Combined treatment of liver failure and hepatorenal syndrome with orthotopic liver transplantation

in Acta Gastro-Enterologica Belgica (1992), 55(4), 350-357

Hepatorenal syndrome (HRS) is a severe complication of liver failure with high mortality. The pathogenesis of this reversible functional renal failure is not yet clearly understood. Diagnosis is based ... [more ▼]

Hepatorenal syndrome (HRS) is a severe complication of liver failure with high mortality. The pathogenesis of this reversible functional renal failure is not yet clearly understood. Diagnosis is based upon the association of clinical and biological criteria. A patient was admitted to our institution for severe liver failure secondary to an exacerbation of cirrhosis, where he developed a fulminant hepatorenal syndrome. Both, the renal and hepatic failure were successfully treated by orthotopic liver transplantation. Special attention was paid to the immunosuppressive treatment with Cyclosporine whose use, we believe, should be delayed until function has partially recovered. [less ▲]

Arachidonic acid and cyclooxygenase metabolism in acute lung injury

in Adult Respiratory Distress Syndrome (1992)

Plasma myeloperoxidase and vitamin E levels in head injury: preliminary results related to outcome.

in Journal of Neurosurgical Anesthesiology (1992), 4(1), 26-30

This preliminary study was designed to assess a possible role of neutrophil activation and to determine the prognostic value of plasma myeloperoxidase (MPO) and vitamin E (Vit. E) levels in severe head ... [more ▼]

This preliminary study was designed to assess a possible role of neutrophil activation and to determine the prognostic value of plasma myeloperoxidase (MPO) and vitamin E (Vit. E) levels in severe head injury. Plasma MPO and Vit. E levels were measured in nine severely head-injured patients (Glasgow Coma Score </=8) (ages 12-80 years) 6, 12. 18, 24, and 30 h after trauma. Patients were classified into two groups according to outcome after discharge from the ICU: group D (death; n = 5) and group S (survival; n = 4). Plasma MPO levels were increased immediately after trauma and then decreased. The MPO peak observed after 6 h was significantly higher (p < 0.05) in group D (mean +/- SEM: 1,237 +/- 122 ng/ml) than in group S (mean +/- SEM: 543 +/- 148 ng/ml). Plasma Vit. E levels were lower than normal values and decreased over time. They were always significantly lower (p < 0.05) in group D than in group S, except for the first sample. These differences cannot be explained entirely by total plasma lipid (TL) values since no statistical difference in TL concentrations was found between the two groups during the course of study. The ratio of Vit. E to TL. considered as the best index of Vit. E status, was lower in group D than in group S. and the difference reached statistical significance (p < 0.05) 12 h after trauma. In conclusion, in spite of the limited number of patients included in this study, it appears that severe head injury is associated with an increase in MPO and a decrease in Vit. E levels. These biochemical changes are of greater magnitude in group D than in group S; they suggest neutrophil activation and lipoperoxidation processes. Finally, plasma MPO and Vit. E seem to be new discriminant factors of outcome in head-injured patients. [less ▲]

Intérêt de la différence aterio-veineuse en O2 dans l'approche thérapeutique de l'hypertension intracrânienne post-traumatique

in Agressologie : Revue Internationale de Physio-Biologie et de Pharmacologie Appliquées aux Effets de l'Agression (1991), 32(6-7), 366-368

Elevated intracranial pressure (ICP) is undoubtedly a determinant factor of outcome in severe head injured patient. Until now, medical treatment of elevated ICP in diffuse brain lesions consisted of ... [more ▼]

Elevated intracranial pressure (ICP) is undoubtedly a determinant factor of outcome in severe head injured patient. Until now, medical treatment of elevated ICP in diffuse brain lesions consisted of hyperventilation, CSF drainage, mannitol and barbiturates without accurate selection criteria. In fact, in comatose patients, the cerebral blood flow (CBF) can vary independently of the cerebral metabolic rate of oxygen (CMRO2) which is typically reduced. The venous oxygen saturation (SjO2) measured in the jugular bulb and the arterial-jugular oxygen difference (ajDO2) can be used for more appropriately selecting therapeutic measures. According to the following equation: CMRO2 = CBF x ajDO2, the measurement of the changes in ajDO2 might serve as an indicator of CBF adequacy, out of the presence of cerebral ischemia. A decreased ajDO2 suggests that CBF is excessive for cerebral metabolic requirements and an elevated ajDO2 indicates a decreased CBF. Consequently, treatment of elevated ICP in the presence of a low ajDO2 should be more oriented towards moderate hyperventilation and administration of metabolic depressive agents with maintenance of normal arterial blood pressure. Conversely, in case of high ajDO2, ICP control should aim to increase CBF by maintaining normocapnia, improving hemodynamic status or reducing extravascular volume accordingly. [less ▲]

Cytokines et choc septique

in Bulletin de l'Académie Royale de Médecine de Belgique (1991), 146(6-7), 270

Choice of sedation according to ventilatory mode

in Journal of drug development (1991), 4(Suppl 3), 77-81

Heparin-induced thrombocytopenia: A case report

in Angiology (1990), 41(12), 1075-1081

The authors report a case of heparin-induced thrombocytopenia, in whom massive pulmonary embolism occurred in spite of heparin anticoagulation. Successful pulmonary thrombectomy was carried out under ... [more ▼]

The authors report a case of heparin-induced thrombocytopenia, in whom massive pulmonary embolism occurred in spite of heparin anticoagulation. Successful pulmonary thrombectomy was carried out under cardiopulmonary bypass, with limitation of platelet clumping during bypass by aggregation inhibitors. This report is a comprehensive contribution to a better understanding of this rare immunoallergic complication of heparin administration, with a high incidence of serious thromboembolic events. The optimal management for cases of unavoidable reexposure to heparin is discussed. [less ▲]

Insuffisance respiratoire postopératoire - sevrage

in Anesthésie Réanimation Chirurgicale (1990)

Posttraumatic Parathyroid Crisis and Severe Hypercalcemia Treated with Intravenous Bisphosphonate (Apd). Case Report

in Acta Anaesthesiologica Belgica (1990), 41(1), 47-50

te hypercalcemia (4.03 mmol/l) developed in a 50 years old woman after head and intraabdominal trauma (and splenectomy). After failure to correct the calcium levels by intravenous saline, furosemide ... [more ▼]

te hypercalcemia (4.03 mmol/l) developed in a 50 years old woman after head and intraabdominal trauma (and splenectomy). After failure to correct the calcium levels by intravenous saline, furosemide, steroids and calcitonin, two hemodialyses were performed; definitive control of hypercalcemia was obtained by intravenous (3-amino-1-hydroxypropylidene)-1.1-bisphosphonic acid (APD). APD is a new drug analog of pyrophosphate; its main property is to block bone resorption, irrespective of its stimulus. As suspected by clinical and laboratory data and confirmed by arteriographic findings, surgery and pathologic examination, the underlying pathology was a mild primary hyperparathyroidism which was acutely worsened (parathyroid crisis) in the course of the trauma. Definitive treatment consisted of the removal of the adenoma responsible of the hyperparathyroidism. [less ▲]

Operative mortality following surgery for colorectal cancer

in British Journal of Surgery (1989), 76(7), 745-747

From 1973 to 1986 at the Baviere Hospital, University of Liege, 476 patients underwent surgery for colorectal cancers. The overall operative mortality rate was 13.4 per cent. The following postoperative ... [more ▼]

From 1973 to 1986 at the Baviere Hospital, University of Liege, 476 patients underwent surgery for colorectal cancers. The overall operative mortality rate was 13.4 per cent. The following postoperative life-threatening complications occurred: myocardial infarction (14 per cent of the postoperative deaths) during the first three postoperative days; bronchopneumonia (27 per cent of the postoperative deaths) mainly during the first postoperative week; pulmonary embolism (17 per cent of the postoperative deaths) mainly during the second postoperative week; anastomotic leakage and cerebrovascular accident (14 and 8 per cent of the postoperative deaths respectively) mainly during the third and fourth postoperative weeks. Specific risk factors were chronic obstructive airways disease associated with a higher incidence of postoperative bronchopneumonia, and previous myocardial infarction associated with postoperative myocardial infarction and pulmonary embolism. General risk factors were old age and emergency procedure, both of which were associated with a higher incidence of infectious complications. The operative mortality rate fell from 20.1 per cent in the 1973-79 period to 7.8 per cent in the 1980-86 period. [less ▲]