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See detailApproche factuelle du traitement de l'herpes genital
Nikkels, Arjen ULg; Pierard, Gérald ULg

in Revue Médicale de Liège (2000), 55(5), 430-437

Genital herpes is a sexually transmitted disease. After the primary infection, the virus establishes a life-long latency in the sacral dorsal root ganglia. Recurrences may occur at an unpredictable rate ... [more ▼]

Genital herpes is a sexually transmitted disease. After the primary infection, the virus establishes a life-long latency in the sacral dorsal root ganglia. Recurrences may occur at an unpredictable rate. The clinical signs are not always easy to recognize and viral identification techniques may be helpful such as immunohistochemistry and in situ hybridization on Tzanck smears and muco-cutaneous biopsies. The treatment of genital herpes can follow one of three strategies using antiviral drugs, non-specific immunomodulators, and vaccination. The new oral antiviral drugs decrease the severity of clinical manifestations without, however, providing a definitive cure. In this article recent knowledge about the clinical aspects, differential diagnosis, diagnostic methods, treatment options and management is reviewed. [less ▲]

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See detailReflux gastro-oesophagien de l'adulte: diagnostic et traitement
Louis, Edouard ULg; Belaiche, Jacques ULg

in Revue Médicale de Liège (2000), 55(5), 341-4

Gastro-oesophageal reflux is a frequent problem affecting up to one third of the Belgian adult population. It is most often a benign non evolutive disease. It is however frequently chronic, with a ... [more ▼]

Gastro-oesophageal reflux is a frequent problem affecting up to one third of the Belgian adult population. It is most often a benign non evolutive disease. It is however frequently chronic, with a significant negative impact on quality of life. The diagnostic and therapeutic management must be adapted to each individual case. In the majority of cases, the purpose of therapy is the control of symptoms and, in a small number of cases with severe oesophagitis the aim is a complete and persistent healing of lesions. A Franco-Belgian consensus meeting on diagnostic and therapeutic management of gastro-oesophageal reflux disease in adults was recently held. Guidelines have been proposed. The aim of the present paper is to highlight the main principles of these guidelines and to comment on their adjustment to current belgian medical practice. [less ▲]

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See detailRecommandations en matiere de traitement du cancer rectal
Gast, Pierrette ULg; Bours, Vincent ULg; Detroz, Bernard ULg et al

in Revue Médicale de Liège (2000), 55(5), 350-5

Curative resection of primary tumor and metastases is the only way to obtain a prolonged survival. Several additional treatments are under evaluation; some are already routinely proposed, in order to ... [more ▼]

Curative resection of primary tumor and metastases is the only way to obtain a prolonged survival. Several additional treatments are under evaluation; some are already routinely proposed, in order to reduce the tumor size and to allow surgery, to reduce the recurrence rate, and to give a better survival in case of unresectable metastases. Even in case of unresectable metastases, resection of the primary tumor should be envisaged, as quality of life with an evolving rectal tumor is very poor. [less ▲]

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See detailRecommandations dans la prise en charge de l'Helicobacter pylori: point de vue recent de la Societe nationale francaise de Gastroenterologie
Van Kemseke, Catherine ULg; Belaiche, Jacques ULg

in Revue Médicale de Liège (2000), 55(5), 345-9

Guidelines for management of Helicobacter pylori are in constant evolution since its discovery in 1982 by Marshall and Warren. This article presents and comments recent guidelines developed under the ... [more ▼]

Guidelines for management of Helicobacter pylori are in constant evolution since its discovery in 1982 by Marshall and Warren. This article presents and comments recent guidelines developed under the auspices of the "Societe Nationale Francaise de Gastroenterologie". [less ▲]

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See detailLe Problem-Based Learning, description d'une pedagogie conduisant a la medecine factuelle
Chalon, Patrice ULg; Delvenne, Catherine ULg; Pasleau, Françoise ULg

in Revue Médicale de Liège (2000), 55(4), 233-8

Problem-Based Learning is an educational method which uses health care scenarios to provide a context for learning and to elaborate knowledge through discussion. Additional expectations are to stimulate ... [more ▼]

Problem-Based Learning is an educational method which uses health care scenarios to provide a context for learning and to elaborate knowledge through discussion. Additional expectations are to stimulate critical thinking and problem-solving skills, and to develop clinical reasoning taking into account the patient's psychosocial environment and preferences, the economic requirements as well as the best evidence from biomedical research. Appearing at the end of the 60's, it has been adopted by 10% of medical schools world-wide. PBL follows the same rules as Evidence-Based Medicine but is student-centered and provides the information-seeking skills necessary for self-directed life long learning. In this short article, we review the theoretical basis and process of PBL, emphasizing the teacher-student relationship and discussing the suggested advantages and disadvantages of this curriculum. Students in PBL programs make greater use of self-selected references and online searching. From this point of view, PBL strengthens the role of health libraries in medical education, and prepares the future physician for Evidence-Based Medicine. [less ▲]

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See detailComment resoudre en pratique un probleme diagnostique ou therapeutique en suivant une demarche EBM?
Delvenne, Catherine ULg; Pasleau, Françoise ULg

in Revue Médicale de Liège (2000), 55(4), 226-32

Evidence-Based Medicine (EBM) can be defined as the use of best current evidence from clinical research in making decisions about the care of individual patients. It consists of a process of turning ... [more ▼]

Evidence-Based Medicine (EBM) can be defined as the use of best current evidence from clinical research in making decisions about the care of individual patients. It consists of a process of turning clinical problems into questions and then locating the best available evidence to answer them, critically appraising the evidence for its validity and usefulness, and applying the findings to clinical practice. The present article presents the EBM principles and their application to diagnostic and therapeutic questions. Further detailed information on Evidence-Based Medicine is presented at the URL address: http: inverted question markwww.ebm.lib.ulg.ac.be/prostate/ebm.+ ++htm. [less ▲]

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See detailL'infarctus aigu du myocarde: prise en charge, pronostic et suivi
Lancellotti, Patrizio ULg; Pierard, Luc ULg

in Revue Médicale de Liège (2000), 55(4), 278-85

Acute myocardial infarction (AMI) is a serious condition which requires rapid hospital management. In this article, we review the current recommendations concerning AMI treatment, as well as our ... [more ▼]

Acute myocardial infarction (AMI) is a serious condition which requires rapid hospital management. In this article, we review the current recommendations concerning AMI treatment, as well as our therapeutic approach, which is based on the evidence provided by several large well controlled clinical trials. Mid and long term prognosis are mainly related to the development of left ventricular dysfunction which determines heart failure, the occurrence of severe ventricular arrhythmias and the persistence of residual myocardial ischemia. Several treatments (aspirin, beta-blockade, ACE inhibitors, statins) have shown their benefit in terms of secondary prevention. [less ▲]

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See detailSelection de ressources EBM sur l'Internet
Delvenne, Catherine ULg; Pasleau, Françoise ULg

in Revue Médicale de Liège (2000), 55(4), 220-5

To integrate Evidence-Based Medicine (EBM) into practice, the physician has access to a number of resources on the Internet. They belong to two distinct groups: tools intended for EBM learning and EBM ... [more ▼]

To integrate Evidence-Based Medicine (EBM) into practice, the physician has access to a number of resources on the Internet. They belong to two distinct groups: tools intended for EBM learning and EBM syntheses prepared by different international organizations. The present article presents the main EBM resources on the network and comments on them. These information are also available on the URL site: http:www.ebm.lib.ulg.ac.be/prostate/link_ebm .htm. [less ▲]

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See detailRelativite de la prise en charge des cancers cutanes. Plaidoyer pour la synergie entre le medecin generaliste et le dermatologue-oncologue
Pierard, Gérald ULg; Pierard-Franchimont, Claudine ULg; Cornil, F. et al

in Revue Médicale de Liège (2000), 55(4), 247-252

The clinical diagnosis and treatment of cutaneous cancers represent a frequent situation in cancerology. About one third of all human cancers take their origin from the skin. The general practitioner and ... [more ▼]

The clinical diagnosis and treatment of cutaneous cancers represent a frequent situation in cancerology. About one third of all human cancers take their origin from the skin. The general practitioner and the dermatologist-oncologist play the key role in that field of health care. [less ▲]

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See detailDiagnostic et traitement de l'insuffisance cardiaque
Pierard, Luc ULg; Kulbertus, Henri ULg

in Revue Médicale de Liège (2000), 55(4), 271-7

The incidence of heart failure is consistently progressing among our population; it now represents a major problem of public health and is extremely costly for our health system. Over recent years ... [more ▼]

The incidence of heart failure is consistently progressing among our population; it now represents a major problem of public health and is extremely costly for our health system. Over recent years, several well controlled studies have been devoted to heart failure. They allow to propose guidelines which fulfill all the requirements of Evidence-Based Medicine. These recommendations, however, are not always easy to apply in the individual patient. Guidelines for the sometimes difficult diagnosis of heart failure will be reviewed. On the basis of the results of large controlled clinical trials, we shall envisage the comprehensive treatment of a heart failure patient taking into account the functional class as well as some individual characteristics (age, presence of hypertension, atrial fibrillation, renal insufficiency). The different pharmacologic agents which have demonstrated efficacy will be reviewed and the strategies to avoid the potential pitfalls of their simultaneous use will be indicated. The key role of the general practitioner in the surveillance and titration of heart failure therapy will be emphasized. [less ▲]

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See detailTraitement de l'angor instable
Legrand, Victor ULg

in Revue Médicale de Liège (2000), 55(4), 286-9

Unstable angina generally is a serious condition which often requires hospital treatment. In this review article, we shall describe our therapeutic approach to unstable angina. It is almost identical ... [more ▼]

Unstable angina generally is a serious condition which often requires hospital treatment. In this review article, we shall describe our therapeutic approach to unstable angina. It is almost identical worldwide. This attitude is based on the evidence provided by well controlled clinical trials. It is therefore a good example of Evidence-Based Medicine. [less ▲]

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See detailTraitement de l'angor pectoris chronique
Legrand, Victor ULg

in Revue Médicale de Liège (2000), 55(4), 290-6

Stable angina is one of the manifestations of coronary artery disease. In this review, we shall define the clinical criteria for the diagnosis of angina. The different techniques of evaluation will be ... [more ▼]

Stable angina is one of the manifestations of coronary artery disease. In this review, we shall define the clinical criteria for the diagnosis of angina. The different techniques of evaluation will be discussed with a particular emphasis on the international recommendations for the use of coronary arteriography. The different therapeutic modalities will be outlined based on the results of large controlled clinical trials. Finally, the guidelines proposed for the use of coronary by-pass surgery and PTCA will be reviewed. [less ▲]

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See detailLes traitements post-menopause a revoir? Une polemique nouvelle!
Foidart, Jean-Michel ULg; Desreux, Joëlle ULg; Pintiaux, Axelle ULg

in Revue Médicale de Liège (2000), 55(3), 156-60

The study by Schairer et al. aims to determine whether increases in risk of breast cancer associated with the estrogen-progestin regimen are greater than those associated with estrogen alone. This study ... [more ▼]

The study by Schairer et al. aims to determine whether increases in risk of breast cancer associated with the estrogen-progestin regimen are greater than those associated with estrogen alone. This study is a cohort of follow-up data for 1980-1995 from the Breast Cancer Detection Demonstration Project, a nationwide breast cancer screening program that involved 29 screening centers throughout the United States. A total of 46,355 postmenopausal women were followed. During follow up, 2,082 cases of breast cancer were identified. Increases in risk with estrogen only and estrogen-progestin only were restricted to use within the previous 4 years. The relative risk increased by 0.01 with each year of estrogen-only use and by 0.08 with each year of estrogen-progestin-only use among recent users. Among women with a Body Mass Index of 24.4 kg/m2 or less, increases in relative risk with each year of estrogen-only use and estrogen-progestin-only use among recent users were 0.03 and 0.12, respectively. The authors conclude that the estrogen-progestin regimen increases breast cancer risk beyond that associated with estrogen alone. This study was largely commented in the lay media. Unfortunately the Belgian media introduced the confusion between the relative risk and the risk attributable to estrogen and estrogen-progestin. The aim of this manuscript is to precisely inform our colleagues, to analyze the Schairer study and to present the actual figures of risk associated with the use of estrogen and estrogen-progestin replacement therapy. Finally, we formulate some suggestions for the physician to whom the patient declares: "Did you read the negative effects of hormones?". What should we advice? [less ▲]

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See detailExiste-t-il des progres dans le traitement du cancer du pancreas metastatique?
Jerusalem, Guy ULg; Bours, Vincent ULg; Fillet, Georges ULg

in Revue Médicale de Liège (2000), 55(3), 146-8

Pancreatic cancer is one of the most lethal cancers in the western world. The authors review the different chemotherapeutic regimens for the palliative approach of this disease. 5-fluorouracil has been ... [more ▼]

Pancreatic cancer is one of the most lethal cancers in the western world. The authors review the different chemotherapeutic regimens for the palliative approach of this disease. 5-fluorouracil has been the only drug with some efficacy for a longtime. Recently a clinical benefit has been obtained with gemcitabine. Polychemotherapy regimens based on gemcitabine, 5-fluorouracil, cisplatin and/or epirubicin have been administered in clinical phase II trials. The superiority of polychemotherapy in terms of palliative benefits or survival is uncertain. Palliative care remains an important issue. [less ▲]

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See detailAdenocarcinome pancreatique: role de l'anatomie pathologique
Delvenne, Philippe ULg; Delvenne, Catherine ULg; Quatresooz, Pascale ULg et al

in Revue Médicale de Liège (2000), 55(3), 135-40

Duct cell adenocarcinoma is by far the most frequent neoplasm of the pancreas, accounting for about 80% of malignant tumors. In this report, we describe the main diagnostic pitfalls of this cancer in ... [more ▼]

Duct cell adenocarcinoma is by far the most frequent neoplasm of the pancreas, accounting for about 80% of malignant tumors. In this report, we describe the main diagnostic pitfalls of this cancer in routine or frozen sections, as well as the help of immunohistology to make the differential diagnosis. We also discuss the potential interest of tumor markers for evaluating the prognosis of these tumors and provide information about the creation of a Web site (URL: http://www.ebm.lib.ulg.ac.be/index.htm) created to help clinicians exploit the laboratory results. [less ▲]

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See detailTomographie a emission de positons au 18FDG et adenocarcinome pancreatique
Daenen, Frédéric ULg; Hustinx, Roland ULg; Belhocine, Tarik et al

in Revue Médicale de Liège (2000), 55(2), 89-94

FDG-PET imaging non invasively studies the glucose metabolism which is usually increased in malignant lesions. We evaluated the clinical performance of PET for detecting pancreatic cancer and its ... [more ▼]

FDG-PET imaging non invasively studies the glucose metabolism which is usually increased in malignant lesions. We evaluated the clinical performance of PET for detecting pancreatic cancer and its recurrence. In our series of 24 studies, PET appears to complement other imaging modalities. As compared to CT, in particular, it demonstrated fewer false positive results in the pancreas and it was also more sensitive. Moreover, whole-body FDG-PET allows for the entire staging of the disease. [less ▲]

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See detailComment j'explore ... la dissection de l'aorte thoracique
Hubin, L.; Hoffer, E.; Ghaye, Benoît ULg et al

in Revue Médicale de Liège (2000), 55(1), 49-56

Thoracic aortic dissection constitutes an acute pathology that requires a rapid, accurate and reliable diagnosis. The authors describe and illustrate the advantages and limitations of imaging modalities ... [more ▼]

Thoracic aortic dissection constitutes an acute pathology that requires a rapid, accurate and reliable diagnosis. The authors describe and illustrate the advantages and limitations of imaging modalities used in this pathology. [less ▲]

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See detailMise au point d'une hyperparathyroidie primitive: apport de la scintigraphie
Brasseur, Edmond ULg; PHILIPS, Jean-Christophe ULg; BELHOCINE, Tarik et al

in Revue Médicale de Liège (2000), 55(1), 39-44

We report a case of hyperparathyroidism whose diagnosis was suspected by a clinical history and confirmed by routine laboratory tests. Scintigraphy has permitted to localize a focalized lesion ... [more ▼]

We report a case of hyperparathyroidism whose diagnosis was suspected by a clinical history and confirmed by routine laboratory tests. Scintigraphy has permitted to localize a focalized lesion corresponding to an adenoma endocrinopathy. The new developments of this imaging technique will be discussed further. Some aspects of physiopathology will be briefly considered and a therapeutic algorithm will be proposed. [less ▲]

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See detailInfo-congres. Recherche en diabetologie: rayonnement europeen de l'Ecole de Liege.
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(10), 960-7

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See detailInfo-congres. L'etude "MIRACL" ou "Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering".
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(12), 1064-6

The results of the "MIRACL" trial ("Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering") were presented at the recent annual meeting of the American Heart Association in New Orleans last ... [more ▼]

The results of the "MIRACL" trial ("Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering") were presented at the recent annual meeting of the American Heart Association in New Orleans last November 2000. This study demonstrates that atorvastatin, at a daily dose of 80 mg starting within the first 24 to 96 hours after an acute coronary event (unstable angina or non-Q-wave acute myocardial infarction) and maintained for 4 months, improves the cardiovascular prognosis by decreasing the combined risk of death (any cause), nonfatal myocardial infarction, resuscitated cardiac arrest and worsening angina with new objective evidence of ischemia requiring urgent hospitalization (-16% versus placebo, p < 0.05). [less ▲]

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