints, requiring temporary interruption of dancing. The combination of regular dance lessons with an additional exercise program resulted in improved physical fitness in preprofessional dancers, without affecting the aesthetical appearance. A relatively high injury rate was observed during the intervention period. These results suggest that a randomized, controlled trial should be performed to examine the effectiveness of additional exercise in dancers on physical fitness and musculoskeletal injury rate.
Birth, 2012
BackgroundDamage to the perineum is common after vaginal delivery, and it can be caused by lacera... more BackgroundDamage 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.MethodsA 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).ResultsConsidering 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 ...
Journal of Nuclear Medicine Technology, Sep 1, 1996
This study investigates the behavior of two different radionuclide labels for liquid test meals a... more This study investigates the behavior of two different radionuclide labels for liquid test meals and the stability of radionuclide labeling of solid meals. Methods: Technetium-99m DTPA and 99 mTc colloid were compared as labels for liquid test meals in an in vivo investigation of gastric emptying rate. Half emptying time and retention percentages were used as parameters. Stability of solid test meals labeling using 99 mTc colloid on liver pate was determined in vitro. After incubation in gastric acid, samples of the labeled solid meals were incubated in bile with pancreatic juice. After separation, activity of 99 mTc is determined in the solid phase and in the supernatant. Technetium-99m activity was also measured in plasma during gastric emptying measurements for solids in healthy volunteers. Results: Liquid gastric emptying was faster if DTPA was used. Colloid remained in the stomach longer. There was little dissociation of 99 mTc from the solid test meal into gastric acid and into bile with pancreatic juice. Activity levels of 99 mTc in plasma remained low throughout the emptying study. We prefer DTPA as the label for gastric emptying study of liquid meals. We suspect that colloid adheres to the gastric wall and falsifies the results. The current labeling of solid test meals is stable in gastric and duodenal environments. Adsorption of 99 mTc into plasma remains very limited. Subsequent resecretion of 99 mrc in whatever form into gastric juice is excluded.
Journal of Nuclear Medicine Technology, 1996
Objective: This study investigates the behavior of two dif ferent radionuclide labels for liquid... more Objective: This study investigates the behavior of two dif ferent radionuclide labels for liquid test meals and the sta bility of radionuclide labeling of solid meals. Methods: Technetium-99m DTPA and 99 mTc colloid were compared as labels for liquid test meals in an in vivo inves tigation of gastric emptying rate. Half emptying time and retention percentages were used as parameters. Stability of solid test meals labeling using 99 mTc colloid on liver pate was determined in vitro. After incubation in gastric acid, samples of the labeled solid meals were incubated in bile with pancreatic juice. After separation, activity of 99 mTc is determined in the solid phase and in the supernatant. Tech netium-99m activity was also measured in plasma during gastric emptying measurements for solids in healthy volun teers. Results: Liquid gastric emptying was faster if DTPA was used. Colloid remained in the stomach longer. There was little dissociation of 99 mTc from the solid test meal into ...
Abstract — In some patients, the severity of aortic valve stenosis is difficult to estimate. In... more Abstract — In some patients, the severity of aortic valve stenosis is difficult to estimate. In an elderly patient with aortic valve stenosis, heart failure and other co-morbid conditions, severity of aortic valve stenosis was estimated with a dobutamine stress echocardiography. The patient died six days after valve replacement. A literature search revealed pitfalls in the diagnostic procedure and difficulties in the interpretation of dobutamine stress echocardiography. Absence of contractile reserve, low mean transvalvular gradient and presence of coronary artery disease in this patient can be considered as increased risk. However, valve replacement might be offered on an individual basis.
Methods in enzymology, 2009
Degenerative aortic valve disease is the most frequent acquired valve disease. Especially in the ... more 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.
The Journal of heart valve disease, 2007
Over the past 20 years, both the typical age and co-morbidity of patients referred for aortic val... more Over the past 20 years, both the typical age and co-morbidity of patients referred for aortic valve replacement (AVR) have increased. In order to assess the effect of these changes on hospital complications, an evaluation was conducted of patient characteristics within this time period. This retrospective study included 1,000 consecutive patients who underwent AVR with a pericardial valve. Concomitant coronary artery bypass grafting (CABG) was performed in 610 cases. Among 25 preoperative and five perioperative factors, and eight hospital complications, the changes in incidence that occurred during the periods 1986-1991, 1992-1996, 1997-2001, and 2002-2006, were investigated. Predictive factors for non-cardiac hospital complications required further exploration, as these were the only complications to increase significantly with time; however, this type of complication is less lethal. Significant increases were identified in age, and in the incidence of non-cardiac co-morbidity, pre...
The Journal of heart valve disease, 2006
Calcification in aortic valves is the most common valvular lesion in western populations. This ev... more Calcification in aortic valves is the most common valvular lesion in western populations. This event is correlated with cellular degeneration in the valvular cusps, although there is no exact evidence how these cells die: this requires further exploration. Twelve human severely calcified aortic valves obtained during cardiac surgery were studied by semi-quantitative analysis, and results compared with data from 12 human control aortic valves obtained during autopsy. Tissue analysis was by hematoxylin and eosin and Alcian blue staining. Detection of neurons was by immunohistochemical staining of PGP9.5 and neurofilament. In order to detect autophagy, an immunohistochemical staining for ubiquitin was used. The TUNEL technique was used to detect apoptosis. Co-localization of Alizarin red with ubiquitin labeling was performed on non-decalcified aortic valves. Hematoxylin and eosin staining showed moderate to severe mineralization in 10 of 12 patients in the surgical group, but in only o...
The Journal of heart valve disease, 2004
The study aim was to determine if aortic valve replacement in octogenarians is still rewarding. B... more The study aim was to determine if aortic valve replacement in octogenarians is still rewarding. Between 1986 and 2000, 500 patients received a Carpentier-Edwards pericardial valve in the aortic position. Of these patients, 348 also underwent coronary artery bypass grafting (CABG). Sixty patients were aged > or =80 years. A retrospective follow up totaled 2,022 patient-years. A Cox multivariate regression analysis included 17 preoperative potential risk factors: age >80 years; gender; carcinoma; chronic obstructive pulmonary disease; renal failure; stroke; arterial hypertension; carotid artery disease; myocardial infarction; coronary artery disease; conduction defects; atrial fibrillation; medically treated endocarditis; severity of symptoms; urgent operation; left ventricular function; and need for digitalis. For hospital mortality, independent predictors were urgent surgery (Risk Ratio 10.2, 95% CI 2.5-42.0, p = 0.001); age over 80 (RR 4.5, CI 1.3-14.9; p = 0.015); need for d...
Hepato-gastroenterology
Gastric emptying rate for solid and for liquid test meals was investigated retrospectively in pat... more Gastric emptying rate for solid and for liquid test meals was investigated retrospectively in patients with longstanding epigastric distress after partial gastrectomy, either as primary treatment or after failure of vagotomy for peptic ulcer in order to find an explanation for the postoperative symptoms. Radionuclide-labeled liquid and solid test meals were used to evaluate gastric emptying rate, at least one year after surgery. The lag phase for liquid test meals disappeared in all operated patients. Partial gastrectomy usually lead to fast emptying but this resective procedure, if performed after vagotomy, lead to stasis in a significant number of patients. Gastric emptying rate for solids increased in only a few of these symptomatic patients. In most of them however, there was a normal to decreased emptying rate. If a vagotomy had preceded the resective procedure, gastric emptying rate decreased significantly. In all these symptomatic patients, gastric emptying had been disturbed...
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Papers by Wilhelm Mistiaen