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See detailPharma-clinics. Le medicament du mois. La levofloxacine (Tavanic).
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(11), 1015-7

Levofloxacin, the (-)-(S)-enantiomer isolated from the racemate ofloxacin, is launched by Aventis under the trade name of Tavanic. This new oral and parenteral antibiotic belongs to the fluoroquinolone ... [more ▼]

Levofloxacin, the (-)-(S)-enantiomer isolated from the racemate ofloxacin, is launched by Aventis under the trade name of Tavanic. This new oral and parenteral antibiotic belongs to the fluoroquinolone family and exerts a bactericidal activity upon a large spectrum of microorganisms, including Gram negative and Gram positive bacilli (among which Streptococcus pneunomiae), and atypical respiratory pathogens. It also has interesting pharmacokinetic properties. Besides the classical indications of other fluoroquinolones (especially complicated urinary tract infections, including pyelonephritis, and severe skin and soft tissue infections), levofloxacin is indicated for the treatment of acute sinusitis, acute exacerbations of chronic bronchitis and community-acquired pneumonia. [less ▲]

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See detailComment j'explore ... les anomalies du metabolisme glucidique, de l'insulinosecretion et de la sensibilite a l'insuline avec une hyperglycemie provoquee par voie orale.
Luyckx, Françoise ULg; Scheen, André ULg

in Revue Médicale de Liège (2000), 55(9), 881-5

Oral glucose tolerance test (OGTT) has been widely used for the diagnosis of diabetes mellitus, gestational diabetes, impaired glucose tolerance or reactive hypoglycaemia. Simultaneous measurements of ... [more ▼]

Oral glucose tolerance test (OGTT) has been widely used for the diagnosis of diabetes mellitus, gestational diabetes, impaired glucose tolerance or reactive hypoglycaemia. Simultaneous measurements of plasma glucose and insulin levels also allow to derive indices of insulin secretion and insulin sensitivity. Whereas OGTT is not considered anymore as the first choice for the diagnosis of diabetes mellitus, it remains useful for studying abnormalities of glucose metabolism as well as of insulin secretion and insulin action. [less ▲]

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See detailL'etude clinique du mois. Insulino-independance prolongee apres transplantation d'ilots de langerhans chez le patient diabetique de type 1: l'aboutissement d'un reve?
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(8), 803-5

A Canadian research team recently reported a series of 7 consecutive patients with type 1 brittle diabetes who could achieve sustained excellent metabolic control in the absence of insulin therapy after ... [more ▼]

A Canadian research team recently reported a series of 7 consecutive patients with type 1 brittle diabetes who could achieve sustained excellent metabolic control in the absence of insulin therapy after successful islet transplantation. This exceptional success, which contrasts with previous less favourable results, is probably due to the transplantation of a higher number of islets of good quality and to the use of a new glucocorticoid-free immunosuppressive regimen. These remarkable results which provide proof of the principle that islet transplantation can be reproducibly successful, at least for one year, may raise new hope in patients with type 1 diabetes. However, the problem of supply and demand of islets is huge and will require a careful, and probably difficult, selection of the best candidates to benefit from this new therapeutic approach. [less ▲]

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See detailPharma-clinics. Le medicament du mois. Le rofecoxib (Vioxx).
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(7), 751-3

Rofecoxib (Vioxx, Merck Sharp & Dohme) is a potent and selective inhibitor of the COX-2 isoform of cyclooxygenase which is used as a nonsteroidal anti-inflammatory drug (NSAID). It is indicated in the ... [more ▼]

Rofecoxib (Vioxx, Merck Sharp & Dohme) is a potent and selective inhibitor of the COX-2 isoform of cyclooxygenase which is used as a nonsteroidal anti-inflammatory drug (NSAID). It is indicated in the symptomatic relief of pain due to osteoarthritis. The initial oral dosage of rofecoxib is 12.5 mg once daily in adults, and this dose may be increased up to a maximal dosage of 25 mg once daily if necessary. Its clinical efficacy seems to be similar to that of other NSAIDs at maximal recommended dosages, but its safety profile, especially gastrointestinal tolerance, is much better because of the COX-2 selectivity. Ongoing clinical trials are performed in patients with rheumatoid arthritis. [less ▲]

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See detailLe controle glycemique chez le patient diabetique. Recommandations apres les etudes DCCT et UKPDI.
Paquot, Nicolas ULg; Scheen, André ULg; Lefebvre, Pierre ULg

in Revue Médicale de Liège (2000), 55(5), 372-5

Diabetes mellitus is a chronic disorder characterized by microvascular and cardiovascular complications that substantially increase the morbidity and mortality associated with the disease. Several studies ... [more ▼]

Diabetes mellitus is a chronic disorder characterized by microvascular and cardiovascular complications that substantially increase the morbidity and mortality associated with the disease. Several studies showed the association between the complications of diabetes and elevated blood glucose levels. Clinical trials have also demonstrated that treatment that lowers blood glucose reduces the risks of diabetic complications (mainly microvascular complications). The control of diabetes is assessed by frequent measurements of HbA1c. A reasonable goal in type 1 diabetes is a value of HbA1c < or = 7.2%. In type 2 diabetes, the optimal goal is a value of HbA1c < or = 6.5%, but a value < or = 8% seems to be an acceptable goal in these patients. [less ▲]

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See detailRecommandations pour le traitement de l'obesite.
Luyckx, Françoise ULg; Scheen, André ULg

in Revue Médicale de Liège (2000), 55(5), 367-71

Obesity represents a major medical problem which is now considered more seriously from a scientific, clinical and economical point of view. Such an evolution was mandatory when considering the usual ... [more ▼]

Obesity represents a major medical problem which is now considered more seriously from a scientific, clinical and economical point of view. Such an evolution was mandatory when considering the usual contempt for what is now considered as a chronic disease and especially the charlatanism which was observed among medical and non-medical spheres. Hence, as for numerous other pathologies, international guidelines have recently been published to optimize the management of obesity, from the view point of efficacy and, more particularly, safety. We will summarize the main recommendations as far as diet and physical treatment, pharmacotherapy and bariatric surgery are concerned. Finally, we will briefly describe general guidelines on the management of obese subjects taking into account the degree of weight excess and the presence of complications. [less ▲]

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See detailLes recommandations du Belgian Lipid Club pour le diagnostic et le traitement des hyperlipidemies: resume pour le praticien.
Ducobu, J.; Scheen, André ULg

in Revue Médicale de Liège (2000), 55(5), 360-6

The present paper summarizes the last recommendations of the Belgian Lipid Club for the diagnosis and treatment of hyperlipidaemias which were published in 1999. These guidelines are in agreement with the ... [more ▼]

The present paper summarizes the last recommendations of the Belgian Lipid Club for the diagnosis and treatment of hyperlipidaemias which were published in 1999. These guidelines are in agreement with the "Recommendations of the second Task Force of European and other societies on Coronary Protection", published in 1998. We will briefly describe the evidence supporting the treatment of dyslipidaemias, especially hypercholesterolaemia, to improve coronary prognosis of at high risk subjects as well as the general strategies, lipid objectives and therapeutic means, in a practical way for the clinician. [less ▲]

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See detailEvidence-based medicine. Apport des essais cliniques controles.
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(4), 216-9

Controlled clinical trials are the support of Evidence-Based Medicine. In most instances, only them can indeed provide the demonstration of both the efficacy and safety of a pharmacological treatment ... [more ▼]

Controlled clinical trials are the support of Evidence-Based Medicine. In most instances, only them can indeed provide the demonstration of both the efficacy and safety of a pharmacological treatment, based upon rigorous scientific experimental observations avoiding potential bias due to subjective interpretation. In order to be able to extrapolate conclusions of drug trials to clinical practice and to positively influence physician's attitudes, "explanatory" trials, which aim at proving the intrinsic activity of the molecule, should be completed by "pragmatic" trials, which aim at demonstrating the clinical utility of the drug. [less ▲]

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See detailComment je traite.... De la pharmacologie speciale a la therapeutique medicale: plaidoyer pour un enseignement privilegiant l'apprentissage au raisonnement therapeutique, de la decision a la prescription.
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(9), 811-6

Clinical pharmacology and therapeutics are two complementary disciplines which should lead the medical student, through an optimized training, to a rational prescription of drugs, ultimate and important ... [more ▼]

Clinical pharmacology and therapeutics are two complementary disciplines which should lead the medical student, through an optimized training, to a rational prescription of drugs, ultimate and important step of the medical approach. Such a learning should occur progressively throughout the medical education, focusing, first, on the therapeutic reasoning ("why?") and, second, on the practical application leading to the prescription ("how?"). The medical student should learn the difficult task of integrating disease, drug and patient, in order to optimize the benefit/risk ratio, while being informed about new concepts such as "Evidence-Based Medicine" and pharmacoeconomics. [less ▲]

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See detailActualites therapeutiques 2000.
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(9), 852-61

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 emphasized. [less ▲]

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See detailDe l'inapplicabilite de certaines recommandations therapeutiques en pratique: l'exemple du remboursement des medicaments hypolipidemiants en Belgique.
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(4), 260-4

International guidelines from the Task Force of European and other Societies on Coronary Prevention and national guidelines from the Belgian Lipid Club recently emphasized the potential interest of ... [more ▼]

International guidelines from the Task Force of European and other Societies on Coronary Prevention and national guidelines from the Belgian Lipid Club recently emphasized the potential interest of adequate management of patients with even moderate hypercholesterolaemia. However, current criteria for the reimbursement of lipid-lowering drugs in Belgium do not allow to follow these guidelines. A solution should be urgently found in order to bridge the gap and permit practitioners, after diet failure, to effectively prescribe lipid-lowering agents in patients who should benefit in priority of such a treatment. It is certainly the case in secondary prevention as well as, in high risk individuals, in primary prevention, i.e. in situations where these drugs have provided enough evidence of their efficacy with an acceptable cost-benefit ratio. [less ▲]

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See detailL'etude clinique du mois. L'etude STOP-2 dans l'hypertension arterielle du sujet age.
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(1), 64-6

After the demonstration of the efficacy of beta-blockers or diuretics versus placebo to prevent cardiovascular complications in elderly hypertensive patients in the first STOP-Hypertension study in 1991 ... [more ▼]

After the demonstration of the efficacy of beta-blockers or diuretics versus placebo to prevent cardiovascular complications in elderly hypertensive patients in the first STOP-Hypertension study in 1991, a Swedish group published at the end of 1999 the STOP-2 Hypertension study. The latter randomised trial showed in a similar population that the cardiovascular protection of more recent antihypertensive agents such as calcium antagonists and angiotensin-converting-enzyme inhibitors is similar to that of the conventional antihypertensive drugs used in the first study. In fact, the degree of blood pressure control appears to be more important than the type of antihypertensive drugs used, and this conclusion is reinforced by the observation that numerous patients should rapidly be treated by more than one antihypertensive agent to reach blood pressure targets. [less ▲]

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See detailLa mesure de l'efficacite therapeutique, etape essentielle dans la medecine factuelle.
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(4), 206-10

Evidence-based medicine relies on the results from clinical trials. We will describe the various modes of expression of the results (absolute risk reduction, relative risk reduction, odds ratios, number ... [more ▼]

Evidence-based medicine relies on the results from clinical trials. We will describe the various modes of expression of the results (absolute risk reduction, relative risk reduction, odds ratios, number needed to treat to avoid one event,...) and we will insist upon the clinical significance and the pitfalls in the interpretation of these various indices of therapeutic efficacy. [less ▲]

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See detailVitamines anti-oxydantes dans la prevention des maladies cardio-vasculaires. 1ere partie: Le point sur les etudes epidemiologiques.
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(1), 11-8

The hypothesis of the atherogenic role of oxidized. LDL lipoproteins and the observation of the longevity of individuals on a "mediterranean diet" led to the concept that antioxidant vitamins may exert ... [more ▼]

The hypothesis of the atherogenic role of oxidized. LDL lipoproteins and the observation of the longevity of individuals on a "mediterranean diet" led to the concept that antioxidant vitamins may exert cardiovascular protective effects. In this first article, we summarize the results of the main epidemiological studies which analyzed the influence of dietary intakes (or resulting plasma concentrations) in vitamin E (alpha-tocopherol), vitamin A (beta-carotene) or vitamin C (ascorbic acid). The three types of studies available in the literature provided quite heterogeneous results, in favour of a protective role of antioxidant vitamins as far as cross-cultural and most prospective observational studies were concerned, but rather negative when considering case-control studies. However, in general, epidemiological studies tended to support, a beneficial role of these antioxidant vitamins to prevent cardiovascular diseases, at least in some subgroups of individuals. [less ▲]

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See detailVitamines anti-oxydantes dans la prevention des maladies cardio-vasculaires. 2eme partie: le point sur les essais cliniques.
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(2), 105-9

Various epidemiological studies suggested that individuals with high intake of antioxidant vitamins (E, A and C) have a better cardiovascular prognosis than subjects with relative deficiencies in such ... [more ▼]

Various epidemiological studies suggested that individuals with high intake of antioxidant vitamins (E, A and C) have a better cardiovascular prognosis than subjects with relative deficiencies in such vitamins. However, placebo-controlled randomized clinical trials did not demonstrate that a specific supplementation in either alpha-tocopherol (vitamin E) or beta-carotene (vitamin A) allows to reduce the incidence of major cardiovascular events, in the general population or even in various subgroups at high risk, and there is no such controlled trials with vitamin C alone. Some studies suggested that combined supplements of several antioxidant vitamins might be more efficacious, and these observations led to initiate several large controlled studies. Thus, until now, there is no convincing arguments in the literature in favour of artificial supplements of antioxidant vitamins. It seems preferable to encourage a well-balanced healthy diet while awaiting the results of the large prospective ongoing trials with combined supplementation. [less ▲]

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See detailPharma-clinics. Le medicament du mois. La moxonidine (Moxon).
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(1), 61-3

Moxonidine (Moxon, Solvay Pharma) is the first member of a new class of centrally-acting antihypertensive agents. The selective activation of central I1 imidazoline receptors results in an inhibition of ... [more ▼]

Moxonidine (Moxon, Solvay Pharma) is the first member of a new class of centrally-acting antihypertensive agents. The selective activation of central I1 imidazoline receptors results in an inhibition of peripheral sympathetic activity and produces arterial vasodilatation. Moxonidine is indicated in the treatment of essential arterial hypertension, at a usual daily dose of 0.4 mg (initial dose of 0.2 mg/day), in one administration per day. Its tolerance profile is better than that of other centrally-acting antihypertensive agents which stimulate alpha-2 adrenergic receptors, and similar to that of medications of other classes. As monotherapy, the antihypertensive efficacy of moxonidine is similar to that of most other antihypertensive agents. In case of insufficient response, moxonidine may be associated with other antihypertensive compounds, which leads to a better efficacy with no deterioration of its good tolerance profile. [less ▲]

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See detailLa grippe: de la prevention vaccinale au traitement antiviral.
Nkoghe, D.; Scheen, André ULg

in Revue Médicale de Liège (2000), 55(1), 19-23

Influenza is a highly infectious disease responsible for dangerous epidemics, especially in patients at high risk. The vaccine exerts a valuable protective effect estimated up to 70% and is still ... [more ▼]

Influenza is a highly infectious disease responsible for dangerous epidemics, especially in patients at high risk. The vaccine exerts a valuable protective effect estimated up to 70% and is still considered as the key-approach against influenza. Antiviral agents of the first generation (amantadine, rimantadine, ribavirine) have limited use because of poor tolerance and occurrence of resistance. Zanamivir or Relenza, marketed by Glaxo Wellcome, is a new virostatic drug acting as a neuraminidase inhibitor. It prevents the release of new viruses and so stop the propagation of the infection. It must be taken orally by inhalation within 48 hours after the onset of symptoms. The treatment lasts 5 days (10 mg twice daily). Its efficacy has been demonstrated in controlled clinical trials, and its tolerance is generally excellent. However, caution is recommended in patients with asthma and chronic bronchitis because of the potential risk of bronchoconstriction. No resistance has been detected until now. Zanamivir is active on all strains of influenza A and B viruses. [less ▲]

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See detailLes non-recommandations dans le traitement de l'arthrose et de la polyarthrite rhumatoïde, ou pourquoi la médecine basée sur le niveau de preuve ne s'applique pas (encore) à la rhumatologie
Malaise, Michel ULg

in Revue Médicale de Liège (2000), 55(5), 466-475

The speed with which the phrase "Evidence-Based Medicine" has entered our language has been astonishing. Virtually all medical areas are concerned, but it probably applies best when clearcut diagnosis can ... [more ▼]

The speed with which the phrase "Evidence-Based Medicine" has entered our language has been astonishing. Virtually all medical areas are concerned, but it probably applies best when clearcut diagnosis can be made or when mortality or well-defined morbidity are the outcomes, two conditions not really frequently encountered in rheumatology. We will discuss why rheumatology is probably not ready yet for the concept and will systematically review why "Evidence-Based Medicine" could in fact be "evidence-biased medicine". We will emphasize why evidence-based medicine can not replace the personal experience and knowledge of patients, two major corner-stones in the clinician's daily work, but should simply be an access to scientific data for the benefit of both patient and physician. [less ▲]

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See detailLe médecin généraliste face à l'urgence dentaire.
Dabée, Jean-Claude ULg; Geerts, Sabine ULg; Charpentier, Joseph ULg

in Revue Médicale de Liège (2000), 55(12), 1022-7

Counselling and drug prescription are the only means for the phycisian to manage dental emergencies. Among these, some are infection related: pulpitis, apical and periodontal abscesses, acute necrotizing ... [more ▼]

Counselling and drug prescription are the only means for the phycisian to manage dental emergencies. Among these, some are infection related: pulpitis, apical and periodontal abscesses, acute necrotizing ulcerative gingivitis and alveolitis. Urgent medical treatment includes antibiotics, mouth rinses and analgesics except for pulpitis (pain caused by thermal stimuli) for which analgesics alone are prescribed. Infection non related dental emergencies are: hemorrhage for which the best treatment is compression; trauma, mainly dental avulsion for which reimplantation must be done as soon as possible; acute TMD such as open lock which can be reduced by the Nelaton handling. [less ▲]

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See detailPharma clinics. Comment je traite ... un trouble de la kaliémie
Neven, Ingrid; Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (2000), 55(1), 4-7

The treatment of dyskalemia must be primarily etiological and later symptomatic. When moderate but significant hypokalemia exists (K < 3 mmol/l or 3.5 mmol/l with cardiac disease), oral K supplements must ... [more ▼]

The treatment of dyskalemia must be primarily etiological and later symptomatic. When moderate but significant hypokalemia exists (K < 3 mmol/l or 3.5 mmol/l with cardiac disease), oral K supplements must be given. The intravenous route must be reserved for emergency or impossible oral administration. Acute and severe hyperkalemia (K > 7 mmol/l) must be first corrected by different intravenous measures with secondary oral intervention. In chronic and/or moderate hyperkalemia (K > 5.5 mmol/l), the oral route for treatment is prefered. In any case, the research of the cause (mainly drug induced) is fundamental. [less ▲]

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