Browsing by Author "Warren, B."

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    Recombinant human platelet-activating factor acetylhydrolase for treatment of severe sepsis: Results of a phase III, multicenter, randomized, double-blind, placebo-controlled, clinical trial
    (2004) Opal, S.; Laterre, P-F.; Abraham, E.; Francois, B.; Wittebole, X.; Lowry, S.; Dhainaut, J-F.; Warren, B.; Dugernier, T.; Lopez, A.; Sanchez, M.; Demeyer, I.; Jauregui, L.; Lorente, J. A.; McGee, W.; Reinhart, K.; Kljucar, S.; Souza, S.; Pribble, J.; Opal, S.; Laterre, P-F.; Abraham, E.; Francois, B.; Wittebole, X.; Lowry, S.; Dhainaut, J-F.; Warren, B.; Dugernier, T.; Lopez, A.; Sanchez, M.; Demeyer, I.; Jauregui, L.; Lorente, J. A.; McGee, W.; Reinhart, K.; Kljucar, S.; Souza, S.; Pribble, J.
    Objective: Platelet-activating factor (PAF) and structurally-related oxidized phospholipids are proinflammatory mediators in systemic inflammatory states such as severe sepsis. The enzyme platelet-activating factor acetylhydrolase (PAF-AH) rapidly degrades PAF and oxidized phospholipids into inactive metabolites. Reduced PAF-AH activity has been observed in patients with severe sepsis and may contribute to their systemic inflammatory response and organ dysfunction. A previous clinical trial with recombinant human PAF-AH (rPAF-AH, Pafase) suggested that this treatment may decrease 28-day all-cause mortality in patients with severe sepsis. The current study was undertaken to confirm this result. Design: A prospective, randomized, double-blind, placebo-controlled, multicenter, international trial. Setting: One hundred forty-six intensive care units from nine countries. Patients: Approximately 2,522 patients were planned to be enrolled ≤12 hrs after the onset of severe sepsis. Eligible patients were randomized to receive either rPAF-AH 1.0 mg/kg or placebo administered intravenously once daily for five consecutive days. Measurements and Main Results: The study was terminated based on the recommendation of an independent data and safety monitoring committee after the second of three planned interim analyses, and the enrollment of 1,425 patients. rPAF-AH treatment was well tolerated among the 1,261 patients included in the interim analysis (643 rPAF-AH and 618 placebo), but did not decrease 28-day all-cause mortality compared with placebo (25% for rPAF-AH vs. 24% for placebo; relative risk, 1.03; 95% confidence Interval, 0.85-1.25; p = .80). There were no statistically significant differences between treatment groups in any of the secondary efficacy end points. The overall incidence of adverse events was similar among rPAF-AH and placebo-treated patients, and no rPAF-AH-treated patients developed antibodies to PAF-AH. Conclusions: rPAF-AH was well tolerated and not antigenic, but did not decrease 28-day all-cause mortality in patients with severe sepsis.
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    Takayasu's disease : a report of 3 cases
    (Health & Medical Publishing Group, 1985) Du Toit, D. F.; Warren, B.; McCormich, M.; Laker, L.
    Three patients with Takayasu's disease are described. In 2 cases aortography demonstrated an occlusion of the great vessels at the origin of the arch of the aorta. In 1 patient there was concomitant aneurysmal dilatation of the brachiocephalic trunk. Common and internal carotid artery stenosis occurred in 1 patient and was associated with hemiplegia and blindness. All 3 patients had constitutional symptoms and signs of the disease as well as markedly elevated erythrocyte sedimentation rates; 2 patients had moderate clinical responses to steroid administration in the short term and 1 developed bilateral calf vein thrombosis, which responded satisfactorily to conservative management.
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    An unusual presentation of carcinoma of the colon in a child : a case report
    (Health & Medical Publishing Group, 1984) Heydenrych, J. J.; Warren, B.
    A patient with carcinoma of the large bowel who presented with a subphrenic abscess is reported. This case emphasizes two important facts relating to colonic cancer in childhood: (i) premalignant disease of the large bowel is no prerequisite for the development of colonic cancer; and (ii) in childhood this disease is characterized by a fulminating course and high mortality. In about 50% of cases the tumor is of the signet ring or mucin-producing type, which explains the grave prognosis.