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See detailAnalysis of Endotoxin Effects on the Intact Pulmonary Circulation
Lambermont, Bernard ULg; Kolh, Philippe ULg; Detry, Olivier ULg et al

in Cardiovascular Research (1999), 41(1), 275-81

OBJECTIVE: The mechanism of sustained alterations in pulmonary hemodynamics during endotoxin shock remains unclear. To gain more detailed knowledge we used the four-element windkessel model as a ... [more ▼]

OBJECTIVE: The mechanism of sustained alterations in pulmonary hemodynamics during endotoxin shock remains unclear. To gain more detailed knowledge we used the four-element windkessel model as a descriptor of the pulmonary circuit. METHODS: Consecutive changes in characteristic resistance (R1), vascular compliance (C), input resistance (R2) and inductance (L) were continuously assessed following injection of endotoxin in 6 anaesthetised pigs, and were compared with the corresponding values measured in a similar group of sham-operated animals. RESULTS: Endotoxin challenge resulted in a biphasic pulmonary artery pressure response. Blood flow decreased progressively from 2.8 +/- 0.2 l/min to 2 +/- 0.2 l/min. Ohmic pulmonary vascular resistance (PVR) increased gradually from 0.2 +/- 0.04 to 0.76 +/- 0.1 mm Hg s ml-1. The early increase in PAP (from 14 +/- 2 to 27 +/- 4 mm Hg) was mediated by changes in both R1 (from 0.04 +/- 0.01 to 0.06 +/- 0.01 mm Hg s ml-1) and R2 (from 0.16 +/- 0.04 to 0.61 +/- 0.2 mm Hg s ml-1). These responses, in turn, altered the proximal vascular compliance. A subsequent increase in PAP (from 27 +/- 2 to 32 +/- 3 mm Hg) paralleled the specific decline in distal pulmonary vasculature compliance from 0.84 +/- 0.1 to 0.65 +/- 0.1 ml/mmHg. Analysis of the time course of PVR did not allow us to distinguish between vasoconstriction and stiffening of the vascular tree as mechanisms accounting for PAP changes. CONCLUSIONS: Endotoxemia leads to pulmonary hypertension, which is a result of constriction of proximal pulmonary arteries during the early phase, whereas the late phase is characterised by a decline in distal pulmonary vasculature compliance. [less ▲]

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See detailModifications fonctionelles et tissulaires induites par la préservation et la reperfusion des greffons pulmonaires
Detry, Olivier ULg

Doctoral thesis (1999)

The lungs are organs whose sensitivity to ischaemia and reperfusion is well known. In a rabbit model of lung ischaemia, we showed that the cold ischaemia longer than 6 hours is accompanied by a ... [more ▼]

The lungs are organs whose sensitivity to ischaemia and reperfusion is well known. In a rabbit model of lung ischaemia, we showed that the cold ischaemia longer than 6 hours is accompanied by a significant reduction in tissue contents in vitamins E and C, two important protectors against the lesions appearing at the time of ischaemia and the reperfusion (Pincemail 1999). Moreover, lungs are different from the other transplanted organs by the importance of a fragile structure, the alveole, zone of exchange between the alveolar air and the capillary blood. It was shown that among the alveolar cells, the type II pneumatocytes, secreting the surfactant, is of primary importance for the post-transplant function. It was shown that the quality of surfactant decreases after conservation and reperfusion of the lungs, and that, in vitro, the effectiveness of surfactant continuously decreases with the prolongation of the duration of ischaemia (Erasmus 1994). Moreover the administration of surfactant before the pulmonary reperfusion improves the postoperative function of the grafts in the rat (Erasmus 1996). It is known that, if all the pulmonary cells contain mitochondria, more than 50% of the mitochondria isolated from lungs come from type II pneumatocytes (Fisher, 1976). We chose to study the mitochondrial respiratory function of these important alveolar cells for the pulmonary function after ischaemia and reperfusion. In this work, we developed a porcine model of ischaemia (hypo- and/or normothermic) and of normothermic reperfusion. This reperfusion was accompanied by a postoperative non-function, objectified by aerodynamic and hemodynamic parameters, as by the appearance of pulmonary oedema. This non-function was observed after 24 hours a hypothermic ischaemia, which is incompatible with a normal function of the pulmonary grafts in clinical transplantation. The reperfusion with a solution of Krebs-Henseleit bicarbonate remove any immunological artefact and any influence of the circulating blood cells in the pulmonary lesions appearing at the time of the reperfusion. On the other hand, this solution is different from blood to a significant degree, by not containing protectors against the production of free radicals at reperfusion. It is thus possible that our model exacerbates this production of free radicals, more especially as the lung is a tissue particularly rich in polymorphonuclear cells. In this model, we could show that after 24 hours of cold ischaemia the mitochondria underwent a moderate deterioration of the oxidoreductases but without decrease in the effectiveness of oxidative phosphorylation, decrease that could be demonstrated after 48 hours of cold ischaemia. These lesions are comparable to the mitochondrial lesions that we had observed after cold ischaemia of rabbit kidney (Willet 1995). After reperfusion, the mitochondrial lesions are more severe, with a decrease in the effectiveness of oxidative phosphorylation. Concerning normothermic ischaemia, the first 30 minutes did not cause significant mitochondrial lesions. These results at least corroborate the literature data on the relative good pulmonary tolerance to normothermic ischaemia, explained in theory by the persistence of oxygen in the airways and thus of the persistence of aerobic metabolism in spite of the circulatory arrest. For the other organs, the circulatory arrest implies anoxia, that is not really the case of lung, as oxygen is present in airways. Pulmonary transplantation could thus profit from an increase in graft pool available by harvesting lung graft from non-heart beating donors. After 45 minutes of normothermic ischaemia, mitochondrial oxidative phosphorylation dysfunction appears, related to a significant deterioration in the ATP synthase function. These results confirm that the cellular metabolism is then disturbed by the appearance of cellular anoxia because of the progressive consumption of oxygen present in the alveoles, or of the substrates necessary to the cellular metabolism. The description and the discussion of the importance of these mitochondrial alterations in the genesis of lung graft dysfunction after transplantation must be integrated with the very broad framework of the disturbances appearing at the time of tissue ischaemia and reperfusion. From our study it comes out that hypothermia at 4°C protects effectively the pulmonary mitochondrial function since significant deteriorations do not appear before 24 hours of hypothermic ischaemia. To determine if mitochondrial deteriorations appearing after normothermic reperfusion are the cause or the consequence of the non-function of the lung appears difficult. On the other hand the lesions appearing after 45 minutes of normothermic ischaemia deserve in an unquestionable way a later study, with evaluation of the mitochondrial function after circulatory arrest in normothermy (30 and 45 minutes) and normothermic reperfusion, and with evaluation of the mitochondrial function after 30 and 45 minutes (or more) of circulatory arrest normothermic but continuation of pulmonary ventilation, or conservation of the lungs in inflation with air or pure oxygen. Our mitochondrial data should also be compared with a study of the pulmonary function by a model of transplantation with survival of the receiver pig. [less ▲]

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See detailTransplantation combinée du foie et du coeur chez un patient souffrant de thalassémie majeure
Detry, Olivier ULg; Defechereux, Thierry ULg; Honore, Pierre ULg et al

in Médecine & Chirurgie Digestives (1999), 28(3), 109-110

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See detailLiver transplantation in a Jehovah's witness
Detry, Olivier ULg; Honoré, Pierre ULg; Delwaide, Jean ULg et al

in Lancet (1999), 353

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See detailIntracranial pressure during liver transplantation for fulminant hepatic failure.
Detry, Olivier ULg; Arkadopoulos, N.; Ting, P. et al

in Transplantation (1999), 67(5), 767-70

During orthotopic liver transplantation (OLT) for fulminant hepatic failure (FHF), some patients develop cerebral injury secondary to intracranial hypertension. We monitored intracranial pressure (ICP ... [more ▼]

During orthotopic liver transplantation (OLT) for fulminant hepatic failure (FHF), some patients develop cerebral injury secondary to intracranial hypertension. We monitored intracranial pressure (ICP) and cerebral perfusion pressure (CPP) before and during OLT in 12 FHF patients undergoing transplantation. All four patients who had normal ICP preoperatively maintained normal ICP/CPP throughout OLT. During OLT, four of the eight patients with pretransplant intracranial hypertension had six episodes of ICP increase. These episodes of intracranial hypertension occurred during failing liver dissection (n=3) and graft reperfusion (n=3). At the end of the anhepatic phase, the ICP was lower than the preoperative ICP in all patients, and was below 15 mmHg in all but one patient. These data suggest that in FHF patients who develop intracranial hypertension before OLT, dissection of the native liver and graft reperfusion are associated with a risk of brain injury resulting from intracranial hypertension and cerebral hypoperfusion. [less ▲]

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See detailClinical use of a bioartificial liver to treat acetaminophen-induced fulminant hepatic failure
Detry, Olivier ULg; Arkadopoulos, N.; Kahaku, E. et al

in American Surgeon (1999), 65

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See detailAquaporin-4 water channel plays a role in the pathogenesis of cerebral edema in fulminant hepatic failure
Margulies, J. E.; Thompson, R. C.; Wycoff, K. et al

in Surgical Forum (1999), 46

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See detailDiverticulosis and Diverticulitis in the Immunocompromised Patients
Detry, Olivier ULg; Honore, Pierre ULg; Meurisse, Michel ULg et al

in Acta Chirurgica Belgica (1999), 99(3, May-Jun), 100-2

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See detailTransplantation hépatique: expérience et résultats du programme de l'Université de Liège
Honore, Pierre ULg; Detry, Olivier ULg; Meurisse, Michel ULg et al

in Revue Médicale de Liège (1998), 53(12), 735-7

The orthotopic liver transplantation (OLT) program of the University of Liege was initiated in 1986. Between 1986 and December 1998, 150 adult OLT have been performed in our institution, including 18 ... [more ▼]

The orthotopic liver transplantation (OLT) program of the University of Liege was initiated in 1986. Between 1986 and December 1998, 150 adult OLT have been performed in our institution, including 18 liver retransplantations, 1 combined heart and liver transplantation and 3 combined liver and kidney transplantations. The aim of this study was to report the last 3 years of our experience. From January 1996 to November 1998, we performed 50 OLT on 49 patients. Three were retransplantations and two were combined liver and kidney transplantations. Fourty-three patients were transplanted for chronic liver disease and 6 for acute or subacute hepatopathy. Mean waiting time on the list was 4 weeks. Immunosuppression was based on triple therapy (cyclosporin A/tacrolimus, steroids, azathioprine), with steroid and azathioprine withdrawal in most of the patients after 3 months. In the chronic liver disease group, operative (< 30 days) survival was 95% (peroperative myocardial infarction in 2 patients). In the acute liver disease group, postoperative survival was 66%. No perioperative death occurred in 1997 and 1998. Actuarial one year survival was 87%. In our experience, OLT has become a safe procedure. [less ▲]

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See detailManagement of Recipients of Hepatic Allografts Harvested from Donors with Malignancy Diagnosed Shortly after Transplantation
Detry, Olivier ULg; Honore, Pierre ULg; Jacquet, Nicolas et al

in Clinical Transplantation (1998), 12(6), 579-81

Transmission of undiagnosed malignancy with the graft is a dramatic complication of liver transplantation. Alternatives in the management of the recipients of livers, harvested from donors with malignancy ... [more ▼]

Transmission of undiagnosed malignancy with the graft is a dramatic complication of liver transplantation. Alternatives in the management of the recipients of livers, harvested from donors with malignancy diagnosed shortly after transplantation, are either early re-transplantation or close follow-up without re-operation. We reported 4 cases of liver recipients whose allografts were harvested from donors who were diagnosed with malignancy shortly after the liver transplantation. One recipient underwent re-transplantation, and the three other allografts were not removed. No recipient developed recurrence in the follow-up. While graft removal may be the only way to avoid tumor recurrence in recipients of liver graft harvested from donor with malignancy, close follow-up without re-operation may also be considered. The risk of tumor transferral may depend on the histopathological aggressiveness and metastatic potential of the donor tumor, and may be low for low-grade, local tumors. This risk should be evaluated by analyzing large series, using databases of Eurotransplant or United Network for Organ Sharing. [less ▲]

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See detailManagement of Fulminant Hepatic Failure
Detry, Olivier ULg; Honore, Pierre ULg; Meurisse, Michel ULg et al

in Acta Chirurgica Belgica (1998), 98(6), 235-40

Fulminant hepatic failure is an infrequent but dreadful disease, occurring usually in young patients. Despite fulminant hepatic failure is reversible in most of the cases, some patients develop brain ... [more ▼]

Fulminant hepatic failure is an infrequent but dreadful disease, occurring usually in young patients. Despite fulminant hepatic failure is reversible in most of the cases, some patients develop brain edema and intracranial hypertension, which are the most common cause of death in these patients. Liver transplantation significantly improves the prognosis of selected patients in who precise criteria predict a low chance of survival. This review summarizes the modern standard of care of patients with fulminant hepatic failure, with particular underlining of the management of brain oedema and intracranial hypertension. [less ▲]

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See detailTransplantation d'un rein prélevé laparoscopiquement chez un donneur vivant apparente
Detry, Olivier ULg; Defechereux, Thierry ULg; Hamoir, Etienne ULg et al

in Revue Médicale de Liège (1998), 53(11), 657-9

Transplantation of kidney grafts harvested in living donors has demonstrated better results than grafts harvested from brain dead donors. Recently, laparoscopic live donor nephrectomy has been introduced ... [more ▼]

Transplantation of kidney grafts harvested in living donors has demonstrated better results than grafts harvested from brain dead donors. Recently, laparoscopic live donor nephrectomy has been introduced to reduce the live procurement morbidity. [less ▲]

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See detailLa transplantation rénale: aspect chirurgical
Detry, Olivier ULg; Bonnet, Pierre ULg; Meurisse, Michel ULg

in Horizon (1998), 18(70), 48-49

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See detailInfections à Cytomegalovirus (CMV) chez les transplantés d’organes
Detry, Olivier ULg

in Virologics : la Virologie du Sida au Zona (1998)

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See detailEffects of Peep on Systemic Venous Capacitance
Lambermont, Bernard ULg; Detry, Olivier ULg; D'Orio, Vincenzo ULg et al

in Archives of Physiology & Biochemistry (1998), 105(4), 373-8

The aim of the present study was to determine effects of positive end expiratory pressure (PEEP) application on peripheral venous capacitance and relate them to concomitant central hemodynamic ... [more ▼]

The aim of the present study was to determine effects of positive end expiratory pressure (PEEP) application on peripheral venous capacitance and relate them to concomitant central hemodynamic disturbances. The venous volume-pressure (V/P) relationships were studied in 6 intact anesthetized pigs to describe the effects of PEEP on systemic venous compliance (computed as the slope of the V/P relationship) and unstressed volume (referred to as the extrapolated volume intercept). Cardiac volumes as well as partitioning of circulating blood volume between central (ITBV) and peripheral (PBV) compartments were assessed by thermo-dye dilution techniques. During a 15 cm H2O PEEP application, venous compliance was reduced by 48%, while unstressed volume was increased by 25% and peripheral blood pooling increased from 63 to 74%. As a result, left heart and right ventricular end diastolic volumes were decreased by 8% and by 44%, respectively. It is concluded that increased venous unstressed volume and reduced compliance depicted the distension of the venous tree secondary to PEEP which acted as an impediment to venous return. As a consequence, cardiac output was reduced because of decreased preload. [less ▲]

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See detailCorrection of Pressure Waveforms Recorded by Fluid-Filled Catheter Recording Systems: A New Method Using a Transfer Equation
Lambermont, Bernard ULg; Gérard, Paul ULg; Detry, Olivier ULg et al

in Acta Anaesthesiologica Scandinavica (1998), 42(6), 717-20

BACKGROUND: Pressure measuring systems using fluid-filled catheters can result in the recording of distorted pressure waveforms. It results in phase delay, overestimation of systolic and, to a lesser ... [more ▼]

BACKGROUND: Pressure measuring systems using fluid-filled catheters can result in the recording of distorted pressure waveforms. It results in phase delay, overestimation of systolic and, to a lesser extent, of diastolic pressure. We designed and evaluated a method to correct this pressure waveform distortion using an appropriate transfer equation obtained from the dynamic response of the fluid-filled catheter. This transfer equation is based on the principle that a fluid-filled catheter recording system is considered as an underdamped dynamic system fully characterized by its natural frequency (omega n) and damping ratio (zeta). METHODS: Pressure waveforms, simultaneously recorded in vitro or in vivo by a fluid-filled catheter (Pc) and a micromanometer-tipped catheter (Pref), were used to validate the method. Dynamic response of the catheter used was obtained from a fastflush test. The corrected signal (Ppred) was obtained using omega n, zeta and the following transfer equation: d2Pc/dt2 + 2 omega n zeta dPc/dt + omega n 2Pc = C Ppred (t) After correction of Pc, Ppred was compared, using a linear regression, with Pref taken as reference. RESULTS: Our results showed that Ppred was fitted to Pref with excellent coefficient correlation (0.99). The mean error and the standard error of estimate were respectively -1.16 mmHg and 1.4 mmHg. CONCLUSION: This new method can convert the distorted pressure waveforms transmitted by any fluid-filled catheters into high-fidelity signals. It suppresses the phase delay and the over-estimation of systolic pressure induced by fluid-filled catheters. [less ▲]

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See detailTime Domain Method to Identify Simultaneously Parameters of the Windkessel Model Applied to the Pulmonary Circulation
Lambermont, Bernard ULg; D'Orio, Vincenzo ULg; Gérard, Paul ULg et al

in Archives of Physiology & Biochemistry (1998), 106(3), 245-52

Lumped models are frequently used to provide a satisfactory description of the hemodynamic properties of the pulmonary vasculature. The purpose of this study is to describe a method to identify ... [more ▼]

Lumped models are frequently used to provide a satisfactory description of the hemodynamic properties of the pulmonary vasculature. The purpose of this study is to describe a method to identify simultaneously the parameters values of windkessel models components. The following equation was used to obtain R1 (characteristic resistance), R2 (peripheral resistance), C (total compliance) and L (inertance): [formula: see text] where ki are the following functions of L, R1, R2 and C: [formula: see text] To assess the accuracy of the method, estimates of R1, R2, and C were compared to characteristic impedance Rc, vascular resistance PVR and pulmonary arterial compliance Cd respectively computed from referenced methods. Comparison between R1 and Rc, PVR and R1 + R2, C and Cd were obtained in 5 anaesthetised pigs during basal conditions and after endotoxin-shock. The results indicate that in both conditions, comparisons evidenced highly significant correlations between values computed by the different approaches (p < 0.0001). Although our method yielded to consistently lower values than values provided by referenced methods, the results were concordant with respect to the expected response of pulmonary vasculature to endotoxin insult. We conclude that our method of identification is suitable for the assessment of lumped parameters windkessel model estimates. The main interest is that actual resistance and compliance values can be obtained easily and simultaneously by a global method approach. [less ▲]

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See detailPulmonary Impedance and Right Ventricular-Vascular Coupling in Endotoxin Shock
D'Orio, Vincenzo ULg; Lambermont, Bernard ULg; Detry, Olivier ULg et al

in Cardiovascular Research (1998), 38(2), 375-82

OBJECTIVE: We tested the hypothesis that right heart failure during endotoxin shock may result from altered ventriculovascular coupling responsible for impeding power transfer to the pulmonary circulation ... [more ▼]

OBJECTIVE: We tested the hypothesis that right heart failure during endotoxin shock may result from altered ventriculovascular coupling responsible for impeding power transfer to the pulmonary circulation. METHODS: The changes in vascular pulmonary input impedance and right ventricular contractility produced by low-dose endotoxin infusion were studied in 6 intact anesthetized dogs. RESULTS: Endotoxin insult resulted in pulmonary hypertension (from 22 +/- 2 to 33 +/- 3 mmHg) associated with significant decreases in stroke volume (from 26.9 +/- 4 to 20.2 +/- 3 ml) and right ventricular ejection fraction (from 41 +/- 3 to 32 +/- 2%). The first minimum of input impedance spectrum and zero phase were shifted towards higher frequencies. Input resistance and characteristic resistance were dramatically increased. The latter change contributed to a significant increase in the pulsatile component of total right ventricular power output from 13 to 21%, indicating a reduction in the hydraulic right ventricle power output delivered into the main pulmonary artery. Overall changes in input pulmonary impedance were indicative of increased afterload facing the right ventricle leading to depressed performance. In contrast, right ventricular systolic elastance was simultaneously increased from 0.56 to 0.93 mmHg/ml indicating an increase in right heart contractility. CONCLUSION: These data suggest that pulmonary hypertension in the setting of experimental endotoxin shock is accompanied by deleterious changes in the pulmonary impedance spectrum, which are responsible for a mismatch of increased contractile state of the right ventricle to the varying hydraulic load ultimately leading to ventricular-vascular uncoupling. [less ▲]

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See detailNormothermic preservation of rabbit hearts using a new perfluorocarbon emulsion
De Roover, Arnaud ULg; Deby, G.; Chapelle, Jean-Paul ULg et al

Poster (1998, March 07)

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See detailMalignancy transplantation with heart graft
Detry, Olivier ULg; Hans, Marie-France ULg; Defraigne, Jean-Olivier ULg et al

in Journal of Heart & Lung Transplantation (1998), 17(3), 331-332

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