2021 - volume 76 (1)
|Editorial. From 2020 to 2021: live with COVID-19 without neglecting other pathologies|
|Congenital ocular melanocytosis|
Dequinze M , Borlon A , Bonnet S , Lepièce G
Rev Med Liege 2021, 76(1),2-6
Summary : Congenital oculodermal melanocytosis represents a unilateral accumulation of melanocytes in the episclera, sclera and uveal tract. Clinically, it manifests with iris heterochromia, episcleral and scleral pigmented patches, dark pigmentation of the trabecular meshwork and the fundus. This congenital disorder is a predisposing factor for uveal melanoma and chronic glaucoma. We report here the case of a Caucasian woman who presents some of these characteristics.
|Which place to be reserved to sulphonylureas and which precautions to be taken ?|
Rev Med Liege 2021, 76(1),7-12
Summary : Sulphonylureas (SU) for a long time occupied an essential role in the management of type 2 diabetes (T2D). However, the launch of new oral antidiabetic drugs (OAD), firstly DPP-4 inhibitors (gliptins) and more recently SGLT2 inhibitors (gliflozins), has markedly changed the scene. Indeed, in contrast to SU, these new OAD (of course more expensive) offer the advantage of a very low risk of hypoglycaemia and a beneficial impact on bodyweight. Furthermore, gliflozins have proven to exert a cardiovascular and renal protection in patients at high risk. SU keep a place in the management of T2D, yet it becomes more and more limited. For sure, SU should be avoided among elderly frailty people and patients at high risk of hypoglycaemia.
|Empyema and subacute invasive aspergillosis following drowning|
Debruche M , Vaillant F , Paulus A , Heinen V , Corhay JL , Duysinx B
Rev Med Liege 2021, 76(1),13-17
Summary : Empyema and subacute invasive aspergillosis are rare pathologies that should not be overlooked because of the need for early treatment and a different management of bacterial infections which are more frequent. We report the case of a 75-year-old man with subacute invasive aspergillosis and an empyema following drowning and cardiopulmonary arrest.
|Spontaneous rupture of a splenic artery aneurysm during the third trimester of pregnancy|
Vieujean S , Dauby M , Remacle G , Kridelka F , Dewandre PY , Capelle X
Rev Med Liege 2021, 76(1),18-22
Summary : We report the case of a 24-year-old female patient with spontaneous rupture of a splenic artery aneurysm in the third trimester of pregnancy. Pregnancy, throughout the physiological and hormonal changes it imposes, promotes the occurrence of aneurysm of the splenic artery and its rupture. Although this is a rare complication, its prognosis is severe and its typical clinical picture associating abdominal pain, hypotension and anemia is misleading for the clinician who likelier evokes a retroplacental hematoma or an uterine rupture. The maternal and foetal survival depends on rapid diagnosis and multidisciplinary management. Thus, it‘s important for the clinician to consider this differential diagnosis when abdominal pain or hemoperitoneum occurs in pregnant woman, particularly during the third trimester of pregnancy.
|Acute right heart failure|
Tridetti J , Dumont R , Nguyen Trung ML , Ancion A , Dulgheru E , Hans G , Amabili P , Jacquet O , Lancellotti P
Rev Med Liege 2021, 76(1),23-30
Summary : Even though, it has long been considered as a passive channel allowing communication between the systemic and pulmonary circulations, it is now clearly established that the right ventricle plays an essential role in cardio-pulmonary couple physiology. Its failure results in a clinical presentation that reflects the systemic congestion and reduced cardiac output. It is the consequence of two pathological situations frequently encountered in intensive care including pulmonary vascular resistance increase and right ventricle contraction alteration. Mechanical ventilation, certain drugs and volume overload can also participate. The management of the acute right heart failure is based on the combination of supportive treatment and causal treatment, specific to the etiology. Supportive therapy aims to optimize filling pressures, reduce afterload and support cardiac contractibility. With the growing number of therapeutic options used according to co-morbidities, decision-making by a multidisciplinary heart team seems essential.
|Tobacco and cannabis consumption : toxicity and management of quitting|
Perriot J , Peiffer G , Underner M
Rev Med Liege 2021, 76(1),31-35
Summary : The use of cannabis is most often associated with that of tobacco. While the addictive power of cannabis is low, that of tobacco is high. The regular use of both tobacco and cannabis is at the origin of the increase in dependence on each substance, which makes stopping this double consumption often difficult. This combined use can cause somatic and mental complications. Practitioners should identify this dual use, advise stopping and offer their help after a careful evaluation of both consumptions and their causes. The management includes psychotherapeutic support; If the efficacy of medications to aid stopping cannabis has not been proven to aid in stopping cannabis, nicotine replacement therapy can limit withdrawal syndrome, craving and improve patients’ adherence to monitoring.The mobilization of practitioners in the management of patients and the development of effective cannabis cessation pharmacotherapies are essential.
|Recovery after gynaecological surgery in French-speaking Belgium : survey and recommendation of the GGOLFB surgical working group|
de Landsheere L , Pastijn A , Vasseur S , Smajda S , Dehan C , Keuller H , Dehon S , Nervo P , Goffioul V , Nazac A
Rev Med Liege 2021, 76(1),36-43
Summary : Since the introduction of laparoscopy and mini-invasive techniques, gynaecological surgery has largely evolved. However, post-operative recommendations still remain very restrictive with poor evidence from literature. The survey, performed by the GGOLFB surgical working group, shows that the post-operative advices to the patients are very heterogeneous for the sick leave period as for more specific advices like the period of disallowance of sexual intercourse, bathing and weightlifting. It is nevertheless fundamental to prescribe clear and precise advices to patients, from the first pre-operative consultation on, which will substantially improve the perception of their recovery and promote a return to their normal activity under good conditions. It is not necessary to be too restrictive concerning certain activities in the post-operative period, neither to give too long periods of work incapacity because it may have a negative impact on their quality of life. This survey and the data from literature helped our surgical taskforce group to propose and develop harmonised recommendations on recovery and work incapacity after gynaecological surgery, taking into account the actual surgical practice in 2020.
|Retrospective study of the thyroid balance in pregnant women : definition of TSH and FT4 reference values|
Schoneveld L , Cavalier E , Valdes-Socin H , Grandfils S , Ladang A
Rev Med Liege 2021, 76(1),44-49
Summary : Pregnancy leads to many physiological changes, particularly in the thyroid. This implies that the reference values of the thyroid parameters may change according to the trimesters of the pregnancy and that the management of pregnant women differs. Establishing reference values is not easy and can be done in several ways. In our study, we review the reference values of TSH and FT4 of pregnant women followed up at Liege University Hospital compared to control women. This has been achieved using retrospective data from our laboratory. We show that the small decrease in the TSH reference values in pregnant women is barely visible in a small cohort. Our FT4 values confirm what the literature shows, i.e. a slight increase during the first trimester. We emphasize the difficulty and the relevance of making reference values for pregnant women.
|Mental health of children refugees : a review|
Sadzot P , Malchair A
Rev Med Liege 2021, 76(1),50-55
Summary : This review is devoted to all health professionals in order to raise awareness of the psychopathological consequences of forced migration on the mental health of children. First, we will talk about the psychological consequences of immigration in a global way, and then we will discuss about some specific situations. We will finish with prevention and care of these vulnerable children.
|Which complementary examination does replace a bad clinical examination ? A good clinical examination ! A mood ticket...|
Rev Med Liege 2021, 76(1),56-57
Summary : The writer rebels in a mood ticket on the dictatorship of the complementary examinations at the expense of the clinical approach. She comments on the multiple reasons, medical and medicolegal, which in the 21st century still encourages a good history taking and a good clinical examination.
|How I explore... protrusio acetabuli in children|
Kabore C , Mettepenningen L , Rondia J, Allington N
Rev Med Liege 2021, 76(1),58-63
Summary : Protrusio acetabuli is a clinical entity with variable clinical presentation consisting of a medial deviation of the acetabulum in the pelvic direction. Qualified as a silent deformity in view of its asymptomatic nature until the onset of early degenerative changes, the patient will present with progressive joint pain and stiffness until the development of secondary osteoarthritis. In view of the potentially destructive primary causes associated with the development of secondary protrusion acetabuli, the radiological demonstration of this pathology in young patients cannot be neglected and should lead to the investigation of the underlying pathologies associated with this anomaly. This entity must generate regular clinical and radiological monitoring, and potentially multidisciplinary approach in the event of the appearance of diagnostic criteria for Marfan syndrome, which may vary over time and across individuals.
|Ultra-rapid lispro (Lyumjev®)|
Philips JC , Paquot N
Rev Med Liege 2021, 76(1),64-68
Summary : Development of new insulins aims to mimic in a better way the natural physiology of this hormone secreted by the pancreas. Rapid insulin analogues have proven a better capacity to reduce postprandial glycaemic peaks after eating. Nevertheless, these molecules are still quite inaccurate to limit glycaemic excursions after the meals. This reality is often described by patients using continuous glucose monitoring systems. So, there is undeniably a place for even more rapid insulins. The ones named «ultra-rapid insulin» tend to better control hyperglycaemia after meals thanks to more favourable profiles regarding pharmacodynamics and pharmacokinetics. Ultra-rapid lispro (URLi) Lyumjev®, is the new ultra-rapid insulin available in Belgium. This review aims to describe its advantages compared to some other rapid insulins thanks to data obtained from trials in type 1 and type 2 diabetes.