Le cas clinique du mois. Masse médiastinale antérieure chez une patiente acromégale.

in Revue Médicale de Liège (2003), 58(12), 724-728

The discovery of an anterior asymptomatic mediastinal mass with acromegaly creates a dilemma for the clinician. As acromegaly can be due to a pituitary tumor but also to an ectopic production of GHRH, the ... [more ▼]

The discovery of an anterior asymptomatic mediastinal mass with acromegaly creates a dilemma for the clinician. As acromegaly can be due to a pituitary tumor but also to an ectopic production of GHRH, the first diagnostic step consists of finding the etiology of the disease in order to use adequate treatment. This can be complicated by the fact that acromegaly can be associated with other tumors (for instance in MEN-1 disease and Carney Complex) and because chronic GH hypersecretion can stimulate tumor overgrowth and perhaps tumor formation. We describe the case of a 44-year-old acromegalic woman with an anterior mediastinal mass. We present the different diagnoses and a review of the literature. [less ▲]

Remplacement valvulaire mitral par homogreffe

in Revue Médicale de Liège (2002), 57(7), 459-62

The total homograft replacement of the left AV valve and subvalvular apparatus constitutes a delicate operation, which may prove beneficial in young patients with extensive bacterial endocarditis. The ... [more ▼]

The total homograft replacement of the left AV valve and subvalvular apparatus constitutes a delicate operation, which may prove beneficial in young patients with extensive bacterial endocarditis. The case of a staphylococcal endocarditis in a young drug addicted patient, operated three years previously of mitral valve repair for the same pathology, is presented. In addition to the complete excision of infected tissues and valvular substitution with biological material, this technique has the advantage of avoiding long term anticoagulation. The history, technical key points, and current indications of mitral homograft in the surgery of the left atrio-ventricular valves are reviewed. [less ▲]

Communication interventriculaire et infarctus récent du myocarde

in Revue Médicale de Liège (2001), 56(12), 823-829

Rupture of the interventricular septum is a classical complication of acute myocardial infarction. The diagnosis should be evoked when the patient's hemodynamic condition deteriorates in the presence of a ... [more ▼]

Rupture of the interventricular septum is a classical complication of acute myocardial infarction. The diagnosis should be evoked when the patient's hemodynamic condition deteriorates in the presence of a new systolic murmur. A transthoracic or, preferably, transesophageal echocardiography confirms the diagnosis. Early surgical correction constitutes the best treatment. Despite recent progresses, mortality remains high but long term results are encouraging. The risk factors conditioning prognosis, the surgical options and the question of simultaneous coronary bypass will be discussed after a thorough review of the literature. [less ▲]

Le syndrome de Shone: presentation de quatre cas et revue de la litterature

in Revue Médicale de Liège (2001), 56(7), 506-10

The observation of four clinical cases of Shone's complex, two of them presenting first with predominant coarctation of the aorta, prompted us to review the pertinent literature. Patients with ... [more ▼]

The observation of four clinical cases of Shone's complex, two of them presenting first with predominant coarctation of the aorta, prompted us to review the pertinent literature. Patients with multiobstructive lesions of the left heart, including Shone's complex, represent a surgical challenge where the adequate management of mitral valve anomalies, subaortic stenosis, and coarctation constitutes the key prognostic factor for satisfactory mid-term outcome. [less ▲]

Heart Graft Monitoring by the Ventricular Evoked Response

in Pacing & Clinical Electrophysiology (2000), 23(11, Pt 2), 2003-5

Monitoring of the negative slew rate of the evoked T wave has been proposed as a noninvasive diagnostic tool to follow heart transplant recipients. The clinical contribution of this measurement on ... [more ▼]

Monitoring of the negative slew rate of the evoked T wave has been proposed as a noninvasive diagnostic tool to follow heart transplant recipients. The clinical contribution of this measurement on telemetrically recorded, paced unipolar ventricular electrograms was evaluated in the detection of grade 3 acute allograft rejection. Thirteen patients undergoing heart transplantation received a DDD pacemaker connected to two epimyocardial leads. Electrograms were recorded and digitized after each endomyocardial biopsy (EMB). The maximum slew rate of the descending slope of the repolarization phase (RSP) was extracted and normalized. A 20% downward shift of RSP from the reference value was considered abnormal. Results of signal processing were blinded during the first 6 months. Eleven patients completed the 6 months blinded period and two patients died. A total of 101 EMB were graded according to the International Society for Heart and Lung Transplantation classification. Grade 3 was assigned to 9 EMB. A significant difference was found between RSP values measured during grade 3 rejection episodes and other RSP values (P < 0.001). A diagnostic model consisting of a single threshold test confirmed the ability of RSP to predict significant signs of rejection on EMB (P < 0.0001). The sensitivity of RSP in detecting grade 3 rejections was 100%, specificity was 81%, negative predictive value 100%, and positive predictive value 35%. The use of RSP as a noninvasive monitoring tool to pose the indication for a biopsy would avoid 73% of EMB. Monitoring of transplanted hearts based on the analysis of the ventricular evoked response is promising and may markedly reduce the number of EMB. [less ▲]

Typical Presentation of Intramural Aortic Haemorrhage (Iah) with Evidence of Intimal Tear at Mri and Angiography

in Acta Chirurgica Belgica (1999), 99(1), 44-6

A typical appearance of IAH was evidenced by CT and TEE in a 56-year-old hypertensive female suspected of developping classical acute aortic dissection (AAD). Further examination with MRI and aortography ... [more ▼]

A typical appearance of IAH was evidenced by CT and TEE in a 56-year-old hypertensive female suspected of developping classical acute aortic dissection (AAD). Further examination with MRI and aortography showed unequivocally the presence of an intimal tear in the aortic arch. This coexistence of intimal tear has never been evidenced preoperatively in patients with IAH. This observation demonstrates at the outset that IAH is part of the spectrum of AAD. [less ▲]

Prise en charge médico-chirurgicale des enfants cardiopathes: résultats de l'expérience liégeoise

in Revue Médicale de Liège (1999), 54(2), 95-9

OBJECTIVE: Evaluation of the results obtained in the management of congenital heart diseases in Liege. MATERIAL AND METHODS: We evaluated the results, the mortality and the morbidity of diagnostic and ... [more ▼]

OBJECTIVE: Evaluation of the results obtained in the management of congenital heart diseases in Liege. MATERIAL AND METHODS: We evaluated the results, the mortality and the morbidity of diagnostic and interventional cardiac catheterization, and of the cardiac surgery in the 123 cardiac children who were referred to us during the three first years of operation of our medico-surgical team. RESULTS: 89 children underwent a catheterization, including 12 therapeutic interventions, whereas 68 were operated. In the two domains, the results are completely comparable with those of the established centers. CONCLUSIONS: The widening of the activity of paediatric cardiology and the creation of an activity of pediatric cardiac surgery in Liege appeared important to us for the quality of management of the cardiac children. This goal could be reached only if our results were comparable with those of the literature. The bet seems to be held. The ultimate objective is to contribute by an adequate policy of management to the quality of life and the health of the cardiac children. [less ▲]

La transposition corrigée des gros vaisseaux ou double discordance

in Revue Médicale de Liège (1997), 52(9), 603-5

Traitement chirurgical de l'insuffisance tricuspide. L'annuloplastie de Carpentier

in Revue Médicale de Liège (1997), 52(3), 159-62

Evaluation of the Solitary Pulmonary Nodule by Positron Emission Tomography Imaging

in European Respiratory Journal (1996), 9(3), 410-4

Current noninvasive imaging methods are not sufficiently reliable for accurate detection of malignancy in most solitary pulmonary nodules (SPNs). Positron emission tomography (PET) using 18 ... [more ▼]

Current noninvasive imaging methods are not sufficiently reliable for accurate detection of malignancy in most solitary pulmonary nodules (SPNs). Positron emission tomography (PET) using 18-fluorodeoxyglucose (FDG), showing increased FDG uptake and retention in malignant cells, has proved useful to differentiate malignant from benign tissue and could, therefore, contribute to the evaluation of the SPN. We performed a prospective study of 50 patients referred to the Pneumology Department with unclear diagnoses of SPN after conventional radiological screening. PET study was performed on each subject before an invasive procedure was proposed. Thirty three patients had a malignant nodule and 17 had a benign nodule. The mean size of malignant nodule was 3 cm (range 1.5-4.5 cm). All showed a marked increase in 18-FDG uptake. The mean size of benign nodule was 1.8 cm (range 0.5-3.5 cm). PET imaging showed the absence of 18-FDG uptake and correctly identified 15 of 17 benign nodules. There was two false-positive cases with a moderate increase in 18-FDG uptake (1 postprimary tuberculosis; and 1 anthracosilicotic nodule with nonspecific inflammation). At present, the sensitivity and specificity of the method are 100 and 88%, respectively. The positive and negative predictive values of PET imaging for SPNs are 94 and 100%, respectively. Our preliminary results demonstrate that PET-FDG imaging is a noninvasive technique, which appears highly accurate in differentiating malignant SPN from benign SPN. [less ▲]