References of "Damas, Pierre"
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See detailA french validation study of the Coma Recovery Scaled-Revised (CRS-R)
Schnakers, Caroline ULg; Majerus, Steve ULg; Giacino, Joseph et al

in Brain Injury (2008), 22(10), 786-792

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See detailLes échelles d’évaluation des états de conscience altérée
Ledoux, Didier ULg; Piret, Sonia ULg; Boveroux, Pierre ULg et al

in Réanimation (2008), 17

L’évaluation de l’état de conscience revêt une importance clinique considé- rable. En effet, déterminer avec précision la sévérité de l’altération de conscience permet non seulement d’établir un pronostic ... [more ▼]

L’évaluation de l’état de conscience revêt une importance clinique considé- rable. En effet, déterminer avec précision la sévérité de l’altération de conscience permet non seulement d’établir un pronostic vital et fonctionnel mais aussi de suivre plus efficacement l’évolution clinique des patients avec lésion cérébrale et d’optimaliser l’utilisation des ressources disponibles. Dans cet article, nous passons en revue les principales échelles d’évaluation des états de conscience altérée. Nous nous intéressons particu- lièrement à instrument récemment publié, l’échelle «Full Outline of UnResponsiveness» (FOUR). En effet, cette dernière constitue une avancée considérable dans l’évaluation cli- nique des patients présentant un état de conscience altérée. Parmi les apports de cette échelle, on notera sa contribution au diagnostic d’un locked-in syndrome, d’un état de conscience minimale ou encore d’un état de mort cérébrale. Nous pensons qu’en rai- son de son apport à l’examen clinique durant la phase initiale d’un état de conscience altérée, l’échelle FOUR devrait être préférée à la désormais classique échelle de Glasgow. [less ▲]

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See detailBloodless liver transplantation: Experience with Jehovah's witnesses
Detry, Olivier ULg; De Roover, Arnaud ULg; Coimbra Marques, Carla ULg et al

in Transplant International (2007, September), 20(Supplement 2), 291812

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See detailCystatin C blood level as a risk factor for death after heart surgery
Ledoux, Didier ULg; Monchi, M.; Chapelle, Jean-Paul ULg et al

in European Heart Journal (2007), 28(15), 1848-53

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See detailPancreatic cellular injury after cardiac surgery with cardiopulmonary bypass: Frequency, time course and risk factors
Nys, Monique ULg; Venneman, Ingrid ULg; Deby-Dupont, G. et al

in Shock (Augusta, Ga.) (2007), 27(5), 474-481

Although often clinically silent, pancreatic cellular injury (PCI) is relatively frequent after cardiac surgery with cardiopulmonary bypass; and its etiology and time course are largely unknown. We ... [more ▼]

Although often clinically silent, pancreatic cellular injury (PCI) is relatively frequent after cardiac surgery with cardiopulmonary bypass; and its etiology and time course are largely unknown. We defined PCI as the simultaneous presence of abnormal values of pancreatic isoamylase and immunoreactive trypsin (IRT). The frequency and time evolution of PCI were assessed in this condition using assays for specific exocrine pancreatic enzymes. Correlations with inflammatory markers were searched for preoperative risk factors. One hundred ninety-three patients submitted to cardiac surgery were enrolled prospectively. Blood IRT, amylase, pancreatic isoamylase, lipase, and markers of inflammation (alpha1-protease inhibitor, alpha2-macroglobulin, myeloperoxidase) were measured preoperatively and postoperatively until day 8. The postoperative increase in plasma levels of pancreatic enzymes and urinary IRT was biphasic in all patients: early after surgery and later (from day 4 to 8 after surgery). One hundred thirty-three patients (69%) experienced PCI, with mean IRT, isoamylase, and alpha1-protease inhibitor values higher for each sample than that in patients without PCI. By multiple regression analysis, we found preoperative values of plasma IRT >or=40 ng/mL, amylase >or=42 IU/mL, and pancreatic isoamylase >or=20 IU/L associated with a higher incidence of postsurgery PCI (P < 0.005). In the PCI patients, a significant correlation was found between the 4 pancreatic enzymes and urinary IRT, total calcium, myeloperoxidase, alpha1-protease inhibitor, and alpha2-macroglobulin. These data support a high prevalence of postoperative PCI after cardiac surgery with cardiopulmonary bypass, typically biphasic and clinically silent, especially when pancreatic enzymes were elevated preoperatively. [less ▲]

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See detailCascade high volume hemofiltration : Preliminary data in septic shock patients
WIESEN, Patricia ULg; MONCHI, Mehran; DUBOIS, Bernard ULg et al

in Blood Purification (2007), 25

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See detailActualites therapeutiques en medecine intensive.
CANIVET, Jean-Luc ULg; Monchi, Mehran; PREISER, Jean-Charles ULg et al

in Revue Médicale de Liège (2007), 62(5-6), 277-80

Over the last ten years, much progress has been achieved in intensive care medicine. Large randomized studies, most often their multicentric, were performed and their results were translated into rules to ... [more ▼]

Over the last ten years, much progress has been achieved in intensive care medicine. Large randomized studies, most often their multicentric, were performed and their results were translated into rules to be followed for the most appropriate treatment of life-threatening organ failures. The place of non-invasive ventilation in the management of hypercapnic or hypoxic respiratory insufficiencies was thus defined, and the methods for less traumatic mechanical ventilation were specified. The techniques of renal replacement therapy were compared and the optimal doses of dialysis or hemofiltration were established. The metabolic support of the patients was also altered following landmark studies, such as the management of blood glucose, which deeply influenced the approach to critically ill patients. [less ▲]

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See detailCadaveric liver transplantation for non-acetaminophen fulminant hepatic failure: A 20-year experience
Detry, Olivier ULg; De Roover, Arnaud ULg; Coimbra Marques, Carla ULg et al

in World Journal of Gastroenterology (2007), 13(9), 1427-1430

AIM: To investigate the long-term results of liver transplantation (LT) for non-acetaminophen fulminant hepatic failure (FHF). METHODS: Over a 20-year period, 29 FHF patients underwent cadaveric whole LT ... [more ▼]

AIM: To investigate the long-term results of liver transplantation (LT) for non-acetaminophen fulminant hepatic failure (FHF). METHODS: Over a 20-year period, 29 FHF patients underwent cadaveric whole LT. Most frequent causes of FHF were hepatitis B virus and drug-related (not acetaminophen) liver failure. All surviving patients were regularly controlled at the out-patient clinic and none was lost to follow-up. Mean follow-up was 101 mo. RESULTS: One month, one-, five- and ten-year patient survival was 79%, 72%, 68% and 68%, respectively. One month, one-, five- and ten-year graft survival was 69%, 65%, 51% and 38%, respectively. Six patients needed early (< 2 mo) retransplantation, four for primary non-function, one for early acute refractory rejection because of ABO blood group incompatibility, and one for a malignant tumor found in the donor. Two patients with hepatitis B FHF developed cerebral lesions peri-transplantion: One developed irreversible and extensive brain damage leading to death, and one suffered from deep deficits leading to continuous medical care in a specialized institution. CONCLUSION: Long-term outcome of patients transplanted for non-acetaminophen FHF may be excellent. As the quality of life of these patients is also particularly good, LT for FHF is clearly justified, despite lower graft survival compared with LT for other liver diseases. (C) 2007 The WJG Press. All rights reserved. [less ▲]

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See detailL'anticoagulation de l'hémofiltration continue: Citrate versus Héparine
Damas, Pierre ULg; Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (2007), 62

L'insuffisance rénale aiguë aux Soins Intensifs affecte un patient sur cinq et souvent nécessite le recours à une épuration extra-rénale. L'hémofiltration continue est choisie pour certains patients ... [more ▼]

L'insuffisance rénale aiguë aux Soins Intensifs affecte un patient sur cinq et souvent nécessite le recours à une épuration extra-rénale. L'hémofiltration continue est choisie pour certains patients (instabilité hémodynamique, neurologique, mais nécessite, comme d'ailleurs l'hémodialyse, une anticoagulation. Le citrate, utilisé dans le travail publié, est sorti vainqueur de sa comparaison avec l'héparine non fractionnée. Son utilisation nécessite cependant une surveillance attentive. [less ▲]

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See detailMolecular epidemiology of extended-spectrum beta-lactamase-producing Enterobacteriaceae colonizing the digestive tract of patients admitted to intensive care units in a Belgian university hospital
CHRISTIAENS, Geneviève ULg; Damas, Pierre ULg; Docquier, J. D. et al

in American Society of Microbiology (Ed.) Program and Abstracts of the 46th Intersciences Conference on Antimicrobial Agents and Chemotherapy (2006, September)

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See detailFasciites nécrosantes: stratégie diagnostique et thérapeutique
Smeets, Laurent ULg; Bous, Aurélie ULg; Lecoq, Jean-Pierre ULg et al

in Revue Médicale de Liège (2006), 61(4), 240-244

The necrotizing fasciitis is a medico-surgical emergency, characterized by the rapid speard of the infection in the subcutaneous tissue, involving fascia superficialis. Peaucity of cutaneous findings ... [more ▼]

The necrotizing fasciitis is a medico-surgical emergency, characterized by the rapid speard of the infection in the subcutaneous tissue, involving fascia superficialis. Peaucity of cutaneous findings early in the course of the disease makes diagnosis a challenge for physician. Pain out of proportion to clinical findings, fever and signs of systemic toxicity are the keys in identification of necrotizing fasciitis. Delayed diagnosis lead to sepsis syndrom and/or multiple organ failure and correlate with poor oucome. Radiolographs, CT-scan or MRI are main radiologic studies, but such procedures should never delay surgical intervention. Intravenous antibiotics, fluid and electrolyte management and analgesia are needed in addition to radical debridment. Clindamycin, hyperbaric oxygen therapy and intravenous immunoglobulins are discussed treatments. Only prompt recognition and immediat care warrant a lower mortality and morbidity for this life-threatening infection. [less ▲]

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See detailSelection of resistance during sequential use of preferential antibiotic classes
Damas, Pierre ULg; Canivet, Jean-Luc ULg; Ledoux, Didier ULg et al

in Intensive Care Medicine (2006), 32

OBJECTIVE: To determine the effect of antibiotic class pressure on the susceptibility of bacteria during sequential periods of antibiotic homogeneity. DESIGN AND SETTING: Prospective study in a mixed ICU ... [more ▼]

OBJECTIVE: To determine the effect of antibiotic class pressure on the susceptibility of bacteria during sequential periods of antibiotic homogeneity. DESIGN AND SETTING: Prospective study in a mixed ICU with three separated subunits of eight, eight, and ten beds. PATIENTS AND PARTICIPANTS: The study examined the 1,721 patients with a length of stay longer than 2 days. INTERVENTIONS: Three different antibiotic regimens were used sequentially over 2 years as first-choice empirical treatment: cephalosporins, fluoroquinolone, or a penicillin-beta-lactamase inhibitor combination. Each regimen was applied for 8 months in each subunits of the ICU, using "latin square" design. RESULTS: We treated 731 infections in 546 patients (32% of patients staying more than 48 h). There were 25.5 ICU-acquired infections per 1,000 patient-days. Infecting pathogens and colonizing bacteria were found in 2,739 samples from 1,666 patients (96.8%). No significant change in global antibiotic susceptibility was observed over time. However, a decrease in the susceptibility of several species was observed for antibiotics used as the first-line therapy in the unit. Selection pressure of antibiotics and occurrence of resistance during treatment was documented within an 8-month rotation period. CONCLUSIONS: Antibiotic use for periods of several months induces bacterial resistance in common pathogens [less ▲]

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See detailCombination therapy versus monotherapy: a randomised pilot study on the evolution of inflammatory parameters after ventilator associated pneumonia
Damas, Pierre ULg; Garweg, Christophe ULg; Monchi, Mehran et al

in Critical Care (2006), 10(2), 52

Introduction Combination antibiotic therapy for ventilator associated pneumonia (VAP) is often used to broaden the spectrum of activity of empirical treatment. The relevance of such synergy is commonly ... [more ▼]

Introduction Combination antibiotic therapy for ventilator associated pneumonia (VAP) is often used to broaden the spectrum of activity of empirical treatment. The relevance of such synergy is commonly supposed but poorly supported. The aim of the present study was to compare the clinical outcome and the course of biological variables in patients treated for a VAP, using a monotherapy with a beta-lactam versus a combination therapy. Methods Patients with VAP were prospectively randomised to receive either cefepime alone or cefepime in association with amikacin or levofloxacin. Clinical and inflammatory parameters were measured on the day of inclusion and thereafter. Results Seventy-four mechanically ventilated patients meeting clinical criteria for VAP were enrolled in the study. VAP was microbiologically confirmed in 59 patients (84%). Patients were randomised to receive cefepime (C group, 20 patients), cefepime with amikacin (C-A group, 19 patients) or cefepime with levofloxacin (C-L group, 20 patients). No significant difference was observed regarding the time course of temperature, leukocytosis or C-reactive protein level. There were no differences between length of stay in the intensive care unit after infection, nor in ventilator free days within 28 days after infection. No difference in mortality was observed. Conclusion Antibiotic combination using a fourth generation cephalosporin with either an aminoside or a fluoroquinolone is not associated with a clinical or biological benefit when compared to cephalosporin monotherapy against common susceptible pathogens causing VAP. [less ▲]

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See detailProspective survey of digestive tract colonization with enterobacteriaceae that produce ESBLs in intensive care units
Christiaens, Geneviève ULg; Ciccarella, Y.; Damas, Pierre ULg et al

in Journal of Hospital Infection (2006), 62(3), 386-388

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See detailLiver transplantation in Jehovah's witnesses
Detry, Olivier ULg; De Roover, Arnaud ULg; Delwaide, Jean ULg et al

in Transplant International (2005), 18(8), 929-936

For religious reasons, Jehovah's witnesses refuse transfusion of blood products (red cells, platelets, plasma), but may accept organ transplantation. The authors developed a multidisciplinary protocol for ... [more ▼]

For religious reasons, Jehovah's witnesses refuse transfusion of blood products (red cells, platelets, plasma), but may accept organ transplantation. The authors developed a multidisciplinary protocol for liver transplantation in Jehovah's witnesses. In a 6-year period, nine Jehovah's witness patients were listed for liver transplantation. They received preoperative erythropoietin therapy, with iron and folic acid that allowed significant haematocrit increase. Two patients underwent partial spleen embolization to increase platelet count. Seven patients underwent cadaveric whole liver transplantation, and two right lobe living-related liver transplantation, using continuous circuit cell saving system and high dose aprotinin. No patient received any blood product during the surgical procedure. One patient suffering from deep anaemia after living-related liver transplantation was transfused as required by his family, but died from aspergillus infection. One 6-year-old child was transfused against her parent's will. The authors demonstrated that it is possible to increase haematocrit and platelet levels in cirrhotic patients awaiting liver transplantation. They were able to reduce intraoperative need for blood products, allowing liver transplantation in prepared Jehovah's witness patients. This experience may be beneficial for non-Jehovah's witness liver transplant recipients. [less ▲]

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See detailEffect of hydroxyethylstarch on renal function in cardiac surgery: A large scale retrospective study
Wiesen, Patricia ULg; Canivet, Jean-Luc ULg; Ledoux, Didier ULg et al

in Acta Anaesthesiologica Belgica (2005), 56(3), 257-263

BACKGROUND: Recent reports indicated negative effects of hydroxyethylstarch (HES) on renal function. The goal of this large scale retrospective study was to detect whether there was an association between ... [more ▼]

BACKGROUND: Recent reports indicated negative effects of hydroxyethylstarch (HES) on renal function. The goal of this large scale retrospective study was to detect whether there was an association between postoperative deterioration of renal function and the use of HES 200 kD, 0.5 DS in the cardiac surgery setting. METHODS: Retrospective analysis of daily collected data in 3124 patients who underwent coronary artery bypass and/or valvular surgery. Three groups were compared according to differences in fluid therapy: --GEL: gelatin was used as priming fluid of extracorporeal circulation (ECC) and for postoperative filling (n = 1276). --MIX: HES was used as priming fluid of ECC an gelatin was used for postoperative filling (n = 1008). --HES: HES was used as priming fluid of ECC and for postoperative filling (n = 840). MAIN RESULTS: There were no significant differences in postoperative serum creatinine concentrations between the 3 groups: GEL: 12,2 +/- 0,5 mg/l; MIX: 12,3 +/- 0.5 mg/l; HES: 12,3 +/- 0.6 mg/l. The need for postoperative extrarenal epuration was not significantly different between the 3 periods: GEL: 2,9%; MIX: 3,1%; HES: 3,8%. CONCLUSION: The use of HES 200 kD, 0.5 DS in cardiac surgery does not seem to be associated with a clinically significant deterioration of postoperative renal function. [less ▲]

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See detailThe European Union Directive on Clinical Research: present status of implementation in EU member states’ legislations with regard to the incompetent patient
Lemaire, Florence ULg; Bion, J.; Blanco, J. et al

in Intensive Care Medicine (2005), 31

A European-wide response is slowly emerging to the European Union Directive on Clinical Research (2001/20/CE) establishing good practice in the conduct of clinical trials on medicinal products [1]. The ... [more ▼]

A European-wide response is slowly emerging to the European Union Directive on Clinical Research (2001/20/CE) establishing good practice in the conduct of clinical trials on medicinal products [1]. The Directive was to have been incorporated and made effective in member states’ national laws by 1 May 2004. Among many other aspects of this wide-ranging Directive passed by the European Parliament on 4 April 2001 is the requirement for prior informed consent by a legal representative for research involving incompetent patients. A preliminary survey conducted by this group in 2002 demonstrated that many states did not possess clear definitions for a legal representative in matters of health, and in the absence of a waiver of informed consent none could validly recruit patients to clinical trials in emergency situations. The Directive therefore had the potential to make clinical research very difficult in intensive care, and impossible in emergency situations such as cardiopulmonary resuscitation. We now report current progress among member states in implementing the Directive. [less ▲]

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