Verhandelingen - Koninklijke Academie voor Geneeskunde van België
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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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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.
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Female genital mutilation is a collective name for all traditional practices concerning the cutting of the female genitals. Approximately 130 million are genitally cut worldwide, more than 100 million live in Africa. ⋯ FGM is deeply rooted in culture, tradition, religion and the identity. Hence, the struggle against FGM must be a combined effort of law enforcement, targeted information- and sensibilization campaigns, education and training activities for various target groups that aim at establishing behavioural changes.
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Verh. K. Acad. Geneeskd. Belg. · Jan 2001
Review[Twenty years of in vitro fertilization: realization and questions for the future].
IVF is a well-established procedure for the treatment of longstanding infertility due to tubal disease, endometriosis, unexplained infertility or certain types of infertility involving a male factor. IVF can also be applied to couples requiring oocyte donation. Conventional IVF involves several related procedures: patient selection, ovarian stimulation, oocyte retrieval, semen preparation, insemination of cumulus-oocyte complexes, assessment of fertilization, assessment of embryo cleavage, replacement to the uterus of mostly two or three embryos, cryopreservation of excess embryos and establishment of pregnancy. ⋯ The results of 1437 fetal karyotypes indicate that in comparison with a control group there is after ICSI a slight but significant increase of sex chromosomal aneuploidies and de-novo structural aberrations. The percentage of ICSI children (n = 2840) with major congenital malformations was similar to the malformation rate in children from conventional IVF (n = 2955) or natural conception. This prospective follow-up study should be continued much longer--if possible until adulthood to assess the fertility of these children.
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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.