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See detailComment je traite un patient hypertendu âgé
Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (1994), 49(6), 303-304

La stratégie thérapeutique proposée en pratique est la suivante. 1. Le traitement de personnes âgées hypertendues doit être initié à partir du moment où les valeurs de pression artérielle ont été mesurées ... [more ▼]

La stratégie thérapeutique proposée en pratique est la suivante. 1. Le traitement de personnes âgées hypertendues doit être initié à partir du moment où les valeurs de pression artérielle ont été mesurées à plusieurs reprises et trouvées dépassant les valeurs de 160et/ou 95 mmHg, en raison de la démonstration de l'efficacité certaine de ce traitement dans la diminution de l'incidence des complications cardiovasculaires du patient hypertendu âgé. 2. Le régime sans sel strict doit être évité. Une correction de l'excès de poids doit bien sûr être associée au traitement médicamenteux. 3. Pour le traitement médicamenteux, il est nécessaire de choisir des agents antihypertenseurs dont l'utilisation est bien connue du prescripteur. 4. Ne pas viser d'emblée l'efficacité maximale. Il est conseillé d'augmenter la posologie par palliers successifs. 5. Une surveillance attentive du patient est nécessaire avec recherche des effets secondaires médicamenteux. 6. Si le traitement est inefficace, il est nécessaire de remettre en question ce premier choix. Celui-ci est classiquement un diurétique ou, en cas de contre-indication, un antagoniste calcique. 7. Le schéma thérapeutique doit être facile à comprendre du patient et consister en une prise unique. 8. Rappelons que le but du traitement est de prolonger l'existence du patient tout en assurant une qualité de vie correcte. [less ▲]

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See detailComment je traite un patient hypertendu diabétique de type II
Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (1994), 49(9), 473-474

1. Les patients diabétiques de type II se caractérisent par une prévalence élevée d'hypertension artérielle avec ses conséquences vasculaires sous-tendues par l'insulinorésistance. 2. Le traitement de l ... [more ▼]

1. Les patients diabétiques de type II se caractérisent par une prévalence élevée d'hypertension artérielle avec ses conséquences vasculaires sous-tendues par l'insulinorésistance. 2. Le traitement de l'hypertension artérielle constitue une mesure importante de prévention des complications cardiovasculaires, à côté de la correction d'une dyslipémie, de l'arrêt du tabagisme et de l'équilibre glycémique. 3. L'approche non pharmacologique constitue une première étape obligée mais efficace. 4. Le niveau de pression artérielle à atteindre est inférieur à 130/85 mmHg chez ce type de patient. 5. Le traitement médicamenteux est difficile, lié au risque accru d'effets métaboliques et vasculaires secondaires. 6. Les inhibiteurs de l'enzyme de conversion, les antagonistes calciques et les nouveaux bêtabloquants à propriété vasodilatatrice constituent un excellent premier choix. L'âge et d'éventuelles complications athéroscléreuses, déjà présentes au moment du traitement, orientent ce choix. [less ▲]

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See detailComment je traite une ascite
Gielen, S.; Delwaide, Jean ULg; Detry, Olivier ULg et al

in Revue Médicale de Liège (2001), 56(12), 809-815

Ascites is the most common of the major complications of cirrhosis. The initial evaluation of a patient with ascites should include a history, physical evaluation and some investigations. Treatment should ... [more ▼]

Ascites is the most common of the major complications of cirrhosis. The initial evaluation of a patient with ascites should include a history, physical evaluation and some investigations. Treatment should consist of treating the underlying liver disease, sodium restricted diet (2 g of Na+/day) and diuretics. This regimen is effective in 90 % of patients. The treatment options for the diuretic-resistant patients include serial therapeutic paracentesis, peritoneovenous shunting, TIPSand liver transplantation. The treatment and prophylaxis of spontaneous bacterial peritonitis which is a frequent and severe complication in cirrhotic patients with ascites is also important. The differential diagnosis with secondary bacterial peritonitisis is essential because the latter usually does not resolve unless patients are surgically treated. [less ▲]

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See detailComment je traite … recommandations pour instaurer un traitement medicamenteux
SCHEEN, André ULg

in Revue Médicale de Liège (2014), 69(10), 526-530

Initiating a new pharmacological therapy is an important step in the global medical approach. Such a decision is the final step of a careful reasoning and should respect some rules in order to guarantee ... [more ▼]

Initiating a new pharmacological therapy is an important step in the global medical approach. Such a decision is the final step of a careful reasoning and should respect some rules in order to guarantee the best efficacy, but also safety for the patient. Clinical inertia should be avoided, but the essential principles of the evidence based medicine should also be taken into account. This concise article summarizes the main fundamental rules and cautions that should be respected by any clinician when initiating a new pharmacological therapy. [less ▲]

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See detailComment je traite … Recommandations pour interrompre un traitement médicamenteux
SCHEEN, André ULg

in Revue Médicale de Liège (2014), 69(12), 644-649

L’interruption d’un traitement pharmacologique est une situation clinique fréquente qui peut paraître plus simple à gérer que l’instauration d’un nouveau traitement, mais qui impose néanmoins de remplir ... [more ▼]

L’interruption d’un traitement pharmacologique est une situation clinique fréquente qui peut paraître plus simple à gérer que l’instauration d’un nouveau traitement, mais qui impose néanmoins de remplir certaines conditions et de respecter certaines précautions : 1) pouvoir expliciter les raisons qui justifient l’arrêt du traitement; 2) vérifier qu’il n’y a pas de danger à interrompre le traitement (même si cette interruption est transitoire); 3) savoir comment gérer au mieux l’arrêt de la thérapeutique, en particulier choisir entre une interruption immédiate et une décroissance posologique progressive; et, enfin, 4) assurer un suivi approprié du patient dûment informé chez lequel le traitement vient d’être stoppé. [less ▲]

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See detailComment je traite … Recommandations pour surveiller et optimiser un traitement médicamenteux en cours
SCHEEN, André ULg

in Revue Médicale de Liège (2014), 69(11), 581-585

Any pharmacological treatment should ideally be effective and safe. The supervision of an ongoing therapy should control that individualized goals are reached while tolerance and safety are present. In ... [more ▼]

Any pharmacological treatment should ideally be effective and safe. The supervision of an ongoing therapy should control that individualized goals are reached while tolerance and safety are present. In case of not reaching the predefined objectives, the causes of failure should first be screened (for instance, exclusion of poor patient compliance), and the treatment should be then optimized : dose adjustment, add-on of another drug (if possible synergistic combination) and/or shift to a more effective pharmacological therapy. In some cases, therapeutic monitoring may be useful or even mandatory in order to better adjust drug dosing and thus guarantee both efficacy and safety. [less ▲]

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See detailComment je traite. . . une jeunesse qui s'étiole. Remonter le temps par les peelings chimiques.
Xhauflaire, Emmanuelle ULg; Marcq, V.; Pierard, Claudine ULg et al

in Revue Médicale de Liège (2005), 60(10), 761-6

Chemical peels induce the destruction and exfoliation of the epidermis using selected caustic substances. The specific properties of these agents result in a limited and controlled destruction of ... [more ▼]

Chemical peels induce the destruction and exfoliation of the epidermis using selected caustic substances. The specific properties of these agents result in a limited and controlled destruction of epidermal layers and of the superficial dermis. The choice of the appropriate method, the preparatory phase and the post-peeling care are very important to reach optimal results. Some types of peeling are routinely used. We briefly report those designed for the superficial and medium depth peelings. The topical application of glycolic acid at high concentration induces a superficial peel resulting in shading of small wrinkles. Trichloracetic acid used at an appropriate concentration acts more deeply and thus represents a good indication for more severe signs of ageing. These peels have been used for decades by dermatologists to improve the visible signs of skin ageing and to treat some alterations of the cutaneous relief. [less ▲]

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See detailComment je traite... certaines pathologies cutanées par le biais de l'immunité innée.
Pierard-Franchimont, Claudine ULg; Pierard, Gérald ULg

in Revue Médicale de Liège (2008), 63

L’immunité innée repose sur une organisation biologique complexe qui a des implications certaines dans diverses pathologies, en particulier au niveau de la peau. Son fonctionnement dépend de deux piliers ... [more ▼]

L’immunité innée repose sur une organisation biologique complexe qui a des implications certaines dans diverses pathologies, en particulier au niveau de la peau. Son fonctionnement dépend de deux piliers principaux qui sont les récepteurs PRR (protein recognition receptor) et des peptides antimicrobiens. Chez l’homme, les principaux PRRs sont les Toll-like récepteurs (TLRs) et les peptides antimicrobiens majeurs comprennant les α- et β-défensines, et la cathélicidines. L’expression de ces composants de l’immunité innée est modulée par certains médicaments, ce qui représente un mode d’action qui était resté ignoré par le passé. [less ▲]

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See detailComment je traite... un herpès labial récidivant.
Nikkels, Arjen ULg; Pierard, Gérald ULg

in Revue Médicale de Liège (2008), 63

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See detailComment je traite... un intertrigo lie a l'embonpoint.
Henry, Frédérique ULg; Pierard, Claudine ULg; Flagothier, Caroline ULg et al

in Revue Médicale de Liège (2007), 62(2), 67-70

Intertrigo is a common inflammatory disorder of various origins. It can represent a single skin manifestation or be part of a disorder possibly exhibiting specific manifestations on other parts of the ... [more ▼]

Intertrigo is a common inflammatory disorder of various origins. It can represent a single skin manifestation or be part of a disorder possibly exhibiting specific manifestations on other parts of the body. Hence, intertrigo may represent a sign of a peculiar disease. It may also result from physicochemical aggressions of the skin following occlusion of the large skinfolds particularly in case of stoutness. In this intance, a treatment similar to that of diaper dermatitis can be offered. A paste enriched or not with miconazole nitrate is indicated to prevent or treat most presentations of intertrigo. [less ▲]

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See detailComment je traite... un patient avec une insuffisance cardiaque sévère ou aggravée
Pierard, Luc ULg

in Revue Médicale de Liège (1995), 50(5), 197-8

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See detailComment je traite... un patient diabetique de type 2: le projet "DREAM" pour une meilleure collaboration medecin generaliste-medecin specialiste. Diabetes Reinforcement of Adequate Management.
Scheen, André ULg

in Revue Médicale de Liège (1998), 53(2), 58-62

Type 2 diabetes is an important public health problem because of its high prevalence and morbidity rate which both are associated with a considerable social and human cost. The general practitioner should ... [more ▼]

Type 2 diabetes is an important public health problem because of its high prevalence and morbidity rate which both are associated with a considerable social and human cost. The general practitioner should play a central role in the management of patients with type 2 diabetes and try to meet the therapeutic objectives. Main goals include reinforcement of early diagnosis, by a better screening of individuals at risk for type 2 diabetes, achievement of a good glycaemic control, through an optimized antidiabetic treatment, correction of associated risk factors as well as detection and treatment of disease complications. DREAM ("Diabetes Reinforcement of Adequate Management") is a pilot project which started in Liege area end 1997 for at least 2 years. It aims at improving the management of type 2 diabetic patients through a better free collaboration between general practitioners and diabetologists and the adhesion to an optimized therapeutic strategy. This ambitious project benefits from the valuable support of three pharmaceutical companies. [less ▲]

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See detailComment je traite... Une acné par isotretinoine.
Pierard, Claudine ULg; Nikkels, Arjen ULg; Pierard, Gérald ULg

in Revue Médicale de Liège (2008), 63(3), 115-8

Acne benefits from a series of treatments. The introduction of isotretinoin was a therapeutic breakthrough which considerably improved both the evolution and the prognosis of the disease. Indications of ... [more ▼]

Acne benefits from a series of treatments. The introduction of isotretinoin was a therapeutic breakthrough which considerably improved both the evolution and the prognosis of the disease. Indications of this retinoid kept changing over the past twenty years. New clinical conditions emerged including the management of disease recurrences. The daily dosages must be selected according to the type of acne, the gender of the patient and the pharmaco-economical implications. Teratogenicity must never be neglected as it represents the dreadful adverse event of the drug. A European Directive currently marks out the way to use this retinoid. [less ▲]

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See detailComment je traite... une hidradénite suppurée
Devillers, Céline ULg; Franchimont, Claudine ULg; Pierard, Gérald ULg

in Revue Médicale de Liège (2009), 64

Hidradenitis suppurativa is a chronic and debilitating inflammatory disease. It presents as recurrent abcesses, sinus tracts and scarring. The condition usually develops in the axillae and groins, and ... [more ▼]

Hidradenitis suppurativa is a chronic and debilitating inflammatory disease. It presents as recurrent abcesses, sinus tracts and scarring. The condition usually develops in the axillae and groins, and more rarely involves the breasts, perineum and buttocks. There are many myths around hidradenitis suppurativa including its origin and pathomechanisms. Some antibiotics as well as corticosteroids and other immune downregulators are porly effective in this stubborn condition. By contrast, TNF-α antagonists appear promising. Radical surgery is another effective option. [less ▲]

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See detailComment je traite... une intoxication au paracetamol.
Bertrand, Xavier ULg; Brasseur, Edmond ULg; Ghuysen, Alexandre ULg et al

in Revue Médicale de Liège (2008), 63(7-8), 465-8

Drug self-poisoning is a common cause of admission in ED. Among various incriminated substances, paracetamol is often implicated and presents a severe toxicity. We briefly describe the epidemiology and ... [more ▼]

Drug self-poisoning is a common cause of admission in ED. Among various incriminated substances, paracetamol is often implicated and presents a severe toxicity. We briefly describe the epidemiology and physiopathology of paracetamol self-poisoning. We then clarify the diagnostic elements, thresholds of toxicity, indications for treatment and different available therapeutic guidelines. [less ▲]

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See detailComment je traite.... De la pharmacologie speciale a la therapeutique medicale: plaidoyer pour un enseignement privilegiant l'apprentissage au raisonnement therapeutique, de la decision a la prescription.
Scheen, André ULg

in Revue Médicale de Liège (2000), 55(9), 811-6

Clinical pharmacology and therapeutics are two complementary disciplines which should lead the medical student, through an optimized training, to a rational prescription of drugs, ultimate and important ... [more ▼]

Clinical pharmacology and therapeutics are two complementary disciplines which should lead the medical student, through an optimized training, to a rational prescription of drugs, ultimate and important step of the medical approach. Such a learning should occur progressively throughout the medical education, focusing, first, on the therapeutic reasoning ("why?") and, second, on the practical application leading to the prescription ("how?"). The medical student should learn the difficult task of integrating disease, drug and patient, in order to optimize the benefit/risk ratio, while being informed about new concepts such as "Evidence-Based Medicine" and pharmacoeconomics. [less ▲]

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See detailComment je traite.... la colonisation bactérienne critique d'un ulcère de jambe. Le Yin et le Yang des pansements argentiques.
Pierard, Claudine ULg; Quatresooz, Pascale ULg; Paquet, Philippe ULg et al

in Revue Médicale de Liège (2004), 59(6), 403-6

The critical bacterial colonizaion of leg ulcers can impair their healing rate, aggravate the patient discomfort and increase the medical and nursing costs. In recent times, the dressings designed for leg ... [more ▼]

The critical bacterial colonizaion of leg ulcers can impair their healing rate, aggravate the patient discomfort and increase the medical and nursing costs. In recent times, the dressings designed for leg ulcers have followed a pace of conceptual revolution. Some of them are now offered containing an antiseptic of the silver salt family. The silver concentraton delivered into the wound bed is important to consider when assessing treatment efficacy. The diversity of the silver-based dressings currently on the European market is as large as their differences in activity. Only a minority of these dressings adequately control the wound biocenosis. Their cost which is high for the patient, must be compared to that of nursing care that may become less important. The expected beneficit is a reduction in healing time. [less ▲]

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See detailComment je traite.... Le cancer avance du pancreas par une approche innovante dirigee contre les nouvelles cibles
Polus, Marc ULg; Bours, Vincent ULg; Jerusalem, Guy ULg et al

in Revue Médicale de Liège (2002), 57(7), 428-32

A better knowledge of fundamental mechanisms of carcinogenesis allows the development of novel therapeutic tools specifically targeting the cancer cell. Our understanding of cellular and molecular ... [more ▼]

A better knowledge of fundamental mechanisms of carcinogenesis allows the development of novel therapeutic tools specifically targeting the cancer cell. Our understanding of cellular and molecular mechanisms controlling cellular cycle and cell survival is an important step for new anti-cancer treatments. This review will focus on new therapeutic's strategies in advanced pancreatic cancer. [less ▲]

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See detailComment je traite.... Un cancer du pancreas avance
Polus, Marc ULg; Jerusalem, Guy ULg; Sautois, Brieuc ULg et al

in Revue Médicale de Liège (2002), 57(3), 131-4

Median survival of advanced pancreatic cancer is about three months. Unfortunately, chemotherapy is not a curative approach. Chemotherapy improves the quality of life and overall survival compared to best ... [more ▼]

Median survival of advanced pancreatic cancer is about three months. Unfortunately, chemotherapy is not a curative approach. Chemotherapy improves the quality of life and overall survival compared to best supportive care. Nevertheless, as the overall survival remains disappointing, clinical research must ongoing to define better treatment regimen. [less ▲]

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See detailComment je traite.... Un carcinome basocellulaire par l'imiquimod topique (Aldara).
Pierard-Franchimont, Claudine ULg; Nikkels, Arjen ULg; Paquet, Philippe ULg et al

in Revue Médicale de Liège (2005), 60(4), 207-209

Basal cell carcinoma is the most frequent cancer in humans. Several clinical types are distinguished. They are bound to distinct evolutive prognosis. The surgical excision is the treatment of choice which ... [more ▼]

Basal cell carcinoma is the most frequent cancer in humans. Several clinical types are distinguished. They are bound to distinct evolutive prognosis. The surgical excision is the treatment of choice which is rarely followed by recurrence. However, when the lesion is superficial and non aggressive and when the body site is adequate, topical applications of imiquimod can provoke the neoplastic regression. This type of immunotherapy brings 70 to 90% complete remission. A medical follow-up of the treated site is mandatory for a couple of years. [less ▲]

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