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See detailLiving related liver transplantation in adults: First year experience at the University of Liege
Detry, Olivier ULg; De Roover, Arnaud ULg; Delwaide, Jean ULg et al

in Acta Chirurgica Belgica (2004), 104(2, MAR-APR), 166-171

Living related liver transplantation (LRLT) in adult recipients has been recently developed to overcome the organ donor shortage, but LRLT leaves the healthy donors at risk of serious post-operative ... [more ▼]

Living related liver transplantation (LRLT) in adult recipients has been recently developed to overcome the organ donor shortage, but LRLT leaves the healthy donors at risk of serious post-operative complications, or even death. The aim of this paper is to report the prospective evaluation of the initial experience of adult LRLT at the University of Liege. From March 2002 till March 2003, in a consecutive series of 35 adult liver transplantations, five recipients (mean age : 51 years) underwent LRLT, including one retransplantation. Indications for transplantation were autoimmune hepatitis, hepatitis B virus related cirrhosis with hepatocarcinoma (two cases), hepatitis C virus related cirrhosis with hepatocarcinoma, and ischemic intrahepatic bile duct necrosis 10 years after primary liver transplantation. Mean age of the donors was 34 years (range : 21-53 years). All donation cases were intra familial at first degree. The right lobe was used as a graft in four cases and the left lobe in one case. All right lobe donors developed transient hyperbilirubinemia and hypocoagulation for 4 to 6 days. No severe complication (transfusion, bile duct fistula, reintervention, rehospitalization) nor significant long-term sequelae were observed in the donors. In the recipients, graft function was immediate, and there was no small-for-size syndrome. One recipient developed biliary fistula treated by reoperation. One recipient died from invasive aspergillosis 11 days after the procedure. The four other recipients were alive without recurrence of the disease at follow-up. This report confirmed that LRLT may be a valuable alternative to cadaveric liver transplantation in the era of organ donor shortage. However, even if there was no severe complication for the donors in our preliminary experience, LRLT puts healthy living donors at risk of significant morbidity and even death. [less ▲]

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See detailLe cas clinique du mois. Syndrome de Down et myxoedeme: description d'un cas et revue de la litterature
Serpe, Philippe ULg; Gaillard, J. F.; Serpe, J. N. et al

in Revue Médicale de Liège (2004), 59(3), 131-135

A case of myxedema secondary to undetected hypothyroidism developed in a 48 year old 21-trisomic male. This paper presents a short discussion about different possible diagnoses and a review of the ... [more ▼]

A case of myxedema secondary to undetected hypothyroidism developed in a 48 year old 21-trisomic male. This paper presents a short discussion about different possible diagnoses and a review of the literature concerning the relationship between Down Syndrome and hypothyroidism or other diseases. [less ▲]

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See detailLe cas clinique du mois. Cirrhose autoimmune traitee par transplantation hepatique 'a partir d'un lobe hepatique droit preleve chez un donneur vivant
Detry, Olivier ULg; De Roover, Arnaud ULg; Coimbra Marques, Carla ULg et al

in Revue Médicale de Liège (2004), 59(2), 69-74

The authors describe the case of a 17-year-old girl who suffered from end-stage liver failure due to chronic autoimmune hepatitis. Liver failure was complicated by severe portal hypertension ... [more ▼]

The authors describe the case of a 17-year-old girl who suffered from end-stage liver failure due to chronic autoimmune hepatitis. Liver failure was complicated by severe portal hypertension, hypersplenism and refractory ascites. Liver transplantation was indicated. She was listed for cadaveric whole liver transplantation, but her infrequent blood group (B) increased waiting time. Her condition deteriorated to Child C liver failure and living related liver transplant was considered. Her father was compatible and proposed himself for donation. Right lobe procurement was decided in order to provide sufficient liver mass. No transfusion of red cells, platelets, or fresh frozen plasma was used either in the donor or the recipient. Both recipient and donor left the ward at postoperative day 14, without complication. They were both asymptomatic and with normal liver tests at one year follow-up. Living related liver transplantation using the right lobe may offer an alternative to liver transplant candidates in this period of organ donor shortage. [less ▲]

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See detailActualites en anesthésie-réanimation en chirurgie cardiaque adulte
Roediger, Laurence ULg; Larbuisson, Robert ULg; Senard, Marc ULg et al

in Revue Médicale de Liège (2004), 59(1), 35-45

Anesthetic techniques and treatment of cardiac surgery patients have considerably evolved over the past twenty years. The demand for cardiac surgical procedures is increasing. This demand coincides with a ... [more ▼]

Anesthetic techniques and treatment of cardiac surgery patients have considerably evolved over the past twenty years. The demand for cardiac surgical procedures is increasing. This demand coincides with a change in the profile of patients presenting for surgery, requiring modification in perioperative management strategies. Several new anesthetics, related drugs, and technologies have become available in recent years that inevitably have made new approaches with patient management possible. In parallel to these new developments, there have appeared real opportunities to apply novel physiologic and pharmacologic concepts that may redefine our clinical practice. Fast-tracking, which emphasizes the major role of anesthetic management in postoperative outcome, is one such line of investigation. Fast-tracking was first introduced in an attempt to decrease the time to tracheal extubation and reduce expensive time in intensive care unit areas. Large doses of opioids have been clearly identified as a factor in delaying weaning from mechanical ventilatory support after cardiac surgery. Thus, early investigations emphasized the importance of limiting the dose of potent opioid analgesics during the intraoperative period to achieve early recovery. Supplementation with hypnotic drugs allows reduction of the opioid dose, enabling earlier extubation without compromising hemodynamic stability. Fast track cardiac anesthesia (FTCA) is becoming an accepted practice for perioperative management of cardiac surgical patients. FTCA is a key component to successful conduction of fast-track cardiac surgery. Also, analgesia management in cardiac surgery is becoming more important with the establishment of minimally invasive direct coronary artery bypass surgery and fast track management of conventional cardiac surgery patients. [less ▲]

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See detailLiver transplantation in Jehovah's witnesses
DETRY, Olivier ULg; DE ROOVER, Arnaud ULg; DELWAIDE, Jean ULg et al

in Acta Gastro-Enterologica Belgica (2004), 67

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See detailAuditory processing in severely brain injured patients: differences between the minimally conscious state and the persistent vegetative state.
Boly, Mélanie ULg; FAYMONVILLE, Marie-Elisabeth ULg; Peigneux, Philippe ULg et al

in Archives of Neurology (2004), 61(2), 233-8

BACKGROUND: The minimally conscious state (MCS) is a recently defined clinical condition; it differs from the persistent vegetative state (PVS) by the presence of inconsistent, but clearly discernible ... [more ▼]

BACKGROUND: The minimally conscious state (MCS) is a recently defined clinical condition; it differs from the persistent vegetative state (PVS) by the presence of inconsistent, but clearly discernible, behavioral evidence of consciousness. OBJECTIVE: To study auditory processing among patients who are in an MCS, patients who are in a PVS, and healthy control subjects. METHODS: By means of (15)O-radiolabeled water-positron emission tomography, we measured changes in regional cerebral blood flow induced by auditory click stimuli in 5 patients in an MCS, 15 patients in a PVS, and 18 healthy controls. RESULTS: In both patients in an MCS and the healthy controls, auditory stimulation activated bilateral superior temporal gyri (Brodmann areas 41, 42, and 22). In patients in a PVS, the activation was restricted to Brodmann areas 41 and 42 bilaterally. We also showed that, compared with patients in a PVS, patients in an MCS demonstrated a stronger functional connectivity between the secondary auditory cortex and temporal and prefrontal association cortices. CONCLUSIONS: Although assumptions about the level of consciousness in severely brain injured patients are difficult to make, our findings suggest that the cerebral activity observed in patients in an MCS is more likely to lead to higher-order integrative processes, thought to be necessary for the gain of conscious auditory perception. [less ▲]

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See detailCardiac tamponade and pulmonary compression due to volvulus of oesophageal coloplasty
Canivet, Jean-Luc ULg; Piret, Sonia ULg; Hick, Gaëtane ULg et al

in Acta Anaesthesiologica Belgica (2004), 55(2), 125-127

We describe an unusual case of cardiac tamponade and pulmonary compression due to acute volvulus of colon interposition occuring late after oesophagectomy. Clinical signs were suggestive of cardiac ... [more ▼]

We describe an unusual case of cardiac tamponade and pulmonary compression due to acute volvulus of colon interposition occuring late after oesophagectomy. Clinical signs were suggestive of cardiac tamponade but there was no evidence of pericardial effusion by transthoracic echocardiography. Thoracic-CT provided the diagnostic clue in revealing the extrapericardial nature (a major dilatation of the colonic transplant) of the tamponade. This diagnosis should be considered in case of acute cardiopulmonary distress occuring early or late after oesophagectomy. [less ▲]

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See detailCitrate vs. heparin for anticoagulation in continuous venovenous hemofiltration: a prospective randomized study
Monchi, Mehran; Berghmans, Denis; Ledoux, Didier ULg et al

in Intensive Care Medicine (2004), 30(2), 260-265

Abstract Objective: To compare the efficacy and safety of adjusted-dose unfractionated heparin with that of regional citrate anticoagulation in intensive care patients treated by continuous venovenous ... [more ▼]

Abstract Objective: To compare the efficacy and safety of adjusted-dose unfractionated heparin with that of regional citrate anticoagulation in intensive care patients treated by continuous venovenous hemofiltration (CVVH). Design and setting: Prospective, randomized, clinical trial in a 32-bed medical and surgical ICU in a university teaching hospital. Patients: ICU patients with acute renal failure requiring continuous renal replacement therapy, without cirrhosis, severe coagulopathy, or known sensitivity to heparin. Interventions: Before the first CVVH run patients were randomized to receive anticoagulation with heparin or trisodium citrate. Patients eligible for another CVVH run received the other study medication in a crossover fashion until the fourth circuit. Measurements and results: Fortynine circuits (hemofilters) were analyzed: 23 with heparin and 26 with citrate. The median lifetime of hemofilters was 70 h (interquartile range 44–140) with citrate anticoagulation and 40 h (17–48) with heparin (p=0.0007). One major bleeding occurred during heparin anticoagulation and one metabolic alkalosis (pH=7.60) was noted with citrate after a protocol violation. Transfusion rates (units of red cells per day of CVVH) were, respectively, 0.2 (0.0–0.4) with citrate and 1.0 (0.0–2.0) with heparin (p=0.0008). Conclusions: Regional citrate anticoagulation seems superior to heparin for the filter lifetime and transfusion requirements in ICU patients treated by continuous renal replacement therapy. [less ▲]

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See detailEpidemiology and outcome of acute lung injury in European intensive care units. Results from the ALIVE study
Brun-Buisson, Christian; Minelli, Cosetta; Bertolini, Guido et al

in Intensive Care Medicine (2004), 30(1), 51-61

Abstract Objectives: To re-examine the epidemiology of acute lung injury (ALI) in European intensive care units (ICUs). Design and setting: A 2-month inception cohort study in 78 ICUs of 10 European ... [more ▼]

Abstract Objectives: To re-examine the epidemiology of acute lung injury (ALI) in European intensive care units (ICUs). Design and setting: A 2-month inception cohort study in 78 ICUs of 10 European countries. Patients: All patients admitted for more than 4 h were screened for ALI and followed up to 2 months. Measurements and main results: Acute lung injury occurred in 463 (7.1%) of 6,522 admissions and 16.1% of all mechanically ventilated patients; 65.4% cases occurred on ICU admission. Among 136 patients initially presenting with “mild ALI” (200< PaO2/FiO2 £300), 74 (55%) evolved to acute respiratory distress syndrome (ARDS) within 3 days. Sixty-two patients (13.4%) remained with mild ALI and 401 had ARDS. The crude ICU and hospital mortalities were 22.6% and 32.7% (p<0.001), and 49.4% and 57.9% (p=0.0005), respectively, for mild ALI and ARDS. ARDS patients initially received a mean tidal volume of 8.3±1.9 ml/kg and a mean PEEP of 7.7±3.6 cmH2O; air leaks occurred in 15.9%. After multivariate analysis, mortality was associated with age (odds ratio (OR) =1.2 per 10 years; 95% confidence interval (CI): 1.05–1.36), immuno-incompetence (OR: 2.88; Cl: 1.57–5.28), the severity scores SAPS II (OR: 1.16 per 10% expected mortality; Cl: 1.02–1.31) and logistic organ dysfunction (OR: 1.25 per point; Cl: 1.13–1.37), a pH less than 7.30 (OR: 1.88; Cl: 1.11–3.18) and early air leak (OR: 3.16; Cl: 1.59–6.28). Conclusions: Acute lung injury was frequent in our sample of European ICUs (7.1%); one third of patients presented with mild ALI, but more than half rapidly evolved to ARDS. While the mortality of ARDS remains high, that of mild ALI is twice as low, confirming the grading of severity between the two forms of the syndrome. [less ▲]

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See detailResuscitation and monitoring after abdominal trauma
Damas, Pierre ULg; Hartstein, Gary ULg

in Imaging and intervention in abdominal trauma (2004)

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See detailLes toxidermies paroxystiques graves.
Paquet, Philippe ULg; Flagothier, Caroline ULg; Pierard, Claudine ULg et al

in Revue Médicale de Liège (2004), 59(5), 286-92

Some drug reactions showing cutaneous expression exhibit a paroxysmal course. These diseases encompass the toxic epidermal necrolysis, the drug hypersensitivity syndrome, and the acute generalized ... [more ▼]

Some drug reactions showing cutaneous expression exhibit a paroxysmal course. These diseases encompass the toxic epidermal necrolysis, the drug hypersensitivity syndrome, and the acute generalized exanthematic pustulosis. These syndromes are associated with dismal outcome. They represent medical emergencies needing hospitalization in specialized care units. [less ▲]

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See detailResidual cerebral functioning in the vegetative state
Laureys, Steven ULg; Faymonville, Marie-Elisabeth ULg; De Tiège, X. et al

in Arco di Giano (2004)

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See detailRight lobe living-related liver transplantation in a Jehovah's Witness
Detry, Olivier ULg; De Roover, Arnaud ULg; Kaba, Abdourahmane ULg et al

in Transplant International (2003), 16(12), 895-896

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See detailFavourable outcome of a brain trauma patient despite bilateral loss of cortical somatosensory evoked potential during thiopental sedation
Robe, Pierre; Dubuisson, Annie ULg; Bartsch, Sébastien et al

in Journal of Neurology, Neurosurgery & Psychiatry (2003), 74(8), 1157-1158

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See detailBronchoalveolar lavage fluids of ventilated patients with acute lung injury activate NF-kappa B in alveolar epithelial cell line: role of reactive oxygen/nitrogen species and cytokines
Nys, Monique ULg; Deby-Dupont, Ginette; Habraken, Yvette ULg et al

in Nitric Oxide (2003), 9(1), 33-43

In human alveolar epithelial cell line, we investigated the binding activity of NF-kappaB induced by the bronchoalveolar lavage fluids (BALs) from ventilated patients with acute lung injury (ALI), in ... [more ▼]

In human alveolar epithelial cell line, we investigated the binding activity of NF-kappaB induced by the bronchoalveolar lavage fluids (BALs) from ventilated patients with acute lung injury (ALI), in correlation with the concentrations of inflammatory cytokines, RNOS, and the severity of the ALI. In BALs obtained in 67 patients (16 bronchopneumonia, 14 infected ARDS, 20 ARDS, and 17 ALI patients without bronchopneumonia and no ARDS), we measured endotoxin, IL-1beta, IL-8, and nitrated proteins (NTP), the activity of mycloperoxidase, and the capacity to activate the NF-kappaB in alveolar A549 cells by electrophoretic mobility shift and supershift assays. The neutrophil counts and mean IL-1beta, IL-8, myeloperoxidase, and NTP values were increased in bronchopneumonia and infected ARDS groups compared to ARDS and ALI without bronchopneumonia and no ARDS groups (P < 0.001). The number of neutrophils was correlated to those of IL-1beta, IL-8, myeloperoxidase, NTP, and endotoxin in all groups (P < 0.0001). NF-kappaB activity was induced in alveolar like cells by BALs in all groups, was higher in bronchopneumonia and infected ARDS groups (P < 0.02), and was correlated to IL-1beta (P = 0.0002), IL-8 (P = 0.02), NTP (P = 0.014), myeloperoxidase (P = 0.016), and neutrophil counts (P = 0.003). BALs of bronchopneumonia and infected ARDS patients had increased inflammatory mediators (compared to ARDS and ALI without bronchopneumonia and no ARDS patients) that correlated to neutrophil counts and to the NF-kappaB-binding activity. These mediators and NF-kappaB activation may induce an amplification of inflammatory phenomena. By in vitro studies, we confirmed that NO-derived species (10(-6) to 10(-5) M peroxynitrite and 10(-5) M nitrites) and myeloperoxidase (at concentration equivalent to that found in BALs) can participate in the NF-kappaB activation. (C) 2003 Elsevier Inc. All rights reserved. [less ▲]

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See detailOccurrence of MRSA endocarditis during linezolid treatment
Ben Mansour, El Hassan; Jacob, Eric; Monchi, Mehran et al

in European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology (2003), 22(6), 372-373

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See detailBronchoalveolar lavage fluids of patients with lung injury activate the transcription factor nuclear factor-kappa beta in an alveolar cell line
Nys, Monique ULg; Deby-Dupont, G.; Habraken, Yvette ULg et al

in Clinical Science (2002), 103(6), 577-585

In bronchoalveolar lavage (BAL) fluid from ventilated patients, cytotoxic oxidant activity is correlated with neutrophil activation. The aim of the present study was to investigate the hypothesis that BAL ... [more ▼]

In bronchoalveolar lavage (BAL) fluid from ventilated patients, cytotoxic oxidant activity is correlated with neutrophil activation. The aim of the present study was to investigate the hypothesis that BAL fluid induces activation of the transcription nuclear factor-kappaB (NF-kappaB) in human alveolar cells, in correlation with inflammatory mediators. We measured endotoxin, inflammatory cytokines [Interleukin-1beta (IL-1beta), IL-8], nitrated proteins and the activity of myeloperoxidase (MPO) in BAL fluid from ventilated patients developing bronchopneumonia (n = 19 samples) or with acute respiratory distress syndrome (ARDS) (n = 14), and from ARDS/infection-free patients (n = 11). We also exposed alveolar cells to the BAL fluid or to human MPO, H2O2 or HOCl, and tested nuclear extracts for the activation of NF-kappaB. IL-1beta, IL-8, nitrated protein, MPO and endotoxin levels were significantly higher in BAL fluid from patients with bronchopneumonia than in that from the ARDS and ARDS/infection-free groups. A correlation was observed between IL-8 and MPO values (r = 0.82). The level of NF-kappaB activity induced by the BAL fluid was correlated with levels of IL-1beta (P < 0.001), IL-8 (P < 0.005) and MPO (P < 0.002), and with the neutrophil count (P < 0.002), and was higher for BAL fluid from the bronchopneumonia group. NF-kappaB activation by MPO was also demonstrated. The activation of NF-kappaB by BAL fluid, especially that from bronchopneumonia patients, suggests that a similar phenomenon may occur in vivo, leading to potential amplification of the inflammatory reaction. [less ▲]

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See detailBrain function in the vegetative state
Laureys, Steven ULg; Antoine, S.; Boly, Mélanie ULg et al

in Acta Neurologica Belgica (2002), 102(4), 177-185

Positron emission tomography (PET) techniques represent a useful tool to better understand the residual brain function in vegetative state patients. It has been shown that overall cerebral metabolic rates ... [more ▼]

Positron emission tomography (PET) techniques represent a useful tool to better understand the residual brain function in vegetative state patients. It has been shown that overall cerebral metabolic rates for glucose are massively reduced in this condition. However, the recovery of consciousness from vegetative state is not always associated with substantial changes in global metabolism. This finding led us to hypothesize that some vegetative patients are unconscious not just because of a global loss of neuronal function, but rather due to an altered activity in some critical brain regions and to the abolished functional connections between them. We used voxel-based Statistical Parametric Mapping (SPM) approaches to characterize the functional neuroanatomy of the vegetative state. The most dysfunctional brain regions were bilateral frontal and parieto-temporal associative cortices. Despite the metabolic impairment, external stimulation still induced a significant neuronal activation (i.e., change in blood flow) in vegetative patients as shown by both auditory click stimuli and noxious somatosensory stimuli. However this activation was limited to primary cortices and dissociated from higher-order associative cortices, thought to be necessary for conscious perception. Finally, we demonstrated that vegetative patients have impaired functional connections between distant cortical areas and between the thalami and the cortex and, more importantly, that recovery of consciousness is paralleled by a restoration of this cortico-thalamo-cortical interaction. [less ▲]

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See detailCortical processing of noxious somatosensory stimuli in the persistent vegetative state
Laureys, Steven ULg; Faymonville, Marie-Elisabeth ULg; Peigneux, Philippe ULg et al

in NeuroImage (2002), 17(2), 732-741

The persistent vegetative state (PVS) is a devastating medical condition characterized by preserved wakefulness contrasting with absent voluntary interaction with the environment. We used positron ... [more ▼]

The persistent vegetative state (PVS) is a devastating medical condition characterized by preserved wakefulness contrasting with absent voluntary interaction with the environment. We used positron emission tomography to assess the central processing of noxious somatosensory stimuli in the PVS. Changes in regional cerebral blood flow were measured during high-intensity electrical stimulation of the median nerve compared with rest in 15 nonsedated patients and in 15 healthy controls. Evoked potentials were recorded simultaneously. The stimuli were experienced as highly unpleasant to painful in controls. Brain glucose metabolism was also studied with [F-18]fluorodeoxyglucose in resting conditions. In PVS patients, overall cerebral metabolism was 40% of normal values. Nevertheless, noxious somatosensory stimulation-activated midbrain, contralateral thalamus, and primary somatosensory cortex in each and every PVS patient, even in the absence of detectable cortical evoked potentials. Secondary somatosensory, bilateral insular, posterior parietal, and anterior cingulate cortices did not show activation in any patient. Moreover, in PVS patients, the activated primary somatosensory cortex was functionally disconnected from secondary somatosensory, bilateral posterior parietal, premotor, polysensory superior temporal, and prefrontal cortices. In conclusion, somatosensory stimulation of PVS patients, at intensities that elicited pain in controls, resulted in increased neuronal activity in primary somatosensory cortex, even if resting brain metabolism was severely impaired. However, this activation of primary cortex seems to be isolated and dissociated from higher-order associative cortices. (C) 2002 Elsevier Science (USA). [less ▲]

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