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Introduction: As new treatments are becoming available for patients with myasthenia gravis (MG), it is worth reflecting on the actual status of MG treatment to determine which patients would most likely benefit from the new treatments., Methods: We reviewed the clinical files of all MG patients seen at the Department of Neurology of the Antwerp University Hospital during the years 2019, 2020 and 2021., Results: 163 patients were included. Age at diagnosis varied from the first to the eighth decades, with a peak of incidence from 60 to 70 years for both genders, and an additional peak from 20 to 30 years in women. Diplopia and ptosis were by far the most common onset symptom. At maximum disease severity, 24% of the patients still had purely ocular symptoms and 4% needed mechanical ventilation. 97% of the patients received a treatment with pyridostigmine and 68% with corticosteroids, often in combination with immunosuppressants. More than half reported side effects. At the latest visit, 50% of the patients were symptom-free. Also, half of the symptomatic patients were fulltime at work or retired with no or mild limitations in daily living. The remaining patients were working part-time, on sick leave, or retired with severe limitations., Discussion and Conclusion: The majority of MG patients are doing well with currently available treatments, but often at the cost of side effects in the short and in the long term. A significant group is in need of better treatments., (© 2023. The Author(s) under exclusive licence to Belgian Neurological Society.)

Purpose: To determine the effects of the sodium content of maintenance fluid therapy on cumulative fluid balance and electrolyte disorders., Methods: We performed a randomized controlled trial of adults undergoing major thoracic surgery, randomly assigned (1:1) to receive maintenance fluids containing 154 mmol/L (Na154) or 54 mmol/L (Na54) of sodium from the start of surgery until their discharge from the ICU, the occurrence of a serious adverse event or the third postoperative day at the latest. Investigators, caregivers and patients were blinded to the treatment. Primary outcome was cumulative fluid balance. Electrolyte disturbances were assessed as secondary endpoints, different adverse events and physiological markers as safety and exploratory endpoints., Findings: We randomly assigned 70 patients; primary outcome data were available for 33 and 34 patients in the Na54 and Na154 treatment arms, respectively. Estimated cumulative fluid balance at 72 h was 1369 mL (95% CI 601-2137) more positive in the Na154 arm (p < 0.001), despite comparable non-study fluid sources. Hyponatremia < 135 mmol/L was encountered in four patients (11.8%) under Na54 compared to none under Na154 (p = 0.04), but there was no significantly more hyponatremia < 130 mmol/L (1 versus 0; p = 0.31). There was more hyperchloremia > 109 mmol/L under Na154 (24/35 patients, 68.6%) than under Na54 (4/34 patients, 11.8%) (p < 0.001). The treating clinicians discontinued the study due to clinical or radiographic fluid overload in six patients receiving Na154 compared to one patient under Na54 (excess risk 14.2%; 95% CI - 0.2-30.4%, p = 0.05)., Conclusions: In adult surgical patients, sodium-rich maintenance solutions were associated with a more positive cumulative fluid balance and hyperchloremia; hypotonic fluids were associated with mild and asymptomatic hyponatremia.

Background: Malignant pleural mesothelioma (MPM) is a rare but aggressive neoplasm that typically originates from the mesothelial surfaces of the pleural cavity. Exposure to asbestos is the principal etiological agent of MPM. The disease is characterized by difficult stage classification and limited consensus on therapeutic approach. We have evaluated the experience with MPM in the Antwerp University Hospital over the past 15 years., Methods: A database was created with all patients diagnosed with or treated for a MPM between 2001 and 2015. A total of 101 patients were included on which different survival analyses were performed combined with a reproduction of demographic, clinical, histologic and therapeutic data, and these were compared to literature data., Results: Vast majority of our 101 patients were male (80%) with a median age of 66 years at diagnosis with predominantly epitheloid histology (81%). Overall median survival was 18.3 months and overall 1-, 2- and 5-year survival rates were 68%, 37% and 7%, respectively. Kaplan-Meier analysis showed a non-significant difference in survival between the several best (b) TNM-stages (p = .356). A significant difference in survival was observed in patients undergoing surgery versus no surgery (p = .008), between the different histological types (p < .0001) and treatment with chemotherapy alone versus chemotherapy with surgery (p < .0001). Smoking at diagnosis and epitheloid histology have been identified as significant prognostic factors in the multivariate Cox regression model (HR 3.13 and 0.53, respectively)., Conclusion: Descriptive and survival analysis of our patient database confirmed the limitations of the current staging system and were concordant with literature regarding MPM.

Objective: To prospectively evaluate quality of life (QoL) evolution after sleeve lobectomy and pneumonectomy with the European Organisation for Research and Treatment of Cancer (EORTC) QoL Questionnaire-C30 and LC-13., Methods: From January 2003 till December 2005, QoL was prospectively recorded after 10 sleeve lobectomies and 20 pneumonectomies. Questionnaires were administered before surgery and 1, 3, 6, and 12 months postoperatively (MPO) with response rates of 100%, 90.0%, 76.7%, 80.0% and 73.3%, respectively., Results: Sleeve lobectomy was characterized by a 1 month temporary decrease in physical and social functioning scores after surgery (1MPO p = 0.026 and p = 0.048, respectively). After sleeve lobectomy, quality of life scores approximated baseline preoperative values 1 month after surgery. In the 12 months follow-up period after pneumonectomy, there was no return to baseline in physical and role functioning (12MPO p = 0.001 and p = 0.011, respectively). Pneumonectomy patients reported a significant increase in postoperative dyspnea (1MPO p = 0.027, 6MPO p = 0.025, 12MPO 0.021), general pain (1MPO p = 0.006, 3MPO p = 0.008, 6MPO p = 0.005, 12MPO p = 0.036), thoracic pain (6MPO p = 0.019) and shoulder dysfunction (6MPO p = 0.04, 12MPO p = 0.026).Comparing both resections, significant differences in evolution of physical functioning (1MPO p = 0.014, 3MPO p = 0.008, 6MPO p = 0.004), role functioning (1MPO p = 0.041), cognitive functioning (6MPO p = 0.005, 12MPO p = 0.013) and shoulder dysfunction (12MPO p = 0.049) were reported in favor of sleeve lobectomy., Conclusions: The high burden of dyspnea, general pain, thoracic pain and shoulder dysfunction reported after pneumonectomy, is not seen after sleeve lobectomy. In patients with anatomically appropriate early-stage lung cancer, sleeve lobectomy offers better quality of life than does pneumonectomy.