2018 - volume 73 (4)
|Image of the month : Left ventricle apical aneurism (Apical Outpouching) in a context of apical hypertrophic cardiomyopathy|
|How I treat … an acute otitis media in children|
Heinrichs V , Frère J
Rev Med Liege 2018, 73(4),167-172
Summary : Acute otitis media (AOM) is very common in early childhood (< 2 years). As a spontaneous recovery occurs in > 80 % of cases, antibiotics use should not be systematic. The aim of this review is to discuss AOM diagnostic criteria based on the latest recommendations, aiming a wiser use of antibiotics. Antibiotics use in a child with AOM should take into account the age, the severity of the disease, uni- or bilateral otitis, the presence or absence of otorrhea, and the presence of possible risk factors. Delayed antibiotics prescription might be considered in some specific circumstances. The first line antibiotic treatment is amoxicillin, and increased dosage is efficient in case of resistant pneumococci. Pain evaluation is important, and, in every treatment protocols for AOM, pain-relievers use is needed.
|Coexistence of a disc herniation and psoas hematoma revealed by L3 deficiency|
Bemora JS , Labidi M , Marijon P , Bouazza S , Aldahak N , Froelich S
Rev Med Liege 2018, 73(4),173-175
Summary : Radiculopathy is a constellation of symptoms secondary to a pathology affecting the nerve root, the most frequent cause of which is a herniated intervertebral disc. We report a case of a 58-year-old man under anticoagulant admitted to the neurosurgery department of Lariboisière hospital (Paris) for an L3 motor deficit that occurred progressively over a period of 24 hours with an L3-L4 disc herniation on the MRI. However, a psoas hematoma was also noted. Biological assessments revealed a hemostasis disorder. The final clinical diagnosis was a spontaneous hematoma caused by anticoagulant overdose. Psoas hematomas usually occur in patients with coagulopathy.
|Which place for thiazide and thiazide-like diuretics in patients with type 2 diabetes ?|
Scheen AJ , Krzesinski JM
Rev Med Liege 2018, 73(4),176-182
Summary : The use of thiazides as antihypertensive agents has been challenged because associated metabolic adverse events, including new-onset diabetes. However, these metabolic disturbances are less marked with low-dose of hydrochlorothiazide and with thiazide-like diuretics such as chlorthalidone and indapamide. In post hoc analyses of subgroups of patients with hypertension and type 2 diabetes, thiazide(-like) diuretics resulted in a significant reduction in cardiovascular events, all-cause mortality and hospitalization for heart failure compared to placebo. Furthermore, they were shown to be non-inferior to other antihypertensive agents, including blockers of the renin-angiotensin system in diabetic patients without albuminuria. Benefits attributed to thiazide(-like) diuretics (especially at low dose) in terms of cardiovascular protection outweigh the risk of worsening glucose control and inducing other metabolic disorders in patients with type 2 diabetes. Thus low dose thiazide(-like) drugs still play a major role in the treatment of hypertension in patients with type 2 diabetes.
|Management of renal cell carcinoma associated with an extensive inferior vena cava tumor thrombus|
Battisti C , Sohngen F , Lavigne JP , Andrianne R
Rev Med Liege 2018, 73(4),183-190
Summary : Each main kind of cancer has rather typical or atypical clinical presentations, depending upon several factors related to histopathology or staging. The diagnosis of renal cell carcinoma associated with an extensive inferior vena cava tumor thrombus usually implies prognostic, workup, and surgical management issues. The incidental discovery of this rare clinical entity presented as deep vein thrombosis is narrated, with some therapeutic elements, including an example of alternative surgical treatment. The importance of preoperative assessment - particularly local regarding operability, is emphasized as well.
|Osteoarticular tuberculosis nosology and diagnostic pitfalls|
Kabore C , Poncin M , Hurtgen B , Moerman F , Moonen M
Rev Med Liege 2018, 73(4),191-196
Summary : Osteoarticular or skeletal tuberculosis is a clinical manifestation of extrapulmonary tuberculosis, occurring during the lympho-hematogenous spread of Mycobacterium tuberculosis from a pulmonary primary infection or reactivation of latent infection, years or even decades after the initial infection. Bone and joint tuberculosis is a rare disease with non-specific symptoms and radiological characteristics, often delaying diagnosis for more than a year after clinical onset. First-line hospital departments should develop a clinical suspicion when confronted with a subacute inflammatory bone or joint pathology in patients with underlying comorbidities, especially when coming from tuberculosis-endemic countries. We report a clinical case characterized by lumbar and pelvic abscesses, before addressing in detail the different types of skeletal involvement related to tuberculosis, through a review of the literature.
|Bradykinin and cardiovascular protection. Role of perindopril, an inhibitor of angiotensin conversion enzyme|
Lancellotti P , Ancion A , D’Orio V , Gach O , Maréchal P , Krzesinski JM
Rev Med Liege 2018, 73(4),197-205
Summary : The endothelium plays a vital role as part of the cardiovascular continuum. Risk factors such as hypertension and dyslipidemia unbalance angiotensin II - bradykinin homeostasis, leading to endothelial dysfunction and changes in vascular structure that promote atherosclerosis and thrombosis. When dealing with risk factors, treatment should focus on the prevention and restoration of endothelial function. Not all cardiovascular drugs are able to reverse vascular and structural endothelial dysfunction. Increasing levels of bradykinin is an effect of the use of angiotensin-converting enzyme inhibitors (ACE-Is), and also a fundamental part of their mode of action. The cardiovascular protection observed with ACE-I, and not with sartans, can be explained rationally by the specific effects of bradykinin on the endothelium. In the pharmacological class of ACE-Is, perindopril likely produces the strongest effects on bradykinin, which may explain, at least in part, the documented superiority of this drug in the prevention and treatment of cardiovascular disease.
|Screening of frailty in the Emergency Unit : myth or reality ?|
Rev Med Liege 2018, 73(4),206-210
Summary : At present, it is recognized that screening for frailty in the elderly is a major public health issue. Frailty screening in emergency unit is essential to optimize the management of elderly patients in hospital. Ideally, the role of a mobile geriatric team seems essential, taking over the frailty screening carried out in the emergency department, in order to optimize intra-hospital management and consequently reduce further intra-hospital visits and possible risks of decompensation of geriatric syndromes.
|Faster aspart insulin (FIASP®)|
Paquot N , Scheen AJ
Rev Med Liege 2018, 73(4),211-215
Summary : Fast-acting insulin aspart (faster aspart), commercialized under the trade name of Fiasp®, is insulin aspart in a new formulation aiming to mimic the physiologic prandial insulin release more closely than currently available rapid-acting insulin products. Fiasp® is insulin aspart (NovoRapid®) in which two excipients (L-arginine and niacinamide) have been added, L-arginine serving as a stabilising agent, while niacinamide being responsible for accelerated initial absorption after subcutaneous administration. The pharmacokinetic characteristics of insulin faster aspart have the potential to better reproduce the fast endogenous prandial insulin secretion and thereby to improve postprandial glucose control compared with insulin aspart. The onset phase 3 programme compares head-to-head insulin faster aspart to insulin aspart. Studies showed significant reductions in postprandial glucose increment (in type 1 and type 2 diabetic patients), and glycated haemoglobin (HbA1C, in type 1 diabetes), without markedly increasing the risk of hypoglycaemia. A post hoc analysis of pooled data from six clinical trials conducted in patients with type 1 diabetes confirmed the beneficial pharmacokinetic and pharmacodynamic profiles of insulin faster aspart (earlier plasma insulin appearance, early insulin exposure two times greater and earlier offset of exposure of insulin faster aspart versus insulin aspart).