2021 - volume 76 (9)
|Image of the month|
|Chest pain after extraction of a wisdom tooth : about a case of pneumomediastinum|
Brolet E , Bato O , Goffin P
Rev Med Liege 2021, 76(9),648-650
Summary : We here describe the story of a young man who developed a major pneumomediastinum after the removal of a wisdom tooth. The patient was hospitalized in the intensive care unit for continuous monitoring and for the administration of prophylactic antibiotic therapy to avoid infectious complications. Pneumomediastinum after dental procedures has already been reported and its management, although simple, remains subject to major complications if inadequately treated.
|Köbner’s phenomenon in dermatology|
Giet G, Senterre Y , Lebas E , Libon F , Dezfoulian B, Nikkels AF
Rev Med Liege 2021, 76(9),651-656
Summary : Köbner’s phenomenon and its related phenomena are dermatological curiosities that are still partially misunderstood. The Köbner phenomenon is by far the best known and the most studied. It is characterized as the appearance of an inflammatory or infectious dermatosis in an area of healthy skin after skin trauma. The dermatoses most frequently concerned are psoriasis, lichen planus and vitiligo. The inverse Köbner phenomenon and the Renbök phenomenon are two very similar phenomena. The first represents the disappearance of a skin lesion after skin trauma. The second is characterized by a skin trauma that is more specifically induced by another dermatosis. Finally, the Wolf’s isotopic phenomenon corresponds to the appearance of a new dermatosis on an area of the skin that was previously the site of another healed dermatosis
|Lockdown and their effects on hospital emergency department attendance|
Bavestrello Piccini G , Cavenaile JC
Rev Med Liege 2021, 76(9),656-660
Summary : In order to limit the spread of the COVID-19 infection, the Belgian authorities established a lockdown from the 18th of March to the 3rd of May 2020. To our knowledge, an analysis of the effect of the lockdown on the Emergency Department attendance by patients with non-urgent pathologies has not been realized yet. We reviewed the files of patients who presented to the Emergency Department of the Brugmann Hospital in Bruxelles during the lockdown period with affections that were evaluated at 4-5 according to the Manchester Triage System (MTS). We then calculated the proportion of these passages with respect to the total passages to the Emergency Department, and subsequently compared the results with the data referring to the same period in the previous year (from 18/03/2019 to 03/05/2019). The results show a clear decrease in the Emergency Department attendance by patients with non-urgent affections during the 2020 lockdown period.
|Diagnosis and management of liver cysts|
Klein L , Meurisse N , Honoré P , De Roover A , Detry O
Rev Med Liege 2021, 76(9),661-665
Summary : Cystic hepatic lesions are frequent and sometimes large. They are generally asymptomatic and discovered by chance. The differential diagnosis of these lesions includes congenital, post-traumatic, benign or malignant tumors, as well as infectious pathologies. Conventional or contrast ultrasonography, abdominal computed tomography and magnetic resonance imaging can be used to characterize them. Therapeutic abstention with or without iconographic monitoring constitutes the optimal management of many benign liver cysts without clinical repercussions. Treatments for symptomatic or potentially aggressive lesions may include fenestration, puncture with sclerotherapy, or surgical resection. In this article, the authors discuss how to diagnose and treat the various hepatic cystic lesions.
|Cervicothoracic neuroblastomas : benefits of transmanubrial osteomuscular-sparing approach|
Martus S , Gatineau-Sailliant S , Tebache M , Sanoussi A , Minga Lowampa E , Demarche M
Rev Med Liege 2021, 76(9),666-671
Summary : We report the case of a child suffering from a neonatal cervicomediastinal neuroblastoma encasing the left subclavian artery and the left vertebral artery. There is only a few pediatric tumors extending from the neck to the upper part of the thorax. Because of the complex vascular and neurological anatomy of this area, the surgical excision of these cervicothoracic neuroblastomas is a real challenge. It is why, when we decided to propose a surgical management, we used the Transmanubrial Osteomuscular-Sparing Approach (TOSA), of which technique and benefits will be explained in this article.
|Autism spectrum disorder : ethiopathogenesis and benefits of early diagnosis|
Guilbaud J , Vuattoux D , Bezzan G , Malchair A
Rev Med Liege 2021, 76(9),672-676
Summary : Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that manifests in altered or reduced social behaviours, social communication disorders, and repetitive behaviours and/or restricted interests. The etiology of ASD is complex and multifactorial. The etiopathogenesis of the disorder is multiple, including brain abnormalities, visual contact and early interaction disorders. These signs are often the focus of parental concerns. In addition, since ASD is neurodevelopmental, all signs are not always present simultaneously. Indeed, they appear progressively, until the age of 3 years, at which the diagnosis can usually be made. Nevertheless, in more complex cases, this diagnosis may be considered later. The first signs of ASD (before 24 months) will be addressed because they are crucial for an early diagnosis. Their knowledge allows the establishment of a follow-up as well as its quick specific care. Indeed, by acting during a developmental period when brain plasticity is high, early intervention allows to modify the evolution of symptoms, and later on to limit secondary handicaps
|Dual therapies as a treatment of human immunodeficiency virus : the end of a paradigm ?|
Plum PE , Darcis G , Moutschen M
Rev Med Liege 2021, 76(9),677-682
Summary : Current guidelines increasingly consider some dual antiretroviral therapies as bona fide alternatives to triple therapy as these regimens are proven to be safe and efficacious. These drug sparing regimens have many advantages such as a reduction of drug burden and subsequent toxicity, preservation of future treatment options, cost reduction and avoidance of drug-drug interactions. In the past, some dual therapies were associated with a higher risk of selecting resistance mutations. Nevertheless, current and future dual regimens based on powerful drugs with a high genetic barrier are non-inferior to triple therapies and could become the future gold standard for HIV treatment.
|Oocyte cryopreservation : medical and social indications|
Vervier J , Jouan C , Nisolle M , Henry L
Rev Med Liege 2021, 76(9),683-688
Summary : The increasing survival rate in cancer patients and the global tendency to delay motherhood are two distinct phenomena leading to an increased demand for fertility preservation. Currently, fertility preservation is possible to be achieved with less hormonal exposure and without delaying oncological treatments. Based on this knowledge, any patient with an oncological diagnosis should be referred to a fertility specialist to consider gamete cryopreservation. In addition, the indication for fertility preservation have been extended to many benign pathologies. Awareness of age-related fertility decline coupled with a tendency to delay motherhood is leading more and more women to consider social egg freezing. For these women, oocyte cryopreservation allows them to maintain their reproductive lifespan until an age when they feel ready to become mothers.
|Quality of life in the medical field : a brief overview of its origin, semantics, measuring instruments and clinical use|
Louis G , Pétré B , Charlier N , Voz B , Guillaume M
Rev Med Liege 2021, 76(9),689-696
Summary : Since the early 1970s, the concept of quality of life has been the subject of increasing interest in the medical field, although no scientific consensus has emerged on how to define and measure it. The aim of this narrative review of the literature is to decrypt the notion of quality of life in the medical field, in order to enable clinicians-researchers and clinicians who use quality of life measurement instruments in clinical practice to form an informed and nuanced opinion on the issue. To do so, the paper is divided into three parts. Firstly, a brief overview of the origin of the concept in the medical field is given by exposing the main factors explaining its emergence and its rise in importance. Next, the plurality of definitions of quality of life and its derivatives (e.g. health-related quality of life), as well as its measurement instruments in the medical field, are explored. Finally, some benchmarks for the use of health-related quality of life instruments in clinical practice are presented.
|How to explore… a blepharospasm|
Marx B , Depierreux F
Rev Med Liege 2021, 76(9),697-700
Summary : Blepharospasm is a particularly distressing form of focal dystonia, specifically affecting the eyelids and causing involuntary closing of the eyes or an increased blinking. Despite its frequency, the diagnosis of this condition is often delayed. Diagnostic criteria are mainly clinical, but sometimes further investigations may be necessary as blepharospasm may be included in a complex clinical picture.
|Mental illnesses: the playground for new technologies|
Rev Med Liege 2021, 76(9),701-708
Summary : The current health care crisis, induced by the coronavirus pandemic, is at the origin of significant global changes within our societies and profoundly modifies the health care sector as well, especially in the field of mental health. Nowadays, this latter is particularly poorly equipped in financial and human resources. Without major and immediate changes, the mental health sector will not be able to cope with the expected exponential rise of care needs, exacerbated by the rapid deterioration of mental health in the general population and among health care providers. We intend to illustrate the potential role and benefit of new technologies, able to solve the imbalance. Without any possible doubt, the health care crisis has provided a formidable momentum for their arousal, but we still have to determine their accessibility, feasibility, efficacy and efficiency by running controlled clinical trials.