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See detailComment je traite… L’insomnie chronique par la thérapie comportementale et cognitive
Dethier, Marie ULg; Blairy, Sylvie ULg; POIRRIER, Robert ULg

in Revue Médicale de Liège (in press)

L’insomnie est actuellement traitée majoritairement par la pharmacothérapie. Or la thérapie comportementale et cognitive pour l’insomnie présente une meilleure efficacité à long terme que celle-ci. Dans ... [more ▼]

L’insomnie est actuellement traitée majoritairement par la pharmacothérapie. Or la thérapie comportementale et cognitive pour l’insomnie présente une meilleure efficacité à long terme que celle-ci. Dans cet article nous décrivons les principes de base de ce traitement psychothérapeutique de courte durée. Il s’agit de combiner des méthodes de restriction de sommeil, de contrôle des stimuli en lien avec le sommeil, d’apprentissage de techniques de relaxation, des conseils sur l’hygiène de sommeil et des techniques de thérapie cognitive appliquées aux cognitions envahissants les moments d’insomnie. [less ▲]

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See detailLe point sur l’évaluation de la force des muscles respiratoires
Kellens, Isabelle ULg; Crielaard, Jean-Michel ULg

in Revue Médicale de Liège (in press)

The strength of respiratory muscles is crucial for quality of life, especially for patients with lung or neurological disorders. Several methods can be used to assess them: i.e direct or indirect ... [more ▼]

The strength of respiratory muscles is crucial for quality of life, especially for patients with lung or neurological disorders. Several methods can be used to assess them: i.e direct or indirect, voluntary or involuntary. The conventional spirometry method assesses indirectly the respiratory function by measuring maximum inspiratory and expiratory pressure, which reflects the coordination of all respiratory muscles. Techniques of magnetic and electrical stimulation can detect a specific muscle dysfunction, independently of the patient's motivation, however they are invasive methods as measurements are made in the esophagus and stomach. The voluntary techniques are generally non-invasive and require patient's cooperation. Measures of respiratory muscle strength, coupled to a conventional spirometry, can predict the development of ventilatory support in patients at risk, and may be useful during weaning from mechanical ventilation in intensive care units. [less ▲]

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See detailLe phénotype d’Akhenaton ; revue critique entre canons artistiques et expression pathologique.
JEDIDI, Zayd ULg; JEDIDI, Haroun ULg; LAVEAUX, Elisabeth ULg et al

in Revue Médicale de Liège (in press)

Of all the royal families of ancient or modern fame, few are as iconic as the eighteenth dynasty of pharaohs of the New Kingdom of Egypt, whose opulence and deeds we are still familiar to nearly 3,500 ... [more ▼]

Of all the royal families of ancient or modern fame, few are as iconic as the eighteenth dynasty of pharaohs of the New Kingdom of Egypt, whose opulence and deeds we are still familiar to nearly 3,500 years after their time. Tenth pharaoh of this dynasty and father of Tutankhamun, Akhenaten (Amenhotep/Amenhotep IV) still fascinates Egyptologists and history lovers through the many questions surrounding his atypical rule. One of the most striking aspects of the so-called Amarna period concerns the representations of the pharaoh himself, very confusing compared to the traditional iconography of the New Kingdom. These intriguing portraits of Pharaoh raised a whole lot of medical assumptions, more or less substantiated. We review here the main theories developed throughout history. [less ▲]

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See detailLa polykystose rénale autosomique dominante : comment et pourquoi identifier les patients "rapidement progresseurs" vers l'insuffisance rénale terminale?
bodson, aurélie; MEUNIER, Paul ULg; Krzesinski, Jean-Marie ULg et al

in Revue Médicale de Liège (2016), 71(4), 184-192

Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited disease characterised by the progressive development of multiple and bilateral cysts in kidneys and other organs. Most patients ... [more ▼]

Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited disease characterised by the progressive development of multiple and bilateral cysts in kidneys and other organs. Most patients with ADPKD will develop, sooner or later, end-stage renal disease (ESRD). The morbidity and mortality associated with ESRD prompt physicians to identify early ADPKD patients considered as «rapid progressors», who have the greatest risk to rapidly develop ESRD. The rate of progression can be assessed by clinical - especially with the «predicting renal outcome in polycystic kidney disease score» (PROPKD-Score) -, biological (a decline of the glomerular filtration rate (GFR) of 4,4 - 5,9 ml/min/year and/or the doubling of serum creatinine within a 36-month period), or radiological criteria (total kidney volume (TKV) adjusted for the size > 600 cc/m and/or TKV annual growth rate > 5 %). Nowadays, there is no curative treatment for ADPKD. However, vasopressin-2 receptor antagonists, such as tolvaptan, appear to slow down the growth of renal cysts and the slope of GFR decline. The current management of ADPKD patients is mostly based on correcting the risk factors for progression, i.e. encouraging (over)-hydration, normalizing blood pressure, stimulating smoking cessation. [less ▲]

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See detailLa vignette diagnostique de l’étudiant. L’importance du facteur temps et de la chronologie des événements dans l’anamnèse médicale
SCHEEN, André ULg

in Revue Médicale de Liège (2016), 71

Summary : Medical history taking represents a key step in the diagnostic approach. A structured interview with a special attention to the chronology of events is mandatory. The medical student often fails ... [more ▼]

Summary : Medical history taking represents a key step in the diagnostic approach. A structured interview with a special attention to the chronology of events is mandatory. The medical student often fails to use the information on time in an optimal way. The aim of this article is to draw the attention on a few key elements, especially the age of the patient, the duration of symptoms, the time of occurrence of complaints within the 24h period and, finally, how to interpret the simultaneous or sequential occurrence of two (or more) events. [less ▲]

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See detailLe médicament du mois. Le dulaglutide (Trulicity®) : Nouvel agoniste des récepteurs du Glucagon-Like Peptide-1 en injection hebdomadaire pour traiter le diabète de type 2
SCHEEN, André ULg

in Revue Médicale de Liège (2016), 71

Summary : Dulaglutide (Trulicity®) is a new once-weekly agonist of Glucagon-Like Peptide-1 (GLP-1) receptors indicated in the treatment of type 2 diabetes. Phase III clinical trials in AWARD programme ... [more ▼]

Summary : Dulaglutide (Trulicity®) is a new once-weekly agonist of Glucagon-Like Peptide-1 (GLP-1) receptors indicated in the treatment of type 2 diabetes. Phase III clinical trials in AWARD programme demonstrated the efficacy and safety of dulaglutide in patients with type 2 diabetes treated by diet and exercise, metformin, a combination of metformin and a sulfonylurea or metformin and pioglitazone or even by supplements of prandial insulin. In the AWARD programme, dulaglutide (subcutaneous 0.75 or 1.5 mg once weekly) exerted a greater glucose-lowering activity than metformin, sitagliptin, exenatide or insulin glargine, and was non-inferior to liraglutide 1.8 mg once daily. Dulaglutide is currently reimbursed in Belgium after failure of and in combination with a dual oral therapy with metformin and a sulfonylurea or metformin and pioglitazone. [less ▲]

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See detailCOMMENT J'EXPLORE... LA BIPOLARITE EN PEDOPSYCHIATRIE : UNE SEMIOLOGIE DIMENSIONNELLE
SCHOLL, Jean-Marc ULg

in Revue Médicale de Liège (2016), 71(2), 94-100

Despite its high frequency, bipolarity in childhood is little understood and is often diagnosed only after several years of development, and this during a time when the child’s psychosocial future is at ... [more ▼]

Despite its high frequency, bipolarity in childhood is little understood and is often diagnosed only after several years of development, and this during a time when the child’s psychosocial future is at stake. A proper diagnosis requires recognition of accurate clinical signs. It is therefore essential to furnish clinicians with precise semiological markers. This paper presents a dimensional semiology for use in anamnesis and in clinical observation of the child. These clinical signs enable the identification of a bipolar manic temperament in the child and/or the identification of various different forms of childhood bipolar and depressive disorder. The relevant differential diagnoses and comorbidities are also presented. [less ▲]

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See detailLe médicament du mois. Insuline glargine 300 U/mL (Toujeo®)
SCHEEN, André ULg

in Revue Médicale de Liège (2016), 71

Summary : This article presents a new formulation of insulin glargine concentrated at 300 U/mL (Gla-300). It is commercialized under the trade name of Toujeo® in an optimized pre-filled SoloStar™ pen for ... [more ▼]

Summary : This article presents a new formulation of insulin glargine concentrated at 300 U/mL (Gla-300). It is commercialized under the trade name of Toujeo® in an optimized pre-filled SoloStar™ pen for the treatment of type 1 and type 2 diabetes in adults. Besides a threefold higher concentration compared to the classical insulin Lantus® (100 U/mL or Gla-100), both pharmacokinetic and pharmacodynamic profiles of Gla-300 are flatter and longer (more than 24 hours) and have a lesser intra-/inter-variability, which makes them more reproducible. Overall, Toujeo® offers the same hypoglycaemic efficacy and the same safety profile when compared with Lantus®. However, a lower risk of hypoglycaemia, especially at night, a slightly smaller weight gain and a better flexibility in the time of injection have been reported. The two insulin formulations are not bioequivalent and the daily insulin requirement is slightly higher with insulin Gla-300 than with insulin Gla-100. The shift from an already available basal insulin towards Toujeo® may require a dose adjustment and a reinforcement of blood glucose monitoring. [less ▲]

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See detailComment je traite... la sténose aortique asymptomatique
MEURICE, Caroline ULg; DULGHERU, Raluca Elena ULg; PIERARD, Luc ULg

in Revue Médicale de Liège (2016), (71), 6-10

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See detailPremière consultation de contraception chez les adolescentes
BELIARD, Aude ULg

in Revue Médicale de Liège (2016), 71(1), 28-33

Adequate contraception prescription is mandatory for teenagers to avoid any unwanted pregnancy. Counselling and description of side effect improve compliance. Use of condom is important to avoid sexually ... [more ▼]

Adequate contraception prescription is mandatory for teenagers to avoid any unwanted pregnancy. Counselling and description of side effect improve compliance. Use of condom is important to avoid sexually transmitted infections. Combined estroprogestin contraception has multiple non-contraceptive benefits, e.g. dysmenorrhea improvement. Familial and personal history is needed before contraception prescription. Further consultation 3 months later has to be planned to evaluate compliance, side effects and to adapt contraception if needed. [less ▲]

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See detailLE CAS CLINIQUE DU MOIS Thrombose veineuse ovarienne gauche et extension à la veine rénale
JEAN, FLORENCE; CLAUDOT, A.; ISTACE, B. et al

in Revue Médicale de Liège (2016), 71(1), 17-21

Ovarian vein thrombosis is a rare, but potentially serious postpartum complication. In 80 % of the cases, it occurs on the right side and in less than 6 % on the left side; it is bilateral in 14 % of ... [more ▼]

Ovarian vein thrombosis is a rare, but potentially serious postpartum complication. In 80 % of the cases, it occurs on the right side and in less than 6 % on the left side; it is bilateral in 14 % of cases. The usual clinical features include abdominal pain, fever and leucocytosis. However, the diagnosis is often complicated by other non specific signs and symptoms. Ovarian vein thrombosis may cause sepsis, pulmonary thromboembolism, and thrombosis of the inferior vena cava and the renal vein. The diagnosis can be established by CT scan or nuclear magnetic resonance imaging, which has a high sensitivity and specificity. Treatment for the ovarian vein thrombosis includes antibiotics and anticoagulation. The complications can sometimes be surgically managed. Prompt diagnosis and treatment can decrease the morbidity and the mortality. Nowadays, the fatal issue is rare as the appropriate treatment is quickly instaured. [less ▲]

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See detailUne présentation rare de craniosténose associée à un crâne lacunaire
Vaessen, françois; Thimmesch, Mathieu; BORN, Jacques et al

in Revue Médicale de Liège (2016), 71(3), 120-123

A rare case of lacunar skull deformity associated with craniosynostosis Summary : The lacunar skull is a radiologic description characterised by the presence of lacunae in the cranial vault. Its ... [more ▼]

A rare case of lacunar skull deformity associated with craniosynostosis Summary : The lacunar skull is a radiologic description characterised by the presence of lacunae in the cranial vault. Its physiopathology remains up to now poorly understood; it is mostly associated with neural tube defects. The association of a lacunar skull with a craniosynostosis has rarely been described in the literature. The case of a 9-month-old patient presenting a multisutural craniosynostosis with a lacunar skull is reported in this article. The surgical treatment allowed to remodel the skull and to hope for a spontaneous regression of the lacunae. [less ▲]

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See detailApport du cathétérisme cardiaque dans le diagnostic et le traitement de la maladie coronarienne avant 40 ans
MEURICE, Caroline; LEGRAND, Victor ULg; PIERARD, Luc ULg

in Revue Médicale de Liège (2016), 71(3), 129-136

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See detailLes croyances délétères des patients lombalgiques : revue narrative de la littérature
Demoulin, Christophe ULg; Roussel, Nathalie; Marty, Marc et al

in Revue Médicale de Liège (2016), 71(1), 40-46

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See detailFacteurs pronostiques du cancer pulmonaire non à petites cellules
GESTER, Fanny; PAULUS, Astrid ULg; SIBILLE, Anne ULg et al

in Revue Médicale de Liège (2016), 71(1), 34-39

Summary : Non small cell lung cancer is the most frequent type of lung cancer and its prognosis is still very poor. Relapse is frequent and can be observed even in early stages of the disease, in spite of ... [more ▼]

Summary : Non small cell lung cancer is the most frequent type of lung cancer and its prognosis is still very poor. Relapse is frequent and can be observed even in early stages of the disease, in spite of a surgical management with curative intent. This paper gives an overview of the main prognostic factors, the two most important of which remain the staging and tumor histology. These also determine the therapeutic strategy. Other factors of poor prognosis might also be useful for clinicians, particularly in their decision to refer patients for adjuvant therapies. Keywords : Non-small cell lung cancer – Prognostic factors – Pulmonary oncology – Surgery [less ▲]

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See detailComment j'explore le malaise du nourrisson
Zambelli, Laura ULg; Battisti, Oreste ULg

in Revue Médicale de Liège (2016), 71

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See detailTribulations d’une vieille dame : De la « loi relative aux anormaux et délinquants d’habitude » à la « loi relative à l’internement des personnes atteintes d'un trouble mental »
Garcet, Serge ULg

in Revue Médicale de Liège (2015), 70e année

Le système belge de prise en charge des délinquants atteints de troubles mentaux est organisé selon un principe de défense sociale. Il se caractérise par une double attention pour, d’une part, la ... [more ▼]

Le système belge de prise en charge des délinquants atteints de troubles mentaux est organisé selon un principe de défense sociale. Il se caractérise par une double attention pour, d’une part, la protection de la société par une neutralisation du risque et, d’autre part, la nécessité de soins à prodiguer à la personne internée. L’évolution du cadre juridique de la loi de 1930 relative aux anormaux et délinquants d’habitude à la loi relative à l’internement des personnes atteintes d'un trouble mental de 2014 rend compte des vicissitudes nées du tiraillement entre ces deux piliers sécuritaire et thérapeutique. Dans ce difficile rapport de forces, bien que publiée mais pas encore d’application, la version de 2014 de la loi constitue à bien des égards une évolution positive dans la prise en compte des personnes internées et de leurs besoins. [less ▲]

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See detailComment je traite ... A propos du positionnement des inhibiteurs de la DPP-4 (gliptines) dans le traitement du diabète de type 2
SCHEEN, André ULg

in Revue Médicale de Liège (2015), 70

Summary : Dipeptidyl peptidase-4 (DPP-4) inhibitors (gliptins) are more and more prominent medications in the management of type 2 diabetes (T2D), with five molecules commercialized and as many fixed-dose ... [more ▼]

Summary : Dipeptidyl peptidase-4 (DPP-4) inhibitors (gliptins) are more and more prominent medications in the management of type 2 diabetes (T2D), with five molecules commercialized and as many fixed-dose combinations with metformin. After failure of metformin monotherapy, gliptins compete with old medications such as sulphonylureas, on the one hand, or with new oral antidiabetic agents such as inhibitors of renal sodium-glucose cotransporters type 2 (SGLT2) (gliflozines), on the other hand. Another alternative is the use of an incretin mimetic (agonist of glucagon-like peptide-1 receptors, to be injected subcutaneously) rather than an incretin enhancer such as a gliptin, before considering insulin therapy. This article analyses the arguments in favour of DPP-4 inhibitors. We will mainly consider the use of gliptins in patients with recently diagnosed T2D, in elderly and frail patients and in those with chronic kidney disease. To illustrate the discussion, we will analyze the results of both interventional and observational studies with vildagliptin. Obviously, these various groups of patients represent a large proportion of T2D population. [less ▲]

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See detailPRISE EN CHARGE DES TUMEURS EPITHELIALES THYMIQUES
PAULUS, Astrid ULg; SIBILLE, Anne ULg; BOURHABA, Maryam ULg et al

in Revue Médicale de Liège (2015), 70(12), 623-8

Thymic epithelial tumors (TET) are rare. Their optimal care is still poorly defined because of their rarity and of the resulting difficulty to conceive large clinical trials. This review of the literature ... [more ▼]

Thymic epithelial tumors (TET) are rare. Their optimal care is still poorly defined because of their rarity and of the resulting difficulty to conceive large clinical trials. This review of the literature presents the current clinical and therapeutic data on this form of tumors and underlines the need for a multidisciplinary approach to advanced stage TET. Three clinical situations can be encountered: encapsuled tumors lead to radical surgery; tumors associated with capsular invasion justify a postoperative radiotherapy; advanced stages require a multimodal treatment by chemotherapy, possibly completed by surgery and adjuvant radiotherapy. Besides systemic chemotherapies, the place of new therapeutic strategies, such as somatostatin analogues and targeted treatments, requires to be defined. Treatment of late stage TET is based upon a multidisciplinary dialogue, ideally by a reference team. [less ▲]

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