[In-hospital treatment of COVID-19 patients]. / COVID-19 in het ziekenhuis.

Covid-19 infection is now a pandemic disease. Most patients have mild symptoms without the need for hospitalization. On average, 5% of the COVID-19-positive patients have severe respiratory symptoms. We present 3 patients aged 45, 67 and 75 years, who were admitted to the ICU with severe respiratory symptoms. We describe the presentation of the COVID-19 patients on the emergency department, the development of the disease, and the treatment of these patients on the ICU.

Optical detection of preneoplastic lesions of the central airways.

Current routine diagnosis of premalignant lesions of the central airways is hampered due to a limited sensitivity (white light bronchoscopy) and resolution (computer tomography (CT), positron emission tomography (PET)) of currently used techniques. To improve the detection of these subtle mucosal abnormalities, novel optical imaging bronchoscopic techniques have been developed over the past decade. In this review we highlight the technological developments in the field of endoscopic imaging, and describe their advantages and disadvantages in clinical use.

SUVmax during 18FDG-PET scanning in small cell lung cancer: similar information as in non-small cell lung cancer?

In patients with non-small cell lung carcinoma (NSCLC) fluorine-18 fluorodeoxyglucose positron emission tomography (18FDG-PET)-scanning is shown to be of prognostic value. Small cell lung cancer (SCLC) is an aggressive tumor with poor prognosis. Limited results on the prognostic and predictive value of the maximum standard uptake values (SUVmax) obtained during 18FDG-PET scanning in SCLC are available. An observational study in 75 chemonaive patients diagnosed with SCLC who underwent a 18FDG-PET scan was performed. SUVmax values of the primary tumor were related to the overall survival (OS) and the progression free survival (PFS). Significant lower SUVmax values of the primary tumor were observed in patients with stage I-III disease compared to stage IV disease. SUVmax did not discriminate for either OS or PFS in the whole group of patients. In patients with stage IV disease and treatment with chemotherapy, OS and PFS were significantly higher in patients with a high SUVmax. (p-value 0.005 and 0.002 respectively) compared to patients with a low SUVmax value. In patients with SCLC metabolic activity determined using 18FDG-PET (SUVmax) differed between stage I-III and stage IV diseases. Compared to NSCLC, the relationship between SUVmax) and prognosis seems more complex.

HIF1a expression in bronchial biopsies correlates with tumor microvascular saturation determined using optical spectroscopy.

Tumor hypoxia is generally considered to be related to aggressive behaviour of a tumor. As in lung cancer direct determination of oxygenation is difficult, hypoxia-related proteins have been studied. A number of studies on these proteins show different results and the usefulness of these protein expressions remains questionable. In this article, we relate one of these hypoxia-related proteins (hypoxia-inducible factor, HIF1a) to a direct in vivo spectroscopic measurement of tumor blood saturation performed during bronchoscopy. Seventeen samples from malignancies and non-malignant tissues were studied. Microvascular saturation levels in the no malignancy group equalled 87+/-11.5% (range 71-100%) and in the malignant group 43+/-21% (range 6-63%). This difference was statistically significant (p<0.0002). There was a significant difference in the spectroscopically determined saturations between the biopsies with negative expression of HIF1a and the biopsies with positive expression of HIF1a (p<0.005). From these data, it can be concluded that HIF1a expression is related to a low microvascular blood saturation as determined in vivo by optical spectroscopy. This study may lead to a better acceptance of the usage of different techniques to establish hypoxia in order to study the effect of hypoxia on therapeutic interventions and prognosis of lung cancer.