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See detailComment j'explore ... la néphropathie diabétique. Deuxième partie: suivi de la filtration glomérulaire
Weekers, Laurent ULg; Scheen, André ULg; Godon, J. P.

in Revue Médicale de Liège (1998), 53(9), 571-5

The natural history of diabetic renal disease can be divided into different stages according to the degree of albuminuria and the level of glomerular filtration rate (GFR). Assessment of the early ... [more ▼]

The natural history of diabetic renal disease can be divided into different stages according to the degree of albuminuria and the level of glomerular filtration rate (GFR). Assessment of the early hyperfiltration state, as well as determination of the rate of decline in kidney function at a later stage require precise and accurate methods to measure GFR. In this article, we briefly remind the reader of the physiological basis of GFR. We then review the different techniques for the monitoring of kidney function (inulin clearance, endogenous creatinine clearance, plasma disappearance of a radiolabelled tracer) and discuss the pro and cons of each of them in different clinical settings. Finally, we try to define a rational use of these techniques in everyday clinical practice. [less ▲]

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See detailComment j'explore ... la nephropathie diabetique. Premiere partie: micro- et macro-albuminurie.
Weekers, Laurent ULg; Scheen, André ULg; Lefebvre, Pierre ULg

in Revue Médicale de Liège (1998), 53(8), 494-8

Diabetic nephropathy (DN) appears in about 30% of patients with type 1 diabetes (D1) and 15 to 60% of patients with type 2 diabetes (D2). It is preceded by microalbuminuria. Microalbuminuria is defined as ... [more ▼]

Diabetic nephropathy (DN) appears in about 30% of patients with type 1 diabetes (D1) and 15 to 60% of patients with type 2 diabetes (D2). It is preceded by microalbuminuria. Microalbuminuria is defined as an albumin excretion rate between 30 and 300 mg/24 h (on a 24-hour urine collection) or between 20 and 200 micrograms/min (on an overnight collection) in at least two out of three consecutive collections made within a 6-month period. Alternative screening techniques use either dipstick (Micral-Test II) or the albumin to creatinine ratio on an early morning urine sample (30-300 mg/g creatinine). Once persistent microalbuminuria is confirmed, 80% of type 1 diabetic patients and 20 to 50% of type 2 diabetic patients will progress to DN. In D2, microalbuminuria also represents a powerful predictor of early mortality from cardiovascular disease. Macroalbuminuria (AER > 300 mg/24 h, corresponding to a total protein excretion > 500 mg/24 h) will eventually lead to a end-stage renal insufficiency within 10 to 20 years. In D2, numerous patients will die from cardiovascular disease before reaching end-stage renal failure. Angiotensin-converting enzyme inhibitors can slow down the evolution toward DN when prescribed when microalbuminuria appears. Screening for microalbuminuria should therefore be a part of the annual clinical assessment in every diabetic patient. [less ▲]

Detailed reference viewed: 76 (0 ULg)
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See detailComment j'explore ... le controle glycemique des patients diabetiques a domicile.
Scheen, André ULg

in Revue Médicale de Liège (1999), 54(11), 893-7

Self blood glucose monitoring is now a key element in the management of diabetic patients. However, in order to improve overall blood glucose control, self-monitoring should lead to self-management. This ... [more ▼]

Self blood glucose monitoring is now a key element in the management of diabetic patients. However, in order to improve overall blood glucose control, self-monitoring should lead to self-management. This implies that the patient modifies his/her behaviour (diet, exercise, oral antidiabetic agents, insulin doses) to ameliorate the metabolic status according to his/her blood glucose measurements. While the place of home blood glucose monitoring is rather well defined in type 1 diabetes, it remains more controversial in type 2 diabetes. [less ▲]

Detailed reference viewed: 17 (0 ULg)
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See detailComment j'explore ... le nodule pulmonaire solitaire
Bury, Thierry ULg

in Revue Médicale de Liège (1998), 53(6), 370-3

The need to document the nature of a solitary pulmonary nodule is a frequent occurrence in clinical practice. It is also a diagnostic dilemma to the physician. Is it malignant or benign? Should it be ... [more ▼]

The need to document the nature of a solitary pulmonary nodule is a frequent occurrence in clinical practice. It is also a diagnostic dilemma to the physician. Is it malignant or benign? Should it be observed, biopsied or removed? We review what is known about the solitary nodule and discuss the clinical approach to its evaluation. [less ▲]

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See detailComment j'explore ... le risque coronarien individuel extrapole a 10 ans.
Scheen, André ULg; Rorive, Georges ULg; Kulbertus, Henri ULg

in Revue Médicale de Liège (1999), 54(2), 118-21

The European Societies of Cardiology. Atherosclerosis and Hypertension agreed upon a table allowing to evaluate the coronary risk after 10 years according to five parameters (sex, age, smoking, total ... [more ▼]

The European Societies of Cardiology. Atherosclerosis and Hypertension agreed upon a table allowing to evaluate the coronary risk after 10 years according to five parameters (sex, age, smoking, total cholesterol, arterial blood pressure) and aggravating factors (familial history, diabetes mellitus, low HDL cholesterol, hypertriglyceridaemia). The risk level is based upon the equations of the prospective US study of Framingham. The calculation of such a risk is mainly interesting before considering intensified primary prevention in an individual free of any cardiovascular disease. The efforts should first focus on individuals with a high coronary risk, i.e. > 20% after 10 years. As far as secondary prevention is concerned, the patients should always be considered at high risk and beneficiate of all available therapeutic means. [less ▲]

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See detailComment j'explore ... Le risque d'un patient d'evoluer vers un diabete de type 2.
Scheen, André ULg; Paquot, Nicolas ULg; Jandrain, Bernard ULg

in Revue Médicale de Liège (2002), 57(2), 113-5

Both the prevalence and the incidence of type 2 diabetes are increasing rapidly. Effective prevention measures, including lifestyle or drug prescription, have been recently reported. It is thus important ... [more ▼]

Both the prevalence and the incidence of type 2 diabetes are increasing rapidly. Effective prevention measures, including lifestyle or drug prescription, have been recently reported. It is thus important to detect at risk individuals in order to provide appropriate diet and exercise recommendations or even pharmacological treatment. We summarize the most useful indices based on anamnesis, clinical examination and biological assays that can help to detect subjects at high risk of progression towards type 2 diabetes. [less ▲]

Detailed reference viewed: 321 (8 ULg)
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See detailComment j'explore ... le risque metastatique du melanome
Pierard, Gérald ULg; Arrese, J. E.; Pierard-Franchimont, Claudine ULg et al

in Revue Médicale de Liège (2001), 56(2), 120-3

The development of new therapeutic protocols for malignant melanoma calls for an upgraded assessment of the individual risk to develop metastases. The predictive sentinel lymph node method is best ... [more ▼]

The development of new therapeutic protocols for malignant melanoma calls for an upgraded assessment of the individual risk to develop metastases. The predictive sentinel lymph node method is best practiced in a multidisciplinary approach. The selective lymphadenectomy of the first draining lymph node is followed by minutely detailed histologic examination combined with immunohistochemistry. [less ▲]

Detailed reference viewed: 29 (1 ULg)
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See detailComment j'explore ... le syndrome d'Alport par la biopsie cutanée. Quand la peau parle pour le rein.
Delanaye, Pierre ULg; Nikkels, Arjen ULg; Martalo, O. et al

in Revue Médicale de Liège (2002), 57(10), 670-1

Alport's syndrome is a severe hereditary renal disease. Type IV collagen is abnormal in its molecular composition both in the kidneys and the skin. Immunohistochemistry performed on a conventional skin ... [more ▼]

Alport's syndrome is a severe hereditary renal disease. Type IV collagen is abnormal in its molecular composition both in the kidneys and the skin. Immunohistochemistry performed on a conventional skin biopsy allows to prove the diagnosis in the affected subjects and in healthy women exhibiting the mutation on a single X chromosome. [less ▲]

Detailed reference viewed: 101 (16 ULg)
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See detailComment j'explore ... le syndrome d'insulinoresistance grace a ses marqueurs biologiques.
Luyckx, Françoise ULg; Scheen, André ULg; Gielen, Jean-Louis ULg et al

in Revue Médicale de Liège (1997), 52(10), 686-91

Detailed reference viewed: 29 (1 ULg)
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See detailComment j'explore ... les anomalies du metabolisme glucidique, de l'insulinosecretion et de la sensibilite a l'insuline avec une hyperglycemie provoquee par voie orale.
Luyckx, Françoise ULg; Scheen, André ULg

in Revue Médicale de Liège (2000), 55(9), 881-5

Oral glucose tolerance test (OGTT) has been widely used for the diagnosis of diabetes mellitus, gestational diabetes, impaired glucose tolerance or reactive hypoglycaemia. Simultaneous measurements of ... [more ▼]

Oral glucose tolerance test (OGTT) has been widely used for the diagnosis of diabetes mellitus, gestational diabetes, impaired glucose tolerance or reactive hypoglycaemia. Simultaneous measurements of plasma glucose and insulin levels also allow to derive indices of insulin secretion and insulin sensitivity. Whereas OGTT is not considered anymore as the first choice for the diagnosis of diabetes mellitus, it remains useful for studying abnormalities of glucose metabolism as well as of insulin secretion and insulin action. [less ▲]

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See detailComment j'explore ... les dermites des langes.
Flagothier, Caroline ULg; Pierard, Claudine ULg; Pierard, Gérald ULg

in Revue Médicale de Liège (2004), 59(2), 106-9

Diaper dermatitis is a frequent condition. Several clinical types are distinguished. The most frequent type results from increased fragility of the newborn buttock skin when covered by diapers. According ... [more ▼]

Diaper dermatitis is a frequent condition. Several clinical types are distinguished. The most frequent type results from increased fragility of the newborn buttock skin when covered by diapers. According to the mechanisms involved and the severity of the dermatitis, one can distinguish the intertrigo of the chubby baby, and the so-called "W", "Y" and "red panties" types of diaper dermatitis. When the effects of occlusion are not controlled by adequate absorption by the diapers, hyperhydration of the stratum corneum occurs and progresses to maceration. As a result, the value of the coefficient of friction of the skin increases with epidermal weakening to rubbing. In addition, fecal enzymes (urease, proteases and lipases) alter urines and skin. Judicious hygiene measures and the correct choice of diapers are mandatory. Cutaneous colonization by microorganisms, the most important of which being Candida albicans, is the main complication. Adequate preventive and curative measures can combat diaper dermatitis with confidence. A miconazole paste allows to improve the tribological properties of the interface between diapers and the skin. It also abates the impact of Candida albicans in the pathogenesis of the skin disorder. [less ▲]

Detailed reference viewed: 94 (0 ULg)
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See detailComment j'explore ... les differentes formes de diabete sucre: diagnostic differentiel clinique et biologique.
Scheen, André ULg; Philips, Jean-Christophe ULg; Luyckx, Françoise ULg et al

in Revue Médicale de Liège (2001), 56(9), 650-5

Owing to the increasing prevalence of diabetes mellitus and the various aspects of this disease, we present a practical approach which allows the clinician to more easily differentiate type 1 diabetes ... [more ▼]

Owing to the increasing prevalence of diabetes mellitus and the various aspects of this disease, we present a practical approach which allows the clinician to more easily differentiate type 1 diabetes, type 2 diabetes and secondary diabetes of pancreatic origin, i.e. the most common forms of diabetes mellitus. Such an approach uses simple diagnostic criteria, based upon both clinical characteristics (family history, personal history, clinical presentation) and biological markers (C-peptide, autoantibodies,...). A right diagnosis should allow to optimize the management of the diabetic patient. [less ▲]

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See detailComment j'explore ... les pathologies thyroidiennes par cytoponction echoguidee.
Meunier, Paul ULg; Lebrun, Yves ULg; Quatresooz, Pascale ULg et al

in Revue Médicale de Liège (1998), 53(12), 784-787

From a retrospective study of 259 files, the authors stress the value of US-guided thyroid cytoponction and its essential role in case of thyroid cancer suspicion. This very specific and inexpensive ... [more ▼]

From a retrospective study of 259 files, the authors stress the value of US-guided thyroid cytoponction and its essential role in case of thyroid cancer suspicion. This very specific and inexpensive method fits perfectly into the other exploration techniques. It is the deciding factor in the thyroid nodule differential diagnostic and therapeutic planning. [less ▲]

Detailed reference viewed: 62 (4 ULg)
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See detailComment j'explore ... les secrets d'une meta-analyse.
Scheen, André ULg

in Revue Médicale de Liège (2003), 58(1), 41-6

Meta-analysis is becoming a key partner of Evidence-Based Medicine. This statistical tool is currently used in most systematic reviews and allows to quantitatively synthesize the results of several ... [more ▼]

Meta-analysis is becoming a key partner of Evidence-Based Medicine. This statistical tool is currently used in most systematic reviews and allows to quantitatively synthesize the results of several studies by a single weighted average whose precision is indicated by the confidence interval. A standardized graphical representation allows, at first glance, to derive a lot of useful information, especially the number of studies taken into account for the analysis, the mean effect observed in each study with its confidence interval, the relative size (number of subjects) of each study, the homogeneity/heterogeneity of between-study results, finally the overall mean effects with its confidence interval. The meta-analysis plays a key-role in epidemiology, for the evaluation of a risk or a protective factor, and in therapeutics, for summarizing the results of numerous clinical trials with a specific drug or a pharmacological class in a given disease. [less ▲]

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See detailComment j'explore ... les troubles de la calcémie
Janssens, Lise; Krzesinski, Jean-Marie ULg

in Revue Médicale de Liège (1999), 54(9), 764-769

Mechanisms for calcium homeostasis are complex but their understanding is important before investigating the calcium disorders. Hypercalcaemia is often due to hyperparathyroidism or cancers. The ... [more ▼]

Mechanisms for calcium homeostasis are complex but their understanding is important before investigating the calcium disorders. Hypercalcaemia is often due to hyperparathyroidism or cancers. The diagnostis must thus be rapid and a treatment decided in a global approach. Hypocalcaemia, more frequently noted, is often due to a general disorder with hypoalbuminemia or chronic renal failure. [less ▲]

Detailed reference viewed: 309 (28 ULg)
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See detailComment j'explore ... nouveaux critères pour le diagnostic du diabète sucré
Scheen, A. J.; Paquot, Nicolas ULg; Lefebvre, P. J.

in Revue Médicale de Liège (1997), 52(9), 606-9

Detailed reference viewed: 4 (0 ULg)
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See detailComment j'explore ... Sur le plan coronarien, un patient avant chirurgie non cardiaque
Hoffer, E.; Pierard, Luc ULg

in Revue Médicale de Liège (1997), 52(3), 178-82

Detailed reference viewed: 2 (0 ULg)
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See detailComment j'explore ... un cancer broncho-pulmonaire par imagerie metabolique (TEP-18-FDG).
Bury, Thierry ULg; DUYSINX, Bernard ULg; CORHAY, Jean-Louis ULg et al

in Revue Médicale de Liège (2000), 55(3), 178-83

Continuing advances in PET imaging have resulted in an improved ability to evaluate thoracic malignancies. Published reports demonstrate that PET provides accurate noninvasive detection of malignancy that ... [more ▼]

Continuing advances in PET imaging have resulted in an improved ability to evaluate thoracic malignancies. Published reports demonstrate that PET provides accurate noninvasive detection of malignancy that is useful in the characterization of a pulmonary solitary nodule and in the mediastinal or extrathoracic staging of known lung cancer. Preliminary studies suggest that PET may also be able to assess the therapeutic response after surgery or radiation therapy. [less ▲]

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See detailComment j'EXPLORE ... un hypogonadisme hypogonadotrope congenital isole
Valdes-Socin, H.; Debray, François-Guillaume ULg; Parent, Anne-Simone ULg et al

in Revue Médicale de Liège (2010), 65(11), 634-41

Congenital Isolated hypogonadotropic hypogonadism (CIHH) is caused by an inherited mechanism of impairment of the pituitary-gonadal axis, interfering with gonads' control. Currently, different forms of ... [more ▼]

Congenital Isolated hypogonadotropic hypogonadism (CIHH) is caused by an inherited mechanism of impairment of the pituitary-gonadal axis, interfering with gonads' control. Currently, different forms of HHCI with (Kallmann syndrome or KS) or without anosmia-hyposmia are known. There are six forms of KS already described but in several cases no genetic mutation is found. The genetic anomalies already described are: KAL1 (locus Xp23) coding for anosmine-1, KAL-2 or FGFRI (8p11. locus 2 - p11.1) coding for Fibroblast Growth Factor Receptor 1 (FGFR1), KAL4 or PROk2 (locus 3p21.1) and KAL3 or ProKR2 (locus 20p13) coding respectively for the Prokinecitin-2 and its receptor, KAL5 or CHD7 (locus_8q12.1) coding for a chromodomain helicase DNA-binding protein-7 gene (CHD7) and lastly KAL6 or FGF8 (10Q 24 loci) coding for Fibroblast Growth Factor 8. The other genetic anomalies without anosmia are less frequent. These are associated either with Gnrhl gene (8p2-11. 2), GnRHR (4q21.2), GPR54 (19p13),TAC3R or neurokinine receptor 3 (4 q 25), LH (19q13.32) or FSH (11p13). The isolated congenital hypogonadotrophic hypogonadism phenotype is variable depending on gender, the importance of the deficit, and ultimately, according to a specific regulatory mechanism of the axis, affected by an inherited genetic anomaly. In this review, we describe the essential aspects of the different phenotypes and genotypes of HHCI, in order to assess clinicians an early disease's diagnosis and management. [less ▲]

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See detailComment j'explore ... un nez rouge.
Pierard, Claudine ULg; Henry, Frédérique ULg; Rakic, L. et al

in Revue Médicale de Liège (2003), 58(7-8), 515-8

A red nose is a semiological sign shared in common by a series of diseases. The differential diagnosis is important to establish. A careful clinical examination often allows to reach the precise diagnosis ... [more ▼]

A red nose is a semiological sign shared in common by a series of diseases. The differential diagnosis is important to establish. A careful clinical examination often allows to reach the precise diagnosis. A skin biopsy is required when erythema is accompanied by a cutaneous infiltration suggesting some granulomatous and tumoral processes. [less ▲]

Detailed reference viewed: 32 (2 ULg)