Verhandelingen - Koninklijke Academie voor Geneeskunde van België
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Verh. K. Acad. Geneeskd. Belg. · Jan 2004
ReviewFluorescent molecules as tools to study Ca2+ signaling, mitochondrial dynamics and synaptic function in enteric neurons.
The enteric nervous system (ENS) controls different tasks in the gastrointestinal tract. One of the ganglionated networks, the myenteric plexus is situated between longitudinal and circular muscle layers of the gut wall and basically controls intestinal motility. Several studies using micro-electrode recordings have generated invaluable information on neuronal subtypes, membrane conductances and simple synaptic inputs. ⋯ In this report we summarize the results of different fluorescent imaging techniques to investigate important cellular and subcellular characteristics of enteric neurons. Because optical methods provide both spatial and temporal information they can be used to study activity and patterns in neuronal networks. Imaging is applicable to multi-layered intestinal preparations; therefore it provides a useful and promising tool to further expand our understanding of gastro-intestinal motility control and enteric neuroscience in general.
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Verh. K. Acad. Geneeskd. Belg. · Jan 2003
ReviewNew classifications and concepts of pathogenesis and management of diffuse interstitial lung diseases.
The diffuse interstitial lung diseases (ILD) are a very complex group of disorders, of which more than 200 specific disease entities are known. All ILD are characterized by a homogenous or heterogenous affection of the lung parenchyma. ⋯ More specifically much research has been carried out on the important group of "idiopathic interstitial pneumonias" (IIP) and in particular on "idiopathic pulmonary fibrosis" (IPF). Recently several international consensus reports have been published with guidelines on the histologic and clinical definitions and on the classification and the diagnostic-therapeutic management.
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Verh. K. Acad. Geneeskd. Belg. · Jan 2002
ReviewEndocrinology in intensive care medicine: new insights and therapeutic consequences.
Sepsis, excessive inflammation, multiple organ failure and weakness prolong the need for intensive care in critically ill patients. Furthermore, the risk of death is high in the prolonged critically ill patient (20% after two weeks and 30% after 3 weeks). In prolonged critical illness, protein hypercatabolism and relative preservation of adipose tissue with fatty infiltration of vital organ systems is present. ⋯ In a large prospective randomized clinical study (1548 patients), we showed that ICU mortality was reduced by 42% with strict normalization of glycemia using exogenous insulin infusion (N Engl J Med 2001). This was due to prevention of typical ICU complications such as sepsis, multiple organ failure and need for prolonged invasive organ support and intensive care. We conclude that the new concept of reduced stimulation of pituitary function in prolonged critically ill patients opens new therapeutic perspectives to reverse the paradoxical 'wasting syndrome' but that maintenance of strict normoglycemia with insulin is crucial to also increase the chances of survival of these patients.
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Patients suffering from critical illnesses like cardiac arrest with resuscitation and hypovolemic shock often are in need of medication. Under these conditions pharmacokinetics and pharmacodynamics can be markedly altered. In this paper the results of our experimental work in animals on the pharmacology during resuscitation and hypovolemia is discussed. ⋯ Changes in plasma concentrations as well as in brain sensitivity occur. It is concluded that animal experiments highlight changes in the action of drugs during critical conditions. Such information can be helpful in view of the practical and ethical problems related to the study of the action of drugs in critically ill patients.
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Verh. K. Acad. Geneeskd. Belg. · Jan 2001
ReviewStudy of the impact of HIV genotypic drug resistance testing on therapy efficacy.
During recent years significant progress has been made in the treatment of HIV-1, at least in part due to the availability of potent antiretroviral drugs. The goal of the current treatment strategies is to inhibit the viral replication as completely as possible by using a combination of 3 or more antiretroviral drugs. This Highly Active Antiretroviral Therapy (HAART) has radically changed the clinical outcome of HIV, leading to decreased mortality and morbidity, at least in developed countries. ⋯ Both resistance and treatment adherence are crucial factors in determining the therapy response. Retrospective studies, such as ours, and a limited number of prospective trials already proved the short-term benefit of therapy switch based on the results of resistance tests in addition to standard of care. To ultimately define the role of tools as resistance testing and adherence monitoring with eventual adherence interventions, more prospective trials are needed as well in treatment-naïve as in experienced patients.