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See detailL'etude clinique du mois. Toxicite de l'hyperglycemie en soins intensifs et effets benefiques d'une insulinotherapie optimisee.
Scheen, André ULg

in Revue Médicale de Liège (2001), 56(12), 859-61

A large Belgian, prospective, controlled study was performed in 1.548 critically ill patients (83% without history of diabetes) hospitalised in a surgical intensive care unit. On admission, patients were ... [more ▼]

A large Belgian, prospective, controlled study was performed in 1.548 critically ill patients (83% without history of diabetes) hospitalised in a surgical intensive care unit. On admission, patients were randomly assigned to receive intensive intravenous insulin therapy (maintenance of blood glucose at a level between 80 and 110 mg/dl) or conventional treatment (infusion of insulin only if the blood glucose level exceeded 215 mg/dl and maintenance of glucose at a level between 180 and 200 mg/dl). Intensive insulin therapy reduced morbidity and mortality by 40%. These remarkable results should influence further therapeutical attitudes in intensive care units and open new perspectives for the management of critically ill patients. [less ▲]

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See detailPharma clinics le medicament du mois. Le nebivolol (Nobiten).
Scheen, André ULg

in Revue Médicale de Liège (2001), 56(11), 788-91

Nebivolol (Nobiten, Menarini) is a new beta-blocker recommended for the management of essential hypertension, at a dose of 5 mg once daily. It is administered as a racemic mixture of equal proportions of ... [more ▼]

Nebivolol (Nobiten, Menarini) is a new beta-blocker recommended for the management of essential hypertension, at a dose of 5 mg once daily. It is administered as a racemic mixture of equal proportions of d- and l-enantiomers. As a lipophilic agent, it is metabolised in the liver and transformed in several active metabolites, essentially via the CYP 2D6, an isoform of cytochrome P450 characterized by a genetic polymorphism. Nebivolol is highly specific for beta-1 adrenergic receptors; it is devoid of intrinsic sympathomimetic or membrane stabilising activity. Interestingly enough, it appears to have nitric oxide-mediated vasodilatory effects which might explain its favourable haemodynamic profile. Several comparative trials demonstrated an antihypertensive activity that was similar or slightly superior to that observed with various other reference antihypertensive agents. Nebivolol has an additive antihypertensive effect in combination with hydrochlorothiazide. All studies reported that the drug has a good clinical and biological tolerance profile. Therefore, nebivolol may be recommended as an alternative first-line treatment option for the management of patients with mild to moderate essential hypertension. [less ▲]

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See detailL'image du mois. Perte de l'arythmie sinusale respiratoire dans la neuropathie autonome diabetique.
Scheen, André ULg; Geronooz, I.; Philips, Jean-Christophe ULg et al

in Revue Médicale de Liège (2001), 56(10), 669-70

Detailed reference viewed: 84 (0 ULg)
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See detailRhabdomyolyse fatale sous cerivastatine.
Scheen, André ULg

in Revue Médicale de Liège (2001), 56(8), 592-4

Cerivastatin was recently withdrawn from the market after the report of more than 30 deaths in the United-States among patients receiving a combination of cerivastatin and gemfibrozil, a fibrate which is ... [more ▼]

Cerivastatin was recently withdrawn from the market after the report of more than 30 deaths in the United-States among patients receiving a combination of cerivastatin and gemfibrozil, a fibrate which is not anymore on the Belgian market. The cause of death was attributed to severe rhabdomyolysis. Cases were also reported among patients treated by cerivastatin only. Recommendations for better use of lipid-lowering drugs are given in order to optimize the benefit/risk ratio of such treatment. [less ▲]

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See detailComment j'explore ... les differentes formes de diabete sucre: diagnostic differentiel clinique et biologique.
Scheen, André ULg; Philips, Jean-Christophe ULg; Luyckx, Françoise ULg et al

in Revue Médicale de Liège (2001), 56(9), 650-5

Owing to the increasing prevalence of diabetes mellitus and the various aspects of this disease, we present a practical approach which allows the clinician to more easily differentiate type 1 diabetes ... [more ▼]

Owing to the increasing prevalence of diabetes mellitus and the various aspects of this disease, we present a practical approach which allows the clinician to more easily differentiate type 1 diabetes, type 2 diabetes and secondary diabetes of pancreatic origin, i.e. the most common forms of diabetes mellitus. Such an approach uses simple diagnostic criteria, based upon both clinical characteristics (family history, personal history, clinical presentation) and biological markers (C-peptide, autoantibodies,...). A right diagnosis should allow to optimize the management of the diabetic patient. [less ▲]

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See detailActualites therapeutiques 2001.
Scheen, André ULg

in Revue Médicale de Liège (2001), 56(9), 612-24

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 main characteristics of each molecule 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 main characteristics of each molecule as well as its modalities of appropriate use in clinical practice will be pointed out. [less ▲]

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See detailUn sujet obese par une approche multidisciplinaire: l'exemple du Centre de l'Obesite du CHU Ourthe-Ambleve.
Scheen, André ULg; Rorive, Marcelle ULg; Letiexhe, Michel ULg et al

in Revue Médicale de Liège (2001), 56(7), 474-9

Obesity is a mulfactorial disease whose prevalence is progressively increasing. Ideally, it requires a multidisciplinary management by medical doctors, dieticians, psychologists and kinetherapists. The ... [more ▼]

Obesity is a mulfactorial disease whose prevalence is progressively increasing. Ideally, it requires a multidisciplinary management by medical doctors, dieticians, psychologists and kinetherapists. The new "Centre de l'Obesite" at the University of Liege aims at fulfilling such objectives with: 1) a first outpatient visit including the simultaneous participation of an endocrinologist, a dietician and a psychologist; 2) a structured and individualized programme of physical rehabilitation; 3) an individualized management of obese subjects as in-(hospital) and/or outpatients, using medical and/or surgical approaches; and 4) an opportunity to benefit of other specialized medical advices, if necessary, in order to increase both the efficacy and safety of the treatment. Owing to the increasing importance of obesity and the well-known difficulties to succeed in treating it, general practitioners should consider this new centre as a valuable help rather than a competitive structure for the management of their patients, especially those with severe or morbid obesity. [less ▲]

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See detailL'etude clinique du mois. Prevention du diabete de type 2 chez le sujet avec exces ponderal et diminution de la tolerance au glucose: efficacite des mesures hygieno-dietetiques.
Scheen, André ULg

in Revue Médicale de Liège (2001), 56(6), 463-5

The "Finnish Diabetes Prevention Study" is a prospective controlled study recently published in the New England Journal of Medicine which compared the risk of developing type 2 diabetes among 265 high ... [more ▼]

The "Finnish Diabetes Prevention Study" is a prospective controlled study recently published in the New England Journal of Medicine which compared the risk of developing type 2 diabetes among 265 high-risk patients treated by changes in lifestyle to that of 257 matched controlled patients. This intervention trial demonstrated that the risk of type 2 diabetes could be reduced by 58% (p < 0.001) after a mean follow-up of 3.2 years with changes in lifestyle of high-risk overweight subjects with impaired glucose tolerance. [less ▲]

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See detailPratique de l'exercice musculaire chez le patient diabetique.
Jandrain, Bernard ULg; Scheen, André ULg

in Revue Médicale de Liège (2001), 56(5), 300-5

Muscular exercise is recommended in patients with type 1 or type 2 diabetes mellitus and is part of the overall management, in combination with diet, oral antidiabetic agents and/or insulin. From a ... [more ▼]

Muscular exercise is recommended in patients with type 1 or type 2 diabetes mellitus and is part of the overall management, in combination with diet, oral antidiabetic agents and/or insulin. From a pathophysiological point of view, regular physical activity enhances insulin sensitivity, thus contributing to improve blood glucose control and to reduce cardiovascular risk factors associated to diabetes mellitus. From a practical point of view, however, muscular exercise in a diabetic patient requires special caution, in particular careful selection of the type of exercise, respect of metabolic and/or cardiovascular contraindications, and appropriate adjustment of current pharmacological/dietary treatment. [less ▲]

Detailed reference viewed: 76 (1 ULg)
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See detailPharma-clinics. Le medicament du mois. Le repaglinide (NovoNorm).
Scheen, André ULg

in Revue Médicale de Liège (2001), 56(6), 456-9

Repaglinide (NovoNorm) is an antidiabetic oral agent of the new glinide class with insulinotropic activity. Its action on insulin secretion is more rapid and shorter than that of sulphonylurea compounds ... [more ▼]

Repaglinide (NovoNorm) is an antidiabetic oral agent of the new glinide class with insulinotropic activity. Its action on insulin secretion is more rapid and shorter than that of sulphonylurea compounds. Thanks to these properties, repaglinide is able to better control postprandial hyperglycaemia and is associated with a lower risk of delayed hypoglycaemic episodes. It is indicated for the treatment of type 2 (non-insulin-dependent) diabetes mellitus as monotherapy, after diet failure, or in combination with metformin, when the biguanide is insufficient. NovoNorm is commercialized as tablets of 0.5, 1 and 2 mg, to be taken just before each meal. Initial dosis should be 0.5 mg before meal in diabetic patients on diet alone or 1 mg before meal in patients already receiving an hypoglycaemic agent. If necessary, the dosis should be progressively increased, depending on the individual response, up to 4 mg before meal (maximal daily dosage of 16 mg), in order to optimize blood glucose control. [less ▲]

Detailed reference viewed: 66 (2 ULg)
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See detailVademecum pour la bonne pratique d'une activite physique.
Scheen, André ULg; Crielaard, Jean-Michel ULg

in Revue Médicale de Liège (2001), 56(5), 396-400

The present closing article summarizes some guidelines for the good practice of physical activities in order to develop and maintain cardiorespiratory and muscular fitness, and flexibility. Advice is ... [more ▼]

The present closing article summarizes some guidelines for the good practice of physical activities in order to develop and maintain cardiorespiratory and muscular fitness, and flexibility. Advice is given regarding the recommended quantity and quality of exercise in term of intensity, duration and frequency of training with the aim to optimize the risk/benefit ratio for health, in both aerobic endurance and resistance exercises. The crucial role of an appropriate warm-up and cool-down period, which would include flexibility exercises, is also emphasized. Finally, some practical examples illustrate this vademecum of physical activities. [less ▲]

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See detailL'exercice physique pour prevenir l'obesite, favoriser l'amaigrissement et maintenir la perte ponderale.
Scheen, André ULg; Rorive, Marcelle ULg; Letiexhe, Michel ULg

in Revue Médicale de Liège (2001), 56(4), 244-7

Obesity is a multifactorial disease making difficult the determination of the precise role of one specific factor such as physical activity or sedentary. Nevertheless, numerous arguments, derived from ... [more ▼]

Obesity is a multifactorial disease making difficult the determination of the precise role of one specific factor such as physical activity or sedentary. Nevertheless, numerous arguments, derived from epidemiological observational studies or from randomized controlled interventional trials, support a favourable role of regular physical activity in the control of body weight. Physical activity contributes to prevent the occurrence of weight excess, especially in children or adolescents, to obtain a satisfactory weight loss, in general in combination with reduced-energy diets, and to maintain long-term weight loss. In addition, physical activity improves both the metabolic profile and health of obese subjects. [less ▲]

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See detailAdaptations hormono-metaboliques a l'exercice musculaire.
Scheen, André ULg; Jandrain, Bernard ULg

in Revue Médicale de Liège (2001), 56(4), 195-9

Physical exercise induces numerous metabolic and hormonal changes that may be influenced by various factors, among which the intensity and the duration of the exertion seem to play a major role besides ... [more ▼]

Physical exercise induces numerous metabolic and hormonal changes that may be influenced by various factors, among which the intensity and the duration of the exertion seem to play a major role besides the possible influence of the intake of exogenous substrates. Such modifications are necessary to satisfy the marked increase in energy demand by exercising muscles, while maintaining plasma glucose concentrations within physiological range. The purpose of the present concise review is to analyse the most important fuel-hormonal adaptations observed during short heavy muscular exercise or during prolonged exercise of moderate intensity as well as those observed after physical training in normal subjects. [less ▲]

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See detailPharma clinics. Le medicament du mois. Le clopidogrel (Plavix).
Scheen, André ULg

in Revue Médicale de Liège (2001), 56(3), 186-9

Clopidogrel is launched in Belgium by Sanofi-Synthelabo and Bristol-Myers Squibb under the trade name of Plavix. It is a potent and irreversible ADP receptor antagonist that proved to be more effective ... [more ▼]

Clopidogrel is launched in Belgium by Sanofi-Synthelabo and Bristol-Myers Squibb under the trade name of Plavix. It is a potent and irreversible ADP receptor antagonist that proved to be more effective than aspirin as antiplatelet agent in the multicentre, randomised double-blind CAPRIE study. It is indicated, at a dosage of 75 mg/day, for the reduction of atherosclerotic events including myocardial infarction, ischaemic stroke and vascular death in patients with atherosclerosis manifested by recent stroke, myocardial infarction or established peripheral vascular disease. Furthermore, recent studies demonstrated that the combination of clopidogrel with aspirin is more effective than aspirin alone and better tolerated than the combination ticlopidine-aspirin for the prevention of atherothrombosis after placement of intravascular stents. Ongoing trials are evaluating the efficacy and safety of such clopidogrel-aspirin combination after acute ischaemic coronary events or in patients at very high risk of stroke. Thus the indications of clopidogrel may become even larger in a next future. [less ▲]

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See detailExercice physique et sport: du meilleur au pire.
Scheen, André ULg; Kulbertus, Henri ULg

in Revue Médicale de Liège (2001), 56(4), 193-4

Detailed reference viewed: 43 (1 ULg)
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See detailEffets benefiques de l'activite physique sur les facteurs de risque cardio-vasculaire.
Scheen, André ULg; Paquot, Nicolas ULg

in Revue Médicale de Liège (2001), 56(4), 239-43

Numerous observational (epidemiological surveys) or interventional (controlled trials) studies demonstrated that regular physical activity increases insulin sensitivity in normal subjects and decreases ... [more ▼]

Numerous observational (epidemiological surveys) or interventional (controlled trials) studies demonstrated that regular physical activity increases insulin sensitivity in normal subjects and decreases insulin resistance in patients with obesity and/or type 2 diabetes. These favourable effects are at least partially linked to a reduction in abdominal fat mass. This results in a significant improvement of lipid profile, with a decrease in the concentrations of total cholesterol, LDL cholesterol and triglycerides, associated with an increase of HDL cholesterol level. Such favourable metabolic effects related to regular physical activity probably explain the better cardiovascular prognosis observed in regularly exercising subjects as compared to sedentary individuals. These observations should motivate any practitioner to promote endurance physical exercise in every subject, especially in individuals at high cardiovascular risk. [less ▲]

Detailed reference viewed: 74 (3 ULg)
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See detailPharma-clinics. Le medicament du mois. Le celecoxib (Celebrex).
Scheen, André ULg

in Revue Médicale de Liège (2001), 56(1), 53-5

Celecoxib (Celebrex, Pharmacia) is a potent and selective inhibitor of the COX-2 isoform of cyclooxygenase which is used as nonsteroidal anti-inflammatory drug (NSAID). Its current indications are ... [more ▼]

Celecoxib (Celebrex, Pharmacia) is a potent and selective inhibitor of the COX-2 isoform of cyclooxygenase which is used as nonsteroidal anti-inflammatory drug (NSAID). Its current indications are osteoarthritis and rheumatoid arthritis. The usual recommended daily dosage of celecoxib is 200 mg (in one or two intakes per day), to be increased up to 400 mg (two intakes per day) if necessary. Its clinical efficacy seems to be similar to that of other NSAIDs. However, its safety profile, especially gastro-intestinal tolerance and perhaps renal safety, is much better because of the COX-2 selectivity. [less ▲]

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See detailL'etude clinique du mois. Apres la tempete sur les anorexigenes centraux, l'etude "STORM" avec la sibutramine.
Scheen, André ULg

in Revue Médicale de Liège (2001), 56(1), 56-8

The results of the "Sibutramine Trial of Obesity Reduction and Maintenance" (STORM) published in the last issue of December 2000 of the Lancet are summarized. This clinical trial (open label for the first ... [more ▼]

The results of the "Sibutramine Trial of Obesity Reduction and Maintenance" (STORM) published in the last issue of December 2000 of the Lancet are summarized. This clinical trial (open label for the first 6 months and double blind versus placebo for a further 18 months) demonstrates the positive effect of sibutramine, a new anorectic drug, on long-term weight maintenance after weight loss in obese subjects. The benefit of sibutramine on the cardiovascular risk profile of the obese patient is more particularly discussed. [less ▲]

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See detailEtude clinique du mois. Protection secondaire de l'accident vasculaire cerebral par le perindopril: l'etude PROGRESS.
Scheen, André ULg

in Revue Médicale de Liège (2001), 56(11), 792-5

PROGRESS ("Perindopril pROtection aGainst REcurrent Stroke Study") demonstrated that blood-pressure lowering treatment with perindopril, an angiotensin converting enzyme inhibitor (combined with the ... [more ▼]

PROGRESS ("Perindopril pROtection aGainst REcurrent Stroke Study") demonstrated that blood-pressure lowering treatment with perindopril, an angiotensin converting enzyme inhibitor (combined with the diuretic agent indapamide when necessary), reduces the risk of stroke by 28% (95% CI: 17-38, p < 0.0001) among patients with a history of stroke or transient ischaemic attack. This protective effect was observed among both hypertensive and non-hypertensive individuals. It was more marked in the patients receiving combined perindopril + indapamide treatment (-43%; 95% CI 30-54) who were those who showed the greatest reduction in arterial blood pressure (-12/5 mm Hg). According to these observations, the authors concluded that treatment with these two agents should now be considered routinely for patients with a history of stroke or transient ischaemic attack, irrespective of their blood pressure. [less ▲]

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See detailResponsabilité pénale et faute pénale
Boxho, Philippe ULg

in Revue Médicale de Liège (2001), 56

Detailed reference viewed: 32 (3 ULg)