Verhandelingen - Koninklijke Academie voor Geneeskunde van België
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Verh. K. Acad. Geneeskd. Belg. · Jan 2005
Multicenter StudyClinical pharmacology of non opioid analgesics in neonates.
An integrated approach of neonatal analgesia starts with the systematic evaluation of pain and should be followed by effective interventions, mainly based on the appropriate (i.e. safe and effective) administration of analgesics. In contrast to the more potent opioids, data on the pharmacokinetics and -dynamics of non-opioid analgesics in this specific population are still rare or even lacking. We therefore evaluated various aspects of developmental pharmacology of non-opioid analgesics (paracetamol, ibuprofen, acetylsalicyl acid) in neonates. ⋯ Neonatal renal clearance strongly depends on glomerular filtration rate (GFR) and GFR itself strongly depends on the vaso-dilatative of prostaglandins on the afferent arterioli. We therefore evaluated the impact of the administration of ibuprofen or acetylsalicylic acid on renal clearance in preterm infants and hereby used amikacin clearance as a surrogate marker. We hereby documented the negative effect of ibuprofen on glomerular filtration rate in preterm infants up to 34 weeks and we were able to show that ibuprofen and acetylsalicylic acid had an equal impact on the glomerular filtration rate.
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The first Belgian nuclear emergency plan was drawn up in the aftermath of the Chernobyl accident and was primarily aimed at dealing with the consequences of major accidents happening in large nuclear facilities like nuclear power plants. Both the experience during a decade of nuclear emergency exercises and a changing environment with increased menace of malevolent actions by terrorists urged the modification and extension of the initial plan; The latest "Nuclear and radiological emergency plan for the Belgian territory" was published as the Royal Decree of October 17th, 2003. In contrast to what happened in other emergency situations, nuclear and radiological emergencies are, from the moment they are recognised as such and regardless of their (potential) impact, coordinated at the level of the federal authorities. ⋯ The radiological evaluation is being prepared by introducing "emergency reference levels", for which the Federal Agency for Nuclear Control is responsible. This consists in pre-defining radiation doses which "generally" to "almost invariably" call for the adoption of a given countermeasure. Finally, the nuclear and radiological emergency plan includes stipulations on the required information to the population, on the education and training of (potentially) intervening parties as well as on the minimum requirements for running nuclear emergency exercises.
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Verh. K. Acad. Geneeskd. Belg. · Jan 2004
Review[Predictive models for the early diagnosis of ectopic pregnancy].
In the past patients with acute abdominal pain and presumably suffering from an ectopic pregnancy often required an immediate surgical intervention. The diagnosis of ectopic pregnancy has become more frequent during the last decades but the incidence of ectopic pregnancy rupture has declined. This decline is due to quantitative hCG measurements, minimally invasive surgery and transvaginal ultrasonography. ⋯ The usual biochemical procedures for diagnosing ectopic pregnancy have been developed for pregnancies associated with abdominal pain and abnormal bleeding and not for asymptomatic pregnant women with a much lower pre-test probability of ectopic pregnancy. For this reason new diagnostic procedures and criteria had to be developed and tested to detect ectopic pregnancies in women with PUL, without exerting any deleterious effect on early intra-uterine pregnancies. In our experience the hCG-ratio and our new mathematical model seem to be the best method to satisfy these criteria.
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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.