2017 - volume 72 (12)
|Image of the month. Dermatitis Artefacta.|
|Endocarditis of mitral and aortic prosthetic heart valves caused by Aggregatibacter aphrophilus|
B. Deleixhe , F. Frippiat , P. Léonard , N. Withofs , C. Meex , L. Piérard , M. Moutschen
Rev Med Liege 2017, 72(12),522-528
Summary : We present the case of an acute endocarditis of mitral and aortic prosthetic heart valves caused by Aggregatibacter aphrophilus (Haemophilus aphrophilus-paraphrophilus). This third report in the literature emphasizes the diagnostic work-up and the role of positron emission tomography combined with computed tomography in this setting. The specificities of endocarditis due to the HACEK group (Haemophilus spp., Aggregatibacter, Cardiobacterium hominis, Eikenella corrodens and Kingella spp.) and the specific microbiological data and therapeutic options pertinent to this germ are discussed.
|Post-obstructive diuresis : diagnosis and management|
M. Piraprez , K. Quinonez , M. Sempels , D. Waltrégny , J.-M. Krzesinski , F. Jouret
Rev Med Liege 2017, 72(12),529-533
Summary : The syndrome of “post-obstructive diuresis” corresponds to a massive polyuria and natriuresis occurring after the drainage of an obstructive acute kidney injury. Such a complication needs to be readily detected and managed because of the significant risk for haemodynamic disorders. On the basis of a clinical observation, we describe the pathophysiology of post-obstructive diuresis, as well as its diagnostic and therapeutic management.
|Incidence and treatment of complications observed after endoscopic mucosal resection of superficial digestive tumours in a regional general hospital|
J. M. Deflandre , B. Delhougne , B. Servais , V. Putzeys , A. Vijverman , H. Lu An , M. Demarche , F Croës , C. Brixko , C. Gillard , C. Rinken , A. De Roover , D. Dresse , A. Frère
Rev Med Liege 2017, 72(12),534-539
Summary : Superficial digestive tumours resection by endoscopic mucosal resection and sub-mucosal dissection causes very few complications according to the results obtained in expert centers. This work reports the rate of complications observed in a regional hospital, also comparing the results of their therapeutic management. The first 100 patients treated by endoscopic mucosal resection and sub-mucosal dissection, conducted by conventional techniques, were studied. The usual complications (stenosis, bleeding, perforation) were identified and details of their treatment reported. The overall complication rate was 16 %. Symptomatic stenoses are observed in 4 % of patients. Secondary bleeding occurs in 5 % of cases. Endoscopic management of these complications is effective in all cases, when it is attempted. Perforations complicate 7 % of the procedures. Two patients were assigned to surgery, successfully, the other 5 patients were treated by endoscopic sutures without damage. The complication rates observed in our department are comparable with results reported by the reference western centers. Their endoscopic management is usually successful and rescue surgery is unfrequent.
|What is the value of low-energie lasers in the treatment of androgenetic alopecia ?|
Ph. Paquet , M. Orduz , C. Franchimont , A.F. Nikkels
Rev Med Liege 2017, 72(12),540-546
Summary : Male and female androgenetic alopecia is a common, chronic, psychologically stressful disorder affecting more than 50 % of the individuals by 50 years of age. Despite the current topical (minoxidil) or oral (the inhibitors of 5-? reductase finasteride or dutasteride) treatments, there is a need for more effective management options. The current clinical evidence, the possible mechanisms of action and the rare adverse events of the low level laser therapy in the treatment of androgenetic alopecia are presented.
A. Winckert , L. Vranken , F. Boemer , J. Courtois , E. Cavalier
Rev Med Liege 2017, 72(12),547-551
Summary : Hypophosphatasia (HPP) is a rare genetic disorder characterized by the diminution of the enzymatic activity of the alkaline phosphatase (ALP). The disease mainly involves multiple defects of the mineralization of the skeleton including bone fragilities. It will be expressed to varying degrees of severity and will allow to characterize different forms of HPP. Unfortunately, the prevalence of this pathology remains probably underestimated and its diagnosis must be multidisciplinary by taking into account the biochemical assays, the clinical history as well as the radiological imaging. So, in the approach of this diagnosis, a retrospective screening was carried out by the clinical chemistry department of the CHU of Liège. The aim of this study is to potentially identify the affected patients on the basis of their biochemical assays and their anamnesis in order to propose a genetic screening. Unfortunately, no case could be formally identified, which testifies the difficulty to establish a diagnosis of the slight forms encountered mainly in the adults.
|Tiredness of life in older adults|
N. Van Den Noortgate , P. Vanden Berghe , J. De Lepeleire , G. Ghijsebrechts , J. Lisaerde , A. Beyen en collaboration avec le groupe de travail Soins Palliatifs et Gériatrie (Palliatieve zorg en Geriatrie, PaGe) de la Fédération des Soins palliatifs
Rev Med Liege 2017, 72(12),562-563
Summary : Tiredness of life in older adults can lead to a request for the wish to die. This article provides a practical approach for physicians of this problem on the basis of a flow chart. The main causes of tiredness of life should be identified and evaluated for their reversibility and treatment options. The first group are the physical factors which, besides organ pathology, should also take frailty into account as a possible cause. A second important group are the psychological risk factors such as psychiatric disorders, loneliness, dignity, subjective well-being, coping and spiritual power. These factors also determine the complaint and needs of the patient. Here is a multidisciplinary assessment and approach desirable. This multidisciplinary approach also applies to the socioeconomic risk factors. In addition, the caregiver should examine if the weariness of life indeed gives rise to the suffering of the older person and to what extent this is hopeless and unbearable suffering. Hopelessness is a professional judgment about the remaining treatment and care perspective and is often objectified; unbearable is a matter of the patient and therefore always subjective and personal. The current legislation on euthanasia, the reversibility of the underlying causes and the unbearable suffering will determine whether the request of the patient with tiredness of life can be considered. Some questions will not fit within the proposed framework. For those a multidisciplinary advice of an ethics committee may be desirable.
|Complementarity between randomised controlled trials and observational registries : the example of cardiovascular prevention with SGLT2 inhibitors|
A.J. Scheen , Ph. Ernest , B. Jandrain
Rev Med Liege 2017, 72(12),563-568
Summary : Evidence-based medicine (EBM) is mainly supported by the results of randomised controlled trials (RCTs). If the latter offer guarantees of reliability, especially by minimizing the influence of confounding factors and potential biases, they also have limitations. Observational databases resulting from real life registries, if possible build in a prospective manner, may offer some solutions, but are also exposed to limitations. This article compares the advantages and disadvantages of the two sources of information, which ideally should be complementary. For the purpose of illustration, we shall compare the recent results of RCTs and of observational databases from multinational registries that investigated the effects of sodium-glucose cotransporter type 2 inhibitors (gliflozins) on cardiovascular outcomes in patients with type 2 diabetes.