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Jan Deprest - One of the best experts on this subject based on the ideXlab platform.
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prenatal incision of ureterocele causing bladder outlet obstruction a multicenter case series
Prenatal Diagnosis, 2017Co-Authors: G E Chalouhi, Anne Maude Morency, Roland De Vlieger, J M Martinez, Thomas Blanc, Ryan Hodges, A Gueneuc, Greg Ryan, Jan DeprestAbstract:We reviewed data from a cohort of fetuses with ureterocele diagnosed and operated prenatally in four fetal therapy centers. Inclusion criteria were: (1)ureterocele confirmed on detailed fetal ultrasound examination, (2)absence of additional fetal malformations (3)fetal intervention to decompress the ureterocele with local institutional review boards’ approval. Data on sonographic follow-up, obstetrical, neonatal outcome and postnatal evaluation were collected. Ten cases of prenatally treated ureterocele are described. Six cases benefited from a Fetoscopy for laser incision and decompression, two cases had an ultrasound guided puncture before resorting to a Fetoscopy with laser incision, one case had a balloon catheterization under ultrasound guidance and one case had an ultrasound-guided opening of the ureterocele with a laser fiber passed through a 20G needle. Mean GA at diagnosis was 21.6GW. Two cases underwent TOP. The remaining eight cases recovered normal amniotic fluid volume, and delivered a live-born child at a mean GA of 38.6GW with normal creatinine levels during the first week of life. Prenatal incision provided complete treatment of severely obstructive ureteroceles in 80% of the cases and allowed improvement of urinary electrolytes, renal size and echogenicity, bladder filling in all survivors and recollection of normal amniotic fluid volume, in case of oligoanhydramnios.
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The use of endoscopy in fetal medicine
Gynecological Surgery, 2010Co-Authors: V. Beck, A. Pexsters, L. Gucciardo, T. Mieghem, I. Sandaite, S. Rusconi, Ph Dekoninck, K. Srisupundit, K. O. Kagan, Jan DeprestAbstract:We aimed to review the state of affairs in the field of embryo–Fetoscopy as well as its instrumental requirements. Today, endoscopic procedures of limited complexity are easily possible within the amniotic cavity. Embryoscopy is typically done for diagnostic purposes, such as the demonstration of external anomalies very early in pregnancy and/or obtaining embryonic tissues in recurrent miscarriages. Fetoscopy is the direct visualization of the amniotic cavity from the second trimester onwards. Its principal indications are complications of monochorionic twinning and severe congenital diaphragmatic hernia. There is level I evidence that fetoscopic laser surgery for twin–twin-transfusion syndrome is superior over amniodrainage. Fetoscopic endoluminal tracheal occlusion is done for severe diaphragmatic hernia. Whether tracheal occlusion yields better outcomes than expectant management during pregnancies is currently being investigated in a randomized trial. There are a number of less common procedures discussed as well. Overall, maternal risks of embryo–Fetoscopy are minimal. The most frequent complication is rupture of the membranes and as a consequence preterm delivery. Fetal surgery seems safe and has, therefore, become a clinical reality. Although the stage of technical experimentation is over, most interventions remain investigational. Inclusion of patients into trials whenever possible should be encouraged, rather than building up casuistic experience.
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The use of endoscopy in fetal medicine
Gynecological Surgery, 2010Co-Authors: V. Beck, A. Pexsters, L. Gucciardo, T. Mieghem, I. Sandaite, S. Rusconi, Ph Dekoninck, K. Srisupundit, K. O. Kagan, Jan DeprestAbstract:We aimed to review the state of affairs in the field of embryo–Fetoscopy as well as its instrumental requirements. Today, endoscopic procedures of limited complexity are easily possible within the amniotic cavity. Embryoscopy is typically done for diagnostic purposes, such as the demonstration of external anomalies very early in pregnancy and/or obtaining embryonic tissues in recurrent miscarriages. Fetoscopy is the direct visualization of the amniotic cavity from the second trimester onwards. Its principal indications are complications of monochorionic twinning and severe congenital diaphragmatic hernia. There is level I evidence that fetoscopic laser surgery for twin–twin-transfusion syndrome is superior over amniodrainage. Fetoscopic endoluminal tracheal occlusion is done for severe diaphragmatic hernia. Whether tracheal occlusion yields better outcomes than expectant management during pregnancies is currently being investigated in a randomized trial. There are a number of less common procedures discussed as well. Overall, maternal risks of embryo–Fetoscopy are minimal. The most frequent complication is rupture of the membranes and as a consequence preterm delivery. Fetal surgery seems safe and has, therefore, become a clinical reality. Although the stage of technical experimentation is over, most interventions remain investigational. Inclusion of patients into trials whenever possible should be encouraged, rather than building up casuistic experience.
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Biochemical Composition of Fluids for Amnioinfusion during Fetoscopy
Gynecologic and Obstetric Investigation, 2008Co-Authors: P. N. Adama Van Scheltema, Jan Deprest, P.s. In’t Anker, A. Vereecken, Frank P.h.a. Vandenbussche, Roland DevliegerAbstract:Objective: To evaluate which of the commercially available solutions is best suited for amnioinfusion during Fetoscopy, based on resemblance with the biochemical properties of amnio
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Matrix metalloproteinases -2 and -9 and their endogenous tissue inhibitors in fetal membrane repair following Fetoscopy in a rabbit model
MHR: Basic science of reproductive medicine, 2000Co-Authors: Roland Devlieger, Jan Deprest, Eduard Gratacós, Robert Pijnenborg, Rosemary Leask, Simon C. RileyAbstract:The cellular mechanisms underlying fetal membrane repair are poorly understood. Matrix metalloproteinases (MMP) and the endogenous tissue inhibitors of metalloproteinases (TIMP) play a key role in the control of turnover of extracellular matrix in fetal membranes at normal parturition and preterm prelabour rupture of the fetal membranes (PPROM). The time course of secretion of MMP-2 (72 kDa, gelatinase A) and MMP-9 (92 kDa, gelatinase B) and TIMP into extra-embryonic coelomic, allantoic and amniotic fluids in a rabbit model was examined. Furthermore, to evaluate their role in fetal membrane repair, the changes induced by Fetoscopy at mid-gestation (23 days; gestation length is 32 days) were investigated. Zymography showed predominantly secretion of latent MMP-2 at 18, 23 and 30 days of gestation in all gestational compartments. Reverse zymography detected a broad range of TIMP activity with molecular weights of 27-30 kDa (TIMP-1, glycosylated TIMP-3 and TIMP-4), 24 kDa (unglycosylated TIMP-3) and 21 kDa (TIMP-2). Following Fetoscopy, both MMP-2 and TIMP increased significantly in amniotic fluid and extra-embryonic coelomic fluid, but not in allantoic fluid, as demonstrated by densitometric analyses. These findings indicate a modulating role for MMP and TIMP in the repair processes following a surgically induced fetal membrane defect.
G E Chalouhi - One of the best experts on this subject based on the ideXlab platform.
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prenatal incision of ureterocele causing bladder outlet obstruction a multicenter case series
Prenatal Diagnosis, 2017Co-Authors: G E Chalouhi, Anne Maude Morency, Roland De Vlieger, J M Martinez, Thomas Blanc, Ryan Hodges, A Gueneuc, Greg Ryan, Jan DeprestAbstract:We reviewed data from a cohort of fetuses with ureterocele diagnosed and operated prenatally in four fetal therapy centers. Inclusion criteria were: (1)ureterocele confirmed on detailed fetal ultrasound examination, (2)absence of additional fetal malformations (3)fetal intervention to decompress the ureterocele with local institutional review boards’ approval. Data on sonographic follow-up, obstetrical, neonatal outcome and postnatal evaluation were collected. Ten cases of prenatally treated ureterocele are described. Six cases benefited from a Fetoscopy for laser incision and decompression, two cases had an ultrasound guided puncture before resorting to a Fetoscopy with laser incision, one case had a balloon catheterization under ultrasound guidance and one case had an ultrasound-guided opening of the ureterocele with a laser fiber passed through a 20G needle. Mean GA at diagnosis was 21.6GW. Two cases underwent TOP. The remaining eight cases recovered normal amniotic fluid volume, and delivered a live-born child at a mean GA of 38.6GW with normal creatinine levels during the first week of life. Prenatal incision provided complete treatment of severely obstructive ureteroceles in 80% of the cases and allowed improvement of urinary electrolytes, renal size and echogenicity, bladder filling in all survivors and recollection of normal amniotic fluid volume, in case of oligoanhydramnios.
Bridget Wildt - One of the best experts on this subject based on the ideXlab platform.
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gelatin sponge plug to seal Fetoscopy port sites technique in ovine and primate models
American Journal of Obstetrics and Gynecology, 1999Co-Authors: Francois I. Luks, Bridget Wildt, Koen Peers, Eric A P Steegers, Jan DeprestAbstract:Amniotic fluid leakage and rupture of membranes are common complications of Fetoscopy. We describe a plug technique for leakproof removal of endoscopic cannulas. Thirty gelatin sponge plugs were introduced in 5 pregnant ewes and 5 pregnant rhesus monkeys. In the primate model no evidence of amniorrhexis was noted on postoperative ultrasonography. Myometrium and membranes at the port sites were intact at term. A gelatin sponge plug technique may facilitate leakproof port removal after Fetoscopy. (Am J Obstet Gynecol 1999;181:995-6.)
Deprest Jan - One of the best experts on this subject based on the ideXlab platform.
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Deep Sequential Mosaicking of Fetoscopic Videos
'Springer Science and Business Media LLC', 2019Co-Authors: Bano Sophia, Deprest Jan, Vasconcelos Francisco, Amo, Marcel Tella, Dwyer George, Gruijthuijsen Caspar, Ourselin Sebastien, Poorten, Emmanuel Vander, Vercauteren Tom, Stoyanov DanailAbstract:Twin-to-twin transfusion syndrome treatment requires fetoscopic laser photocoagulation of placental vascular anastomoses to regulate blood flow to both fetuses. Limited field-of-view (FoV) and low visual quality during Fetoscopy make it challenging to identify all vascular connections. Mosaicking can align multiple overlapping images to generate an image with increased FoV, however, existing techniques apply poorly to Fetoscopy due to the low visual quality, texture paucity, and hence fail in longer sequences due to the drift accumulated over time. Deep learning techniques can facilitate in overcoming these challenges. Therefore, we present a new generalized Deep Sequential Mosaicking (DSM) framework for fetoscopic videos captured from different settings such as simulation, phantom, and real environments. DSM extends an existing deep image-based homography model to sequential data by proposing controlled data augmentation and outlier rejection methods. Unlike existing methods, DSM can handle visual variations due to specular highlights and reflection across adjacent frames, hence reducing the accumulated drift. We perform experimental validation and comparison using 5 diverse fetoscopic videos to demonstrate the robustness of our framework.Comment: Accepted at MICCAI 201
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Long-term outcome of pre- and perinatal management of congenital head and neck tumors and malformations
'Elsevier BV', 2019Co-Authors: Beckers Karen, Deprest Jan, Faes Julie, Delaere, Pierre R, Hens Greet, De Catte Luc, Naulaers Gunnar, Claus Filip, Hermans Robert, Vincent Lm ,vander PoortenAbstract:INTRODUCTION: Congenital head and neck pathology may cause direct postnatal airway obstruction. Prenatal diagnosis facilitates safe delivery with pre- and perinatal airway assessment and management and Ex-Utero-Intrapartum-Treatment (EXIT) if necessary. Fetoscopic airway evaluation can optimize the selection of patients in need of an EXIT procedure. METHODS: Description of 11 consecutive fetuses, born with a potential airway obstruction between 1999 and 2011 and treated at the University Hospitals Leuven, with a long-term follow-up until 2018. An algorithm including fetoscopic airway evaluation is presented. RESULTS: In utero imaging revealed seven teratomas, one fourth branchial pouch cyst, one thymopharyngeal duct remnant, one lymphatic malformation and one laryngeal atresia. A multidisciplinary team could avoid EXIT in eight patients by ultrasonographic (n = 2) or fetoscopic (n = 6) documentation of accessible airways. Three patients needed an EXIT-to-airway-procedure. Neonatal surgery included tracheostomy during EXIT (n = 2) and resection of teratoma (n = 7) or branchiogenic pathology (n = 3). All patients do well at long-term (minimum 54 months) follow-up. CONCLUSIONS: Combining prenatal imaging and perinatal Fetoscopy, EXIT-procedure and neonatal surgery yields an optimal long-term outcome in these complex patients. Fetoscopy can dramatically reduce the number of EXIT-procedures.status: publishe
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Prenatal incision of ureterocele causing bladder outlet obstruction - A multicenter case series
John Wiley & Sons, 2017Co-Authors: Chalouhi Gihad, Deprest Jan, Morency Anne-maude, Devlieger Roland, Martinez, José Maria, Blanc Thomas, Hodges Ryan, Gueneuc Alexandra, Ryan Greg, Gratacos EduardAbstract:We reviewed data from a cohort of fetuses with ureterocele diagnosed and operated prenatally in four fetal therapy centers. Inclusion criteria were: (1)ureterocele confirmed on detailed fetal ultrasound examination, (2)absence of additional fetal malformations (3)fetal intervention to decompress the ureterocele with local institutional review boards' approval. Data on sonographic follow-up, obstetrical, neonatal outcome and postnatal evaluation were collected. Ten cases of prenatally treated ureterocele are described. Six cases benefited from a Fetoscopy for laser incision and decompression, two cases had an ultrasound guided puncture before resorting to a Fetoscopy with laser incision, one case had a balloon catheterization under ultrasound guidance and one case had an ultrasound-guided opening of the ureterocele with a laser fiber passed through a 20G needle. Mean GA at diagnosis was 21.6GW. Two cases underwent TOP. The remaining eight cases recovered normal amniotic fluid volume, and delivered a live-born child at a mean GA of 38.6GW with normal creatinine levels during the first week of life. Prenatal incision provided complete treatment of severely obstructive ureteroceles in 80% of the cases and allowed improvement of urinary electrolytes, renal size and echogenicity, bladder filling in all survivors and recollection of normal amniotic fluid volume, in case of oligoanhydramnios.status: publishe
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Thrombin Generation by Fetoscopic Trauma to the Fetal Membranes: An in vivo and in vitro Study
S. Karger, 2016Co-Authors: Engels Alexander, Bauters Dries, Rynkevic Rita, Pranpanus Savitree, Richter Jute, Van Mieghem Tim, Hoylaerts Marc, Deprest JanAbstract:We first aimed to investigate in vivo thrombin generation induced by Fetoscopy, and second we used term membrane explants for measurement of thrombin generation, thrombin receptor location and induction of selected matrix metalloproteinases (MMPs) in tissue culture.status: publishe
A. Garner - One of the best experts on this subject based on the ideXlab platform.
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A new craniosynostosis/mental retardation syndrome diagnosed by Fetoscopy.
Clinical Genetics, 2008Co-Authors: M. Baraitser, C H Rodeck, A. GarnerAbstract:The combination of craniosynostosis, mental retardation, seizures, choroidal coloboma, dysplastic kidneys, bat ears, cleft lip and palate and beaked nose constitutes a new recessive syndrome which has been diagnosed by Fetoscopy.
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a new craniosynostosis mental retardation syndrome diagnosed by Fetoscopy
Clinical Genetics, 2008Co-Authors: M. Baraitser, C H Rodeck, A. GarnerAbstract:The combination of craniosynostosis, mental retardation, seizures, choroidal coloboma, dysplastic kidneys, bat ears, cleft lip and palate and beaked nose constitutes a new recessive syndrome which has been diagnosed by Fetoscopy.