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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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See detailLe streptocoque du groupe B, premiere cause d'infections neonatales graves. Epidemiologie et strategies de prevention
Melin, Pierrette ULg; Schmitz, M.; De Mol, Patrick ULg et al

in Revue Médicale de Liège (1999), 54(5), 460-7

As soon as the early 70's, group B streptococci (GBS) became clearly predominant in neonatal infections. There was a dramatic increase in the incidence of GBS neonatal sepsis and meningitis throughout ... [more ▼]

As soon as the early 70's, group B streptococci (GBS) became clearly predominant in neonatal infections. There was a dramatic increase in the incidence of GBS neonatal sepsis and meningitis throughout developed countries and GBS emerged as the leading cause of severe neonatal infections. Most of these infections, associated with high mortality and morbidity, could be prevented by intrapartum chemoprophylaxis given to risk mothers. AAP, ACOG and the CDC issued guidelines for their prevention. Today, in Belgium, there are still no recommendations for the prevention of GBS early-onset infections. [less ▲]

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See detailLa prevention de la prematurite en Communaute francaise a l'approche de l'an 2000
Nondonfaz, N.; Thoumsin, H.; Van Cauwenberge, Jean-Rémy ULg et al

in Revue Médicale de Liège (1999), 54(5), 440-3

The actual results confirm the dominating influence of psychosocial factors on prematurity and low birth weight. The study performed in Liege indicates that these factors must be taken into account for ... [more ▼]

The actual results confirm the dominating influence of psychosocial factors on prematurity and low birth weight. The study performed in Liege indicates that these factors must be taken into account for better care of the future mother. The systematic use of a prenatal questionnaire on psychosocial factors draws attention towards the personal situation of the future mother. Detection of some organic or psychosocial risk factors must prompt prophylactic measures even in the absence of any sign of pathologies. Prevention of prematurity has, over the last 30 years, been the primary objective of prenatal follow-up. Its importance must be further emphasized. [less ▲]

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See detailLa PMA qui reussit Bilan d'activite du Centre de Procreation Medicalement assistee de l'ULg, 1985-1997
Dubois, Michel ULg; Jouan, Caroline ULg; Thonon, Fabienne ULg et al

in Revue Médicale de Liège (1999), 54(5), 387-92

Assisted reproductive treatments (ART) hold an increasing place in the field of female infertility but also of male infertility with the development of new micromanipulative technologies. From January ... [more ▼]

Assisted reproductive treatments (ART) hold an increasing place in the field of female infertility but also of male infertility with the development of new micromanipulative technologies. From January 1985 to December 1997, more than 3,000 ovarian punctures were achieved at the CPMA of the University of Liege and more than 40,000 oocytes were recovered. Global results show a take home baby rate of 23% per ovum pick-up and 27% per embryo transfer. Embryo cryopreservation offers an efficient solution to the problem of supernumerary embryos and opens the way for IVF-derived procedures such as oocyte or embryo donation, surrogate mother. The transfer of frozen-thawed embryos increases the total ongoing pregnancy rate per cycle of 31%. One of the aims of our Centre in the near future is the development of new technologies such as control of chromosomal abnormalities or genetic defect in preimplantation embryos and clinical applications of oocyte or ovarian tissue freezing. [less ▲]

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See detailHypertension et grossesse
Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (1999), 54(5), 415-423

High blood pressure during pregnancy (BP > or = 140/90 mmHg) is sometimes already noted before conception, with usually a good prognosis (although it could predispose to preeclampsia). alpha-methyldopa is ... [more ▼]

High blood pressure during pregnancy (BP > or = 140/90 mmHg) is sometimes already noted before conception, with usually a good prognosis (although it could predispose to preeclampsia). alpha-methyldopa is the best treatment when needed (agents blocking the renin angiotensin system are not recommended). Preeclampsia, a form of hypertension noted after 20 weeks of gestation with proteinuria is a more serious condition (BP > or = 140/90 mmHg or increase in BP from the 1st trimester > or = 25/15 mmHg). It is generated by placental ischemia and creates maternal endothelial lesions which in turn decrease the blood flow to placenta leading to maternal and fetal syndromes. Hospitalisation is mandatory. No measure other than delivery is known to attenuate or reverse its progression. Treating hypertension during pregnancy (when blood pressure > or = 170/110 mmHg) aims at preventing maternal risk (stroke or eclampsia) but has few effect on foetal lesions. Prevention of this syndrome, which represents the first secondary cause of hypertension, is until now disappointing. [less ▲]

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See detailApproche algorithmique de la puberte precoce et tardive chez la fille
Bourguignon, Jean-Pierre ULg; LEBRETHON, Marie-Christine ULg

in Revue Médicale de Liège (1999), 54(5), 362-6

An algorithmic approach is proposed for the initial management of disorders of female puberty: premature pubarche and precocious or delayed breast development.

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See detailHyperandrogénie: sémiologie, exploration et traitement
Beckers, Albert ULg; Parotte, M. C.; Gaspard, Ulysse ULg et al

in Revue Médicale de Liège (1999), 54(4), 274-282

Androgen excess (AE) is one of the most common endocrine disorders, affecting 10% of adult women before the menopause. The clinical picture varies widely depending on the etiology of AE. Most of these ... [more ▼]

Androgen excess (AE) is one of the most common endocrine disorders, affecting 10% of adult women before the menopause. The clinical picture varies widely depending on the etiology of AE. Most of these women are suffering from hirsutism, acne, menstrual disturbances, anovulation and obesity. Virilization is unusual, except in patients with ovary or adrenal cancer. Polycystic ovary syndrome (PCOS) and idiopathic hirsutism (IH) are the most frequent causes of androgen excess, accounting for more than 90% of the cases. The pathogenesis of PCOS is still an unresolved problem. A hereditary predisposition has been suggested. Enzymatic deficiency is a less frequent cause of AE, the most common deficiency being the non classic 21-OH deficiency (NCAH). AE has been implicated as a side effect of many drugs. Ovary and adrenal tumours are unusual, however, they must be considered especially in case of severe hirsutism or virilization. Complementary investigations are selected based on the result of clinical examination. Pharmacologic therapy, usually with anti-androgens, is the most widely used treatment for PCOS, IH and NCAH. Surgical therapy should be considered only when there is a particular indication such as Cushing's syndrome, ovary or adrenal tumours. [less ▲]

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See detailLe syndrome de tension prémenstruelle ou dysphorie prémenstruelle
Legros, S.; Foidart, Jean-Michel ULg; Gaspard, Ulysse ULg et al

in Revue Médicale de Liège (1999), 54(4), 268-73

Premenstrual Tension Syndrome (PMS) has always existed: it has been first described by an endocrinologist from New York in 1931. It is responsible for significant and psychological disorders which justify ... [more ▼]

Premenstrual Tension Syndrome (PMS) has always existed: it has been first described by an endocrinologist from New York in 1931. It is responsible for significant and psychological disorders which justify the study of its pathogenesis. Hormonal dysfunction has been demonstrated among women who are at risk for PMS; nevertheless, it has been shown that neurological transducers are also affected, such as GABAergic, serotoninergic and endorphinic systems. Interactions between the two systems allow to raise the hypothesis of an inbalance between GABAergic and progesterone derived neurosteroids in a psychoneuroendocrinological model. Based on this hypothesis, psychological symptoms can be efficiently treated by anxiolytic or antidepressant treatment. On the other hand, progesterone derivatives and, sometimes, diuretics, are useful on physical symptoms. As far as we know there is so far no single treatment of demonstrated efficacy in the PMS. [less ▲]

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See detailFaut-il instaurer un traitement en prévention primaire chez la femme hypercholestérolémique?
Paquot, Nicolas ULg

in Revue Médicale de Liège (1999), 54(4), 240-3

Limited data are available in women from randomized trials of lipid-lowering therapy for primary prevention of coronary heart disease (CHD). In women with isolate hypercholesterolemia but no clinical ... [more ▼]

Limited data are available in women from randomized trials of lipid-lowering therapy for primary prevention of coronary heart disease (CHD). In women with isolate hypercholesterolemia but no clinical symptoms of CHD and no other risk factors, there is no evidence that lipid-lowering therapy is of benefit. In postmenopausal women with hypercholesterolemia and other risk factors (particularly diabetes and family history of CHD), lipid-lowering therapy may be of benefit. In those women, hormone replacement therapy may be proposed in the treatment of postmenopausal hypercholesterolemia. [less ▲]

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See detailL'ostéoporose d'involution chez la femme
Reginster, Jean-Yves ULg; Devogelaer, J. P.; Kaufman, J. M. et al

in Revue Médicale de Liège (1999), 54(4), 335-40

Postmenopausal osteoporosis is now considered a major public health problem in aging women, due to the burden related to the consequent fractures. Over recent years, several pharmacological approaches ... [more ▼]

Postmenopausal osteoporosis is now considered a major public health problem in aging women, due to the burden related to the consequent fractures. Over recent years, several pharmacological approaches were developed for the prevention and treatment of osteoporosis. Besides regular physical exercise and calcium rich diet, calcium supplementation can be suggested to both genders, after seventy years as well as systematic vitamin D supplementation in order to cope with the frequent lack observed in our country. Hormone replacement therapy is the first choice in prevention of postmenopausal osteoporosis. Based on a careful evaluation of the needs of a postmenopausal woman as well as on the risk/benefit ratio derived from her individual risk factors, selective estrogen receptor modulators (raloxifene) or second generation bisphosphonates (alendronate) can be considered as alternative to estrogens. Due to its prohibitive cost, nasal calcitonin should be only considered for very specific cases. In osteoporosis confirmed by bone densitometry or by occurrence of fractures, bisphosphonate (alendronate) reduces subsequent fracture rate. Fluoride salts can, in some cases, improve spinal symptomatic osteoporosis. The use of etidronate, a molecule from the past, should be avoided as much as possible and, at any rate, strictly restricted to its legal indication including women with several vertebral crush fractures and severely decreased bone mineral density. [less ▲]

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See detailLe condylome
Kridelka, Frédéric ULg

in Revue Médicale de Liège (1999), 54(4), 283-8

HPV related pathologies are the commonest reasons for consulting a gynaecologist. Genital warts are associated with infection by HPV type 6 or 11. Etiopathogenetic factors and treatment modalities are ... [more ▼]

HPV related pathologies are the commonest reasons for consulting a gynaecologist. Genital warts are associated with infection by HPV type 6 or 11. Etiopathogenetic factors and treatment modalities are reviewed. [less ▲]

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See detailLa femme et les maladies cardio-vasculaires, en particulier, les coronaropathies
Kulbertus, Henri ULg; Legrand, Victor ULg

in Revue Médicale de Liège (1999), 54(4), 244-50

Cardiovascular diseases represent the major cause of death in women. If women are early in life relatively protected by their hormones, after the menopause heart disease and stroke become their greatest ... [more ▼]

Cardiovascular diseases represent the major cause of death in women. If women are early in life relatively protected by their hormones, after the menopause heart disease and stroke become their greatest health threat. Altogether one in three women will die of cardiovascular disease whereas only one in twenty-two will die of breast cancer. The risk factors for cardiovascular diseases are similar in both sexes. It should be noted however that the impact of diabetes on the development of coronary artery disease is markedly higher in woman than in man. In woman the first presenting symptom of coronary artery disease frequently is angina pectoris. In man it is more often an acute myocardial infarction whether it be symptomatic or silent. The various non invasive techniques used for the diagnosis of coronary artery disease may yield results that pose very difficult problems of differential diagnosis in women. Several studies indicate that in the past, probably because of the ignorance by the public and, perhaps, the medical profession of the high prevalence of cardiovascular and coronary artery diseases in women, the latter have not always received an optimal treatment when they suffered an acute ischemic attack. But, in this decade, they have been dramatic changes in the patents of clinical practice related to coronary heart disease in women. Statistical investigations however indicate that thrombolytic therapy appears less efficacious in women than in men whereas beta-blockers administered early in acute MI are of remarkable efficacy in women. It seems generally agreed that the results of revascularization by coronary artery bypass surgery are poorer in women than in men both in terms of operative mortality and morbidity. Initially, the same pessimism was reported for PTCA. However, recent results allow a much more optimistic view. [less ▲]

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See detailLe point sur les polyamines
Dandrifosse, Guy ULg; Deloyer, P.; Grandfils, Christian ULg et al

in Revue Médicale de Liège (1999), 54(3), 175-83

Polyamines are ubiquitous substances. Their intracellular concentration is controlled quickly and rigorously by extremely sophisticated systems. It depends on metabolism and cellular permeability ... [more ▼]

Polyamines are ubiquitous substances. Their intracellular concentration is controlled quickly and rigorously by extremely sophisticated systems. It depends on metabolism and cellular permeability. Polyamines act as structural and functional elements in the cell (nucleic acid conformation, cytoskeleton, radioprotection, apoptosis, proliferation and differentiation of cells...). They also play a role in various diseases (origin of food allergy, cancers...). They present a great therapeutic interest (oncology, molecular transfer to cell nucleus, transfer across the blood-brain barrier, parasitosis, effects on NMDA and GABA receptors in the central nervous system...). [less ▲]

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See detailA propos d'un cas de rhabdomyolyse aigue
Rorive, Andrée ULg; Fraipont, V.; Quatresooz, Pascale ULg et al

in Revue Médicale de Liège (1999), 54(3), 143-8

A 83 years old patient was admitted with a complex clinical picture including cutaneous rash, muscular pain, rhabdomyolysis and renal failure. The clinical picture suggests a dermatopolymyositis. Despite ... [more ▼]

A 83 years old patient was admitted with a complex clinical picture including cutaneous rash, muscular pain, rhabdomyolysis and renal failure. The clinical picture suggests a dermatopolymyositis. Despite of high dose corticotherapy, the patient died on day 22. The anatomical examination shows a cholangiocarcinoma disseminated locally as well as in the lungs and bones. [less ▲]

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