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See detailSyphilis en 2008: controverses et attitudes pratiques.
Frippiat, Frédéric ULiege; GIOT, Jean-Baptiste ULiege; Chandrikakumari, Kavitha et al

in Revue Médicale Suisse (2008), 4(168), 1823-7

Rising incidence rate of syphilis is observed in economically advanced countries, particularly among homosexual men and subpopulation with low socioeconomic status. The various clinical presentations are ... [more ▼]

Rising incidence rate of syphilis is observed in economically advanced countries, particularly among homosexual men and subpopulation with low socioeconomic status. The various clinical presentations are divided into early and late stages, including neurosyphilis. The latter can occur during any stage of the disease, leading to the question "when to perform lumbar puncture", particularly in HIV positive patients. Penicillin continues to be the first-line therapy for all stages of syphilis. An alternative treatment should be considered as an exemption, after advice from a specialist. All patients require prolonged clinical and serological follow-up after treatment to rule out relapse or re-infection. The diagnosis of syphilis is an opportunity to search and treat other sexually transmitted diseases in patients and their sexual partner(s). [less ▲]

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See detailImpact thérapeutique du dépistage de l’ischémie myocardique silencieuse chez le sujet diabétique de type 2
Wallemacq, Caroline ULiege; Scheen, André ULiege

in Revue Médicale Suisse (2008), 168(4), 1800-1804

Coronary artery disease is the major cause of mortality of type 2 diabetic subjects. Its early diagnosis to prevent progression and clinical events has intuitive appeal. Somehow, rationale for screening ... [more ▼]

Coronary artery disease is the major cause of mortality of type 2 diabetic subjects. Its early diagnosis to prevent progression and clinical events has intuitive appeal. Somehow, rationale for screening has not been clearly established. Screening should not modify the medical therapy because diabetic subjects have to be treated in a secondary prevention strategy. We have no data from randomized trials concerning a better outcome after revascularization in this specific population. The question how to select the high risk population to be screened has no response by now. SPECT and stress echocardiography seem valuable for screening but not for risk stratification. A large randomized clinical trial is required to confirm the cost-utility ratio of such a screening. [less ▲]

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See detailInhibition des recepteurs CB1 et metabolisme du glucose: rimonabant dans le diabete de type 2.
Scheen, André ULiege; Paquot, Nicolas ULiege; Van Gaal, Luc F

in Revue Médicale Suisse (2008), 4(168), 1812-7

Endocannabinoid system is overactivated in individuals with abdominal obesity. CBI receptors, first individualized in the brain, are also expressed in the adipocyte, the skeletal muscle, the liver, the ... [more ▼]

Endocannabinoid system is overactivated in individuals with abdominal obesity. CBI receptors, first individualized in the brain, are also expressed in the adipocyte, the skeletal muscle, the liver, the gut, and the pancreas. Their blockade improves glucose tolerance and lipid profile, thanks increased insulin sensitivity and adiponectin levels. Rimonabant, a selective antagonist of CBI receptors, improves glucose control in patients with type 2 diabetes, treated with diet alone, metformin, sulfonylurea or insulin, while it also reduces body weight and other risk factors. Ongoing studies aim at further demonstrating the potential of rimonabant in the management of type 2 diabetes, in the prevention of type 2 diabetes and in the protection against cardiovascular complications in (diabetic) patients with abdominal obesity. [less ▲]

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See detailQuelle place pour une double ou triple inhibition du systeme renine-angiotensine-aldosterone ?
Legrand, Delphine ULiege; Krzesinski, Jean-Marie ULiege; Scheen, André ULiege

in Revue Médicale Suisse (2008), 4(168), 1792-7

The blockade of the renin-angiotensin-aldosterone system (RAAS) is helpful in the management of arterial hypertension, congestive heart failure, post-myocardial infarction and diabetic nephropathy. Such ... [more ▼]

The blockade of the renin-angiotensin-aldosterone system (RAAS) is helpful in the management of arterial hypertension, congestive heart failure, post-myocardial infarction and diabetic nephropathy. Such blockade can be obtained with an angiotensin converting enzyme inhibitor, a specific antagonist of angiotensin II AT1 receptors, an aldosterone receptor antagonist and/or a direct inhibitor of renin such as aliskiren. Various studies have demonstrated that a dual or even triple RAAS inhibition may offer a better cardiorenal protection, in refractory congestive heart failure and in nephropathy with proteinuria. However, in the ONTARGET study, the dual inhibition with ramipril plus telmisartan did not provide any additional benefit compared to ramipril alone in high-risk cardiovascular patients, but showed a worse tolerance profile. [less ▲]

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See detailEndoprotheses coronaires pharmaco-actives chez les patients diabetiques.
Nyssen, Astrid; Legrand, Victor ULiege; Scheen, André ULiege

in Revue Médicale Suisse (2008), 4(168), 1806-10

In diabetic patients, the use of drug-eluting stents (paclitaxel-PES or sirolimus-SES) reduces the risk of restenosis as compared to bare-metal stents. However, the risk of (very) late thrombosis is ... [more ▼]

In diabetic patients, the use of drug-eluting stents (paclitaxel-PES or sirolimus-SES) reduces the risk of restenosis as compared to bare-metal stents. However, the risk of (very) late thrombosis is higher with drug-eluting stents than with bare-metal stents. All together, the incidence of major cardiovascular events is reduced with drug-eluting stents, mainly resulting from a diminution of revascularisation procedures rather than from a reduction in myocardial infarcts or cardiovascular deaths. Attempts to compare SES and PES gave discordant results in both randomised trials and registries. Efficacious antiplatelet therapy in the long run is mandatory in all diabetic patients treated with drug-eluting stents. [less ▲]

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See detailNouveautes dans la prise en charge des valvulopathies du coeur gauche
Davin, Laurent ULiege; Pierard, L.A.; Lancellotti, Patrizio ULiege

in Revue Médicale Suisse (2007), 3(122), 1870-5

In the last years, the management of left valvular disease has considerably evolved. The American guidelines of 1998 were recently reviewed. Since this year, we have European guidelines which are ... [more ▼]

In the last years, the management of left valvular disease has considerably evolved. The American guidelines of 1998 were recently reviewed. Since this year, we have European guidelines which are different in some points. The place of exercise testing in risk stratification of asymptomatic valvular disease is increasing and helps to make earlier decision regarding the need for surgery. [less ▲]

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See detailPrise en charge du cancer pulmonaire non a petites cellules
Bosquee, Léon ULiege; Frusch, Nicolas ULiege; Louis, Renaud ULiege

in Revue Médicale Suisse (2007), 3(122), 1890-5

Surgery, chemotherapy, radiotherapy and "biological" treatment are differently used in the treatment of non small cell lung cancer. Surgery is the cornerstone of the stages I-II treatment; chemotherapy is ... [more ▼]

Surgery, chemotherapy, radiotherapy and "biological" treatment are differently used in the treatment of non small cell lung cancer. Surgery is the cornerstone of the stages I-II treatment; chemotherapy is dominant in the treatment of metastatic stage, but is more and more used in earlier stages. A large discussion is still open for advanced non metastatic stages, even if the association of the 3 major modalities is extensively studied. We discuss our position in this setting. [less ▲]

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See detailUtilité du mycophénolate mofétil en pathologie rénale en dehors de la transplantation
Parotte, Marie-Christine ULiege; Bovy, Christophe ULiege; Krzesinski, Jean-Marie ULiege

in Revue Médicale Suisse (2007), 3

Glomerular diseases remain frequent causes of end-stage renal failure. Immunosuppressive drugs in association with corticosteroids induce remission of proteinuria and stabilize renal function, as well as ... [more ▼]

Glomerular diseases remain frequent causes of end-stage renal failure. Immunosuppressive drugs in association with corticosteroids induce remission of proteinuria and stabilize renal function, as well as prevent relapses, but are responsible for severe portential side-effects: infections, secondary malignancies, sterility and alopecia, and even nephrotoxicity. Mycophenolate mofetil (MMF), a well-known drug in transplantation, presents interesting characteristics potentially useful in the teatment of glomerulopathies. Moreover, its side-effect profile is safer. The present review of literature suggests that MMF is efficient for the treatment of glomerular disease, even if the results of the different studies remain limited and require further confirmation. [less ▲]

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See detailLes incretinomimetiques et incretinopotentiateurs dans le traitement du diabete de type 2.
Scheen, André ULiege; Radermecker, Régis ULiege; Philips, Jean-Christophe ULiege et al

in Revue Médicale Suisse (2007), 3(122), 18841886-8

Glucagon-like peptide-1 (GLP-1) is a gut hormone secreted in response to a meal ingestion, which is rapidly degraded by a specific enzyme, dipeptidylpeptidase-4 (DPP-4). It enhances insulin secretion in a ... [more ▼]

Glucagon-like peptide-1 (GLP-1) is a gut hormone secreted in response to a meal ingestion, which is rapidly degraded by a specific enzyme, dipeptidylpeptidase-4 (DPP-4). It enhances insulin secretion in a glucose-dependent manner, inhibits glucagon secretion, retards gastric emptying,... Two pharmacological approaches have been developed to increase the abnormally low GLP-1 levels in type 2 diabetic patients: either to subcutaneously inject an agent closed to GLP-1 (exenatide), which is partially resistant to the action of DPP-4, either to orally administer a selective DPP-4 inhibitor (sitagliptin,...). These new drugs offer improved blood glucose control of type 2 diabetic patients, without inducing hypoglycaemia and with favourable effects on body weight. [less ▲]

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See detailSpondylodiscite compliquée d'un abcès du psoas
Leclercq, P.; Loly, Catherine ULiege; Giot, Jean-Baptiste ULiege et al

in Revue Médicale Suisse (2007), 3(101), 620-621

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See detailA propos de la prevention et du traitement des maladies cardiovasculaires.
Scheen, André ULiege

in Revue Médicale Suisse (2007), 3(122), 1859-60

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See detailExiste-t-il une "memoire therapeutique" en prevention cardiovasculaire?
Scheen, André ULiege

in Revue Médicale Suisse (2007), 3(122), 1864-61868-9

The prevention of type 2 diabetes and of cardiovascular diseases is a major public health objective. Obviously life-style changes play a major role in this strategy. The Finnish Prevention Study recently ... [more ▼]

The prevention of type 2 diabetes and of cardiovascular diseases is a major public health objective. Obviously life-style changes play a major role in this strategy. The Finnish Prevention Study recently demonstrated that the remarkable diabetes prevention observed after a 4-year lifestyle intervention is maintained after a further 3-year period of follow-up without prolongation of the active intervention. Such a reminiscent effect may also be observed in the prevention of cardiovascular diseases with various pharmacological interventions: an ACE inhibitor (HOPE), a statin (4S), a fibrate (Helsinki Heart Study) or an intensive insulin therapy in type I diabetic patients (DCCT-EDIC). These intriguing results argue for a long-term memory of previous therapeutic interventions in cardiovascular prevention. [less ▲]

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See detailGlitazones et insuffisance cardiaque: resultats des etudes PROactive, ADOPT, DREAM et RECORD.
De Flines, Jenny ULiege; Scheen, André ULiege

in Revue Médicale Suisse (2007), 3(122), 18761878-83

Thiazolidinediones (TZDs) are used as insulin sensitizers in the treatment of type 2 diabetes, but are associated with an increased risk of congestive heart failure (CHF). The odds ratio of ICC was 1.43 ... [more ▼]

Thiazolidinediones (TZDs) are used as insulin sensitizers in the treatment of type 2 diabetes, but are associated with an increased risk of congestive heart failure (CHF). The odds ratio of ICC was 1.43 (pioglitazone vs placebo) in diabetic patients with high cardiovascular risk in the PROactive trial while it averaged 1.22 (rosiglitazone vs metformin) and 2.20 (rosiglitazone vs metformin) in the ADOPT study. In the interim analysis of the ongoing RECORD trial, the odds ratio averaged 2.15 (rosiglitazone vs metformin or sulfonylureas). In four real life registries, the relative risk of CHF with TZDs varied between 1.06 and 1.76 (between 1.10 and 1.44 combined with insulin) as compared to a treatment without TZDs. Such higher CHF risk should be appreciated according to the potential benefits of glitazones in the management of type 2 diabetes. [less ▲]

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See detailLa prescription médicamenteuse chez la personne âgée: que devons-nous savoir?
Wotquenne, Pol ULiege; Petermans, Jean ULiege; Scheen, André ULiege

in Revue Médicale Suisse (2006), 2(76), 1878-801882-3

Because of the increasing longevity of the population, a growing number of very old people are exposed to medications. Drug therapy in this population is difficult because of our lack of knowledge. The ... [more ▼]

Because of the increasing longevity of the population, a growing number of very old people are exposed to medications. Drug therapy in this population is difficult because of our lack of knowledge. The number of drugs administered is generally high and the prescription is often inappropriate. Changes in body composition, malnutrition and renal failure can cause drug accumulation and toxicity. However, hepatic metabolism via cytochrome P450 does not seem to be markedly influenced by oldness. Iatrogenic pathology is frequent in the elderly and may lead to hospitalisation and reduction in quality of life. Specific education of the medical care team should be promoted in order to tackle this important problem of public health. [less ▲]

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See detailDistinction entre patients bons synthetiseurs et bons absorbeurs pour optimiser le traitement hypo- cholesterolemiant.
Radermecker, Régis ULiege; Scheen, André ULiege

in Revue Médicale Suisse (2006), 2(76), 1910-5

The inhibition of cholesterol synthesis by a statin enhances intestinal absorption of both cholesterol and various phytosterols. The atherogenic role of phytosterols, well proven in hypersitosterolemia ... [more ▼]

The inhibition of cholesterol synthesis by a statin enhances intestinal absorption of both cholesterol and various phytosterols. The atherogenic role of phytosterols, well proven in hypersitosterolemia, is now suspected in patients with premature coronary artery disease. The cholestanol/cholesterol ratio can be used as a marker of intestinal cholesterol absorption. Individuals with elevated ratio ("high absorbers") have less favourable cholesterol-lowering response and cardiovascular protection with statin therapy as compared to individuals with low ratio ("high synthesizers"). They may benefit of an adjunct therapy with phytostanols or ezetimibe, both being capable to reduce plasma concentrations of cholesterol and of phytosterols. [less ▲]

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See detailControverses a propos des criteres de jugement dans les essais cliniques de prevention cardiovasculaire.
Scheen, André ULiege

in Revue Médicale Suisse (2006), 2(76), 1875-6

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See detailDiabete sucre et decompensation cardiaque: specificites ethiopathogeniques et therapeutiques.
De Flines, Jenny ULiege; Scheen, André ULiege

in Revue Médicale Suisse (2006), 2(76), 1893-61898-900

Diabetes mellitus increases by 2.5 to 5 the relative risk of congestive heart failure. Besides the classical risk factors of congestive heart failure such as obesity, arterial hypertension and coronary ... [more ▼]

Diabetes mellitus increases by 2.5 to 5 the relative risk of congestive heart failure. Besides the classical risk factors of congestive heart failure such as obesity, arterial hypertension and coronary artery disease that are frequently associated to type 2 diabetes, a diabetic cardiomyopathy plays also a role. This specific complication is related to metabolic factors and oxidative stress, leading to muscular cell apoptosis and fibrosis. The management of a diabetic patient with congestive heart failure has several specificities not only concerning the treatment of cardiac insufficiency but most importantly concerning antidiabetic therapy. The relationship between glitazones, peripheral oedema and risk of congestive heart failure is currently raising much interest and controversies. [less ▲]

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See detailPrevention cardiovasculaire par l'aspirine chez le patient diabetique: que nous apprend la medecine factuelle?
Legrand, Delphine ULiege; Scheen, André ULiege

in Revue Médicale Suisse (2006), 2(76), 1904-8

Diabetes mellitus markedly increases the risk of cardiovascular diseases, with an especially elevated relative risk among women. Aspirin prescription is mandatory in secondary prevention, even if the ... [more ▼]

Diabetes mellitus markedly increases the risk of cardiovascular diseases, with an especially elevated relative risk among women. Aspirin prescription is mandatory in secondary prevention, even if the protection by aspirin appears less efficacious in diabetic than in non-diabetic patients. In primary prevention, available data are paradoxically rather scarce, but also suggest a less effective prevention when diabetes is present. Aspirin remains the first antiplatelet agent in the diabetic population in all international guidelines of cardiovascular prevention although a higher daily dose may be proposed in this subgroup of patients (160-300 mg rather than 75-100 mg). [less ▲]

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See detailLe rimonabant ameliore le profit de risque cardio-metabolique chez le sujet obese ou en surpoids: synthese des etudes "RIO".
Scheen, André ULiege; Van Gaal, L. G.; Despres, J. P. et al

in Revue Médicale Suisse (2006), 2(76), 1916-23

RIO (Rimonabant In Obesity and related disorders) is a large phase 3 programme (>6600 patients) evaluating the efficacy and safety of rimonabant (5 or 20 mg/day), a CBI receptor antagonist of ... [more ▼]

RIO (Rimonabant In Obesity and related disorders) is a large phase 3 programme (>6600 patients) evaluating the efficacy and safety of rimonabant (5 or 20 mg/day), a CBI receptor antagonist of endocannabinoid system, in obese or overweight patients with or without comorbidities (RIO-Europe and RIO-North America), with untreated dyslipidaemia (RIO-Lipids) or with type 2 diabetes treated with metformin or sulfonylurea (RIO-Diabetes). Compared to placebo, rimonabant 20 mg/day consistently increases weight loss, reduces waist circumference, increases HDL cholesterol, lowers triglyceride levels, diminishes insulin resistance, and reduces the prevalence of metabolic syndrome. Almost half of the metabolic effects, including adiponectin increase, occur beyond weight loss, suggesting a direct peripheral effect of rimonabant. [less ▲]

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See detailObservance et persistance: impact sur l'efficience des traitements de l'osteoporose
Reginster, Jean-Yves ULiege; Rabenda, Véronique ULiege

in Revue Médicale Suisse (2005), 1(35), 2278-81

Low adherence to therapies has been repeatedly described as a major determinant of poor clinical outcomes in chronic disorders. Bisphosphonates, the most widely prescribed drugs in this field, have been ... [more ▼]

Low adherence to therapies has been repeatedly described as a major determinant of poor clinical outcomes in chronic disorders. Bisphosphonates, the most widely prescribed drugs in this field, have been linked to a 12-month persistence lower than 40%. The situation is improved when using the weekly formulation compared to the daily intake of the drug. Low compliance results in lesser increase in bone mineral density and decreased anti-fracture efficacy. New medications, currently developed for the management of osteoporosis, will be user-friendly, allowing to an improvement of compliance and persistence. [less ▲]

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