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See detailSequential anti-core glycolipid immunoglobulin antibody activities in patients with and without septic shock and their relation to outcome
Nys, Monique ULg; Damas, Pierre ULg; Joassin, Luc et al

in Annals of Surgery (1993), 217(3), 300-306

OBJECTIVE: This study follows the sequential changes in anti-lipopolysaccharide antibodies in infected patients with and without septic shock. SUMMARY BACKGROUND DATA: A relation between high endogenous ... [more ▼]

OBJECTIVE: This study follows the sequential changes in anti-lipopolysaccharide antibodies in infected patients with and without septic shock. SUMMARY BACKGROUND DATA: A relation between high endogenous levels of anti-LPS antibodies and protection against bacteremia and septic shock in at-risk patient groups has been observed. However, information on the daily follow-up and kinetics of apparition or disappearance of anti-LPS antibody activities and their relations with the protective properties of the different immunoglobulin classes has not been clearly investigated. METHODS: Two hundred and five septic surgical patients were studied during their stay in the intensive care unit during a period of 3 years. Among these patients, septic shock developed in 54 and 47 died. A sensitive ELISA was used to study circulating IgM and IgG antibodies to the core glycolipid (CGL) region of Salmonella minnesota R595. The activities were measured each day when sepsis occurred and every hour during septic shock. RESULTS: Anti-CGL IgM activity was found in 32% of the septic patients. This response, however, most often appeared to be transient. A strong correlation was observed between the occurrence of septic shock and the absence of anti-CGL IgM activity on admission to the ICU (p < 0.02). Anti-CGL IgG activity was detected in 82% of the patients and better correlated with outcome for patients with high or rising activities during their hospitalization (p < 0.0005). In patients with septic shock or irreversible organ failure, a fall in the anti-CGL IgG activity was observed before death, suggesting that the IgG antibodies were consumed during this acute event. Therefore, the anti-CGL IgG activity measured by ELISA could be used as a marker of the evolution of the illness. CONCLUSIONS: Our observations demonstrate the interest to follow-up the evolution of the anti-CGL antibodies during sepsis. The fall of these antibodies during septic shock and in patients who died was an additional argument to perform, as an additive form, passive antibody therapy to decrease lethality in this group of patients. [less ▲]

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See detailAutres médiateurs de l'inflammation et du sepsis
Lamy, Maurice ULg; Deby, Ginette ULg; Damas, Pierre ULg

in Revue du Praticien (La) (1993), 43(1), 19-25

During sepsis, the systemic inflammatory response is characterized by the release of numerous mediators supporting and dispersing inflammation. In Gram negative sepsis, the endotoxins play a starting role ... [more ▼]

During sepsis, the systemic inflammatory response is characterized by the release of numerous mediators supporting and dispersing inflammation. In Gram negative sepsis, the endotoxins play a starting role, while in other sepsis, the triggering mediators or mechanisms are unknown but lead to a similar inflammatory reaction. Coagulation and complement cascades are activated, with the release of chemoattractive substances, mediators and proteases and the activation of phagocytic cells. Macrophages/monocytes and polymorphonuclear leucocytes produce then active oxygen species and cytokines; they degranulate (releasing active enzymes such as myeloperoxidase), they express an increasing number of membrane receptors able to interact with endothelial cells and release a supplementary lot of inflammatory mediators (prostanoids, platelet activating factor, leukotrienes ... ). Platelets, also activated, produce the same mediators (TXA2, PAF ...) or specific ones such as serotonine, platelet factor 4, growth factors. Last, but not least, the endothelial cells are stimulated, directly (by endotoxins) or undirectly (by cytokines, C5a, PAF ...). These cells play then a main role by their own phagocytic activity, by alteration of their antithrombotic and fibrinolytic potential, by their secretion of inflammatory mediators and by an increased expression of receptors of adhesivity for the activated phagocytes or platelets, what leads to endothelium injury with membrane permeability alterations. These cascades of activation, these extensions of the inflammatory reaction by the mediators and by the phagocytes and platelets can explain the frequency of multiple organ failure during sepsis as well as the difficulty of an adequate pharmacological therapy. [less ▲]

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See detailLes morphinomimétiques en réanimation
Lamy, Maurice ULg; Joris, Jean ULg; Damas, Pierre ULg et al

in Réan urg (1993), 2(4bis), 488-494

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See detailMycotic aneurysm of the upper abdominal aorta ruptured into the stomach
Van Damme, Hendrik ULg; Belachew, M.; Damas, Pierre ULg et al

in Archives of Surgery (1992), 127(4), 478-482

We report a case of primary aortogastric fistula with erosion of a mycotic aneurysm of the upper abdominal aorta into the stomach. The patient was successfully operated on with an in situ aortoaortic tube ... [more ▼]

We report a case of primary aortogastric fistula with erosion of a mycotic aneurysm of the upper abdominal aorta into the stomach. The patient was successfully operated on with an in situ aortoaortic tube graft, incorporating the splanchnic vessels, and direct suture of the gastric erosion. [less ▲]

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See detailCytokine serum level during severe sepsis in human Il-6 as a marker of severity
Damas, Pierre ULg; Ledoux, Didier ULg; Nys, Monique ULg et al

in Annals of Surgery (1992), 215(4), 356-362

Forty critically ill surgical patients with documented infections were studied during their stay in an intensive care unit. Among these patients, 19 developed septic shock and 16 died, 9 of them from ... [more ▼]

Forty critically ill surgical patients with documented infections were studied during their stay in an intensive care unit. Among these patients, 19 developed septic shock and 16 died, 9 of them from septic shock. Interleukin 1 beta (IL-1 beta), tumor necrosis factor (TNF alpha), and interleukin 6 (IL-6) were measured each day and every 1 or 2 hours when septic shock occurred. Although IL-1 beta was never found, TNF alpha was most often observed in the serum at a level under 100 pg/mL except during septic shock. During these acute episodes TNF alpha level reached several hundred pg/mL, but only for a few hours. In contrast, IL-6 was always increased in the serum of acutely ill patients (peak to 500,000 pg/mL). There was a direct correlation between IL-6 peak serum level and TNF alpha peak serum level during septic shock and between IL-6 serum level and temperature or C-reactive protein serum level. Moreover, IL-6 correlated well with APACHE II score, and the mortality rate increased significantly in the group of patients who presented with IL-6 serum level above 1000 pg/mL. Thus, IL-6 appears to be a good marker of severity during bacterial infection. [less ▲]

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See detailFibrinolyse intra-artérielle in situ des membres inférieurs
Van Damme, Hendrik ULg; Trotteur, Geneviève ULg; Jamblain, P. et al

in Revue Médicale de Liège (1992), 47(1), 25-41

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See detailIntraoperative cytokines production during orthotopic liver transplantation
Pirenne, J.; Noizat-Pirenne, F.; De Groote, D. et al

in Transplant International : Official Journal of the European Society for Organ Transplantation (1992), 5(Suppl 1), 631-635

In summary, we established that a significant production of the monokines interleukin-6, tumor necrosis factor apha, and interleukin-1 occurred during orthotopic liver transplantation whereas the ... [more ▼]

In summary, we established that a significant production of the monokines interleukin-6, tumor necrosis factor apha, and interleukin-1 occurred during orthotopic liver transplantation whereas the lymphokines interferon gamma and interleukin-2 were not detected. Levels of interleukin-6 reached their maximum values before and especially at the end of the anhepatic phase. They remained high after the anhepatic phase, i. e. after reperfusion of the new livers. Tumor necrosis factor alpha and interleukin-1 reached their maximum values after the anhepatic phase. Not only were interleukin-6, tumor necrosis factor alpha, and interleukin-1 present in the serum but they could also be detected in the bile produced by these new livers. Mechanisms of monokine production during orthotopic liver transplantation is multifactorial in origin and further studies will have to evaluate the relative contribution of the various factors involved. The possibility of an association between peroperative monokines and transplant outcome and their potential clinical implication will have to be elucidated. [less ▲]

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See detailCombined treatment of liver failure and hepatorenal syndrome with orthotopic liver transplantation
Detroz, Bernard ULg; Honore, Pierre ULg; Monami, B. et al

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 ▲]

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See detailMeasurements of mediator cascades during adult respiratory distress syndrome
Lamy, Maurice ULg; Deby-Dupont, G.; Deby, C. et al

in Adult Respiratory Distress Syndrome (1992)

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See detailArachidonic acid and cyclooxygenase metabolism in acute lung injury
Lamy, Maurice ULg; Deby-Dupont, G.; Deby, C. et al

in Adult Respiratory Distress Syndrome (1992)

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See detailMécanisme et traitement du syndrome de détresse respiratoire de l'adulte
Deby, Ginette ULg; Damas, Pierre ULg; Lamy, Maurice ULg

in Mécanisme et traitement du SDRA (1992)

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See detailPlasma myeloperoxidase and vitamin E levels in head injury: preliminary results related to outcome.
Hans, Pol ULg; Franssen, Colette ULg; Pincemail, Joël ULg et al

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 ▲]

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See detailAdult respiratory distress syndrome: local or systemic disease
Deby, Ginette ULg; Lamy, Maurice ULg; Deby, C. et al

in Critical Care (1991), 4(1), 57-83

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See detailIntérêt de la différence aterio-veineuse en O2 dans l'approche thérapeutique de l'hypertension intracrânienne post-traumatique
Franssen, Christine ULg; Hans, Pol ULg; Deprez, Josette ULg et al

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 ▲]

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See detailFast double antibody radioimmunoassay of human granulocyte myeloperoxidase and its application to plasma.
Pincemail, Joël ULg; Deby-Dupont, G.; Deby, Christiane ULg et al

in Journal of Immunological Methods (1991), 137(2), 181-191

The haem enzyme myeloperoxidase (MPO) (EC 1.11.1.7) with a spectral A430/A280 ratio greater than 0.7 and a specific activity of 125 U/mg was purified from isolated human neutrophils. To obtain a ... [more ▼]

The haem enzyme myeloperoxidase (MPO) (EC 1.11.1.7) with a spectral A430/A280 ratio greater than 0.7 and a specific activity of 125 U/mg was purified from isolated human neutrophils. To obtain a radioimmunoassay (RIA) for this enzyme, a specific antiserum against human neutrophil MPO was raised in rabbits and used at an initial dilution of 1/10,000. MPO labelled with 125iodine by a technique of self-labelling in the presence of H2O2, had a specific activity of 24 mCi/mg. After incubation at room temperature (2 h) and separation by double antibody precipitation in the presence of polyethylene glycol, the sensitivity of the RIA was 21 ng/ml. The RIA showed good precision and accuracy with intra- and interassay coefficients of variation of less than 7% for MPO concentrations ranging from 100 to 800 ng/ml, and satisfactory recoveries of known amounts of exogenous MPO in plasma. For the measurement of MPO in blood, the best sampling technique was to collect blood into EDTA. Rapid centrifugation (within 20 min) was necessary for blood collected into heparin. Mean MPO values in normal individuals were 340 +/- 98 ng/ml in EDTA plasma (n = 152) and 332 +/- 82 ng/ml in heparinized plasma (n = 34). When MPO was measured 12-6 h after injury in critically ill patients high values (above 1000 ng/ml) were found in 6/15 patients with multiple injuries. In patients with sepsis (n = 22), MPO values were always above 1000 ng/ml. [less ▲]

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See detailCytokines et choc septique
Lamy, Maurice ULg; Damas, Pierre ULg

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

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See detailThe cytokines: a possible role in sepsis
Damas, Pierre ULg

in Current Opinion in Anaesthesiology (1991), 4(2), 241-246

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See detailChoice of sedation according to ventilatory mode
Lamy, Maurice ULg; Damas, Pierre ULg; Joris, Jean ULg

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

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See detailPancreatic failure in relation to trauma and sepsis in intensive care patients
Lamy, Maurice ULg; Deby, Ginette ULg; Damas, Pierre ULg et al

in Applied Cardiopulmonary Pathophysiology [=ACP] (1991), 4

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