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Fernandez J.,University of Barcelona | Gustot T.,Erasme Hospital | Gustot T.,Free University of Colombia | Gustot T.,French Institute of Health and Medical Research
Journal of Hepatology | Year: 2012

Bacterial infections are very frequent in advanced cirrhosis and become the first cause of death of these patients. Despite numerous experimental data and significant advances in the understanding of the pathogenesis of sepsis in cirrhosis, the outcome remains poor. Classical diagnostic parameters such as C-reactive protein and SIRS criteria have less diagnostic capacity in the cirrhotic population, often delaying the diagnosis and the management of bacterial infection. Prompt and appropriate empirical antibiotic treatment of infection and early resuscitation of patients with severe sepsis or septic shock are essential in determining patient's outcome. A strategy of careful restriction of prophylactic antibiotics to the high-risk populations could reduce the spread of multidrug resistant bacteria. This review is focused on the currently recommended diagnostic, therapeutic and prophylactic strategies for bacterial infections in the cirrhotic population. © 2012 European Association for the Study of the Liver.

van de Borne P.,Erasme Hospital
Current Clinical Pharmacology | Year: 2013

Despite the well documented and very effective non pharmacologic and pharmacologic therapies, hypertension remains often poorly controlled. There is still room for improvements in blood pressure control and recent technological advances have generated a regained interest in the physiopathology of renal sympathetic innervation in hypertension. In this article we review the evidence that renal sympathetic activity is increased in essential hypertension. The postganglionic sympathetic fibers are directed to the afferent and efferent renal arterioles, the juxtaglomerular apparatus, the proximal renal tubule, the loop of Henle, as well as the distal renal tubule and are under the control of many reflex loops, which are summarized in a most comprehensive manner for an unfamiliar reader within this field of research. Studies on renal denervation have provided further insights on the role of the sympathetic system in the kidneys, however their proper interpretation requires a special attention to the experimental protocols, as is explained in the text. Last, the possibility of kidney reinnervation is discussed, as well as the emerging evidence that the kidney is also a sensory organ. In summary, this review article provides a strong scientific background to understand not only the mechanisms of the hypotensive effects, but also those of possible pitfalls, of renal denervation. © 2013 Bentham Science Publishers.

Gustot T.,Erasme Hospital | Gustot T.,Free University of Colombia | Gustot T.,French Institute of Health and Medical Research
Current Opinion in Critical Care | Year: 2011

Purpose of review: To describe the pathogenesis and emphasize prognosis of systemic inflammatory response during severe infection. Recent findings: Host immune response enables to confine and clear microorganisms. Sometimes for current unknown reason depending on host (genetic susceptibilities and comorbidities) and pathogen (load and virulence) factors, this reaction is accompanied by a widespread reaction characterized by a first pro-inflammatory response (called at the bedside, systemic inflammatory response syndrome) and a following 'immune paralysis' (compensatory anti-inflammatory response syndrome) responsible for secondary infections. There are three recognized stages of severe host response to pathogen with progressively increased mortality rates: sepsis, severe sepsis, and septic shock. This excessive reaction induces microthrombi formation, capillary obstruction by red blood cells losing their deformability, microcirculatory alterations, tissue edema by capillary leak, and neutrophil recruitment leading to multiple tissue damages, organ failures (multiple organ dysfunction syndrome) and finally to death. Despite the early detection, the use of modern antibiotics and new resuscitation therapies, sepsis remains a leading cause of death in critically ill patients. Summary: Sepsis is viewed as an excessive host response to pathogen inducing a complex network of molecular cascades leading to tissue damages, organ failures, and death. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Ickx B.E.,Erasme Hospital
European Journal of Anaesthesiology | Year: 2010

In this review, we shall consider the oral and intravenous fluid management of pregnant women during labour and operative delivery in the context of neuroaxial blockade. We shall also discuss the use of blood transfusion in the peripartum period, especially during postpartum haemorrhage. Current management of military casualties and major civilian trauma challenges traditional practices of blood product administration in massive haemorrhage and may radically modify transfusion practices during obstetric haemorrhage. Articles for inclusion were selected from medical databases, including Medline and the Cochrane Library, and additional references were obtained from available relevant publications. © 2010 Copyright European Society of Anaesthesiology.

Schmieder R.E.,Friedrich - Alexander - University, Erlangen - Nuremberg | Redon J.,University of Valencia | Grassi G.,Clinica Medica | Kjeldsen S.E.,University of Oslo | And 6 more authors.
Journal of Hypertension | Year: 2012

Experts from the European Society of Hypertension prepared this position paper in order to summarize current evidence, unmet needs and practical recommendations on the application of percutaneous transluminal ablation of renal nerves [renal denervation (RDN)] as a novel therapeutic strategy for the treatment of resistant hypertension. The sympathetic nervous activation to the kidney and the sensory afferent signals to the central nervous system represent the targets of RND. Clinical studies have documented that catheter-based RDN decreases both efferent sympathetic and afferent sensory nerve traffic leading to clinically meaningful systolic and diastolic blood pressure (BP) reductions in patients with resistant hypertension. This position statement intends to facilitate a better understanding of the effectiveness, safety, limitations and issues still to be addressed with RDN. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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