Care for adult non-ICU Covid-19 patients: early experiences from a Belgian tertiary care centre.

The current Covid-19 outbreak poses many challenges on hospital organisation and patient care. Our hospital lies at the epicentre of the Belgian epidemic. On April 1st, a total of 235 Covid-19 patients had been admitted to our hospital. This demanded an unprecedented adaptation of our hospital organisation, and we have met many clinical issues in the care for Covid-19 patients. In this article, we share our experience in the handling of some of the practical and organisational issues in the care for Covid-19 patients.

'Difficult asthma': can symptoms be controlled in a structured environment?

OBJECTIVE: Difficult asthma implies persistent asthma symptoms despite therapy with high doses of inhaled corticosteroids. The objective was to evaluate children with difficult asthma in a setting that excludes aggravating factors such as poor treatment adherence and adverse environmental influences. PATIENTS AND METHODS: Sixty children (> or =6 years) had been referred because of difficult asthma to the rehabilitation centre over a period of 10 years. The diagnosis of poor asthma symptom control was confirmed if exacerbations continued during stay in the centre or if symptoms interfered with daily activities at least 3 times a week. RESULTS: The median stay at the centre was 5 months. In four patients a diagnosis other than asthma was made. In five patients symptom control remained difficult. In the remaining 51 children, asthma symptoms became well controlled. Many factors contributed to poor asthma control in the home setting: poor treatment adherence (n = 32), parental smoking (n = 22), allergen exposure (n = 10). Psychosocial problems occurred in 36 children. Contributing factors often co-existed. During stay at the centre, lung function improved in the group with well controlled asthma symptoms (P < 0.001) but not in the group with continued poor symptom control. In the majority of children who obtained good symptom control, this persisted in the years following discharge. CONCLUSION: Of 60 children referred with a diagnosis of difficult asthma, optimal medical management in a structured environment resulted in good symptom control in 51 patients; symptom control remained poor in 5 patients, a diagnosis other than asthma was made in 4 patients.

Granulomatous angiopanniculitis of the breast. A case report.

BACKGROUND: Granulomatous angiopanniculitis (GAP) is a rare benign condition of the breast of unknown etiology. Clinically and by fine needle examination, GAP may simulate breast carcinoma. The cytologic characteristics have not been described before. CASE: A 63-year-old female exhibited a palpable mass in her left breast. The fine needle aspirate contained both epithelioid and stromal elements. The epithelioid component consisted of dissociated individual cells and small groups and clusters of atypical cells. The stromal component showed a uniform, not-atypical pattern. The lumpectomy specimen showed nonnecrotizing granulomatous panniculitis and lymphoid angiitis without involvement of ducts or lobules. CONCLUSION: Granulomatous lesions should be borne in mind in the differential diagnosis of breast cancer in fine needle aspiration cytology. GAP must be histopathologically distinguished from granulomatous inflammation in the breast of autoimmune or infectious origin as specific medical therapy may be available for these latter diseases.

The totally extraperitoneal laparoscopic hernia repair. Preliminary results.

BACKGROUND: The totally extraperitoneal laparoscopic hernia repair has become our procedure of choice to manage inguinal hernia in adult patients since March 1993. This technique was developed in an attempt to diminish postoperative pain, shorten the convalescence period and equal the recurrence figures of the classical tension-free repair. METHODS: A complete extraperitoneal dissection is performed. A large Marlex prosthesis (15 x 15 cm) is placed and covers all potential defects. RESULTS: A consecutive series of 195 hernias in 158 patients is proposed. The minimum follow-up in our series is at least 6 months. Morbidity is low and so far, no recurrences have been seen. CONCLUSIONS: The totally extraperitoneal laparoscopic approach for repairing inguinal hernia should have a promising future, because the same principles as the classical tension-free repair are followed. Preliminary results are promising. Further studies, even randomized prospective trials and fair reports of complications, will determine the future of laparoscopic hernia surgery.

Strangulation: a late presentation of right-sided diaphragmatic rupture.

A case of late presentation of a right-sided diaphragmatic rupture due to blunt chest trauma is presented. The patient suffered from strangulation of a herniated segment of small bowel into the chest. Chest radiography suggested diaphragmatic rupture, computed tomography and sonography established the correct preoperative diagnosis. The prevalence, mechanism of injury and possible complications are reviewed. The value of chest radiography and other imaging techniques is discussed.

Small bowel obstruction after laparoscopic inguinal hernia repair: a case report.

The authors present a case of intestinal obstruction after a transabdominal laparoscopic hernia repair, due to bowel entrapment through a not perfectly closed peritoneum. With the tremendous success of laparoscopic cholecystectomy, a laparoscopic approach to inguinal hernias seemed feasible and logical. The transabdominal preperitoneal and the totally extraperitoneal hernia repair, both using a prosthesis, are based on the same principles as the classical tension-free repair. The authors have experience with both new procedures. The case report illustrates a major complication after a transabdominal laparoscopic repair in a consecutive series of 40 patients. This was the reason why the transabdominal approach in our department is replaced by the totally extraperitoneal approach.

Routine screening for unsuspected aortic aneurysms in patients after myocardial revascularization: a prospective study.

Ultrasonography of the abdominal aorta was routinely performed in a consecutive series of 100 patients during postoperative reconvalescence after myocardial revascularization. The mean aortic diameter was greater in the male series (n = 80) then in the female population (n = 20) (2.17 +/- 0.85 cm vs 1.6 +/- 0.3 cm). Abnormalities were only seen in male patients over 50 years of age (n = 65). The overall incidence of aneurysm greater than or equal to 4 cm was 6%. The incidence of aortas at least 3 cm was 7/65 (11%). It is suggested that the incidence of unsuspected aortic aneurysm in this subgroup is high enough to justify continued screening programmes by ultrasound.