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See detailPharma-clinics comment je traite ... une infection par le VIH. III. Les inhibiteurs non nucléosidiques de la transcriptase inverse
Nkoghe, D.; Moutschen, Michel ULg; Leonard, Philippe ULg et al

in Revue Médicale de Liège (1999), 54(12), 909-11

Non nucleoside reverse transcriptase inhibitors (NNRTI) are a new arm in the treatment of the HIV infection. They inhibit the replication by direct non competitive binding to the enzyme, and do not ... [more ▼]

Non nucleoside reverse transcriptase inhibitors (NNRTI) are a new arm in the treatment of the HIV infection. They inhibit the replication by direct non competitive binding to the enzyme, and do not require phosphorylation. The fast emergence of resistance in monotherapy obliges to use them in a triple association. The 103 mutation confers a cross-resistance. The most common adverse event is rash. Association with nucleoside analogues is additive or even synergistic. They are metabolized by the cytochrome P450. Within a combined therapy, their efficiency is comparable to protease inhibitors, notably in patients with low viral load. [less ▲]

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See detailPharma-clinics le médicament du mois. La nevirapine. Viramune
Nkoghe, D.; Leonard, Philippe ULg; Moutschen, Michel ULg et al

in Revue Médicale de Liège (1999), 54(12), 948-51

Nevirapine is the first non nucleoside reverse transcriptase inhibitor registered in Belgium and indicated in the treatment of HIV-1 infection. In association with 2 nucleoside analogues, its efficiency ... [more ▼]

Nevirapine is the first non nucleoside reverse transcriptase inhibitor registered in Belgium and indicated in the treatment of HIV-1 infection. In association with 2 nucleoside analogues, its efficiency is similar to a tritherapy with protease inhibitor, particularly in naive patients with low viral load. It has a good tolerance profile and is easy to take. Studies in progress should permit to widen its indications. [less ▲]

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See detailL'image du mois. Fermeture percutanée de la communication interauriculaire
Massin, M.; Legrand, Victor ULg; Materne, Pierre ULg et al

in Revue Médicale de Liège (1999), 54(12), 907-8

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See detailIntérêt de la tomographie a émission de positons dans l'évaluation des tumeurs digestives
Hustinx, Roland ULg; Paulus, Patrick; Daenen, Frédéric ULg et al

in Revue Médicale de Liège (1999), 54(12), 925-30

Imaging and endoscopic techniques have taken an increasing part in the management of gastroenterological disorders. Among these techniques, FDG-PET imaging has emerged as a powerful tool in the management ... [more ▼]

Imaging and endoscopic techniques have taken an increasing part in the management of gastroenterological disorders. Among these techniques, FDG-PET imaging has emerged as a powerful tool in the management of several cancer diseases, including tumors of the digestive tract. In particular, the role of PET for diagnosing and staging recurrent colorectal cancers, and for differentiating mass forming pancreatitis from carcinoma is now well established. In this review, we will briefly discuss the place of PET imaging in the work-up of the tumors of the digestive tract. [less ▲]

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See detailLe cas clinique du mois. Le cerebral salt wasting syndrome: a propos d'un cas
Llabres, V.; Canivet, Jean-Luc ULg; Hennuy, V. et al

in Revue Médicale de Liège (1999), 54(11), 850-853

A 75 year old woman was found to have a posterior cerebellar lesion which after surgical removal was shown to be a meningioma. Her postoperative course was complicated by a MRSA meningitis and on day 23 ... [more ▼]

A 75 year old woman was found to have a posterior cerebellar lesion which after surgical removal was shown to be a meningioma. Her postoperative course was complicated by a MRSA meningitis and on day 23 after resection, a polyuria up to 11.7 1/24 h became apparent. The diagnosis of cerebral wasting syndrome (CSWS) was made based on biological and clinical features such as an excessive natriuresis (143 mmol/l) resulting in hyponatremia (130 mmol/l) and an osmolarity higher in urine than in blood. A low central venous pressure and a low wedge pressure confirming a volumic depletion indicated the diagnosis of CSWS. This syndrome has marked similarities with the Inappropriate Secretion of Antidiuretic Hormone Syndrome (SIADH) in terms of biological finding with regards to clinical context and presentation. Without an adequate assessment, a patient with CSWS may be misdiagnosed as SIADH. However recognition is important, as water restriction which is part of SIADH treatment, is detrimental to patients with CSWS and can possibly be lethal. [less ▲]

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See detailConfrontation anatomo-clinique. A propos d'un cas de carcinome renal a cellules claires
Daloze, A.; Delbecque, Katty ULg; Delvenne, Philippe ULg et al

in Revue Médicale de Liège (1999), 54(11), 859-63

The authors report the case of a patient with a history of hypertension and multiple intracerebral hemorrhages who was found at post mortem examination to have a renal cell carcinoma. The relationship ... [more ▼]

The authors report the case of a patient with a history of hypertension and multiple intracerebral hemorrhages who was found at post mortem examination to have a renal cell carcinoma. The relationship between renal carcinoma and hypertensive intracerebral hemorrhages is discussed. [less ▲]

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See detailChirurgie, radiotherapie ou hormonotherapie dans le traitement du cancer de la prostate
Bonnet, Pierre ULg; Coppens, Luc ULg; Andrianne, Robert ULg et al

in Revue Médicale de Liège (1999), 54(11), 875-85

Prostatic cancer (PC) became the first diagnosed cancer in western men and is the second leading cause of cancer death in men. Wide utilisation of serum PSA and free PSA measurements, identifies patients ... [more ▼]

Prostatic cancer (PC) became the first diagnosed cancer in western men and is the second leading cause of cancer death in men. Wide utilisation of serum PSA and free PSA measurements, identifies patients requiring transrectalultrasonography (TRUS) and TRUS guided biopsies. Most prostatic cancers diagnosed today are locally limited and may be treated by radical surgery or radiotherapy. In case of disseminated disease, hormonal manipulations remain the treatment of choice. In that field, many new drugs have been designed to allow medical castration with less complications, especially regarding sexual potency. [less ▲]

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See detailReflux gastro-oesophagien et asthme
Lamproye, Anne ULg; Louis, Edouard ULg; Louis, Renaud ULg et al

in Revue Médicale de Liège (1999), 54(10), 805-8

Gastro-oesophageal reflux (GER) is more frequent in asthmatic patients than in the community at large. A causative association between the two diseases is suspected. Twenty-four hour ambulatory ... [more ▼]

Gastro-oesophageal reflux (GER) is more frequent in asthmatic patients than in the community at large. A causative association between the two diseases is suspected. Twenty-four hour ambulatory intraoesophageal pH monitoring represents the golden standard for the diagnosis of GER. The medical and/or surgical treatment of reflux in asthmatic patients with GER can improve pulmonary symptoms and to a lesser extent pulmonary function. The selection of the patients who will benefit from a GER treatment is difficult. Some symptoms like intrinsic asthma, nocturnal crises, could predict a good response to GER treatment. [less ▲]

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See detailPharma clinics. Le médicament du mois. La lercanidipine (Zanidip)
Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (1999), 54(10), 832-834

Lercanidipine (Zanidip) is a new calcium antagonist belonging to the dihydropyridine family suitable for the first-line treatment of hypertension. This molecule displays a high specificity and selectivity ... [more ▼]

Lercanidipine (Zanidip) is a new calcium antagonist belonging to the dihydropyridine family suitable for the first-line treatment of hypertension. This molecule displays a high specificity and selectivity for vascular smooth muscle cells and has, in spite of a short plasma half-life, a long duration of action due to its liposolubility. The usual and once a day dose to treat high blood pressure of any grade is 10 mg, which if needed could be increased to 20 mg once a day. It has a gradual onset of effect on blood pressure, thus leading to a good tolerability and hopefully a better compliance in the treatment of hypertension. No adaptation of the dose is needed in older patients or in patients with moderate renal or liver impairment. [less ▲]

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See detailUne étiologie immunologique à l'hyperprolactinemie: la macroprolactinémie
Lebrun, Yves ULg; Luyckx, Françoise ULg; Brue, T. et al

in Revue Médicale de Liège (1999), 54(9), 759-63

Besides classical etiologies of hyperprolactinaemia (pregnancy, pharmacological treatments, pituitary or hypothalamic perturbations), another less known cause may explain a spectacular idiopathic ... [more ▼]

Besides classical etiologies of hyperprolactinaemia (pregnancy, pharmacological treatments, pituitary or hypothalamic perturbations), another less known cause may explain a spectacular idiopathic elevation of plasma concentrations of prolactin hormone. Macroprolactinaemia is characterized by the presence of a circulating high molecular weight complex of prolactin with an immunoglobulin G. In this article, we report the cases of 3 female patients for whom size exclusion chromatography technique permitted to give a precise biological diagnosis and to avoid heavy, expensive, time consuming and unnecessary clinical investigations or therapeutic actions. Patients with macroprolactinaemia do not exhibit clinical features of classical hyperprolactinaemia, notably as regard to menstrual and fertility disturbances. [less ▲]

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See detailLe retour du bacille de Koch (?) et les mycobactéries "atypiques"
Bartsch, Pierre ULg

in Revue Médicale de Liège (1999), 54(8), 691-7

This brief review describes the current status of the tuberculosis endemics in Belgium as well as the position of this country in the management of the disease: there is no come back of Mycobacterium ... [more ▼]

This brief review describes the current status of the tuberculosis endemics in Belgium as well as the position of this country in the management of the disease: there is no come back of Mycobacterium tuberculosis but a stagnation which further postpones the time of eradication. Some very general considerations about multiresistance are then presented, owing to the raising possibility of being confronted to this problem in the next future, together with more and more numerous cases of so called atypical mycobacteriosis. Simple and general guidelines from the recent literature about tuberculosis, multiresistance and non tuberculous bacteria are briefly recalled. [less ▲]

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See detailPharma-clinics. Comment je traite ... les verrues péri-ungueales
Lambert, Jean-Luc ULg; Richert, Bertrand ULg; de LA BRASSINNE, Michel ULg

in Revue Médicale de Liège (1999), 54(8), 646-52

Warts are common benign lesions for which no specific antiviral treatment is available. In some cases, patients and doctors can be put off by poor results. Before selecting any treatment for peri- and ... [more ▼]

Warts are common benign lesions for which no specific antiviral treatment is available. In some cases, patients and doctors can be put off by poor results. Before selecting any treatment for peri- and subungual warts, it is of utmost importance to bear in mind the risk of damaging the nail matrix. This paper reviews the advantages and inconveniences of the current available treatments in this location. [less ▲]

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See detailEvaluation pronostique des tumeurs solides humaines par immunohistologie
Delvenne, Philippe ULg; Delvenne, Catherine ULg; Fridman, Viviana ULg et al

in Revue Médicale de Liège (1999), 54(8), 677-82

The aim of this project is to evaluate the interest of new tumor markers in the most frequent solid tumors (breast, colon, prostatic cancers, ...). For each of these tumors, potential prognostic markers ... [more ▼]

The aim of this project is to evaluate the interest of new tumor markers in the most frequent solid tumors (breast, colon, prostatic cancers, ...). For each of these tumors, potential prognostic markers have been selected according to the literature and an immunohistologic technique has been developed to analyse them. We will first discuss the role of pathology in oncology, then briefly describe the analyzed markers and finally give information about a Web site (URL: http:/(/)www.ebm. lib.ulg.ac.be/index.htm) created to help clinicians exploit the laboratory results. [less ▲]

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See detailControverses thérapeutiques: le traitement de la maladie de Basedow
Khalife, A.; Valdes Socin, Hernan Gonzalo ULg; Beckers, Albert ULg

in Revue Médicale de Liège (1999), 54(7), 606-610

Hyperthyroidism is a common clinical condition with an annual incidence of about 1%. Approximately, 1 in every 20 women will develop this condition during a lifetime. Most cases are due to Graves'disease ... [more ▼]

Hyperthyroidism is a common clinical condition with an annual incidence of about 1%. Approximately, 1 in every 20 women will develop this condition during a lifetime. Most cases are due to Graves'disease. Solitary toxic nodules and toxic multinodular goiters are also important but less frequent causes. In this article, we will consider only the treatment of Graves'disease. Anti-thyroid drugs, surgery and radio-iodine, all represent effective forms of treatment. There is, however, little consensus regarding the treatment of choice for specific cases. This article discusses the advantages and disadvantages of each treatment. [less ▲]

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See detailImages du mois. Quel est votre diagnostic? Une balanite aigue
Nikkels, Arjen ULg

in Revue Médicale de Liège (1999), 54(7), 634-635

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See detailChirurgie versus angioplastie des artères coronaires
Legrand, Victor ULg; Martinez, Christophe ULg

in Revue Médicale de Liège (1999), 54(7), 593-9

Revascularization techniques such as coronary angioplasty or coronary artery bypass surgery play a growing role in the management of coronary artery disease. Angioplasty is the treatment of choice for ... [more ▼]

Revascularization techniques such as coronary angioplasty or coronary artery bypass surgery play a growing role in the management of coronary artery disease. Angioplasty is the treatment of choice for single coronary lesions while surgery remains the best approach for the revascularization of multivessel disease. There are some exceptions to this rule, however. Bypass surgery may be recommended for the revascularisation of proximal left anterior descending lesions and, of course, for isolated left main stenosis. On the opposite, coronary angioplasty and stenting is used more frequently in the treatment of multivessel lesions amenable to this technique. Choice of either method of revascularization is pragmatic, based on clinical, anatomical and physiological considerations and organized in the setting of a medicosurgical collaboration. [less ▲]

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See detailHomocysteine et risque cardio-vasculaire
Lutteri, Laurence ULg; Chapelle, Jean-Paul ULg; Gielen, Jean-Louis ULg

in Revue Médicale de Liège (1999), 54(6), 541-7

Homocystinuria is an uncommon genetic disease characterized by a marked increase of serum homocysteine (HCY), an intermediate of methionine metabolism. In patients with homocystinuria ... [more ▼]

Homocystinuria is an uncommon genetic disease characterized by a marked increase of serum homocysteine (HCY), an intermediate of methionine metabolism. In patients with homocystinuria, hyperhomocysteinemia promotes the development of atherosclerotic lesions and is responsible for premature coronary artery disease. Recently, several studies have also demonstrated that moderate hyperhomocysteinemia--not necessarily linked to an inborn metabolic defect--may also be considered as an independant risk factor for cardiovascular disease. The main mechanisms of HCY atherogenic action are thought to be LDL oxydation, inhibition of vascular endothelium growth combined with stimulation of smooth muscular cells proliferation, and interference with the coagulation and fibrinolytic systems. Cofactors of key enzymes in HCY metabolism, folic acid, vitamin B12 and vitamin B6, may be given, alone or in combination, for the treatment of hyperhomocysteinemia. Homocysteinemia can be assessed by basal plasma HCY concentration and/or by HCY levels measured after a methionine loading test. Mainly measured till now in specialized laboratories using rather complex techniques (HPLC, GCMS, amino acid analyser ...), HCY determination is today spreading widely owing to the development of automated immunoassays. [less ▲]

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See detailPrévention de la fibrillation auriculaire récidivante et resynchronisation bi-atriale
Evrard, P.; Sakalihasan, Natzi ULg; Garcia, R. et al

in Revue Médicale de Liège (1999), 54(6), 522-6

After conversion of atrial fibrillation, it is important to maintain sinus rhythm. In addition antiarrhythmic drugs, biatrial resynchronization seems to prevent recurrences of atrial fibrillation in ... [more ▼]

After conversion of atrial fibrillation, it is important to maintain sinus rhythm. In addition antiarrhythmic drugs, biatrial resynchronization seems to prevent recurrences of atrial fibrillation in patients with interatrial conduction block: local experience. [less ▲]

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See detailAnesthesie, analgesie et femme enceinte: une association a haut risque!
Brichant, Jean-François ULg; Incagnoli, P.

in Revue Médicale de Liège (1999), 54(5), 448-59

The authors review the changes in obstetric anesthesia and analgesia that have contributed to a decreased maternal mortality as well as those accounting for the clinically significant improvements of ... [more ▼]

The authors review the changes in obstetric anesthesia and analgesia that have contributed to a decreased maternal mortality as well as those accounting for the clinically significant improvements of maternal and neonatal morbidity. [less ▲]

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See detailHELLP syndrome
Emonts, Patrick ULg; Thoumsin, H.; Foidart, Jean-Michel ULg

in Revue Médicale de Liège (1999), 54(5), 444-7

The HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelet count) is a clinical expression of a multilayered disease whose central pathophysiology is abnormal placentation. Clinical research aims ... [more ▼]

The HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelet count) is a clinical expression of a multilayered disease whose central pathophysiology is abnormal placentation. Clinical research aims logically to search for new predictive and specific markers for the early identification of pregnant women at risk of developing a HELLP syndrome, the most common cause of feto-maternal mortality and morbidity. [less ▲]

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