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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 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 phénotype d’Akhenaton ; revue critique entre canons artistiques et expression pathologique.
JEDIDI, Zayd ULg; JEDIDI, Haroun ULg; LAVEAUX, Elisabeth 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 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 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 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 detailL'image du mois : Le processus thrombotique sous la loupe (microscopie intravitale)
Oury, Cécile ULg; Hego, Alexandre ULg; LANCELLOTTI, Patrizio ULg

in Revue Médicale de Liège (2015), 70(11), 537-539

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See detailREGISTRE BELGE ET CENTRES DE RÉFÉRENCE POUR LES MALADIES TROPHOBLASTIQUES GESTATIONNELLES
DELCOMINETTE, Sarah ULg; TIMMERMANS, Marie ULg; DELBECQUE, Katty ULg et al

in Revue Médicale de Liège (2015), 70(11), 550-556

Gestational trophoblastic diseases include placental pathologies comprising fertilization abnormalities (hydatidiform moles) and malignant lesions (choriocarcinoma, placental site trophoblastic tumor and ... [more ▼]

Gestational trophoblastic diseases include placental pathologies comprising fertilization abnormalities (hydatidiform moles) and malignant lesions (choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor). Due to their low incidence and heterogeneity, their diagnosis, management and treatment are not always optimal. Following the example of other European countries, a national registration system with two reference centers has been set up to guide physicians and patients and to propose individualized management. The centers offer their expertise through a systematic centralised pathology review by a panel of experts. HCG values are plotted in regression curves. In case of gestational trophoblastic neoplasia, an imaging work-up is proposed, from which the FIGO score and stage are derived and will guide the choice of treatment. Belgian centers offer a multidisciplinary approach, in partnership with the referent physician. More information for practitioners and patients is available on a web site: www.mole-chorio-bgog.eu, which also harbours a forum of discussion. [less ▲]

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See detailL’ETUDE CLINIQUE DU MOIS EMPA-REG OUTCOME : L’empagliflozine réduit la mortalité chez le patient diabétique de type 2 à haut risque cardiovasculaire
SCHEEN, André ULg

in Revue Médicale de Liège (2015), 70

Summary : EMPA-REG OUTCOME is an international, prospective, placebo-controlled clinical trial investigating the cardiovascular outcomes of empagliflozin, an inhibitor of sodium-glucose cotransporters ... [more ▼]

Summary : EMPA-REG OUTCOME is an international, prospective, placebo-controlled clinical trial investigating the cardiovascular outcomes of empagliflozin, an inhibitor of sodium-glucose cotransporters type 2 (SGLT2), in patients with type 2 diabetes mellitus and known cardiovascular disease. The trial succeeded in reaching the primary objective of non-inferiority and, in addition, showed, after a median follow up of 3.1 years, a superiority of empagliflozin (10 or 25 mg/day) versus placebo as regards the primary composite cardiovascular endpoint (hasard ratio or HR = 0.86; 95% CI 0.74-0.99; P = 0.04), hospitalisations for heart failure (- 35 %), cardiovascular mortality (- 38 %) and all-cause mortality (- 32 %, each p< 0.001). The reduction in mortality appeared early (< 6 months) and concerned all subgroups, without any obvious heterogeneity. This reduction in mortality does not seem to be fully explained by the concomitant slight reductions in HbA1c, body weight, waist circumference, blood pressure and serum uric acid levels in the empagliflozin groups versus the placebo group. Finally, the tolerance and safety profile of empagliflozin was good, with only a moderate increase in benign mycotic genital infections, a well-known adverse event with SGLT2 inhibitors. The remarkable effects of empagliflozin in the EMPA-REG OUTCOME trial, especially on mortality, should modify the management of patients with type 2 diabetes and a high cardiovascular risk in a near future. [less ▲]

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See detailL’ÉTUDE CLINIQUE DU MOIS TECOS : confirmation de la sécurité cardiovasculaire de la sitagliptine
SCHEEN, André ULg; PAQUOT, Nicolas ULg

in Revue Médicale de Liège (2015), 70

Summary : The cardiovascular safety of sitagliptin has been evaluated in TECOS («Trial Evaluating Cardiovascular Outcomes with Sitagliptin»). TECOS recruited patients with type 2 diabetes and a history of ... [more ▼]

Summary : The cardiovascular safety of sitagliptin has been evaluated in TECOS («Trial Evaluating Cardiovascular Outcomes with Sitagliptin»). TECOS recruited patients with type 2 diabetes and a history of cardiovascular disease who received, as add-on to their usual therapy, either sitagliptin (n = 7.257) or placebo (n = 7.266), with a median follow-up of 3 years. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95 % confidence interval, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95 % CI, 0.83 to 1.20; P=0.98). The cardiovascular safety of sitagliptin, which was already shown in meta-analyses of phase II-III randomised controlled trials and in observational cohort studies in real life, is now confirmed in the landmark prospective cardiovascular outcome study TECOS. [less ▲]

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See detailLe médicament du mois. Humalog® 200 U/ml KwikPenTM
SCHEEN, André ULg

in Revue Médicale de Liège (2015), 70

Summary : Insulin lispro (Humalog®) was the first short-acting insulin analogue to be indicated for the treatment of diabetes mellitus requiring insulin therapy. After subcutaneous injection, insulin ... [more ▼]

Summary : Insulin lispro (Humalog®) was the first short-acting insulin analogue to be indicated for the treatment of diabetes mellitus requiring insulin therapy. After subcutaneous injection, insulin lispro has a more favourable pharmacokinetics/pharmacodynamics profile than human insulin, characterized by a faster resorption and a more rapid and less prolonged glucose-lowering activity. These properties allow a better control of postprandial hyperglycaemia and a reduction of the risk of delayed hypoglycaemia, especially at night. The patient’s quality of life is also improved because insulin lispro can be injected within the 15 minutes before meal and even possibly after meal when the amount of food intake is unpredictable. Already commercialized as Humalog® 100 U/ml, insulin lispro is now also available as Humalog® 200 U/ml. A pharmacokinetics/pharmacodynamics study confirmed the bioequivalence of the two formulations, based upon the analysis of both plasma free insulin concentrations and glucose infusion rates to maintain normoglycaemia. Humalog® 200 U/ml is available in a novel disposable 3 ml pen (KwikPenTM), with lower glide force and injection volume; thus this new pen is more convenient for the patient compared with the current pen used to inject Humalog® 100 U/ml. The new formulation Humalog® 200 U/ml is indicated in Europe for adult patients with type 1 or type 2 diabetes who require more than 20 units of prandial insulin per day to cover their meals. [less ▲]

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See detailNouveaux traitements conservateurs des tendinopathies chroniques
Kaux, Jean-François ULg; Croisier, Jean-Louis ULg; Forthomme, Bénédicte ULg et al

in Revue Médicale de Liège (2015), 70(10), 507-510

The pathophysiological mechanisms of tendinopathies integrate various intrinsic and extrinsic factors. Classic «passive» therapeutics have a limited action. Because of a better pathophysiological ... [more ▼]

The pathophysiological mechanisms of tendinopathies integrate various intrinsic and extrinsic factors. Classic «passive» therapeutics have a limited action. Because of a better pathophysiological understanding of tendinopathies, more recent treatments (injections of various compounds, infiltrations of platelet-rich plasma, stem cells) would lead to a longterm healing. In case of failure of conservative managements and depending on the anatomical site, a surgical approach may be considered. [less ▲]

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See detailAnalyse critique des traitements conservateurs classiques des tendinopathies
KAUX, Jean-François ULg; Croisier, Jean-Louis ULg; Forthomme, Bénédicte ULg et al

in Revue Médicale de Liège (2015), 70(9), 456-460

Les thérapeutiques «passives» classiques (anti-inflammatoires, infiltrations de corticoïdes…) des tendinopathies, utilisées de manière relativement empirique, réduisent la douleur et l’inflammation, sans ... [more ▼]

Les thérapeutiques «passives» classiques (anti-inflammatoires, infiltrations de corticoïdes…) des tendinopathies, utilisées de manière relativement empirique, réduisent la douleur et l’inflammation, sans modifier fondamentalement la structure du tendon, expliquant leur vocable et caractère «passif». La rééducation excentrique a été appliquée aux tendinopathies chroniques, non seulement de par l’échec des traitements classiques, mais aussi en raison d’une meilleure compréhension physiopathologique des tendinopathies. Diverses études soulignent l’efficacité de la rééducation excentrique qui, après 20-30 séances, entraîne la guérison et surtout prévient le risque de chronicité. Les ondes de choc, modifiant la structure tendineuse, permettraient une guérison à plus long terme. [less ▲]

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See detailRupture post-traumatique de l’isthme aortique : perspectives modernes de prise en charge
BRULS, Samuel ULg; GOFFIN, Pierre ULg; Sakalihasan, Natzi ULg et al

in Revue Médicale de Liège (2015), 70(9), 415-22

Traumatic aortic rupture of the thoracic aorta (usually at the isthmus) is frequently associated with concomitant life-threatening injuries. Historically, the conventional care consisted of surgical ... [more ▼]

Traumatic aortic rupture of the thoracic aorta (usually at the isthmus) is frequently associated with concomitant life-threatening injuries. Historically, the conventional care consisted of surgical repair of the lesion performed as soon as possible. However, in spite of constant technical improvements the morbi-mortality remains high because of these associated lesions. In addition, their management can have priority and delay aortic surgery. The endovascular approach has been shown to be a feasible and efficient technique and currently represents a valuable alternative to open surgery for patients with multiple traumas. We report a patient presenting with a traumatic aortic rupture of the aortic isthmus, which was successfully treated by delayed combined endovascular (thoracic aortic stentgrafting) and open approach (hemi-aortic arch debranching). [less ▲]

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See detailLe syndrome tarsien antérieur
MILANTS, Christophe ULg; WANG, François-Charles ULg; Gomulinski, Léon et al

in Revue Médicale de Liège (2015), 70(7-8), 400-404

The anterior tarsal tunnel syndrome is a rare entrapment neuropathy of the deep peroneal nerve beneath the inferior extensor retinaculum of the ankle. It is unrecognized and may lead to misdiagnosis and ... [more ▼]

The anterior tarsal tunnel syndrome is a rare entrapment neuropathy of the deep peroneal nerve beneath the inferior extensor retinaculum of the ankle. It is unrecognized and may lead to misdiagnosis and delayed treatment. We report the case of a 77 years old patient complaining of anterior tarsal tunnel syndrome’s symptoms with neuropathic pain located at the dorsal part of the foot without any sensorimotor loss. The electroneuromyography was in favour of the motor impairment of the deep peroneal nerve. MRI exploration of the ankle showed a millimetric bony overgrowth of the upper pole of the navicular irritative to the deep peroneal nerve. Infiltration at overgrowth of the navicular provided a partial and temporary decrease in pain symptoms. Surgical nerve decompression was then considered. [less ▲]

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See detailTraitement personnalisé dans l'asthme : le cas des anticorps monoclonaux dirigés contre l'interleukine-5.
LOUIS, Renaud ULg; Demarche, Sophie ULg; Van Hees, Thierry ULg et al

in Revue Médicale de Liège (2015), 70(5-6), 306-9

Asthma is a chronic inflammatory disease that often features eosinophilia, especially in its most severe forms. Monoclonal antibodies directed towards interleukin-5, such as mepolizumab or reslizumab ... [more ▼]

Asthma is a chronic inflammatory disease that often features eosinophilia, especially in its most severe forms. Monoclonal antibodies directed towards interleukin-5, such as mepolizumab or reslizumab, were shown to be very effective at reducing blood and airways eosinophilia. When administered monthly by intravenous or subcutaneous injection in severe eosinophilic asthmatic patients, they reduce severe exacerbation rate by 50 %, improve asthma control and quality of life, and have an oral glucocorticoids sparing effect in those requiring oral corticoids as maintenance therapy. [less ▲]

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See detailLe cas clinique du mois : prise en charge d'une hypophosphatémie
HUART, Justine ULg; DUBOIS, Bernard ULg; Krzesinski, Jean-Marie ULg et al

in Revue Médicale de Liège (2015), 70(4), 163-168

Hypophosphatemia is defined by a serum phosphate level lower than 0.8 mmol/l. If hypophosphatemia is chronically maintained, it is associated with muscular, osteous, neurological or cardio-respiratory ... [more ▼]

Hypophosphatemia is defined by a serum phosphate level lower than 0.8 mmol/l. If hypophosphatemia is chronically maintained, it is associated with muscular, osteous, neurological or cardio-respiratory disorders. We describe a patient with isolated hypophosphatemia, detail the mechanisms of phosphate homeostasis, and envisage the differential diagnosis of hypophosphatemia. Furthermore, we propose a sequential decisional algorithm based on basic biological tests and few complementary investigations. Treatment options are reviewed. [less ▲]

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