Verhandelingen - Koninklijke Academie voor Geneeskunde van België
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Verh. K. Acad. Geneeskd. Belg. · Jan 2000
ReviewThe role of beta 2-glycoprotein I-dependent lupus anticoagulants in the pathogenesis of the antiphospholipid syndrome.
The antiphospholipid syndrome (APS) is defined as the association of antiphospholipid antibodies (aPL) with arterial or venous thrombosis, recurrent fetal loss, thrombocytopenia or neurologic disorders. Some aPL can be detected via phospholipid dependent coagulation assays where they present as an aspecific coagulation inhibitor termed the lupus anticoagulant (LA). Other antibodies can be measured via immunological assays mostly via their capability to bind to immobilised cardiolipin and are therefore called anticardiolipin antibodies (aCL). ⋯ Further studies also showed that our LA positive anti-beta 2GPI moabs have a potential for the production of LA control specimens, that could be made available to routine hemostasis laboratories to assess intra-laboratory precision of LA testing, to manufacturers to produce highly sensitive assay systems and to control batch-to-batch variability of their reagents and to organizations involved in external quality assessment. In conclusion this work has enabled us to understand the molecular mechanism by which certain autoimmune antibodies found in patients with APS prolong coagulation assays in vitro. The antibodies generated are an important tool to improve the laboratory diagnosis of the lupus anticoagulant and may help us clarify the pathogenic role of autoimmune anti-beta 2GPI antibodies.
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Verh. K. Acad. Geneeskd. Belg. · Jan 2000
Review[Animal experiments: legal, scientific and ethical aspects].
Among the legal aspects the following topics are treated: the definitions of an experimental animal, an animal experiment and alternative methods with special reference to the 3 R's (replacement, reduction and refinement of animal experiments); the qualifications, education and training of researchers and animal technicians; the licence for animal experimentation; the control on animal welfare; the origin and identification of experimental animals; statistical data on the number of experimental animals; ethics committees and their structure and functions in The Netherlands and Flanders. Extrapolation, species specificity and variability are the most important scientific limitations of animal experimentation. After a short historical survey on the man-animal relation, the following ethical aspects are discussed: the instrumental versus intrinsic value of an experimental animal; the hybrid status of the animal; the objectives of animal rights movements; the balance between the human benefit of an animal experiment and the discomfort for the animal; the problem of animal rights and animal suffering and pain.
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Verh. K. Acad. Geneeskd. Belg. · Jan 1999
Review[Chronic asthma: current policy and therapeutic possibilities in the future].
Asthma is a chronic disease with an important and increasing prevalence. The objective of the treatment of asthma is control of the disease. For most patients with chronic asthma this means the regular use of controller medication. ⋯ Many new drugs for the treatment of asthma are currently in development. They either focus on recently discovered pathogenic mechanisms or try to improve existing anti-asthma drugs. There is the distinct hope that cure of asthma might become an achievable goal.
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Verh. K. Acad. Geneeskd. Belg. · Jan 1998
ReviewAcute and prolonged critical illness are two distinct neuroendocrine paradigms.
Acute and prolonged critical illness are different metabolic and neuroendocrine paradigms and should perhaps be approached with different therapeutic strategies. The initial endocrine response consists primarily of an activated release of anterior pituitary hormones and peripheral inactivation of anabolic pathways, thought to provide substrates for survival while anabolism is postponed and to activate the immune cascade while the host is being protected against deleterious effects of the latter. There is still no solid basis for hormonal intervention in the acute phase of illness. ⋯ We demonstrated that selected pituitary-dependent axes can be reactivated in the chronic phase of critical illness, with preserved peripheral responsiveness. Intervening at the hypothalamic-pituitary level appears to be a safer strategy compared to administration of peripheral hormones, as presence of active feed-back inhibition prevents overtreatment on an individual basis at a time when it is difficult--if not impossible--to determine what is a "normal" or "optimal" level of circulating peripheral hormones. Whether this novel endocrine strategy will result in beneficial metabolic effects and, ultimately, will stimulate the recovery process in those patients who need it most, remains to be elucidated.
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Dermatology evolved in the second part of the last century as a branch of internal medicine and was for many years confined to morphologic descriptions. Skin diseases are common and vary enormously in severity. Although most of the conditions are not life threatening, many of them are debilitating due to functional loss, pain and itch, and the social problems they cause. ⋯ Increasing specialisation within dermatology has become more common with the expansion of expertise in dermatopathology, photodermatology, contact dermatology, dermatological surgery, dermatologic pediatrics, phlebology. There are too many dermatologists in our country. If an increasing role in caring for minor skin diseases would be assigned to the generalist, the government he will have to decide how contraction of dermatology manpower would occur and how the dermatology training of the generalist should be improved.