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See detailDysthyroidies et dyslipidemies.
Deschampheleire, M.; Luyckx, Françoise ULg; Scheen, André ULg

in Revue Médicale de Liège (1999), 54(9), 746-50

While overt thyroid disturbances, characterized by symptoms and/or clinical signs with abnormal serum levels of thyroid hormones, are generally associated with perturbations in the lipid profile, the ... [more ▼]

While overt thyroid disturbances, characterized by symptoms and/or clinical signs with abnormal serum levels of thyroid hormones, are generally associated with perturbations in the lipid profile, the situation is less clear as far as subclinical thyroid disturbances, defined by isolated abnormalities of thyroid stimulating hormone (TSH) levels, are concerned. In severe hyperthyroidism, a decrease of total cholesterol, LDL cholesterol and apoprotein B concentrations is generally observed. These biological parameters are normalized when appropriate antithyroid treatment is given. In profound hypothyroidism, on the contrary, elevated levels of total and LDL cholesterol levels are observed, which decrease after hormonal replacement. In both cases, the changes in serum levels of HDL cholesterol, triglycerides and lipoprotein (a) are less systematic, both before and after treatment. Lipid abnormalities associated with subclinical thyroid disturbances remain controversial. However, two recent meta-analyses have shown higher LDL cholesterol levels in presence of subclinical hypothyroidism and a significant reduction of such lipid abnormality after administration of thyroxine. Furthermore, they demonstrated a higher prevalence of subclinical hypothyroidism in a population with hypercholesterolaemia when compared to a population with normal cholesterol levels. Finally, a significant reduction in both total and LDL cholesterol concentrations has been reported after administration of thyroxine in a small group of hypercholesterolaemic patients with basal TSH levels in the upper range of normal values. In view of the results of the literature, strategies are proposed to help the clinician in the management of patients with overt or subclinical thyroid disturbances, associated with dyslipidaemia. [less ▲]

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See detailTraitement de l'hyperlipidemie combinee: fibrate ou/et statine?
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(7), 583-7

Combined hyperlipidaemia, associating hypercholesterolaemia and hypertriglyceridaemia, is a common metabolic disorder with a prevalence of about 1/500. It has a genetic background, but its phenotype is ... [more ▼]

Combined hyperlipidaemia, associating hypercholesterolaemia and hypertriglyceridaemia, is a common metabolic disorder with a prevalence of about 1/500. It has a genetic background, but its phenotype is triggered by various predisposing factors such as obesity, type 2 diabetes and alcohol consumption. Combined hyperlipidaemia is undoubtedly associated with an increased cardiovascular risk and thus deserves specific management. After diet failure, the first drug choice remains controversial. Indeed, fibrates are more active on hypertriglyceridaemia while statins are more active on hypercholesterolaemia (LDL subfraction). Both pharmacological classes have their advantages and disadvantages, and there is no prospective study comparing the cardiovascular protective efficacy of these two treatments in patients with such dyslipidemia. Furthermore, monotherapy is generally incapable of normalizing the lipid profile in the presence of severe combined hyperlipidaemia. Ideally, a statin-fibrate combination would be most appropriate in order to act on the two components of such hyperlipidaemia and to benefit of the complementary and additive action of the two pharmacological classes. Such association is still contra-indicated because of the description of some cases of rhabdomyolysis is high risk patients; however, it now deserves much interest and is currently being tested in large prospective studies, especially in the population with type 2 diabetes. [less ▲]

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See detailPharma-clinics le medicament du mois. Le naratriptan (naramig).
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(3), 189-91

Naratriptan, launched by Glaxo Wellcome under the trade name Naramig, is a potent and selective agonist of 5-HT1B and 5-HT1D vascular receptors. Available as tablets of 2.5 mg, it is indicated in the ... [more ▼]

Naratriptan, launched by Glaxo Wellcome under the trade name Naramig, is a potent and selective agonist of 5-HT1B and 5-HT1D vascular receptors. Available as tablets of 2.5 mg, it is indicated in the acute treatment of migraine, with or without aura. A single oral dose of 2.5 mg naratriptan is characterized by a satisfactory clinical efficacy (already significant after one hour, maximum after 4 hours and persisting during 24 hours), a reduction by half of the recurrence of the migraine crisis within the 24 hours and an excellent tolerance profile. [less ▲]

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See detailL' "epidemie" des maladies metaboliques, un probleme majeur de sante publique.
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(2), 87-94

The industrialized world is confronted to a real epidemic of metabolic diseases triggered by overeating and sedentarity. Obesity, hypercholesterolaemia, diabetes mellitus and the metabolic syndrome ... [more ▼]

The industrialized world is confronted to a real epidemic of metabolic diseases triggered by overeating and sedentarity. Obesity, hypercholesterolaemia, diabetes mellitus and the metabolic syndrome associated to insulin resistance are well-known cardiovascular risk factors which all contribute to increase both morbidity and mortality, to alter the quality of life and to markedly increase the budget of the social security. Preventive measures should be taken urgently in order to correct such a dangerous trend for the public health. [less ▲]

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See detailL'etude clinique du mois. L'etude LIPID: "long-term intervention withpravastatin in ischaemic disease".
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(1), 2-3

The LIPID study is a placebo-controlled, double-bind, randomized trial, performed in 9014 patients with coronary heart disease and total cholesterol levels of 155 to 271 mg/dl. After a mean follow-up of 6 ... [more ▼]

The LIPID study is a placebo-controlled, double-bind, randomized trial, performed in 9014 patients with coronary heart disease and total cholesterol levels of 155 to 271 mg/dl. After a mean follow-up of 6.1 years, patients receiving pravastatin (40 mg/day) had significantly (p < 0.001) lower death rate from coronary heart disease (24%), lower overall mortality (22%) and lower incidence of all cardiovascular outcomes (20 to 29% depending on the event). Interestingly enough, the reduction in death from coronary heart disease or nonfatal myocardial infarction was observed whatever the initial cholesterol concentration, and already significant if total cholesterol was < 213 mg/dl and LDL cholesterol was < 135 mg/dl. Thus, in secondary prevention, the favourable effect of the statin on the coronary heart disease outcomes is observed even in case of initial cholesterol levels yet considered as "normal". [less ▲]

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See detailL'etude clinique du mois. La privation chronique de sommeil predispose-t-elle au syndrome plurimetabolique?
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(11), 898-900

According to a recent experimental study published in the Lancet, sleep debt, frequently imposed by the life habits of industrialized countries, results in profound metabolic (impaired glucose tolerance ... [more ▼]

According to a recent experimental study published in the Lancet, sleep debt, frequently imposed by the life habits of industrialized countries, results in profound metabolic (impaired glucose tolerance) and endocrine (increased sympathetic activity and evening cortisol levels) alterations, which mimic those of normal ageing and may have pathophysiological consequences in the long term. Another study recently published in the International Journal of Obesity demonstrated a significant positive relationship between the duration of shift-work and body mass index or waist to hip ratio, a marker of visceral adiposity. One may thus hypothesize that chronic sleep deprivation could predispose to the metabolic syndrome and increase the cardiovascular risk. [less ▲]

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See detailL'etude clinique du mois. Etudes cliniques a long terme (1-2 ans) avec l'orlistat, nouveau medicament pour le traitement de l'obesite.
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(8), 707-9

Orlistat (Xenical), whose original mechanism of action consists of the selective inhibition of gastrointestinal lipases, has been recently commercialized for the treatment of obesity. Despite its recent ... [more ▼]

Orlistat (Xenical), whose original mechanism of action consists of the selective inhibition of gastrointestinal lipases, has been recently commercialized for the treatment of obesity. Despite its recent launch and when compared to common anorectic agents, it has been much better evaluated in long-term trials carried out according to the rules of Good Clinical Practice. We will summarize the four recently published randomized, placebo-controlled, double-blind clinical trials lasting up to 1 to 2 years and evaluating the effects of orlistat 3 x 120 mg/day in obese patients (BMI > or = 28 kg/m2). [less ▲]

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See detailL'obesite feminine: souci esthetique ou probleme medical?
Luyckx, Françoise ULg; Scheen, André ULg; Lefebvre, Pierre ULg

in Revue Médicale de Liège (1999), 54(4), 262-7

Women more and more frequently refer to medical doctors for treating weight excess. Even if the primum movens is usually a pure esthetic concern, medical aspects should not be neglected. Indeed, if ... [more ▼]

Women more and more frequently refer to medical doctors for treating weight excess. Even if the primum movens is usually a pure esthetic concern, medical aspects should not be neglected. Indeed, if obesity with gynoid adipose tissue distribution is less deleterious than android obesity from a metabolic point of view, severe obesity is frequently associated with cardiovascular risk factors which may hinder the prognosis of these female patients. Other complications are common in obese women, such as oestrogen-related cancers, osteoarticular problems and psychological disturbances. Various therapeutic approaches are available which permit an encouraging weight loss and a rapid improvement of risk factors. Unfortunately, long-term results are often disappointing, essentially because of the difficulty to follow on the long term a strict diet regimen and practice physical exercise and because of the usual unrealistic expectations of the obese women who consult medical doctors. [less ▲]

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See detailPharma-clinics. Le medicament du mois. L'aceclofenac (Biofenac).
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(1), 62-4

Aceclofenac, a phenylacetic acid derivative, is a new nonsteroidal anti-inflammatory drug (NSAID). It is indicated in the symptomatic treatment of pain and inflammatory or degenerative arthropathies ... [more ▼]

Aceclofenac, a phenylacetic acid derivative, is a new nonsteroidal anti-inflammatory drug (NSAID). It is indicated in the symptomatic treatment of pain and inflammatory or degenerative arthropathies: osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, abarticular inflammations, posttrauma or postoperative inflammations. The usual oral dosage of aceclofenac is 100 mg twice daily in adults. Its clinical efficacy seems to be similar to that of other NSAIDs, but its safety profile, especially gastro-intestinal tolerance, appears to be better. Finally, in vitro studies suggested that aceclofenac may exert positive effect on cartilage matrix metabolism. [less ▲]

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See detailComment j'explore ... le controle glycemique des patients diabetiques a domicile.
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(11), 893-7

Self blood glucose monitoring is now a key element in the management of diabetic patients. However, in order to improve overall blood glucose control, self-monitoring should lead to self-management. This ... [more ▼]

Self blood glucose monitoring is now a key element in the management of diabetic patients. However, in order to improve overall blood glucose control, self-monitoring should lead to self-management. This implies that the patient modifies his/her behaviour (diet, exercise, oral antidiabetic agents, insulin doses) to ameliorate the metabolic status according to his/her blood glucose measurements. While the place of home blood glucose monitoring is rather well defined in type 1 diabetes, it remains more controversial in type 2 diabetes. [less ▲]

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See detailL'etude clinique du mois. L'etude CAPPP: "The Captopril Prevention Project".
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(3), 197-9

The Captopril Prevention Project (CAPPP) was a prospective, randomized, open trial which aimed at comparing the prevention by captopril (n = 5492) or by a conventional treatment (n = 5493; diuretics or ... [more ▼]

The Captopril Prevention Project (CAPPP) was a prospective, randomized, open trial which aimed at comparing the prevention by captopril (n = 5492) or by a conventional treatment (n = 5493; diuretics or beta-blockers) of cardiovascular morbidity and mortality in patients with hypertension (diastolic blood pressure > 100 mmHg). After a mean follow-up of 6.1 years, the results regarding the primary endpoint and most secondary endpoints were not significantly different between the two therapeutic modalities. The only differences (perhaps due to a randomisation bias) were a slightly higher incidence of stroke, but a lower risk of diabetes mellitus, in the captopril group than in the group receiving conventional treatment. In conclusion, the CAPPP study demonstrates, for the first time, that captopril, an angiotensin-converting-enzyme inhibitor, is as effective as conventional treatment with diuretics or beta-blockers, two drugs whose efficacy has already been demonstrated when compared to placebo, in the prevention of cardiovascular morbidity and mortality in hypertensive patients. [less ▲]

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See detailComment je traite ... une obesite severe et ses anomalies metaboliques par une gastroplastie.
Luyckx, Françoise ULg; Scheen, André ULg; Letiexhe, Michel ULg et al

in Revue Médicale de Liège (1999), 54(3), 138-42

Severe obesity, defined as a body mass index > or = 35 kg/m2, is frequently associated with various biological abnormalities, particularly in the presence of intra-abdominal adiposity. The most important ... [more ▼]

Severe obesity, defined as a body mass index > or = 35 kg/m2, is frequently associated with various biological abnormalities, particularly in the presence of intra-abdominal adiposity. The most important disorders belong to the so-called insulin resistance syndrome, metabolic syndrome or syndrome X: hyperinsulinaemia, impaired glucose tolerance or type 2 diabetes, dyslipidaemias, hyperuricaemia, hyperfibrinogenaemia. All these metabolic abnormalities are considered as cardiovascular risk factors. They are also correlated with the severity of the liver steatosis which is commonly observed in individuals with severe obesity. We report our experience of the evolution of these metabolic abnormalities after a marked weight loss induced by gastroplasty. We will analyse the favourable effects of bariatric surgery on insulin sensitivity, biological components of the metabolic syndrome, type 2 diabetes and liver steatosis. [less ▲]

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See detailPharma-clinics le medicament du mois. L'orlistat (xenical).
Scheen, André ULg; Ernest, Philippe ULg; Letiexhe, Michel ULg

in Revue Médicale de Liège (1999), 54(3), 192-6

Orlistat (tetrahydrolipstatin), launched by Roche under the trade name Xenical, is a selective inhibitor of pancreatic and gastro-intestinal lipases. It reduces the digestion of dietary fat and its ... [more ▼]

Orlistat (tetrahydrolipstatin), launched by Roche under the trade name Xenical, is a selective inhibitor of pancreatic and gastro-intestinal lipases. It reduces the digestion of dietary fat and its resorption through digestive mucosa by around 30%. It is indicated, at a dose of 3 x 120 mg/day (one dose with each meal) and together with a moderately low-calorie and low-fat diet, for the treatment of obesity. It has been shown, in placebo-controlled two-year trials, to almost double the number of obese subjects who succeed in loosing at least 10% of initial body weight. Independently, it contributes to decrease serum cholesterol levels by 6-10%. Because of its mechanism of action, this drug can induce intestinal side-effects which tend to decrease with time and with the reduction of fat intake, thus improving diet compliance. [less ▲]

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See detailLe diabete gestationnel: physiopathologie et signification pronostique pour la mere.
Geronooz, I.; Scheen, André ULg; Lefebvre, Pierre ULg

in Revue Médicale de Liège (1999), 54(5), 434-9

Pregnancy is associated with important changes in mother metabolism, especially in late gestation, among which a decreased glucose tolerance caused by insulin resistance. In some of these women, glucose ... [more ▼]

Pregnancy is associated with important changes in mother metabolism, especially in late gestation, among which a decreased glucose tolerance caused by insulin resistance. In some of these women, glucose intolerance is increased by a defect in B-cell function and diabetes mellitus occurs. These women who develop a gestational diabetes need a close follow-up because they are at high risk for further development of diabetes, especially type 2 diabetes. [less ▲]

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See detailComment j'explore ... le risque coronarien individuel extrapole a 10 ans.
Scheen, André ULg; Rorive, Georges ULg; Kulbertus, Henri ULg

in Revue Médicale de Liège (1999), 54(2), 118-21

The European Societies of Cardiology. Atherosclerosis and Hypertension agreed upon a table allowing to evaluate the coronary risk after 10 years according to five parameters (sex, age, smoking, total ... [more ▼]

The European Societies of Cardiology. Atherosclerosis and Hypertension agreed upon a table allowing to evaluate the coronary risk after 10 years according to five parameters (sex, age, smoking, total cholesterol, arterial blood pressure) and aggravating factors (familial history, diabetes mellitus, low HDL cholesterol, hypertriglyceridaemia). The risk level is based upon the equations of the prospective US study of Framingham. The calculation of such a risk is mainly interesting before considering intensified primary prevention in an individual free of any cardiovascular disease. The efforts should first focus on individuals with a high coronary risk, i.e. > 20% after 10 years. As far as secondary prevention is concerned, the patients should always be considered at high risk and beneficiate of all available therapeutic means. [less ▲]

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See detailLe risque cardio-vasculaire lie a l'hypercholesterolemie: d'un continuum a la notion de normalite, de seuil d'intervention et d'objectif therapeutique.
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(1), 17-21

There appears to be a continuum between the cardiovascular risk and the level of blood cholesterol, which hinders the definition of normal values, intervention threshold and therapeutic goals. The more ... [more ▼]

There appears to be a continuum between the cardiovascular risk and the level of blood cholesterol, which hinders the definition of normal values, intervention threshold and therapeutic goals. The more and more convincing evidences provided by the "Evidence-Based Medicine" should be confronted to the pharmaco-economical constraints in order to first focus the essential of the efforts and resources on the target population with the highest risk. Unfortunately, the therapeutic strategy concerns a rather high percentage of the population of industrialized countries. [less ▲]

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See detailTraitement antimigraineux: présent et avenir
Schoenen, Jean ULg

in Revue Médicale de Liège (1999), 54(2), 79-86

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See detailL'abus de prescription des substances soporifiques, stupéfiantes ou psychotropes
Boxho, Philippe ULg

in Revue Médicale de Liège (1999), 54

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See detailPrise en charge médico-chirurgicale des enfants cardiopathes: résultats de l'expérience liégeoise
Massin, M.M.; RADERMECKER, Marc ULg; Jalali, H. et al

in Revue Médicale de Liège (1999), 54(2), 95-9

OBJECTIVE: Evaluation of the results obtained in the management of congenital heart diseases in Liege. MATERIAL AND METHODS: We evaluated the results, the mortality and the morbidity of diagnostic and ... [more ▼]

OBJECTIVE: Evaluation of the results obtained in the management of congenital heart diseases in Liege. MATERIAL AND METHODS: We evaluated the results, the mortality and the morbidity of diagnostic and interventional cardiac catheterization, and of the cardiac surgery in the 123 cardiac children who were referred to us during the three first years of operation of our medico-surgical team. RESULTS: 89 children underwent a catheterization, including 12 therapeutic interventions, whereas 68 were operated. In the two domains, the results are completely comparable with those of the established centers. CONCLUSIONS: The widening of the activity of paediatric cardiology and the creation of an activity of pediatric cardiac surgery in Liege appeared important to us for the quality of management of the cardiac children. This goal could be reached only if our results were comparable with those of the literature. The bet seems to be held. The ultimate objective is to contribute by an adequate policy of management to the quality of life and the health of the cardiac children. [less ▲]

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See detailLa dysplasie fibromusculaire
VAN DAMME, Hendrik ULg; Quaniers, Janine ULg; Limet, Raymond ULg

in Revue Médicale de Liège (1999), 54(12), 935-42

Fibromuscular dysplasia is a rare non-atherosclerotic, non-inflammatory arterial disease. It concerns less than 1% of all occlusive artery lesions, but is more common in young female patients, with a ... [more ▼]

Fibromuscular dysplasia is a rare non-atherosclerotic, non-inflammatory arterial disease. It concerns less than 1% of all occlusive artery lesions, but is more common in young female patients, with a prevalence of 3 to 5% of the arterial lesions in that age group. It mainly attains renal and carotid arteries. The authors discuss the etiopathogeny, the prevalence and treatment of fibromuscular dysplasia. Their own surgical experience with 21 renal and 10 carotid lesions of fibromuscular is exposed. [less ▲]

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