Les traitements chirurgicaux de l'incontinence urinaire d'effort féminine: Où en sommes-nous en 2011?

in Bulletin et Mémoires de l'Académie Royale de Médecine de Belgique (2011), 166(3-4), 157-168

L’incontinence urinaire d’effort (IUE) féminine est principalement liée à une hypermobilité cervico-urétrale. Les bandelettes synthétiques placées sans tension sous l’urètre pour corriger cette ... [more ▼]

L’incontinence urinaire d’effort (IUE) féminine est principalement liée à une hypermobilité cervico-urétrale. Les bandelettes synthétiques placées sans tension sous l’urètre pour corriger cette hypermobilité ont révolutionné le traitement chirugical de l’IUE féminine depuis 15 ans. La technique rétropubienne, à savoir le “tension-free vaginal tape” (TVT), a été mise au point en 1996. Elle génère des taux de guérison de l’IUE élevés mais est associée à un risque de saignement intrapelvien et de perforation vésicale et intestinale. La voie transobturatrice de dedans en dehors, développée il y a huit ans dans notre Institution, connaît une diffusion mondiale. La technique est simple et reproductible et l’incidence des complications péri- et post-opératoires est réduite. Les taux de guérison de l’incontinence d’effort sont de près de 90% après 3-5 ans de suivi, similaires à ceux obtenus après pose d’une bandelette par voie rétropubienne. Nous avons récemment amélioré notre technique originale en utilisant une bandelette plus courte tout en réduisant la dissection nécessaire pour l’insertion de celle-ci. Après un suivi minimal d’un an, cette nouvelle technique apparaît aussi efficace et sécurisante que la technique transobturatrice ‘traditionnelle’ mais occasionne moins de douleurs de cuisse post-opératoires. Nous introduisons ainsi pour la première fois le concept du “midi sling” transobturateur. [less ▲]

Regulation of the activity of monoaminergic neurons by ion channels : an opportunity for new therapeutic approaches ?

in Bulletin et Mémoires de l'Académie Royale de Médecine de Belgique (2008), 163(5), 213-22

p27Kip1 independently promotes neuronal differentiation and migration in the cerebral cortex.

in Bulletin et Mémoires de l'Académie Royale de Médecine de Belgique (2007), 162(5-6), 310-4

The generation of glutamatergic neurons by stem and progenitor cells is a complex process involving the tight coordination of multiple cellular activities, including cell cycle exit, initiation of ... [more ▼]

The generation of glutamatergic neurons by stem and progenitor cells is a complex process involving the tight coordination of multiple cellular activities, including cell cycle exit, initiation of neuronal differentiation and cell migration. The mechanisms that integrate these different events into a coherent program are not well understood. Here we show that the cyclin-dependent kinase inhibitor p27Kip1 plays an important role in neurogenesis in the mouse cerebral cortex, by promoting the differentiation and radial migration of cortical projection neurons. Importantly, p27Kip1 promotes neuronal differentiation and neuronal migration via two distinct mechanisms, which are themselves independent of the cell cycle regulatory function of p27Kip1. p27Kip1 inactivation by gene targeting or RNA interference results in neuronal differentiation and radial migration defects, demonstrating that p27Kip1 regulates cell migration in vivo. The differentiation defect, but not the migration defect, is rescued by overexpression of the proneural gene Neurogenin 2. p27Kip1 acts by stabilizing Neurogenin 2 protein, an activity carried by the N-terminal half of the protein. The migration defect resulting from p27Kp1 inactivation is rescued by blocking RhoA signalling, an activity that resides in the c-terminal half of p27Kip1. Thus, p27Kip1 plays a key role in cortical development, acting as a modular protein that independently regulates and couples multiple cellular pathways contributing to neurogenesis. [less ▲]

Evaluation multiparamétrique du risque cardiaque dans les syndromes coronariens aigus: intérêt des marqueurs biologiques sanguins

in Bulletin et Mémoires de l'Académie Royale de Médecine de Belgique (2007), 162(3-4), 207-215

Endometriosis: from research to clinical practice

in Bulletin et Mémoires de l'Académie Royale de Médecine de Belgique (2007), 162(5-6), 263-72

Endometriosis, defined by the development of endometrial tissue outside the uterus, is a benign disease responsible for infertility and pelvic pain. The diagnosis based on a detailed gynaecological ... [more ▼]

Endometriosis, defined by the development of endometrial tissue outside the uterus, is a benign disease responsible for infertility and pelvic pain. The diagnosis based on a detailed gynaecological history and a careful clinical examination should be done as early as possible in order to treat patients correctly. Medical treatment is not appropriate in all cases and surgical treatment should be proposed but morbidity is related to the severity of the lesion. Ectopic implantation of endometrial cells needs complex interactions between host tissue and epithelial endometrial cells. The conditions for the development of endometriosis are oestrogeno-dependent growth of endometrial cells, induction of angiogenesis and lymphangiogenesis. Principal cellular and molecular factors of angiogenesis, lymphangiogenesis and fibrosis should be identified in order to develop new therapeutic strategies of endometriosis. [less ▲]

Développement d'un modèle d'asthme chez le chat: intérêt vétérinaire et biomedical

in Bulletin et Mémoires de l'Académie Royale de Médecine de Belgique (2005), 160(1-2), 133-9140

Feline asthma is a respiratory disorder, which is poorly studied in veterinary medicine and whose therapeutical approach is not based on pre-clinical or clinical studies. Besides the need to establish ... [more ▼]

Feline asthma is a respiratory disorder, which is poorly studied in veterinary medicine and whose therapeutical approach is not based on pre-clinical or clinical studies. Besides the need to establish therapeutical strategies using bronchodilators and anti-inflammatory drugs, the asthmatic cat presents some interest as animal model of human asthma. Given the body size of a cat and the similarities of pathophysiology between feline and human asthma, simultaneous and repeated investigations of lung function, airway inflammation and airway remodelling in response to an allergic stimulus might be performed in felines. The experimental model of feline asthma developed by our laboratory allows, by respecting animal well-being, (1) the non invasive investigation of lung function and airway responsiveness using barometric whole body plethysmography, (2) the investigation of lower airway inflammation by determining hydrogen peroxide in exhaled breath condensate and by analysing bronchoalveolar lavage fluid, (3) the assessment of morphological changes based on thoracic radiography, bronchoscopic scoring and bronchial biopsies. This experimental model allows, on one hand, to elaborate therapeutical approaches for spontaneously asthmatic cats and, on the other hand, the testing of innovative treatments against asthma. [less ▲]

Nouvelles recherches sur la caractérisation des facteurs de virulence de Microsporum canis.

in Bulletin et Mémoires de l'Académie Royale de Médecine de Belgique (2005), 160(5-6), 270-275

Microsporum canis is a worldwide distributed zoophilic and zoonotic dermatophyte which is responsible for most cases of feline ringworm. Its prevalence is on the rise in developed countries. Since 1995 ... [more ▼]

Microsporum canis is a worldwide distributed zoophilic and zoonotic dermatophyte which is responsible for most cases of feline ringworm. Its prevalence is on the rise in developed countries. Since 1995, the author and his Laboratory have developed a research programme to better understand the pathogenesis of M. canis dermatophytosis. Both the potential fungal virulence factors and the host immune response were investigated. A 31.5 kDa keratinolytic subtilase (SUB) and a 43.5 kDa keratinolytic metalloprotease (MEP) were purified from a crude exoantigen consisted in a mixture of inducible proteins secreted by the fungus in a medium enriched with keratin. Additionally, two gene families encoding respectively 3 SUBs and 3 MEPs, including the 2 keratinases previously purified (called SUB3 and MEP3), were characterized. The genes encoding several MEPs and SUBs were shown to be transcribed in vivo during infection by nested RT-PCR. Finally, we demonstrated that a specific cellular immune response towards the crude exoantigen, MEP3 and SUB3 was induced in experimentally infected guinea pigs. This indicates that the potential immunoprotective properties of these antigens are interesting to evaluate in the frame of the development of an efficient vaccine against feline ringworm. [less ▲]

La varicelle et le zona ou les mystères de la latence d'un virus et de sa réactivation

in Bulletin et Mémoires de l'Académie Royale de Médecine de Belgique (2003), 158(3-4), 169-73174-5

Varicella-zoster virus is a Herpesvirus responsible for three distinct clinical features: chicken pox (varicella), shingles (herpes zoster) and post-zosterian pain (post-herpetic neuralgia). Neurological ... [more ▼]

Varicella-zoster virus is a Herpesvirus responsible for three distinct clinical features: chicken pox (varicella), shingles (herpes zoster) and post-zosterian pain (post-herpetic neuralgia). Neurological features of these diseases such as complications of chicken pox, viral latency in sensory ganglia and reactivation as shingles with concurrent and possibly subsequent prolonged pain, are the sequels of the invasion of the peripheral nervous system during primary infection. Prevention is achieved by vaccination with a live attenuated virus strain and therapy calls for specific antiviral agents. In many respects, vzv behaves differently from close relatives. In particular, viral latency in the nervous system is basically different from that of other Herpesviridae. The recent discovery of the expression of some viral regulatory proteins during latency, although it had always been considered that vzv latency was silent, and demonstration that these proteins are immunogenic open new avenues concerning the immune control of vzv reactivation. [less ▲]

Le gigantisme: un mystère élucidé

in Bulletin et Mémoires de l'Académie Royale de Médecine de Belgique (2002), 157(1-2), 111-7117-9

Acromegaly was first described by Pierre Marie in 1886. Some years later, it became clear that acromegaly and gigantism share the same etiology: GH hypersecretion due to a pituitary adenoma, induces ... [more ▼]

Acromegaly was first described by Pierre Marie in 1886. Some years later, it became clear that acromegaly and gigantism share the same etiology: GH hypersecretion due to a pituitary adenoma, induces gigantism if already present during puberty, or an acromegalic if it appears only during the adulthood. During the XXth century, the disease has been well described and is now well controlled with several treatments. Recently, genetic alterations responsible for the disease have been elucidated. [less ▲]

Obesite: aspects therapeutiques

in Bulletin et Mémoires de l'Académie Royale de Médecine de Belgique (2001), 156(10-12), 471-9480-2

Obesity is now recognized as a chronic disease. Its treatment implies a prolonged negative energy balance, by reducing caloric intake and/or increasing energy expenditure. In practice, three therapeutic ... [more ▼]

Obesity is now recognized as a chronic disease. Its treatment implies a prolonged negative energy balance, by reducing caloric intake and/or increasing energy expenditure. In practice, three therapeutic approaches can be considered: 1) life-style modifications, combining well-balanced hypocaloric diet and regular physical exercise, the key-issue in obesity management; 2) in case of failure and as adjunct treatment, anti-obesity drugs, especially orlistat, an intestinal lipase inhibitor, and sibutramine, a central appetite regulator; and 3) in patients with extreme refractory obesity, surgical procedures consisting of gastric restriction (gastroplasty) or intestinal bypass. Anti-obesity treatments must be evaluated in the long run, in terms of efficacy/safety ratio, upon criteria of weight loss, reduction in associated risk factors, improvement of quality of life and, if possible, reduction of morbidity and mortality. [less ▲]