Ce cavernome cérébral est-il la cause d'un syndrome parkinsonien ?

in Revue Médicale de Liège (in press)

We report the case of a patient presenting with an akineto-rigid syndrome of the left hemibody whose etiological exploration by magnetic resonance imaging showed the presence of a cavernoma located in the ... [more ▼]

We report the case of a patient presenting with an akineto-rigid syndrome of the left hemibody whose etiological exploration by magnetic resonance imaging showed the presence of a cavernoma located in the right lenticular region. The interest of this situation lies in establishing whether pathophysiological link may exist between such symptoms and the lesion. [less ▲]

Synovite villonodulaire pigmentée du genou

in Revue Médicale de Liège (2013), 68(3), 104-109

This case report is concerned with a 30 year old patient diagnosed with pigmented villonodular synovitis (PVNS) in the knee. The patient underwent an orthopedic surgical operation to remove the lesions ... [more ▼]

This case report is concerned with a 30 year old patient diagnosed with pigmented villonodular synovitis (PVNS) in the knee. The patient underwent an orthopedic surgical operation to remove the lesions. PVNS is a rare proliferative disorder, mostly benign and affecting the knee; its aetiology remains unclear. It represents a medical challenge because of non-specific symptoms that delay the diagnosis with a very high rate of recurrence. MRI imaging is necessary to explore the lesions, but the final diagnosis can only be made after anatomopathologic analysis of the excised lesions. When multiple lesions are present, the treatment consists of their excision by arthrotomy, or by arthroscopy if the disease is localized. [less ▲]

Les réticences à la vaccination : approche du phénomène à travers les données de la littérature

in Revue Médicale de Liège (2013), 68(2), 74-78

Although it exists since vaccination appeared, reticence towards vaccination seems to be increasing. Through a literature review, this article first analyses the reasons for this reticence. The decline of ... [more ▼]

Although it exists since vaccination appeared, reticence towards vaccination seems to be increasing. Through a literature review, this article first analyses the reasons for this reticence. The decline of infectious diseases leads to greater attention to side effects of vaccines; on the other hand, the social evolution leads patients to search for zero risk in different aspects of life. Suspiciousness towards the State and the influence of media emphasizing potential deleterious effects of each vaccine are additional phenomena explaining people’s hesitations. Anti-vaccination movements using Internet to disseminate their ideas are also responsible. Secondly, the article aims at assessing the public opinion about vaccination. It is still predominantly positive, even if questions remain. A typology of four patients’ profiles based on statistical results is proposed. Finally, after having examined the medical doctors’ opinion concerning vaccination, this article ends with some pieces of advice on how to deal with vaccination in the patientdoctor relationship. [less ▲]

Role limite des medicaments hypoglycemiants oraux dans le diabete de type 1.

in Revue Médicale de Liège (2013), 68(1), 16-21

Management of type 1 diabetes essentially relies upon intensive insulin therapy adjusted according to careful home blood glucose monitoring. The potential role of oral antidiabetic agents is controversial ... [more ▼]

Management of type 1 diabetes essentially relies upon intensive insulin therapy adjusted according to careful home blood glucose monitoring. The potential role of oral antidiabetic agents is controversial and what so ever is limited in type 1 diabetes. Nevertheless, metformin may still be useful in the presence of obesity and/or insulin resistance while acarbose could reduce the amplitude of glycaemic fluetuations, namely postprandial hyperglycaemia and late postmeal glycaemic nadir. Both drugs may also minimize weight gain that results from intensive insulin therapy. Finally, inhibitors of dipeptidyl peptidase-4 (glitpins), by inhibiting glucagon secretion, and inhibitors of renal SGLT2 cotransporters, thus promoting glucosuria independently of insulin, might also be beneficial in type 1 diabetes, although specific studies are still ongoing to verify this hypothesis. [less ▲]

L'Hypotension orthostatique: 1ere partie: definition, symptomatologie, evaluation et physiopathologie.

in Revue Médicale de Liège (2013), 68(2), 65-73

Orthostatic hypotension (OH) is defined by a drop in arterial blood pressure (BP) of at least 20 mmHg for systolic BP and 10 mmHg for diastolic BP after standing. Symptoms are generally quite typical, but ... [more ▼]

Orthostatic hypotension (OH) is defined by a drop in arterial blood pressure (BP) of at least 20 mmHg for systolic BP and 10 mmHg for diastolic BP after standing. Symptoms are generally quite typical, but may also be rather vague. Diagnosis may be easily made by the physician in his/ her office, and confirmed, if necessary, by more sophisticated measurements. Pathophysiology is generally rather complex, but mostly involves a defect in the autonomic nervous system, in its sympathetic component. Failure of peripheral vasoconstriction seems to play a more important role than the defect in reflex tachycardia. Causes of OH are multiples. OH may occur in healthy subjects, when exposed to exceptional circumstances, but is more generally associated with various diseases, either neurological disorders or pathologies characterized by hypovolemia. Medications can also aggravate the risk of OH, among which some antihypertensive or psychotropic agents. Elderly people, especially frailty subjects, are exposed to a high risk of OH, whose origin is often multifactorial, and this complication may have serious medical consequences. [less ▲]

Allogreffe de cellules souches hématopoïétiques chez le patient âgé : jusqu'à quel âge ?

in Revue Médicale de Liège (2013), 68(1), 38-43

In the last decades, the upper age limit for allogeneic hematopoietic cell transplantation has increased from 50-60 years to 70-75 years of age, in part due to the development of allogeneic ... [more ▼]

In the last decades, the upper age limit for allogeneic hematopoietic cell transplantation has increased from 50-60 years to 70-75 years of age, in part due to the development of allogeneic transplantation following reducedintensity or truly nonmyeloablative conditioning. This review describes challenges and opportunities of allogeneic hematopoietic cell transplantation in the elderly. [less ▲]

Fibromyalgie: un syndrome d'Ehlers-Danlos de type hypermobile qui s'ignore?

in Revue Médicale de Liège (2013), 68(1), 22-4

Some patients suffering from fibromyalgia present with clinical signs and alterations in the histopathology, immunohistochemistry and ultrastructure of the dermis similar to the Ehlers-Danlos syndrome ... [more ▼]

Some patients suffering from fibromyalgia present with clinical signs and alterations in the histopathology, immunohistochemistry and ultrastructure of the dermis similar to the Ehlers-Danlos syndrome, hypermobile type (EDSH). Some types of fibromyalgia possibly represent an undiagnosed EDSH. [less ▲]

Comment j’explore …Une différence de risque de survenue d’un événement dans les études cliniques

in Revue Médicale de Liège (2012), 67(11), 597-602

Evidence-based medicine often requires the comparison of two therapeutic interventions in controlled clinical trials with the demonstration of a superiority (versus a placebo or an active comparator) or ... [more ▼]

Evidence-based medicine often requires the comparison of two therapeutic interventions in controlled clinical trials with the demonstration of a superiority (versus a placebo or an active comparator) or at least a non-inferiority (versus an active reference) concerning a primary endpoint that has been defined a priori (occurrence of a major clinical event, for instance). The difference in the occurrence of such an event between two treatments may be statistically analyzed by absolute risk reduction, relative risk reduction, hazard ratio or odds ratio. The present article discusses the nuances, sometimes of importance, concerning the significance of these various indices and analyses the cautions to be taken and the pitfalls to be avoided in their interpretation and use in practice. The clinician is, indeed, increasingly confronted to results of clinical trials, but is generally poorly informed regarding the nuances of these various statistical analyses. [less ▲]

L’image du mois: Pli fessier anormal révélant un syndrome de Currarino.

in Revue Médicale de Liège (2012), 67(10)

We briefly report the case of a man carrying an abnormal intergluteal cleft as an isolated manifestation of Currarino's syndrome.

Quel suivi pour les adultes presentant une cardiopathie congenitale?

in Revue Médicale de Liège (2012), 67(7-8), 407-12

During the last decades, the care of children with congenital heart disease has markedly improved. In consequence, the number of those who reach adulthood is continuously growing. In 2010, the European ... [more ▼]

During the last decades, the care of children with congenital heart disease has markedly improved. In consequence, the number of those who reach adulthood is continuously growing. In 2010, the European Society of Cardiology published guidelines for the management of grown-up congenital heart disease (GUCH) and recommended that each GUCH patient should be examined at least once in a specialized center. Due to their specific needs, this population requires specific and organized care. Indeed, GUCH patients do not only have significant extra-cardiac problems, but also present specific cardiac complications such as right ventricular failure, incisionnal arrhythmias. They may require repeated surgical and/ or percutaneous interventions. Since this emerging population is ageing, they also may suffer from arterial hypertension, diabetes and coronary artery disease. Last but not least, young women with congenital heart disease need specialized advice and care for contraception, follow-up during pregnancy and peripartal management. In order to optimize the follow-up of this growing population, a shared care model where cardiologists, specialized GUCH centers and other specialized centers for the treatment of extra-cardiac problems work in tight collaboration is recommended. [less ▲]