Centre Hospitalier de Wallonie Picarde

Pain is reported in 66% of cancer patients with advanced disease. Adequate pain management is a cornerstone of comprehensive supportive cancer care. The purpose of this study was to assess pain management in Oncology Units in Belgium. A descriptive research design was applied. A structured questionnaire developed by a writing committee was sent to 37 healthcare professionals in 2021. Twenty-four replied. In most centers, pain management is organized through the pain clinic (91.7%), followed by a multidisciplinary team (83.3%) and the palliative care unit (75%). Eighty-seven percent use tools to assess the pain, mostly for in-patients. Pain guidelines are applied in 17 centers with the ESMO guidelines being the most often mentioned. Mild to moderate pain is managed with paracetamol, non-steroidal anti-inflammatory drugs, and tramadol. All centers handle severe pain with strong opioids, including buprenorphine and fentanyl. Only 62% are concerned about the side effects of strong opioids. In case of neuropathic pain, treatments with pregabalin, gabapentine, and tricyclic antidepressants are the most common, followed by opioids and interventional therapies for refractory neuropathic pain. Asking advice to the pain clinic, combination therapy and opioid rotation are used for patients with inadequate analgesia. Eighty to 90% of the centers have access to intraspinal and epidural techniques, respectively. An active teaching program on pain relief is offered in 66%, but only 33% of the centers do active research focused on pain management. This is the first survey on pain management in the Belgian centers. Surprisingly only one-third of the health professionals ask advice to the pain clinic in case of inadequate pain relief, meaning that we are far away from a multidisciplinary patient-centered approach. Therefore, the BSMO Supportive Care Task Force promotes the development of an interdisciplinary committee in every oncology unit.

Uniportal video-assisted thoracoscopic surgery (uVATS) is becoming popular for major lung resections, even for more complex procedures. The technique initially described for minor procedures seems more difficult to reproduce and has a longer learning curve. This review aims to describe the evolution from multiportal to uVATS and to explore its feasibility and reproducibility by identifying its drawbacks and limitations. Research from PubMed was obtained with the terms [uniportal] AND [surgery] OR [single-port] AND [thoracic surgery] OR [VATS]. Papers concerning pediatric cases and non-English papers were excluded. Individual case reports were also excluded. uVATS seems to be widely adopted and performed for minor procedures. The applicability of uVATS for different indications is discussed, even though practically all thoracic surgical interventions can be performed through a single incision. The transition from conventional three-port VATS to uVATS is described in this paper. An increasing number of thoracic surgeons worldwide have adopted this approach, even for major complex anatomical lung resections. Regarding the performance of minor thoracic interventions, we believe this technique is easily reproducible with a short learning curve because the instruments do not cross each other, and intraoperative movements remain intuitive. It is therefore a feasible, safe, and efficacious technique. For these reasons, we believe uVATS should be offered to all patients undergoing minor thoracoscopic procedures.

Abstract Study question Should a national embryo transfer (ET) policy designed in the era of cleavage stage transfers be adapted for blastocyst transfers to avoid twin pregnancies? Summary answer Double embryo transfer policy results in unacceptable high twin rates at all ages and treatment ranks which is significantly more pronounced after double blastocyst transfer. What is known already In 2003, authorities in Belgium implemented a law to reduce multiple pregnancies after ART by tailoring ET policies based on age, embryo quality, and cycle rank. A choice between SET or Double Embryo Transfer (DET) depending on embryo quality is allowed in the second cycle for patients under 36y with SET being mandatory with top quality embryos. DET is allowed as of the first cycle for patients aged 36y or more regardless of embryo quality. Blastocyst transfer results in significantly higher live birth rates, implying an increased risk of multiple pregnancies after multiple blastocyst transfers. Study design, size, duration A analysis of 35,523 double embryo fresh transfer cycles over a period of 10 years from 2012 to 2021 from the Belgian national BELRAP (Belgian Registry on Assisted Procreation) registry was performed. The study included 26,930 double cleavage stage transfers (DET-CL) and 8,593 double blastocyst transfers (DET-BL). Participants/materials, setting, methods The primary outcomes were delivery rate (DR) per transfer and twin delivery rate (TDR). DR includes all deliveries with a least one live birth per transfer; the TDR includes all twin deliveries as a proportion of all deliveries. For analysis, the data were categorized into the following age groups: 18-25 years, 26-29 years, 30-35 years, 36-39 years and 40-45 years. Cycle ranks were categorized as follows: rank 1, rank 2 and cycle 3- ≥ 6. Main results and the role of chance For all age groups and cycle ranks, delivery rate per transfer and twin delivery rate per delivery were significantly higher after DET-Bl compared to DET-Cl (26.0% versus 19.9%; p < 0.0001 and 28.0% versus 20.6%; p < 0.0001, respectively). In the age groups 26-29 years, 30-35 years and 36-39 years, a significantly higher TDR was observed in DET-Bl compared to DET-Cl, respectively (34.4% versus 24.2%, p = 0.0005; 33.5% versus 24.9%, p < 0.0001 and 24.3% versus 17.3%, p = 0.0002). TDR after DET-Bl was significantly lower in women aged 40-45 years compared to all other age groups, 18-25 years, 26-29 years, 30-35 years and 36-39 years, respectively (11.3% versus 32.8%, p < 0.0001; 11.3% versus 34.4%; p < 0.0001; 11.3% versus 33.5%; p < 0.0001 and 11.3% versus 24.3%; p < 0.0001), respectively). DR was significantly lower in cycle rank 1 compared to cycle rank 2 (22.5% versus 25.5%; p < 0.0001) and compared to cycle rank 3 - > 6 rank 1 and (22.5% versus 27.1%; p < 0.0001). After DET-Bl, a significantly lower TDR was observed in cycle rank 1 compared to cycle rank 2 (15.6% versus 30.0%; p < 0.0001) and compared to cycle rank 3 - > 6 (15.6% versus 29.7%; p < 0.0001). Limitations, reasons for caution The retrospective design is a limitation. Outcomes might be influenced by clinical and laboratory improvements over the years. The registry does not collect embryo quality data making it impossible to assess the effect of embryo quality on the ET policy and outcome. Wider implications of the findings This data indicates that a double blastocyst transfer should only be considered from the age of 40 onwards. In the first cycle, regardless of age, we observe a significantly lower twin delivery rate, suggesting that a double ET is performed when only poor-quality blastocysts are available. Trial registration number Not applicable

Hypoxic pulmonary vasoconstriction (HPV) is a major physiological mechanism that prevents the development of hypoxemia secondary to a regional decrease in the ventilation–perfusion ratio (the intrapulmonary shunt effect). Calcium plays a critical role in the cellular response to hypoxia and the regulation of the pulmonary vascular tone. Therefore, calcium channel antagonists such as nicardipine have the potential to interfere with the pulmonary response to hypoxia, increasing intrapulmonary blood shunt and thus worsening underlying hypoxemia. This article reports the case of a 40‐year‐old man suffering from lobar pneumonia, who developed a rapidly progressing hypoxemia after starting nicardipine infusion for blood pressure control. After ruling out all major causes of hypoxemic respiratory failure, the involvement of the calcium channel antagonist was strongly suspected. Hypoxemia caused by HPV release is an underreported side effect of calcium channel blockers. There are few clinical reports that describe the occurrence of this adverse event, and to our knowledge, only one other publication describes a patient suffering from infectious pneumopathy. In this article, we discuss the cellular mechanisms behind the HPV, as well as the pharmacology of calcium channel antagonists and their involvement in the development of acute respiratory failure. The purpose of this report is to remind clinicians dealing with patients affected by acute hypoxemia that pharmacologic HPV inhibition should be considered as part of the differential diagnosis, thus avoiding unnecessary costly and time‐consuming assessments.