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The Medical Review of Liege is a tool for continuous medical training being addressed to students, general practitioners, and specialists.

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2022 - volume 77 (1)

 
Editorial. Fire and Water

Scheen AJ

Rev Med Liege 2022, 77(1),1-4

No abstract available

Aseptic loosening after knee mega-prostheses

Mettlen C , Gennigens C , Kurth W

Rev Med Liege 2022, 77(1),5-7

Summary : The use of mega-joint prostheses has become common practice in the field of reconstructive orthopedic surgery. These new implants are considered as the gold standard for reconstruction after joint and periarticular tumor and bone resections. The placement of these prostheses makes it possible, compared to an amputation, to preserve the pathological limb, but also to be able to ensure a solid assembly allowing immediate support and a quick functional recovery. However, the incidence of various complications following the placement of these implants remains higher compared to conventional joint replacement surgery. The most frequent can be classified into two distinct categories: mechanical and non-mechanical complications.

Fatal serotonin syndrome induced by ecstasy consumption

Stilmant AC , Zhu L, Gorur Y , Cardos B , Yerna M , Ali D

Rev Med Liege 2022, 77(1),8-12

Summary : The use of amphetamines and amphetamine derivatives such as ecstasy can cause serotonin toxic syndrome, an uncommon but potentially serious adverse effect. Although most of the reported cases evolve spontaneously and favourably, in rare cases, serious complications can occur leading to the death of the patient. We report the case of a 27-year-old man admitted to our emergency department for altered consciousness with hyperthermia at 42°C after illicit drug use. The patient developed severe multivisceral failure and disseminated intravascular coagulopathy despite maximalist management focused on cooling and multiorgan supportive therapy. The patient died within hours of admission. The diagnosis is essentially based on the patient history and clinical examination. The first treatment is to stop the toxic and then, to treat the symptoms and support possible organ failures.

Heterotopic ossifications after hospitalisation in intensive care for SARS-CoV-2 pneumopathy

Grosjean D , Dekoster M , Beaudart C , Kaux JF

Rev Med Liege 2022, 77(1),13-17

Summary : We report the case of a 63-year old patient admitted in the intensive care unit for 25 days because of a severe SARS-CoV-2 pneumonia. With diverse symptoms of critical illness polyneuropathy the patient has been taken care of in a rehabilitation centre. Ankylosis and joint motion limitation led to a more extensive imaging assessment. The later showed advanced periarticular heterotopic calcification in both hips and in right shoulder. Although hypothesis about this complication’s physiopathology remains unclear, early identification would allow a better management. It is the first time heterotopic ossification involving three large joints is reported after a SARS-CoV-2 infection.

SGLT2 inhibitors and RAAS blockers : similarities, differences and complementarity

Scheen AJ , Delanaye P

Rev Med Liege 2022, 77(1),18-24

Summary : Both renin-angiotensin-aldosterone system inhibitors (RAASi) and sodium-glucose cotransporter type 2 inhibitors (SGLT2i, gliflozins) reduce the risk of heart failure and of progressing towards end-stage renal disease, especially in patients with type 2 diabetes (T2D). Positive results reported in patients with T2D have been confirmed in people without diabetes. These two pharmacological classes now occupy a privileged place in international guidelines, in diabetology, cardiology and nephrology. The present article describes similarities and differences between these two types of medications. It emphasizes the importance of combining both approaches in order to optimize the cardiovascular and renal prognosis, while maintaining a good safety profile.

Clinical impact of small bowell capsule endoscopy in obscure gastrointestinal bleeding : retrospective single-center study

Moreau AC , Seidel L , Vieujean S , Reenaers C , Louis E

Rev Med Liege 2022, 77(1),25-31

Summary : Introduction : The small-bowel capsule endoscopy (VCE) has been validated in the investigation of obscure gastrointestinal bleeding (OGIB). The aim of this study was to evaluate the clinical impact of VCE for OGIB in routine practice, in terms of subsequent management and the risk of rebleeding. Methods : Our retrospective study analyzed the VCE at the CHU of Liège from March 2016 to December 2019 (cohort of 110 patients with OGIB). Results : We found a diagnostic yield of 58 %, a change in therapeutic attitude in 39 % of patients and a recurrence rate of 22.5 % (out of 102 patients followed at 2 years). The rate of rebleeding was particularly low in patients with normal VCE and in those for whom a therapeutic modification was made. Finally, about 45 % of patients did not have any change in therapeutic attitude nor recurrence. Conclusion : VCE leads to a therapeutic modification in about 40 % of patients with a low risk of relapse. However, VCE could be avoided in some patients as evidenced by a subgroup representing 45 % of patients for whom there was no therapeutic modification nor recurrence.

Clarithromycin consumption at the University Hospital of Liege in 2019. Retrospective study

Schils R , Altdorfer A , Berger L , Fontaine C , Herens S , Mattar L , Robinet S

Rev Med Liege 2022, 77(1),32-38

Summary : Macrolides are one of the treatments of choice in community-acquired pneumonia, either when the clinical and/or biological elements suggest an infection by an intracellular bacteria (so-called atypical), or when the severity of the clinical picture justifies their empirical use. This work is a retrospective monocentric study carried out at the University Hospital of Liege on 25 consecutive patients hospitalized during the year 2019. It aims to specify whether the use of a particular macrolide, clarithromycin, actually meets the national recommendations both in terms of indication, dosage or duration. The results showed justified and adequate use in only 44 % of cases. Nevertheless, the indication was overwhelmingly mentioned in the medical record (96 %). Furthermore, the comparison with national data showed a much higher than average use at the University Hospital of Liege. An action plan is suggested to discuss these results within the Antibiotic Therapy Management Group and then communicate them to the prescribers who are concerned. The aim is to adapt the use of macrolides at the University Hospital of Liege to be more in line with national recommendations.

Ovarian teratoma in children. Clinical case and review of the literature

Rousseau MC , Demarche M , Dresse MF , David BA

Rev Med Liege 2022, 77(1),39-44

Summmary : Teratomas are the most common histologic type of germ cell tumors in pediatrics. There are two types of teratomas, mature, benign and immature, malignant. Initial diagnosis is essential for optimal management. This work, based on a clinical case, aims to review the clinical, radiological, biological and histological characteristics allowing them to be differentiated.

Physical activity and chronic diseases : how can motivational principles contribute to physically active behaviour ?

Bodson F , Mouton A

Rev Med Liege 2022, 77(1),45-51

Summary : Although physical activity is perceived as an effective therapeutic agent in the management of chronic diseases, the literature reports a low participation rate in adapted physical activity programmes and a high drop-out rate during participation. There is room for improvement in supporting the engagement of chronically ill patients in an active lifestyle, especially in optimising the process from medical management to integration into a local adapted sports structure. Based on the motivational principles of the self-determination theory, we propose courses of action to optimise the support of the chronically ill patient in the process of behavioural change. This article emphasises the importance of placing the individual at the centre of his or her physical care and the importance of taking into account individual characteristics in order to act on intrinsic motivation.

Gestational diabetes mellitus : prelude of risks not to be misunderstood

Vandelaer A , Quintana C , Grandfils S , Philips JC , Paquot N

Rev Med Liege 2022, 77(1),52-55

Summary : Gestational diabetes mellitus is a common complication in pregnant women. It is diagnosed between the 24th and 28th last menstrual period thanks to an oral glucose tolerance test with 75 g of glucose. Although blood glucose levels usually return to normal after childbirth, it can lead to some medium- and long-term complications, including cardiovascular, metabolic and renal complications. Early detection of various risk factors related to these complications would avoid some negative consequences for women with background of gestational diabetes.

How I explore... macrocephaly

Vanden Brande L , Alkan S , Barrea C , Leroy P

Rev Med Liege 2022, 77(1),56-62

Summary : Macrocephaly is a frequent reason for seeking advice in a pediatric neurology consultation. It is a non-specific neurological sign that can be isolated, be the sign of a serious acquired pathology or be part of a syndromic picture. Clinical history, physical examination and imaging are key elements of the diagnostic strategy. Signs of intracranial hypertension require an emergency work-up. Genetics, exome in particular, has enabled the characterization of various syndromes associating macrocephaly and neurodevelopmental delay. In this article, we propose an update of practices based on clinical signs.

Diagnosis and treatment of cardiac transthyretin amyloidosis. Innovative therapy with tafamidis.

Legrand D , Nyssen A , Jackers L , Brogneaux C , Pirotte I , Grayet D , Lacremans D , Magnée M

Rev Med Liege 2022, 77(1),63-68

Summary : Cardiac amyloidosis is a rare and severe disease with worse prognosis than classic cardiac insufficiency. Transthyretin amyloïdosis is an underdiagnosed cause of amyloidosis. Technetium scintigraphy allows to confirm diagnosis of transthyretin amyloidosis with great specificity. A new hope is brought by tafamidis, a novel therapeutic option for this specific condition. This medication is the first one that proved a risk reduction in mortality among patients with cardiac amyloidosis in class NYHA I and II. In this article, we review across a clinical case the modalities for the diagnosis and treatment of transthyretin amyloidosis.

Clinical diagnostic approach for heart failure

Nguyen Trung ML , Ancion A , Lancellotti P

Rev Med Liege 2022, 77(1),69-74

Summary : This vignette contains the recommendations for the diagnostic work-up to be followed when a suspicion of heart failure is faced. It underlines the anamnestic and clinical elements that should attract attention and consider the diagnosis. It also details the additional explorations required in this situation.

Centre hospitalier universitaire de Liège Revue Médicale de Liège depuis 1946
ISSN : 0370-629X et e-ISSN : 2566-1566
Rédacteur en chef : A.Scheen
Copyright : Revue Médicale de Liège 2002
Dernière modification : 14-01-2022
Université de Liège