2018 - volume 73 (12)
|Role of metformin in gynaecology and obstetrics|
Scheen AJ , Philips JC , Kridelka F
Rev Med Liege 2018, 73(12),597-602
Summary : Metformin raises much interest in the fields of gynaecology and obstetrics. This article discusses both the efficacy and safety of metformin in the management of polycystic ovary syndrome as well as in the prevention, treatment and follow-up of gestational diabetes. Recent observational data suggest that metformin may also exert positive effects as adjuvant therapy in some cancers, among which endometrial cancer and breast cancer.
|Cushing’s syndrome during pregnancy : diagnostic and therapeutic difficulties|
Gellner K , Emonts P , Hamoir E , Beckers A , Valdes-Socin H
Rev Med Liege 2018, 73(12),603-609
Summary : Cushing’s syndrome (CS), which is often associated with infertility, exceptionally occurs in pregnancy, and markedly increases maternal and fetal morbidity and mortality. Gestational CS may be challenging. Indeed, symptoms of hypercorticism may overlap with physiological hyperactivity of the hypothalamus-pituitary-adrenal axis in normal pregnancy. This case report describes a pregnant patient that underwent a fertility treatment and developed a gestational CS due to an adrenocortical adenoma. Diagnosis of gestational CS was suspected at 13 weeks by a new onset of hypokalemia and arterial hypertension. A multidisciplinary approach was necessary during follow up. At 24 weeks, laparoscopic surgery retrieved a 4 cm adrenocortical adenoma. Cesarean surgery was successfully practiced at 31 weeks, because of preeclampsia. We discuss the differential diagnosis of hypokalemia and arterial hypertension during pregnancy and the diagnosis and management of gestational CS.
|Morel-Lavallée syndrome. Case analysis and focus on medical care|
Choufani C , Virama-Parvedy S
Rev Med Liege 2018, 73(12),610-614
Summary : Morel-Lavallée syndrome is a trauma that remains rare and whose management is not yet standardized. It is a closed delamination between the fascia superficialis and the cutaneous-subcutaneous tissue. This empty space is filled with fluid and may be complicated by surinfection and tissue necrosis. Regularly described in heavy traumatology, it should not be ignored in routine practice. We present the case of a regular leisure athlete with a sus-patellar syndrome of Morel-Lavalée as well as its diagnostic and therapeutic management. The evolution was favorable with a well-conducted conservative treatment. We discuss every step of the possible care in clinical practice to sensitize general practitioners to this pathology.
|Demons-Meigs syndrome secondary to an ovarian Brenner tumour. Case report and literature survey|
Coveliers A , Graas MP , Weerts J , Blétard N , Focan C
Rev Med Liege 2018, 73(12),615-620
Summary : A 65-year old woman presents with a Demons-Meigs syndrome characterized by dyspnea resulting from a transsudative pleural effusion, an important unilateral right ovarian mass and ascites. The diagnosis of a Brenner type histology was obtained after complete surgical removal of ovarian tumor. After discharge the patient entered in a sustained complete response and thus potential cure. Brenner tumor is a rare and often benign ovarian affection. The clinical signs aren’t generally much specific: pelvic pain or heaviness, metrorrhagia and menstrual irregularity may be observed. Brenner tumor may exceptionally induce a Demons-Meigs’s syndrome. This syndrome associates one or more benign tumors of the female reproductive tract with pleural and peritoneal effusions. This could depict a rich but disturbing clinical picture. The prognosis and the regression of the symptomatology are nevertheless excellent after tumor surgical resection.
|Patient partner approach into question|
Pétré B , Scholtes B , Voz B , Ortiz I , Gillain N , Husson E , Guillaume M , Bragard I , Consortium APPS
Rev Med Liege 2018, 73(12),621-628
Summary : Patient engagement in health care system can be regarded as a lever for the general improvement of people’s health, the quality and safety of care. Among the many approaches that co-exist, the model of Patient Partner is relatively recent and declares itself as the most successful to promote this engagement. The authors of this article propose to present briefly the above model and to raise the remaining questions on its operational application. We will then present the research program «Patient Partner Approach to Care» (INTERREG Va) that questions the Patient Partner model in an interregional context (Wallonia - Grand Duchy of Luxembourg - Lorraine - Rhineland-Palatinate and Saarland).
|Management of hyperglycaemia of type 2 diabetes. Paradigm change according to the ADA-EASD consensus report 2018|
Scheen AJ , Paquot N
Rev Med Liege 2018, 73(12),629-633
Summary : The strategy for the management of hyperglycaemia in type 2 diabetes was updated in October 2018 by a group of experts of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). They are triggered by the results of cardiovascular outcome trials published since 2015, which demonstrated a cardiovascular (and renal) protection with two classes of medications, SGLT2 inhibitors (gliflozins) and some GLP-1 receptor agonists (mainly liraglutide) in patients with established cardiovascular disease. Thus, after failure of lifestyle and metformin, the addition of one of these agents is recommended in presence of atherosclerotic cardiovascular disease. In case of heart failure or renal disease, the preference is given to a SGLT2 inhibitor, provided that estimated glomerular filtration rate is adequate (> 45-60 ml/min/1.73 m²). In all other patients, the choice is guided by the main objective, in concertation with the patient : to reduce the risk of hypoglycaemia (gliptin, gliflozin, pioglitazone or GLP1 receptor agonist), body weight excess (SGLT2 inhibitor or GLP-1 receptor) or medication cost (sulphonylurea, pioglitazone). If oral treatment is insufficient, the preference is now given to a GLP-1 receptor agonist rather than basal insulin. Thus, instead of a glucocentric and metabolic viewpoint predominant in the previous position statement, a paradigm change is proposed, focusing on cardiovascular and renal protection, within a patient-centred approach.
|Rheumatoid arthritis and cardiovascular risk factor : literature review|
Zulfiqar AA , Niazi R , Pennaforte JL , Andres E
Rev Med Liege 2018, 73(12),634-639
Summary : The rheumatoid arthritis remains a common condition and constitutes a diagnostic and therapeutic challenge, especially in the elderly. Rheumatoid arthritis is known to be associated with increased mortality, including coronary and cerebrovascular atherosclerosis. A literature review is conducted on the role of rheumatoid arthritis as a cardiovascular risk factor.
|Trisomy 18 in a bichorial-biamniotic twin pregnancy|
Paggetti H , Vandenbossche G
Rev Med Liege 2018, 73(12),640-644
Summary : Screening for chromosomal abnormality such as trisomy 18 in a bichorial-biamniotic twin pregnancy is based on ultrasound and a non-invasive prenatal test (NIPT) from 12 weeks of gestation. An invasive examination such as amniocentesis is necessary for a diagnostic confirmation. The management of these complicated cases consists in performing a selective feticide in the first or third trimester of pregnancy. Trisomy 18 most often results from a chromosomal nondisjunction of maternal origin. Indeed, advanced maternal age is a major cause of chromosomal abnormality and a promoting factor of twin pregnancies. This is a severe condition with a very high stillbirth rate, even though there are certain cases where babies have managed to survive for several years.
|A traumatic cervical spine injury in children?|
Cajgfinger N , Jamblin P , Gilis N
Rev Med Liege 2018, 73(12),645-649
Summary : Cervical spine injuries are a regular reason for consultation in general practice or pediatric emergencies. In many cases, it is difficult to distinguish between whether or not a radiological assessment is necessary. We propose in this article a management strategy based on clinical scores simple to achieve in order to avoid unnecessary radiological examinations for children.