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Fraeyman N, De Bacquer D, Fiers T, Godderis L, Verhaeghe R, Eeckloo K, Gemmel P, Viaene L, Mortier E. Body mass index and occupational accidents among health care workers in a large university hospital. Acta Clin Belg 2023; 78:128-134. [PMID: 35703157 DOI: 10.1080/17843286.2022.2084936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Obesity is associated with a number of chronic diseases such as cardiovascular diseases and cancers. The association of obesity with occupational accidents has been suggested although the evidence is less convincing. The objective of the study is to analyse the relationship between BMI values and ergonomic accidents in a large University Hospital. METHODS The relationship between body mass index (BMI) and the incidence of ergonomic occupational accidents over a period of 8 years was investigated in a cohort of employees of a large University Hospital, covering almost 27,000 person-years of observation. This relationship was stratified according to the variables age, gender, functional status within the organization and work schedule (part-time or full time). Height and weight were objectively measured, demographic data were obtained from the human resource department and the registration of ergonomic accidents was carried out by the safety and prevention department of the hospital. RESULTS The number of ergonomic accidents, expressed as number/1000 person-years was higher for female employees compared to male employees, increased with age and markedly increased from functional class A (leading or expert function and higher educational level) to D (executive function in patient care and technical department). However, the incidence of ergonomic accidents accompanied by loss of working time was not significantly associated with BMI, independently of age and gender. In addition, the type of accident and the severity of the accidents expressed as the number of days absent from work were unrelated to BMI. CONCLUSION No independent relationship between BMI and the incidence of ergonomic accidents could be identified in our cohort. Tailoring working conditions to individual BMI levels is not recommended.
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Affiliation(s)
- N Fraeyman
- Environmental Department [Milieudienst], University Hospital, Gent University, Gent, Belgium.,Central Administration, Secretariat of the Board of Governors, Faculty of Medicine and Health Sciences, University Hospital, Gent University, Gent, Belgium
| | - D De Bacquer
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Gent University, Gent University Hospital, Gent, Belgium
| | - T Fiers
- Clinical Chemistry Laboratory, Gent University Hospital, Gent University, Gent, Belgium
| | - L Godderis
- Department of Public Health and Primary Care, Faculty of Medicine, Leuven University, University Hospital Leuven, Gasthuisberg Campus, Leuven, Belgium
| | - R Verhaeghe
- Central Administration, Secretariat of the Board of Governors, Faculty of Medicine and Health Sciences, University Hospital, Gent University, Gent, Belgium
| | - K Eeckloo
- Central Administration, Secretariat of the Board of Governors, Faculty of Medicine and Health Sciences, University Hospital, Gent University, Gent, Belgium
| | - P Gemmel
- University Ghent, Faculty of Economics and Business Administration, Gent, Belgium
| | - L Viaene
- Safety Department [Preventiedienst], University Hospital, Gent University, Gent, Belgium
| | - E Mortier
- Central Administration, Secretariat of the Board of Governors, Faculty of Medicine and Health Sciences, University Hospital, Gent University, Gent, Belgium
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Grasland A, Hiraux E, Mortier E. Une cause rare de douleurs cervicales. Rev Med Interne 2019; 40:478-479. [DOI: 10.1016/j.revmed.2018.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/21/2018] [Indexed: 11/16/2022]
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Grasland A, Mortier E. L’hôpital de jour en médecine interne : un atout pour le virage ambulatoire. Rev Med Interne 2019; 40:16-19. [DOI: 10.1016/j.revmed.2018.03.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/01/2018] [Accepted: 03/23/2018] [Indexed: 11/29/2022]
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Mortier E, Nadhira-Houhou F, Brichler S, Gilles C, Descamps D, Visseaux B. Présence du virus Zika dans les secrétions vaginales. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jager S, Balthazard R, Dahoun A, Mortier E. Filler Content, Surface Microhardness, and Rheological Properties of Various Flowable Resin Composites. Oper Dent 2016; 41:655-665. [DOI: 10.2341/16-031-l] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
Objectives:
The objectives of this study were to determine the filler content, the surface microhardness (at baseline and after immersion in water for 2 years), and the rheological properties of various flowable resin composites.
Methods:
Three flowable resin composites (Grandioso Heavy Flow [GHF], Grandio Flow [GRF], Filtek Supreme XTE Flow [XTE]), one pit and fissure sealant resin composite (ClinPro [CLI]), and three experimental flowable resin composites with the same matrix and a variable filler content (EXPA, EXPB, EXPC) were tested. The filler content was determined by calcination. The Vickers surface microhardness was determined after polymerization and then after immersion in distilled water at 37°C for 7, 60, 180, 360, and 720 days. The rheological measurements were performed using a dynamic shear rheometer.
Results:
The determined filler contents differed from the manufacturers' data for all the materials. The materials with the highest filler content presented the highest microhardness, but filler content did not appear to be the only influencing parameter. With respect to the values recorded after photopolymerization, the values were maintained or increased after 720 days compared with the initial microhardness values, except for GHF. For the values measured after immersion for 7 days, an increase in microhardness was observed for all the materials over time. All the materials were non-Newtonian, with shear-thinning behavior. At all the shear speeds, GRF presented a lower viscosity to GHF and XTE.
Conclusions:
GRF presented a low viscosity before photopolymerization, associated with high filler content, thereby providing a good compromise between spreadability and mechanical properties after photopolymerization.
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Affiliation(s)
- S Jager
- Stéphanie Jager, DDS, PhD, Faculty of Dentistry, Department of Pediatric Dentistry, Nancy, France
| | - R Balthazard
- Rémy Balthazard, DDS, PhD, Faculty of Dentistry, Department of Conservative Dentistry, Nancy, France
| | - A Dahoun
- Abdesselam Dahoun, Professor, Si2M Department, UMR CNRS 7198, Jean Lamour Institute, Nancy, France
| | - E Mortier
- Eric Mortier, DDS, PhD, Faculty of Dentistry, Department of Conservative Dentistry, Nancy, France
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Vermeir P, Vandijck D, Degroote S, Peleman R, Verhaeghe R, Mortier E, Hallaert G, Van Daele S, Buylaert W, Vogelaers D. Communication in healthcare: a narrative review of the literature and practical recommendations. Int J Clin Pract 2015; 69:1257-67. [PMID: 26147310 PMCID: PMC4758389 DOI: 10.1111/ijcp.12686] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/29/2015] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Effective and efficient communication is crucial in healthcare. Written communication remains the most prevalent form of communication between specialised and primary care. We aimed at reviewing the literature on the quality of written communication, the impact of communication inefficiencies and recommendations to improve written communication in healthcare. DESIGN Narrative literature review. METHODS A search was carried out on the databases PubMed, Web of Science and The Cochrane Library by means of the (MeSH)terms 'communication', 'primary health care', 'correspondence', 'patient safety', 'patient handoff' and 'continuity of patient care'. Reviewers screened 4609 records and 462 full texts were checked according following inclusion criteria: (1) publication between January 1985 and March 2014, (2) availability as full text in English, (3) categorisation as original research, reviews, meta-analyses or letters to the editor. RESULTS A total of 69 articles were included in this review. It was found that poor communication can lead to various negative outcomes: discontinuity of care, compromise of patient safety, patient dissatisfaction and inefficient use of valuable resources, both in unnecessary investigations and physician worktime as well as economic consequences. CONCLUSION There is room for improvement of both content and timeliness of written communication. The delineation of ownership of the communication process should be clear. Peer review, process indicators and follow-up tools are required to measure the impact of quality improvement initiatives. Communication between caregivers should feature more prominently in graduate and postgraduate training, to become engraved as an essential skill and quality characteristic of each caregiver.
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Affiliation(s)
- P Vermeir
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - D Vandijck
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Public Health, Ghent University Hospital, Ghent, Belgium
- Department of Business Economics, Hasselt University, Diepenbeek, Belgium
| | - S Degroote
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Public Health, Ghent University Hospital, Ghent, Belgium
| | - R Peleman
- Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - R Verhaeghe
- Department of Public Health, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - E Mortier
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - G Hallaert
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - S Van Daele
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - W Buylaert
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
- Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium
| | - D Vogelaers
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
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Mortier E, Raifort C. [An abdominal mass]. Rev Med Interne 2015; 36:710-1. [PMID: 25910522 DOI: 10.1016/j.revmed.2015.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/13/2015] [Indexed: 10/23/2022]
Affiliation(s)
- E Mortier
- Service de médecine interne, hôpital Louis-Mourier, AP-HP, 178, rue des Renouillers, 92701 Colombes, France.
| | - C Raifort
- Service de gynécologie-obstétrique, hôpital Louis-Mourier, AP-HP, 178, rue des Renouillers, 92701 Colombes, France
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Rosenthal E, Roussillon C, Salmon-Céron D, Georget A, Hénard S, Huleux T, Gueit I, Mortier E, Costagliola D, Morlat P, Chêne G, Cacoub P. Liver-related deaths in HIV-infected patients between 1995 and 2010 in France: the Mortavic 2010 study in collaboration with the Agence Nationale de Recherche sur le SIDA (ANRS) EN 20 Mortalité 2010 survey. HIV Med 2014; 16:230-9. [PMID: 25522874 DOI: 10.1111/hiv.12204] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aim of this study was to describe the proportion of liver-related diseases (LRDs) as a cause of death in HIV-infected patients in France and to compare the results with data from our five previous surveys. METHODS In 2010, 24 clinical wards prospectively recorded all deaths occurring in around 26 000 HIV-infected patients who were regularly followed up. Results were compared with those of previous cross-sectional surveys conducted since 1995 using the same design. RESULTS Among 230 reported deaths, 46 (20%) were related to AIDS and 30 (13%) to chronic liver diseases. Eighty per cent of patients who died from LRDs had chronic hepatitis C, 16.7% of them being coinfected with hepatitis B virus (HBV). Among patients who died from an LRD, excessive alcohol consumption was reported in 41%. At death, 80% of patients had undetectable HIV viral load and the median CD4 cell count was 349 cells/μL. The proportion of deaths and the mortality rate attributable to LRDs significantly increased between 1995 and 2005 from 1.5% to 16.7% and from 1.2‰ to 2.0‰, respectively, whereas they tended to decrease in 2010 to 13% and 1.1‰, respectively. Among liver-related causes of death, the proportion represented by hepatocellular carcinoma (HCC) dramatically increased from 5% in 1995 to 40% in 2010 (p = 0.019). CONCLUSIONS The proportion of LRDs among causes of death in HIV-infected patients seems recently to have reached a plateau after a rapid increase during the decade 1995-2005. LRDs remain a leading cause of death in this population, mainly as a result of hepatitis C virus (HCV) coinfection, HCC representing almost half of liver-related causes of death.
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Affiliation(s)
- E Rosenthal
- Service de Médecine Interne, Hôpital de l'Archet, CHU de Nice, Nice, France; Université de Nice-Sophia Antipolis, Nice, France
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Poppe C, Devulder J, Mariman A, Mortier E. CHRONIC PAIN THERAPY: AN EVOLUTION FROM SOLO-INTERVENTIONS TO A HOLISTIC INTERDISCIPLINARY PATIENT APPROACH. Acta Clin Belg 2014. [DOI: 10.1179/acb.2003.58.2.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Cassilde AL, Barnaud G, Baccar S, Mortier E. Sudden-onset bilateral deafness revealing early neurosyphilis. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:389-391. [PMID: 24880727 DOI: 10.1016/j.anorl.2014.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 01/30/2014] [Accepted: 02/09/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Rapid-onset of sensorineural hearing loss in a patient at risk of genital or oral exposure to treponema can be secondary to early neurosyphilis, for which delayed treatment may result in irreversible sequelae. SUMMARY OF THE CASE REPORT A 40-year-old, HIV seropositive man with a CD4 lymphocyte count greater than 500/mm(3) presented with rapid-onset of bilateral sensorineural hearing loss over a period of one week. Otorhinolaryngological examination was normal. The audiogram showed bilateral hearing loss of 25 and 30 decibels, respectively. He subsequently developed loss of visual acuity, leading to the diagnosis of syphilitic meningitis affecting the optic and auditory nerves. DISCUSSION In about one half of cases, neurosyphilis is an early manifestation of the disease occurring several weeks or months after contamination. Rapid- or even sudden-onset of hearing loss may be due to auditory neuritis. Clinical interview and syphilis serology in a patient at risk of exposure can allow rapid diagnosis and treatment, consisting of two weeks parenteral penicillin. Recovery of hearing loss is inconstant but can be complete.
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Affiliation(s)
- A-L Cassilde
- Service de médecine interne, hôpital Louis-Mourier, centre hospitalier universitaire, (AP-HP), 178, rue des Renouillers, 92701 Colombes cedex, France
| | - G Barnaud
- Service de microbiologie, hôpital Louis-Mourier, centre hospitalier universitaire, (AP-HP), 178, rue des Renouillers, 92701 Colombes cedex, France
| | - S Baccar
- Service de radiologie, hôpital Louis-Mourier, centre hospitalier universitaire, (AP-HP), 178, rue des Renouillers, 92701 Colombes cedex, France
| | - E Mortier
- Service de médecine interne, hôpital Louis-Mourier, centre hospitalier universitaire, (AP-HP), 178, rue des Renouillers, 92701 Colombes cedex, France.
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Sterpu R, Ichou H, Mahé I, Mortier E. [Reactivation of parvovirus B19 infection in an HIV-infected woman]. Rev Med Interne 2013; 35:396-8. [PMID: 23791089 DOI: 10.1016/j.revmed.2013.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/30/2013] [Accepted: 05/07/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Infection by human parvovirus B19 (erythrovirus B19) is common and usually asymptomatic during childhood conferring lasting protection against a new infection. Parvovirus B19 infection may cause erythema infectiosum (5th disease) and aplastic crisis. Secondary symptomatic parvovirus B19 infection in the same patient is rare and its physiopathology is not always clear. CASE REPORT A 48-year-old HIV-infected female patient presented within 5 years two acute episodes of parvovirus B19 infection although her CD4 cells count was above 500/mm(3). Absence of specific antibodies production after the first episode and persisting parvovirus viremia suggested viral reactivation rather than re-infection. During the second episode, specific antibodies were produced. CONCLUSION Similarly to most DNA viruses, parvovirus B19 reactivation is possible in HIV-infected patients while effectively treated by antiretroviral therapy.
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Affiliation(s)
- R Sterpu
- Service de médecine interne, hôpital Louis-Mourier (AP-HP), 178, rue des Renouillers, 92700 Colombes, France
| | - H Ichou
- Service de microbiologie, hôpital Louis-Mourier (AP-HP), 178, rue des Renouillers, 92700 Colombes, France
| | - I Mahé
- Service de médecine interne, hôpital Louis-Mourier (AP-HP), 178, rue des Renouillers, 92700 Colombes, France
| | - E Mortier
- Service de médecine interne, hôpital Louis-Mourier (AP-HP), 178, rue des Renouillers, 92700 Colombes, France.
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Affo C, Mortier E, Mahe E, Mahe I. [Use of the tourniquet test in diagnosing dengue-like syndrome]. Bull Soc Pathol Exot 2012; 105:361-3. [PMID: 22886461 DOI: 10.1007/s13149-012-0256-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 07/03/2012] [Indexed: 10/28/2022]
Abstract
A 26-year-old nurse presented with a three-day history of sudden onset of pyrexia of 39 °C, malaise, and a patchy maculopapular rash, after returning from a monthlong work in Senegal. A tourniquet was applied to help locate the vein for diagnostic blood sampling. After the procedure, a petechial rash erupted with a demarcation line below the level of the tourniquet. A diagnostic test for dengue fever was performed and confirmed by the polymerase chain reaction (PCR) to be positive for serotype DEN-1. The tourniquet test is performed by inflating a blood pressure cuff tied on the upper arm to a point midway between systolic and diastolic blood pressure for five minutes. The test is considered positive when there are 20 or more petechiae per square inch (6.25 cm(2)) on the forearm, and is one of several clinical parameters considered by the World Health Organization to be important in the diagnosis of dengue fever.
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Affiliation(s)
- C Affo
- Service de médecine interne, hôpital Louis-Mourier (AP-HP), Colombes, France
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Lambaerts K, Van Dyck S, Mortier E, Ivarsson Y, Degeest G, Luyten A, Vermeiren E, Peers B, David G, Zimmermann P. Syntenin, a syndecan adaptor and an Arf6 phosphatidylinositol 4,5-bisphosphate effector, is essential for epiboly and gastrulation cell movements in zebrafish. Development 2012. [DOI: 10.1242/dev.082610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affo C, Volley K, Challal S, Bosquet A, Mortier E, Sterpu R, Grasland A, Ben Ali K, Mahé I. Une myosite granulomateuse : « l’homme léopard ». Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.10.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Montoya B, Simonpoli AM, Ichou H, Mortier E. Proposition systématique de dépistage du VIH dans un service de médecine interne. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.03.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bommenel T, Launay O, Meynard JL, Gilquin J, Katlama C, Lascaux AS, Mahamat A, Martinez V, Pradier C, Rouveix E, Simon A, Costagliola D, Abgrall S, Abgrall S, Barin F, Bentata M, Billaud E, Boue F, Burty C, Cabie A, Costagliola D, Cotte L, de Truchis P, Duval X, Duvivier C, Enel P, Gasnault J, Gaud C, Gilquin J, Grabar S, Katlama C, Khuong MA, Lang JM, Lascaux AS, Launay O, Mahamat A, Mary-Krause M, Matheron S, Meynard JL, Pavie J, Pialoux G, Pilorge F, Poizot-Martin I, Pradier C, Reynes J, Rouveix E, Simon A, Tattevin P, Tissot-Dupont H, Viard JP, Viget N, Brosseau M, Salomon V, Jacquemet N, Guiguet M, Lanoy E, Lievre L, Selinger-Leneman H, Lacombe JM, Potard V, Bricaire F, Herson S, Desplanque N, Girard PM, Meyohas MC, Picard O, Cadranel J, Mayaud C, Clauvel JP, Decazes JM, Gerard L, Molina JM, Diemer M, Sellier P, Honore P, Jeantils V, Tassi S, Mechali D, Taverne B, Bouvet E, Crickx B, Ecobichon JL, Picard-Dahan C, Yeni P, Berthe H, Dupont C, Chandemerle C, Mortier E, Tisne-Dessus D, Weiss L, Salmon D, Auperin I, Roudiere L, Fior R, Delfraissy JF, Goujard C, Jung C, Lesprit P, Vittecoq D, Fraisse P, Rey D, Beck-Wirth G, Stahl JP, Lecercq P, Gourdon F, Laurichesse H, Fresard A, Lucht F, Bazin C, Verdon R, Chavanet P, Arvieux C, Michelet C, Choutet P, Goudeau A, Maitre MF, Hoen B, Elinger P, Faller JP, Borsa-Lebas F, Caron F, Daures JP, May T, Rabaud C, Berger JL, Remy G, Arlet-Suau E, Cuzin L, Massip P, Thiercelin Legrand MF, Pontonnier G, Yasdanpanah Y, Dellamonica P, Pugliese P, Aleksandrowicz K, Quinsat D, Ravaux I, Delmont JP, Moreau J, Gastaut JA, Retornaz F, Soubeyrand J, Galinier A, Ruiz JM, Allegre T, Blanc PA, Bonnet-Montchardon D, Lepeu G, Granet-Brunello P, Esterni JP, Pelissier L, Cohen-Valensi R, Nezri M, Chapadaud S, Laffeuillade A, Raffi F, Boibieux A, Peyramond D, Livrozet JM, Touraine JL, Trepo C, Strobel M, Bissuel F, Pradinaud R, Sobesky M, Contant M. Comparative effectiveness of continuing a virologically effective first-line boosted protease inhibitor combination or of switching to a three-drug regimen containing either efavirenz, nevirapine or abacavir. J Antimicrob Chemother 2011; 66:1869-77. [DOI: 10.1093/jac/dkr208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hendrickx JFA, De Cooman S, Van Zundert AAJ, Grouls REJ, Mortier E, De Wolf AM. Coasting: worth the effort? Acta Anaesthesiol Belg 2011; 62:147-150. [PMID: 22145256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A new anesthesia machine incorporates a "coasting mode", but the extent to which a coasting technique can maintain anesthesia at the end of a procedure under optimal conditions (closed circuit anesthesia) remains unknown. Sixty-nine patients undergoing peripheral or abdominal surgery were assigned to 1 of 9 groups, depending on when desflurane coasting (in O2/air) was started (after 4, 9, 16, 25, 36, 49, 64, 81, or 100 min). The end-expired desflurane concentration was maintained at 4.5% in O2/air prior to coasting with a conventional anesthesia machine. After initiating coasting (using a closed-circuit technique), we examined when the end-expired desflurane concentration reached 70, 60, 50, and 40% of its value during maintenance (= 30, 40, 50 and 60% decrement times, respectively). Decrement times increased with increasing duration of anesthesia, and varied widely. After 64 min of maintenance anesthesia, the end-expired desflurane concentration remained at or above 70, 60, 50, and 40% of its maintenance value during 10.3 +/- 2.3, 16.0 +/- 3.5, 25.0 +/- 5.9, and 45.4 +/- 19.3 min, respectively (average +/- standard deviation). Coasting can briefly maintain anesthesia towards the end of a procedure. While savings with an automated coasting mode are likely to be modest per patient, they may become substantial when multiplied by the number of procedures per day per operating room with no increase in the clinical workload of the anesthesia provider.
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Affiliation(s)
- J F A Hendrickx
- Department of Anesthesiology, Intensive Care and Pain Therapy, Onze Lieve Vrouwziekenhuis, Aalst, Belgium.
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Affo C, Mehenni F, Mortier E, Challal S, Bosquet A, Medjkane A, Sterpu R, Mahé E, Mahé I. Le signe du garrot : c’est dengue. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hassouni N, Ichou H, Zeng F, Mortier E, Branger C, Morand-Joubert L. H-01 Prévalence des mutations et de la résistance du VIH-1 en fonction du sous-type dans deux groupes de patients, non traités et traités par antirétroviraux. Med Mal Infect 2009. [DOI: 10.1016/s0399-077x(09)74374-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Simonpoli AM, Leroy C, Ichou H, Mortier E. Acceptabilité du dépistage rapide du VIH dans un service d’urgence hospitalière d’Île-de-France. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bouchaud G, Garrigue-Antar L, Solé V, Quéméner A, Boublik Y, Mortier E, Perdreau H, Jacques Y, Plet A. 230 The exon 3-encoded domain of IL-15Ralpha contributes to IL-15 high-affinity binding and is crucial for IL-15 antagonistic effect of soluble IL-15Ralpha. Cytokine 2008. [DOI: 10.1016/j.cyto.2008.07.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Paycha F, Mortier E, Sassi R, Mahjoub WK, Huchet V, Vignali JP, Grossin M, Dion E, Vinceneux P. Localisation osseuse de la maladie de Kaposi sans atteinte cutanéomuqueuse contiguë : intérêt de la tomographie par émission de positons au fluorodéoxyglucose (18F). Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.03.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mortier E. New concepts changing anaesthesia practice: is the cost worth the benefit? Acta Anaesthesiol Belg 2006; 57:433. [PMID: 17236647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- E Mortier
- Ghent University (UGent), Sint-Pietersnieuwstraat 25, B-9000 Ghent, Belgium.
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Reyntjens K, Foubert L, De Wolf D, Vanlerberghe G, Mortier E. Glycopyrrolate during sevoflurane–remifentanil-based anaesthesia for cardiac catheterization of children with congenital heart disease. Br J Anaesth 2005; 95:680-4. [PMID: 16199414 DOI: 10.1093/bja/aei254] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Remifentanil is recommended for use in procedures with painful intraoperative stimuli but minimal postoperative pain. However, bradycardia and hypotension are known side-effects. We evaluated haemodynamic effects of i.v. glycopyrrolate during remifentanil-sevoflurane anaesthesia for cardiac catheterization of children with congenital heart disease. METHODS Forty-five children undergoing general anaesthesia with remifentanil and sevoflurane were randomly allocated to receive either saline, glycopyrrolate 6 microg kg(-1) or glycopyrrolate 12 microg kg(-1). After induction of anaesthesia with sevoflurane, i.v. placebo or glycopyrrolate was administered. An infusion of remifentanil at the rate of 0.15 microg kg(-1) min(-1) was started, sevoflurane continued at 0.6 MAC and cisatracurium 0.2 mg kg(-1) was given. Heart rate (HR) and non-invasive arterial pressures were monitored and noted every minute for the first 10 min and then every 2.5 min for subsequent maximum of 45 min. RESULTS Baseline HR [mean (SD)] of 117 (20) beats min(-1) decreased significantly from 12.5 min onwards after starting the remifentanil infusion in the control group [106 (18) at 12.5 min and 99 (16) beats min(-1) at 45 min]. In the groups receiving glycopyrrolate, no significant decrease in HR was noticed. Glycopyrrolate at 12 microg kg(-1) induced tachycardia between 5 and 9 min after administration. Systolic and diastolic arterial pressures decreased gradually, but there were no significant differences in the pressures between groups. CONCLUSION I.V. glycopyrrolate 6 microg kg(-1) prevents bradycardia during general anaesthesia with remifentanil and sevoflurane for cardiac catheterization in children with congenital heart disease. Administering 12 microg kg(-1) of glycopyrrolate temporarily induces tachycardia and offers no additional advantage.
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Affiliation(s)
- K Reyntjens
- Department of Anaesthesiology, University Hospital Ghent, Ghent, Belgium.
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Barnaud G, Deschamps C, Manceron V, Mortier E, Laurent F, Bert F, Boiron P, Vinceneux P, Branger C. Brain abscess caused by Nocardia cyriacigeorgica in a patient with human immunodeficiency virus infection. J Clin Microbiol 2005; 43:4895-7. [PMID: 16145170 PMCID: PMC1234150 DOI: 10.1128/jcm.43.9.4895-4897.2005] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nocardia cyriacigeorgica is a recently characterized species within the genus of Nocardia. We report a brain abscess, following a primary pulmonary colonization, due to this species in a human immunodeficiency virus-infected patient. This case confirms that isolation of Nocardia in sputum is associated with a high risk of disseminated infection in immunocompromised patients.
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Affiliation(s)
- G Barnaud
- Service de Microbiologie, Hôpital Louis Mourier, Colombes, France.
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Chee CC, Mortier E, Dupont C, Bloch M, Simonpoli AM, Rouveix E. Medical and social differences between French and migrant patients consulting for the first time for HIV infection. AIDS Care 2005; 17:516-20. [PMID: 16036237 DOI: 10.1080/09540120412331291760] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The objectives of the study were to describe the medical and social characteristics of patients consulting for the first time after diagnosis of HIV-infection and to compare the medical and social characteristics between French and migrant patients. From 1 January 2001 to 31 December 2002, all consecutive adults consulting for the first time for HIV infection in two HIV outpatient clinics located in the western suburb of Paris, agreed to an interview based on an administered questionnaire regarding their medical and socioeconomic characteristics. Of the 203 patients (98 women, 105 men), one-third (n=70) was of French nationality. Delay (+/-SD) in access to HIV outpatient clinic after diagnosis was shorter in migrant than in French patients, respectively 7.6+/-29.6 months (median=0.5, range=0 to 196.6) and 23.8+/-51.4 months (median=0.9, range=0 to 199.7); p=0.005. There was no significant difference in the medical characteristics between the two groups of patients on their first consultation. However, most of the migrants were living in very poor socio-economic conditions with minimal resources thus sometimes delaying initiation of HAART. The development of social facilities for HIV-positive migrants should be a public health priority.
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Affiliation(s)
- C C Chee
- MGEN-Foundation for Public Health, Paris, France
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Gaba S, Mortier E, Branger C, Vinceneux P. [Consequences of replacing abacavir for indinavir in successful antiretroviral treatment of a patient with HIV infection]. Presse Med 2005; 34:1S14-5. [PMID: 16025662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Abstract
INTRODUCTION Simplification of combined antiretroviral therapy in HIV-infected patients is possible, but virological success can be compromised by the development or emergence of resistant viruses. CASE Worsening renal functioning in a patient under successful combination antiretroviral therapy resulted led to the replacement of indinavir by abacavir. Eight weeks later, his viral load rose and he developed a mutant virus resistant to all the nucleoside analogs. DISCUSSION Our case report illustrates the danger of streamlining combined antiretroviral therapy composed only of nucleoside analogs in patients already successfully treated with nucleoside analogs, by exposing them to the risk of the emergence of a mutant virus.
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Affiliation(s)
- S Gaba
- Service de microbiologie, Hôpital Louis Mourier, AP-HP, Columbes.
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Costagliola D, Potard V, Duvivier C, Pradier C, Dupont C, Salmon D, Duval X, Billaud E, Boué F, Costagliola D, Duval X, Duvivier C, Enel P, Fournier S, Gasnault J, Gaud C, Gilquin J, Grabar S, Khuong MA, Lang JM, Mary-Krause M, Matheron S, Meyohas MC, Pialoux G, Poizot-Martin I, Pradier C, Rouveix E, Salmon-Ceron D, Sobel A, Tattevin P, Tissot-Dupont H, Yasdanpanah Y, Aronica E, Tirard-Fleury V, Tortay I, Abgrall S, Costagliola D, Grabar S, Guiguet M, Lanoy E, Leneman H, Lièvre L, Mary-Krause M, Potard V, Saidi S, Matheron S, Vildé JL, Leport C, Yeni P, Bouvet E, Gaudebout C, Crickx B, Picard-Dahan C, Weiss L, Tisne-Dessus D, Tarnier-Cochin GH, Sicard D, Salmon D, Gilquin J, Auperin I, Viard JP, Roudière L, Boué F, Fior R, Delfraissy JF, Goujard C, Lesprit P, Jung C, Meyohas MC, Meynard JL, Picard O, Desplanque N, Cadranel J, Mayaud C, Pialoux JF, Rozenbaum W, Bricaire F, Katlama C, Herson S, Simon A, Decazes JM, Molina JM, Clauvel JF, Gerard L, Widal GHLF, Sellier P, Diemer M, Dupont C, Berthé H, Saïag P, Mortier E, Chandemerle C, de Truchis P, Bentata M, Honoré P, Tassi S, Jeantils V, Mechali D, Taverne B, Laurichesse H, Gourdon F, Lucht JF, Fresard A, de Dijon C, de Belfort CH, Faller JP, Eglinger P, Bazin C, Verdon R, de Grenoble C, de Lyon C, Peyramond D, Boibieux A, Touraine JL, Livrozet JM, Trepo C, Cotte L, Ravaux I, Tissot-Dupont H, Delmont JP, Moreau J, Gastaut JA, Poizot-Martin I, Soubeyrand J, Retornaz F, Blanc PA, Allegre T, Galinier A, Ruiz JM, d'Arles CH, d'Avignon CH, Lepeu G, Granet-Brunello P, Pelissier L, Esterni JP, de Martigues CH, Nezri M, Cohen-Valensi R, Laffeuillade A, Chadapaud S, de Nîmes JRCHG, May T, Rabaud C, Raffi F, Billaud E, Pradier C, Pugliese P, Michelet C, Arvieux C, Caron F, Borsa-Lebas F, Lang JM, Rey D, de Mulhouse PFCH, Massip P, Cuzin L, Arlet-Suau E, Legrand MFT, Rangueil CHU, de Tourcoing CH, Yasdanpanah Y, Sobesky M, Pradinaud R, Gaud C, Contant M. Impact of Newly Available Drugs on Clinical Progression in Patients with Virological Failure after Exposure to Three Classes of Antiretrovirals. Antivir Ther 2005. [DOI: 10.1177/135965350501000406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To study the prognosis of HIV-infected patients with virological failure after exposure to three classes of antiretroviral drugs (ARVs). Design Cohort study. Setting: French Hospital Database on HIV. Patients Patients previously exposed to at least two nucleoside reverse transcriptase inhibitors (NRTIs), two protease inhibitors and one non-NRTI, with viral load (VL) values of >5000 copies/ml after the exposure criteria were met and a new treatment initiated between 1998 and 2001 with VL >5000 copies/ml. Main outcome measures Risk of new AIDS-defining-events (ADEs) or death from first introduction of a drug never used before occurring between 1998 and 2001 defined as baseline. Results The main baseline characteristics of the 1092 patients were: previous ADE in 49% of cases, median CD4 cell count 181 μl, median VL 4.9 log10 copies/ml, median duration of ARV therapy 5.0 years and previous exposure to a median of nine ARVs. The crude progression rates were 20.1/100 patient-years among patients included in 1998, 15.1 in 1999, 11.1 in 2000 and 8.6 in 2001. After adjustment for baseline characteristics, the calendar year of inclusion was associated with the risk of clinical progression ( P<0.001). When the types of newly available drugs used at baseline or during follow-up were introduced into the model, year of inclusion was no longer associated with the risk of clinical progression ( P=0.42), while exposure to amprenavir/r, lopinavir/r, abacavir or tenofovir was associated with a lower risk. Conclusions The clinical prognosis of heavily pretreated patients experiencing virological failure improved between 1998 and 2001, mainly thanks to the use of newly available drugs with more favourable resistance profiles.
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Affiliation(s)
| | | | - Valérie Potard
- INSERM U720, Université Pierre et Marie Curie, Paris, France
| | - Claudine Duvivier
- INSERM U720, Université Pierre et Marie Curie, Paris, France
- CHU Pitié-Salpétrière, AP-HP, Paris, France
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- Hôpital Bichat-Claude Bernard
| | | | | | | | | | - L Weiss
- Hôpital Européen Georges Pompidou
| | | | | | - D Sicard
- Hôpital Européen Georges Pompidou
| | - D Salmon
- Hôpital Européen Georges Pompidou
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Rivera AM, Strauss KW, van Zundert A, Mortier E. The history of peripheral intravenous catheters: how little plastic tubes revolutionized medicine. Acta Anaesthesiol Belg 2005; 56:271-82. [PMID: 16265830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Herregods L, Barvais L, Brichant JF, Camu F, De Hert S, De Kock M, Dubois P, Ewalenko P, Lamy M, Mortier E, Vandermeersch E, Vermeyen K, Wouters P. Position of SARB in regard to premedication. Acta Anaesthesiol Belg 2005; 56:389-94. [PMID: 16416955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
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Abstract
INTRODUCTION AND METHOD Fifty-five patients (17 adults, 38 children) with meningococcal infection were admitted between 1986 and 2002 in a university hospital (500 beds). Fourteen of them (nine adults, five children) presented with an extra-meningeal infection. We compared adults and children presentations. RESULTS All adults had immunodeficiency. Septic locations were various (three bacteriemia, four pneumoniae, one infected ascitis, one cutaneous abscess). All patients received amoxicillin or third generation cephalosporin. Hospitalisation was prolonged (mean: 47 days). Seven patients required intensive care unit admission, and two of them died. All children (all were less than 36-month-old) presented with fever. Only one was immunodeficient (infected by human immunodeficiency virus). Neisseria meningitidis grew from blood in four, and in the throat for the remaining one. Hospitalisation was of short duration (mean: 4 days) and none of the children required intensive care unit. All the children recovered rapidly with antibiotics. CONCLUSION Outcome of extra-meningeal infection with N. meningitidis is different in adults and children. Adults present with immunodeficiency, infection is severe and patients present with various clinical features; children have a more homogeneous clinical presentation (fever) and outcome is excellent.
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Affiliation(s)
- S Guignard
- Service de médecine interne V, hôpital Louis-Mourier, 178, rue des Renouillers, 92700 Colombes, France.
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Ravelingien A, Mortier F, Mortier E, Kerremans I, Braeckman J. Proceeding with clinical trials of animal to human organ transplantation: a way out of the dilemma. J Med Ethics 2004; 30:92-8. [PMID: 14872084 PMCID: PMC1757120 DOI: 10.1136/jme.2003.004325] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The transplantation of porcine organs to humans could in the future be a solution to the worldwide organ shortage, but is to date still highly experimental. Further research on the potential effects of crossing the species barrier is essential before clinical application is acceptable. However, many crucial questions on efficacy and safety will ultimately only be answered by well designed and controlled solid organ xenotransplantation trials on humans. This paper is concerned with the question under which conditions, given the risks involved and the ethical issues raised, such clinical trials should be resumed. An alternative means of overcoming the safety and ethical issues is suggested: willed body donation for scientific research in the case of permanent vegetative status. This paper argues that conducting trials on such bodies with prior consent is preferable to the use of human subjects without lack of brain function.
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Affiliation(s)
- A Ravelingien
- Department of Philosophy, Ghent University, Belgium.
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Bloch M, Galeazzi G, Mortier E, Simonpoli A, Vinceneux P. Rentabilité de l'examen parasitologique des selles systématique chez le patient originaire d'Afrique sub-saharienne infecté par le VIH. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80548-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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van Aken J, Struys M, Verplancke T, de Baerdemaeker L, Caemaert J, Mortier E. Cardiovascular changes during endoscopic third ventriculostomy. ACTA ACUST UNITED AC 2003; 46:198-201. [PMID: 14506561 DOI: 10.1055/s-2003-42354] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
During an endoscopic third ventriculostomy (ETV) a sudden increase in intracranial pressure (ICP) may occur at any time. In the literature little attention has been paid to the early detection of such an increase. In particular the occurrence of a 'Cushing reflex' has not been discussed in this context. Therefore, we have now analysed retrospectively the anesthesia charts of 88 patients with obstructive hydrocephalus who had undergone ETV under general anesthesia. Monitoring included invasive blood pressure, electrocardiogram, end-expired carbon dioxide, pulse oximetry and heart rate. These variables were now evaluated before and after the introduction of the endoscope and during and after the occurrence of any change. In 67 patients the procedure had been uneventful. In 6 patients the occurrence of tachycardia and hypertension followed by bradycardia and hypertension was clearly the result of an increase in ICP, which we call a Cushing reflex. In his classical description of this pressure response Cushing reported the occurrence of hypertension, bradycardia and apnoea. However, many investigators have shown that beside systemic hypertension, both tachycardia and bradycardia are essential components of the Cushing reflex. Waiting for a persistent bradycardia to alert the surgeon during ETV can allow a fatal asystole.
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Affiliation(s)
- J van Aken
- Department of Anesthesiology, University Hospital, University of Ghent, Belgium.
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Poppe C, Devulder J, Mariman A, Mortier E. Chronic pain therapy: an evolution from solo-interventions to a holistic interdisciplinary patient approach. Acta Clin Belg 2003; 58:92-7. [PMID: 12836491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
The treatment of chronic pain patients has changed over years. Anaesthesiologists treat pain patients, their skills in locoregional anaesthesia techniques and their pharmacological knowledge being a unique resource to reduce pain. However, the International Association for the Study of Pain provides more and more scientific evidence that chronic pain is a biopsychosocial event and that its diagnosis and treatment should be considered in a multidisciplinary frame. Nevertheless, in practice we can't deny the fact that there are several steps in the process in which the patient himself decides if he wants such an approach or not. The 'motivating' phase is a very important pretherapy and basic condition to start up a holistic pain treatment. Therefore, at the Ghent University Hospital Pain Clinic, we focused in a first step how to motivate our pain patients to take part in a multidisciplinary diagnostic examination, the second step is motivate them for an interdisciplinary treatment when it is indicated. We diagnose the four most important pain components: the sensory, myofacial, autonomic and psychosocial problems. The patient who is initially examined by the anaesthesiologist, will also be evaluated by the psychologist and the physician in rehabilitation medicine. By this way each component is mapped and a final (holistic) diagnosis can be made. In a weekly half-a-day meeting, the different specialists discuss the patients and put forward an interdisciplinary treatment plan. On several moments, the patients' treatment progress will be discussed and redirected if necessary. So, we hope to obtain an optimal result and avoid overtreatment and too invasive pain treatment.
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Affiliation(s)
- C Poppe
- Department of Anaesthesiology-Section Pain Clinic, Ghent University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
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Coppens M, Versichelen L, Mortier E. Treatment of postoperative pain after ophthalmic surgery. Bull Soc Belge Ophtalmol 2003:27-32. [PMID: 12442340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
For ophthalmic surgery we have to deal with a wide range of different patient characteristics. We treat young healthy children, in some cases even neonates, but on the other hand we have debilitated aging patients with multiple concomitant diseases. Treatment of postoperative pain is imperative for inpatients, but is even more important for patients who are treated on an outpatient basis. There also is a wide range of different types of ophthalmic surgical procedures. The postoperative care after a cataract extraction is only seldom complicated by severe pain and is completely different of that after a vitrectomy with scleral buckling. More aggressive surgery as enucleation or evisceration of an eye often is a very stressful and painful procedure. We certainly have some excellent strategies to cope with postoperative pain. We can use topical anesthetics or non-steroidal anti-inflammatory medication. Regional anesthesia of the globe is extremely useful for anticipating on postoperative pain, especially when long-acting agents are used. We can administer analgesics by mouth or parenterally. Acetaminophen or paracetamol is widely used and can be supplemented with NSAIDs or opioids. Especially for children one has to use optimal doses of minor analgesics by an adequate route of administration in order to achieve a timely and efficient analgesia.
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Affiliation(s)
- M Coppens
- Anesthesia Department, Ghent University Hospital.
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Peigne V, Végni S, Pouchot J, Vinceneux P, Mortier E. Traitement fortuit d'une myocardite à cytomégaloviruschez un patient au stade sida atteint d'une colite à cytomégalovirus. Rev Med Interne 2002. [DOI: 10.1016/s0248-8663(02)80644-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- A Grasland
- Service de médecine interne V, hôpital Louis-Mourier, 178, rue des Renouillers, 92700 Colombes, France
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Guerreiro S, Bloch M, Meier F, Simonpoli A, Chan Chee C, Mortier E, Pouchot J, Vinceneux P. Caractéristiques des nouveaux consultants pour une infection par le VIH en 2001dans un service de médecine interne. Rev Med Interne 2002. [DOI: 10.1016/s0248-8663(02)80306-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Foubert L, Reyntjens K, De Wolf D, Suys B, Moerman A, Mortier E. Remifentanil infusion for cardiac catheterization in children with congenital heart disease. Acta Anaesthesiol Scand 2002; 46:355-60. [PMID: 11952432 DOI: 10.1034/j.1399-6576.2002.460404.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cardiac catheterization of children with congenital heart disease is increasingly being performed under general anesthesia. Haemodynamic stability during anesthesia and fast and adequate recovery after the procedure is crucial in these patients. We performed a pilot study to evaluate hemodynamic stability when using remifentanil for anesthesia during cardiac catheterization. We also evaluated extubation times and recovery characteristics. METHODS In a randomized, prospective, double-blind study 30 children (aged 1.5-20 months) received a continuous infusion of either 0.2 (group 0.2) or 0.3 microg/kg/min remifentanil (group 0.3) as part of a balanced anesthesia with 0.6 MAC sevoflurane. Heart rate, noninvasive arterial blood pressure, end tidal CO2 and pulse oxymetry were monitored throughout the procedure. Extubation times were noted, and recovery from anesthesia was evaluated using Aldrete scores. RESULTS : Haemodynamic response to intubation was well blunted in both groups. No significant changes in hemodynamic variables were noted from induction of anesthesia until 10 min after intubation. From then on there was a decrease in HR and systolic arterial pressure, which remained significant throughout the procedure in both groups. Extubation times were similar in both groups: 7.3 min (2,1) in group 0.2 vs. 6.6 min (2,1) in group 0.3 (NS). The number of patients with an Aldrete score of nine or more was 14 (group 0.2) vs. 15 (group 0.3), 10 min after extubation (NS). CONCLUSION Both dose regimens of remifentanil provided stable hemodynamic conditions during anesthesia for cardiac catheterization of children with congenital heart disease and allowed for rapid and adequate recovery.
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Affiliation(s)
- L Foubert
- Department of Anesthesia, Division of Cardiac Anesthesia, Ghent University Hospital, Belgium.
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Abstract
BACKGROUND AND OBJECTIVE We reviewed retrospectively the anaesthetic management and perioperative course of eight right hepatectomies for living liver donation. METHODS After preoperative psychiatric evaluation, eight ASA I-II individuals donated the right lobe of their liver to a family member. A graft-recipient body weight ratio of 0.8-1.0% was required for patient selection. Indications for liver transplantation were: hepatitis C viral-related cirrhosis in six patients; combined hepatitis C and B viral cirrhosis in one patient; multifocal hepatocellular carcinoma--four lesions, involving both liver lobes--of hepatitis C viral-related cirrhosis in another patient. Indication for adult-to-adult living-donor liver transplantation was retained in the latter because of rapid deterioration of liver disease, rare recipient's blood group and extended, unresectable hepatocellular carcinoma. Hepatitis C viral-related cirrhosis was casually the primary indication for adult-to-adult living-donor liver transplantation in this group. The condition of the donated hepatic lobe was optimized by appropriate drug and perfusion management. Preoperative investigations included: blood tests (full cell count and film, thyroid function tests, pregnancy tests, full virological tests and bacteriological cultures, and immunological typing), chest radiograph, electrocardiogram plus Doppler cardiac ultrasound, spirometry, aminopyrine breath test, liver Doppler examination, magnetic resonance imaging, angiography and cholangiography and a volumetric study of the whole liver and the right lobe. Haemoglobin and lactate concentrations, liver function tests and international normalized ratio were measured before and after operation. The volume and weight of the resected right lobe was calculated. Anaesthesia was induced with propofol 300 mL h(-1) and sufentanil 0.3 microg kg(-1) intravenously; cisatracurium, 0.15 mg kg(-1), was given to facilitate tracheal intubation. Anaesthesia was maintained during normocapnic ventilation of the lungs with oxygen 40% in air, isoflurane 1-1.5 MAC and sufentanil. Routine anaesthetic monitoring included electrocardiography, pulse oximetry, invasive blood pressure, central venous pressure, urine output, state of neuromuscular blockade and core temperature. Periods of hypotension (<80% of the preoperative blood pressure) or haemodynamic instability (requiring inotropic or vasoactive support) were registered. Total blood loss and transfusion (homologous, autologous or cell-saver blood) requirements were measured; volume replacements were derived. RESULTS Data are presented as mean (range). There was no morbidity or mortality and no periods of intraoperative hypotension or haemodynamic instability. The operation time averaged 619 (525-780)min. Four donors were extubated in the operating room immediately after surgery; the others were extubated in the intensive care unit, where the mean extubation time was 16.3 (5-25)h after arrival. The estimated blood loss was 967 (550-1,600)mL. No homologous blood was administered; five donors received autologous blood, intraoperatively; three donors received a cell-saver blood transfusion. Intraoperative fluid replacement was with crystalloids, colloids and 4% albumin. Total urine output was 1,472 (700-3100)mL. Although intraoperative hypothermia occurred all subjects were normothermic at the end of operation. The pre- and immediately postoperative haemoglobin concentration averaged 13.6 (9.8-15.6) and 10.5 (6.9-13.0)gdL(-1), respectively. On the first postoperative day, the haemoglobin was 11.7 (8.4-15.1)gdL(-1). The donors' liver function tests were transiently elevated in the initial postoperative period. The intensive care unit discharge time was 2 (1-3) days. The hospital stay was 13 (7-17) days. There was no morbidity or mortality. CONCLUSIONS The study demonstrates that right-lobe living-donor surgery was well tolerated, without intraoperative hypotension or haemodynamic instability, without perioperative anaesthetic or surgical complications, and with an excellent general outcome.
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Affiliation(s)
- G Cammu
- Ghent University Hospital, Department of Anaesthesia, Belgium.
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Cammu G, de Baerdemaeker L, den Blauwen N, de Mey JC, Struys M, Mortier E. Postoperative residual curarization with cisatracurium and rocuronium infusions. Eur J Anaesthesiol 2002; 19:129-34. [PMID: 11999596 DOI: 10.1017/s0265021502000236] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Monitoring of neuromuscular blockade still often relies on clinical judgement. Moreover, there are substantial national differences in the use of agents to 'reverse' their effects. We investigated the recovery characteristics and incidence of postoperative residual curarization after cisatracurium and rocuronium infusions for long duration interventions without systematic antagonism. METHODS In 30 patients undergoing major surgery, we measured infusion dose requirements for rocuronium and cisatracurium during propofol anaesthesia. Infusions were discontinued at the beginning of surgical closure; spontaneous recovery of neuromuscular function was awaited in both groups. Neostigmine (50 microg kg(-1)) was administered only when a patient started to wake without a train-of-four ratio (TOF) of 0.9. RESULTS In the cisatracurium and rocuronium groups, four (27%) and one (7%) patients, respectively, had a TOF ratio > or = 0.9 at the end of surgery. The TOF ratio in each group at that time was 51 +/- 32% for cisatracurium and 47 +/- 31% for rocuronium (P = 0.78). Six patients (40%) in the cisatracurium group and seven (47%) in the rocuronium group required neostigmine. The TOF ratio at the time of reversal was 63 +/- 7% for cisatracurium and 40 +/- 19% for rocuronium (P = 0.01). The time interval between the end of surgery and a TOF ratio of 0.9 was 10 +/- 9 min for cisatracurium and 18 +/- 13 min for rocuronium (P = n.s.). CONCLUSIONS Patients receiving a cisatracurium or rocuronium infusion have a high incidence of postoperative residual curarization when the block is not antagonized. When 'reversal' is not attempted, cisatracurium seems to be safer than rocuronium.
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Affiliation(s)
- G Cammu
- Ghent University Hospital, Department of Anaesthesia, Belgium.
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Raschilas F, Mortier E, Combe A, Grasland A, Pouchot J, Vinceneux P. Rifampicine et thrombose veineuse. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)80137-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Champey J, Barete S, Bloch M, Paycha F, Mortier E, Pouchot J, Vinceneux P. Ostéite multifocale à Bartonella quintana chez un sujet VIH. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)80294-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mortier E, Cornelissen F, van Hove C, Dillen L, Richardson A. The focal adhesion targeting sequence is the major inhibitory moiety of Fak-related non-kinase. Cell Signal 2001; 13:901-9. [PMID: 11728830 DOI: 10.1016/s0898-6568(01)00226-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Focal adhesion kinase (FAK) plays an important role in integrin-mediated signal transduction pathways and its C-terminal noncatalytic domain Fak-related non-kinase (FRNK), which is autonomously expressed, acts as an inhibitor of FAK. A model has been proposed where FAK and FRNK compete for an essential common binding protein. A FRNK variant in which the direct interaction with v-Crk-associated tyrosine kinase substrate (CAS) was disturbed by point mutations still functioned as an inhibitor of FAK, suggesting that FRNK is unlikely to inhibit FAK by sequestering CAS. Deletion variants of FRNK within the region N-terminal to the focal adhesion targeting (FAT) sequence were still able to inhibit FAK function, indicating that this region is dispensable for the inhibitory effect of FRNK. Overexpression of a green fluorescent protein (GFP) fusion protein containing the FAT sequence delayed cell spreading and reduced FAK tyrosine phosphorylation. This indicates that the FAT sequence is the major inhibitory moiety within FRNK.
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Affiliation(s)
- E Mortier
- Department of Biochemistry, Janssen Research Foundation, Turnhoutseweg 30, B-2340, Beerse, Belgium
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Mortier E, Galéazzi G, Grasland A, Pouchot J, Vinceneux P. Intérêt de la miltéfosine dans le traitement de la leishmaniose viscérale chez un patient infecté par le VIH. Rev Med Interne 2001. [DOI: 10.1016/s0248-8663(01)83618-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mortier E, Struys M. Effect site modelling and its application in TCI. Acta Anaesthesiol Belg 2001; 51:149-52. [PMID: 11000911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- E Mortier
- Department of Anaesthesiology, Ghent University Hospital, Belgium
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Kamoen E, Herregods L, Defreyne L, Vanlangenhove P, Mortier E. Interventional neuroradiology--anesthetic management. Acta Anaesthesiol Belg 2001; 51:191-6. [PMID: 11129619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Interventional Neuroradiology is a rather young department, that asks for an appropriate anesthesia management. This article highlights mainly the practical approach, with special directions for a thorough premedication, monitoring and patient positioning and extra attention to heparinisation and allergic reactions. Different anesthetic techniques are dealt with, namely conscious sedation and general anesthesia, as well as directives concerning potential complications.
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Affiliation(s)
- E Kamoen
- Department of Anesthesiology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium
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