Mucormycose invasive du poumon et du rachis dorsal.

in Revue Médicale de Liège (2008), 63

Nous rapportons le cas d'un patient de 67 ans atteint d'un syndrome myélodysplasique et qui a développé une mucormycose pulmonaire avec extension tout à fait exceptionnelle vers le rachis dorsal ... [more ▼]

Nous rapportons le cas d'un patient de 67 ans atteint d'un syndrome myélodysplasique et qui a développé une mucormycose pulmonaire avec extension tout à fait exceptionnelle vers le rachis dorsal responsable d'un paraplégie aiguë. Après échec d'un traitement probabiliste anti-aspergillaire, c'est finalement l'analyse des prélèvements obtenus lors de la laminectomie décompressive qui a fourni le diagnostic mycologique. En raison d'une altération majeure de l'état général, la lobectomie prévue n'a pu être réalisée et malgré l'adaptation du traitement antifongique (Abelcet, Posaconazole), le patient est décédé. La mucormycose (ou zygomycose) pulmonaire est une infection fongique peu commune qui touche essentiellement les patients immuno-déprimés. Le champignon pathogène fait partie des zygomycètes dont la caractéristique principale est la capacité d'angio-invasion. L'invasion périneurale est une autre voie de propagation récemment mise en évidence. Les difficultés thérapeutiques associées à cette pathologie sont liées au terrain d'immunodépression, aux difficultés d'obtenir rapidement un diagnostic précis ainsi qu'à l'absence de sensibilité du Mucor aux antifongiques récemment introduits (V-Fend, Cancidas). Ceci souligne le risque inhérent à un traitement antifongique empirique par ces agents et la nécessité d'un prélèvement biopsique précoce en cas de non-réponse au traitement. [less ▲]

Association of abdominal aortic aneurysm, horseshoe kidneys, and left-sided inferior vena cava: report of two cases.

in Journal of Vascular Surgery (2008), 47(3), 645-8

Surgery for abdominal aortic aneurysm may be challenging when rare renal or venous anomalies are present. This article reports two similar cases of aortic abdominal aneurysm associated with horseshoe ... [more ▼]

Surgery for abdominal aortic aneurysm may be challenging when rare renal or venous anomalies are present. This article reports two similar cases of aortic abdominal aneurysm associated with horseshoe kidney and left-sided inferior vena cava treated with a transperitoneal approach. Preoperative knowledge of the anatomic situation enabled appropriate aneurysm repair. Operative strategy is discussed. This report describes an uncommon venous vascular malformation complex and stresses the importance of computed tomography imaging not only in assessing the characteristics of the aneurysmal disease but also in detecting variations in pertinent vascular or parenchymal anatomy. [less ▲]

La CIA, de type ostium primum ou canal atrio-ventriculaire partiel.

in Revue Médicale de Liège (2007), 62(1), 25-8

Often assimilated to simple inter-atrial communication, the ostium primum, or partial atrio-ventricular septal defect, is an entity that is characterized by a different embryological mechanism and ... [more ▼]

Often assimilated to simple inter-atrial communication, the ostium primum, or partial atrio-ventricular septal defect, is an entity that is characterized by a different embryological mechanism and requires some specific surgical expertise. Basically, knowledge of the morphology of the common atrioventricular valve with 5 components, the topography of the A-V node and His bundle, and the ventricular consequences of the absence of atrio-ventricular septal structures must be taken into account. [less ▲]

Metachronous type III and type II acute aortic dissections in puerperium.

in European Journal of Cardio - Thoracic Surgery (2007), 32(3), 541-3

The case of a 30-year-old non-Marfan woman who developed a type III acute aortic dissection 5 days after delivery, followed within 16 h by an independent type II dissection, is reported. Preoperative CT ... [more ▼]

The case of a 30-year-old non-Marfan woman who developed a type III acute aortic dissection 5 days after delivery, followed within 16 h by an independent type II dissection, is reported. Preoperative CT scan imaging and TEE suggested metachronous type II and type III dissection. This was confirmed at surgery, where limited dissection of the aortic root without communication with the isthmic area via the aortic arch was evidenced. The patient underwent repair of the aortic root and adjacent ascending aorta and was medically treated for her type III dissection. This is the first report of metachronous acute aortic dissections in puerperium. [less ▲]

Le cas clinique du mois : “Le pouls alternant : un élément sémiologique rare de dysfonction ventriculaire gauche sévère”.

in Revue Médicale de Liège (2007), 62

Comment j'explore... les nodules pulmonaires de types verre depoli et mixte: une nouvelle semiologie tomodensitometrique de l'adenocarcinome pulmonaire.

in Revue Médicale de Liège (2007), 62(7-8), 515-22

Recently a new computed tomography semiology of the pulmonary adenocarcinoma was highlighted. Studies on ground-glass nodule and on mixed nodule showed the relation between these radiological images and ... [more ▼]

Recently a new computed tomography semiology of the pulmonary adenocarcinoma was highlighted. Studies on ground-glass nodule and on mixed nodule showed the relation between these radiological images and the different anatomopathological forms of lung adenocarcinoma. Ground-glass opacity can correspond to precancerous lesions and morphological characteristics of nodules are correlated with the prognosis. The presence of spiculation, pleural retraction and air bronchogram is significantly more important in neoplasic lesions. The presence or the apparition of a solid component inside the nodule or the presence of indentation is highly suggestive of adenocarcinoma. A lesion smaller than 20 mm and persistant after 1 month must be, either followed up, or removed by a limited surgical resection. Lesions larger than 20 mm or associated with a solid component must be treated by conventional surgery. [less ▲]

The usual causes of left ventricular outflow tract obstruction below the aortic valve in normal ventriculoarterial connection: Review of the physiopathology and surgical implications

in Acta Chirurgica Belgica (2005), 105(5), 475-481

Subaortic narrowing leading to left ventricular outflow tract obstruction (LVOTO) is a significant pathology that may be encountered pre- or postoperatively in both acquired or congenital cardiac disease ... [more ▼]

Subaortic narrowing leading to left ventricular outflow tract obstruction (LVOTO) is a significant pathology that may be encountered pre- or postoperatively in both acquired or congenital cardiac disease. Through a review of the morphological features and mechanisms in the different clinical situations, the anatomic, dynamic and mixed forms of subaortic obstruction are emphasized. Knowledge of the substrate of LVOTO, its physiopathology and natural history allows to plan accordingly the surgical repair and the postoperative management. [less ▲]

L'image du mois. Quadricuspidie aortique, une cause rare d'insuffisance aortique

in Revue Médicale de Liège (2005), 60(2), 75-6

L'image du mois. Myxome de l'oreillette gauche

in Revue Médicale de Liège (2004), 59(7-8, Jul-Aug), 419-20

Increased mRNA expression of decorin in the prolapsing posterior leaflet of the mitral valve.

in Interactive Cardiovascular and Thoracic Surgery (2003), 2(3), 389-94

To improve our understanding of myxomatous degeneration of the valvar tissue as seen in mitral valve prolapse, we have compared the biosynthetic phenotype of the connective tissue cells in myxomatous ... [more ▼]

To improve our understanding of myxomatous degeneration of the valvar tissue as seen in mitral valve prolapse, we have compared the biosynthetic phenotype of the connective tissue cells in myxomatous segments (n=4) resected during surgery with that of homologous segments of normal valves (n=4) harvested in age-matched organ donors. The steady-state level of mRNA for selected extracellular matrix macromolecules and metalloproteinases was assessed by quantitative (internal standard controlled) reverse transcriptase-polymerase chain reaction (RT-PCR). Among the investigated gene products, the decorin mRNA expression was significantly increased in degenerative valve compared with normal tissue (211+/-48 vs. 100+/-70, p<0.02). The level of fibrillin 2 also tended to be increased (194+/-88 vs. 100+/-81, p=0.08). These results suggest that myxomatous valvar tissue is characterized by an overexpression of mRNA for decorin. Owing to the role of this small leucine-rich proteoglycan in the regulation of fibril assembly and stability, this alteration may account for or is a result of a defective organization of the collagen and elastic fibers in this disease and contribute to the intrinsic distensibility and fragility of the myxomatous tissue. [less ▲]