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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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See detailBenefices multiples de la corticotherapie antenatale. Etat de la question en communaute Francaise de Belgique
Franckart, G.; Kurz, X.; Foidart, Jean-Michel ULg et al

in Revue Médicale de Liège (1999), 54(3), 157-65

The benefit of antenatal administration of corticosteroids (betamethasone or dexamethasone) in the newborn prematured babies before the 34 week of gestation has been well demonstrated: reduction of ... [more ▼]

The benefit of antenatal administration of corticosteroids (betamethasone or dexamethasone) in the newborn prematured babies before the 34 week of gestation has been well demonstrated: reduction of respiratory distress syndrome but also a decrease in the incidence of severe intraventricular hemorrhages, episodes of necrotising enterocolitis and neonatal mortality. In this article, we report the impact of this treatment in the Belgian French Community in the population of infants with a birth weight below 1,500 g, born between 1990 and 1994 in the seven neonatal intensive care units. Based on this epidemiological study (compared with international publications) we propose the routine use of corticosteroids during the antenatal period, with the aim of seeing an increase in the use of this treatment, which, although costing little, produces clinical benefit. [less ▲]

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See detailComment j'explore ... l'ostéoporose: mesure de la masse osseuse et analyses biologiques
Reginster, Jean-Yves ULg; Devogelaer, J. P.; Kaufman, J. M. et al

in Revue Médicale de Liège (1999), 54(3), 184-8

The use of bone densitometry, by dual energy x-ray absorptiometry, allows the identification, at an early stage, of subjects who will, 15-20 years later, present a fracture event. Furthermore, this ... [more ▼]

The use of bone densitometry, by dual energy x-ray absorptiometry, allows the identification, at an early stage, of subjects who will, 15-20 years later, present a fracture event. Furthermore, this technique is the most appropriate to confirm the efficacy of preventive or curative therapeutic approaches of osteoporosis. A balanced utilisation of biochemical tests is mandatory to exclude a secondary cause of osteoporosis, to help in the choice of the most appropriate therapeutic strategy and to evaluate the early response of patients to the administered drugs. [less ▲]

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See detailL'image du mois. Aspect echographique de la myocardiopathie hypertrophique apicale
Appeltants, H.; Hoffer, E.; Pierard, Luc ULg

in Revue Médicale de Liège (1999), 54(3), 137

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See detailLe cas clinique du mois. Prolapsus sur dégénérescence fibro-élastique. Les "cheveux blancs" de la valvule mitrale
Radermecker, M. A.; Hoffer, E.; Pierard, Luc ULg et al

in Revue Médicale de Liège (1999), 54(2), 76-8

We report the case of a 73-year-old woman who presents an acute mitral regurgitation secondary to fibro-elastic degenerescence. A mitral valvuloplasty is rapidly performed with complete disappearance of ... [more ▼]

We report the case of a 73-year-old woman who presents an acute mitral regurgitation secondary to fibro-elastic degenerescence. A mitral valvuloplasty is rapidly performed with complete disappearance of valvular insufficiency and the patient leaves the hospital ten days later. Degenerative mitral regurgitation is commonly seen in elderly patients. This constitutes an excellent indication for mitral valvuloplasty, rather than valve replacement. In our experience, mitral valvuloplasty leads to a complete correction of valvular regurgitation without neither stenosis, nor subvalvular obstruction. Left ventricular function is preserved, as subvalvular apparatus is conserved. This approach allows, in the absence of specific indication, anticoagulation withdrawn two to three months later. [less ▲]

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See detailPharma-clinics. Comment je traite ... le zona
Nikkels, Arjen ULg; Pierard, Gérald ULg

in Revue Médicale de Liège (1999), 54(2), 71-75

The treatment of herpes zoster relies on the intravenous or oral administration of antiviral drugs. Oral aciclovir for shingles is hindered by its low bioavailability. New antiviral drugs with improved ... [more ▼]

The treatment of herpes zoster relies on the intravenous or oral administration of antiviral drugs. Oral aciclovir for shingles is hindered by its low bioavailability. New antiviral drugs with improved oral bioavailability (famciclovir and valaciclovir) allow a better efficacy. The opportuneness of treating herpes zoster is different in the immunocompetent and immunocompromised patients, and during childhood and pregnancy. [less ▲]

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See detailLes tumeurs malignes d'origine indéterminée
Rezaei Kalantari, Hassan ULg; Jerusalem, Guy ULg; Bours, Vincent ULg et al

in Revue Médicale de Liège (1999), 54(1), 39-42

Cancers of unknown origin form a specific clinical entity. The diagnostic procedure has to be guided by the therapeutical possibilities and requires a biopsy. Immunohistology, electron microscopy and ... [more ▼]

Cancers of unknown origin form a specific clinical entity. The diagnostic procedure has to be guided by the therapeutical possibilities and requires a biopsy. Immunohistology, electron microscopy and cytogenetics are informative for carcinomas and poorly differentiated adenocarcinomas. The clinical status and the histology allow the definition of groups of patients who can benefit from a specific therapy and have a better prognosis. For the other patients, the prognosis is severe and there is no efficient therapy available. Such tumors are usually characterized by a very aggressive behaviour. [less ▲]

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See detailAtheroemboles et chirurgie cardiaque: importance de la mise au point préopératoire
Kolh, Philippe ULg; Torchiana, D.; Buckley, M.

in Revue Médicale de Liège (1999), 54(1), 43-8

OBJECTIVE: Atheroembolization is a recognized complication of cardiac surgical procedures, and has been implicated in postoperative stroke, renal failure, multiorgan failure, and death. Preoperative ... [more ▼]

OBJECTIVE: Atheroembolization is a recognized complication of cardiac surgical procedures, and has been implicated in postoperative stroke, renal failure, multiorgan failure, and death. Preoperative identification of patients at risk for developing atheroemboli is essential. The aim of this study was to determine preoperative risk factors for atheroemboli and to assess the postoperative course of the patients who developed atheroembolic syndrome. METHODS: A retrospective record review was conducted. From 1/1990 to 12/1994, 5.486 patients underwent coronary artery bypass grafting (CABG), valve operations, or other cardiac surgical procedures at the Massachusetts General Hospital. Among this population, 107 patients (1.9%) developed atheroembolic syndrome. There were compared to a concurrent population of 925 patients operated during the same period. RESULTS: Patients who developed atheroemboli were older, with an increased incidence (p < 0.01) of hypertension, cerebrovascular disease, and aortoiliac disease. Many had a complicated course after catheterization, with renal insufficiency (35%) and evidence of peripheral emboli (12%). Average Intensive Care Unit stay, hospital stay, and hospital cost of these patients were 16.8 days, 48.4 days and 88,000 respectively, compared to 1.5 days, 9.6 days and 23,000 for the concurrent population. Of these 107 patients only two were discharged home, the others either died (48 patients, or 25% of all cardiac surgical deaths during this period), or rehabilitation or chronic hospital facilities. Twenty-seven autopsies were performed and invariably showed a diffusely diseased aorta, with calcification, mural thrombus, and ulceration. CONCLUSIONS: Atheroembolization during cardiac surgical procedures has profound medical and economic consequences. Because of the diffuse nature of aortic disease, measures approaching the disease as a local process are likely to be unsuccessful. Appropriate evaluation would ideally identify patients with extensive aortic atheromatous disease, prior to rather than during surgery. [less ▲]

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See detailL'image du mois. Kyste hydatique hépatique
Radermecker, Régis ULg; Nkoghe, D.; Labasse, J. M. et al

in Revue Médicale de Liège (1999), 54(1), 4-5

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See detailComment j'explore ... une pneumopathie interstitielle diffuse
Bury, Thierry ULg

in Revue Médicale de Liège (1999), 54(1), 54-7

There are a large number of conditions of known or unknown causes that have a tendency to alveolar wall fibrosis. The patient usually presents with progressive dyspnoea and the chest radiograph shows ... [more ▼]

There are a large number of conditions of known or unknown causes that have a tendency to alveolar wall fibrosis. The patient usually presents with progressive dyspnoea and the chest radiograph shows bilateral shadows whereas physiological measurements show a restrictive defect. Because of implications with regard to treatment and prognosis, diagnosis and staging of the disease are important. Computed tomography ("high resolution") and bronchoalveolar lavage are very useful at all stages of management of interstitial lung disease. [less ▲]

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See detailInfo-congres. L'etude HOPE: demonstration de la protection cardio-vasculaire du ramipril, un inhibiteur de l'enzyme de conversion de l'angiotensine.
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(10), 835-6

The results of the HOPE ("Heart Outcomes Prevention Evaluation") study were presented at the XXIst Congress of the European Society of Cardiology in Barcelona (August 28-September 1, 1999). In addition ... [more ▼]

The results of the HOPE ("Heart Outcomes Prevention Evaluation") study were presented at the XXIst Congress of the European Society of Cardiology in Barcelona (August 28-September 1, 1999). In addition, results obtained in the large diabetic sub-population (38% of the 9541 patients included in the trial) were reported at the XXXVth Congress of the European Association for the Study of Diabetes in Brussels (September 28-October 2, 1999). The HOPE trial was terminated early because of a reduction of the relative risk (-22%, p < 0.000002) of major cardiovascular events in the group treated with ramipiril compared to the group receiving placebo. Such a favourable effect of ramipril was observed in non-diabetic subjects in secondary prevention and in diabetic patients in secondary or primary prevention. In the latter population, a significant reduction in the incidence of microangiopathic complications (nephropathy and retinopathy) was also demonstrated. [less ▲]

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See detailL'etude clinique du mois. Interet d'augmenter un taux de cholesterol HDL bas en prevention secondaire de la coronaropathie: resultats de l'etude VA-HIT.
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(9), 773-5

The "Veterans Affairs Cooperative Studies Program High-Density Lipoprotein Cholesterol Intervention Trial" (VA-HIT) is a large randomised, double-blind, placebo-controlled clinical trial for the secondary ... [more ▼]

The "Veterans Affairs Cooperative Studies Program High-Density Lipoprotein Cholesterol Intervention Trial" (VA-HIT) is a large randomised, double-blind, placebo-controlled clinical trial for the secondary prevention of coronary heart disease. It demonstrates that a fibrate treatment (gemfibrozil) significantly reduces the relative risk of major coronary (-22%, p = 0.006) and cardiovascular (-24%, p < 0.001) events in men with coronary heart disease whose primary lipid abnormality is a low HDL cholesterol level. These findings suggest that, in such a population, the rate of coronary events is reduced under gemfibrozil therapy by raising HDL cholesterol levels (+6%) and lowering levels of triglycerides (-31%) without lowering LDL cholesterol concentrations. [less ▲]

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See detailActualites therapeutiques 1999.
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(9), 725-34

The most important drugs registered and/or launched in Belgium during the last year in the various disciplines of internal medicine will be briefly described. The originality of each molecule as well as ... [more ▼]

The most important drugs registered and/or launched in Belgium during the last year in the various disciplines of internal medicine will be briefly described. The originality of each molecule as well as its modalities of appropriate use in clinical practice will be stressed. [less ▲]

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See detailMedicaments et grossesse.
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(5), 409-14

Since the dramatic observations of fetal abnormalities associated to thalidomide use during pregnancy, the risk of malformations when prescribing drugs in pregnant women is a well-known problem, among the ... [more ▼]

Since the dramatic observations of fetal abnormalities associated to thalidomide use during pregnancy, the risk of malformations when prescribing drugs in pregnant women is a well-known problem, among the public as well as among medical doctors. However, the complexity of the problem, the lack of robust scientific data and the emotional context characterizing this period make the prescription of medications to a pregnant woman a difficult task for every people involved in health care, the pharmacist, the general practitioner and even the gynaecologist. [less ▲]

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