2018 - volume 73 (9)
|Image of the month. Early sign of pneumonia detected by ultrasound|
|How I treat… a pelvic organ prolapse at the doctor’s office|
Nohuz E , Jouve E , Clement G , Jacquetin B
Rev Med Liege 2018, 73(9),435-438
Summary : The use of gynecological pessary to put back up prolapsed organs to their normal position appears to be as effective as surgical management to relieve symptoms related to uro-genital prolapse and restore body image. This millenary device can be used temporarily, awaiting a surgical solution or as a therapeutic test (mimicking the effect of a surgical procedure to predict its functional outcome or identifying a masked urinary incontinence). It can also represent an alternative to surgery (patient choice, women who wish to complete childbearing or who are unsuitable for surgery because of medical comorbidities) and thus can be used in first intention. Pessary can also be used to confirm or deny the responsibility of pelvic organ prolapse for atypical symptomatology as pelvic heaviness or pain. However, this use requires adjuvant treatment. In this paper, we highlight an original effective process not yet published to optimize the tolerance of pessary.
|Acute idiopathic eosinophilic pneumonia in a teenager|
Blavier N , Thimmesch M , Lebrun F , Bodart E
Rev Med Liege 2018, 73(9),439-441
Summary : Acute idiopathic eosinophilic pneumonia is a very rare cause of interstitial lung disease in children. Pathophysiological mechanisms and etiology remain poorly understood. It manifests as a febrile dyspnea, progressively worsening. Chest X-ray, performed as first-line, shows bilateral infiltrates. The chest CT confirms a diffuse infiltrative pneumopathy and the bronchoalveolar lavage demonstrates the presence of alveolar hypereosinophilia. The exclusion of other causes of alveolar eosinophilia confirms the diagnosis. A ventilatory support is very often necessary. Systemic corticosteroids provides a spectacular clinical improvement, without recurrence.
|Complications of hyperthermic intraperitoneal chemotherapy: about a case of acute respiratory distress syndrome|
Mathy X , Ancion A , Joris J
Rev Med Liege 2018, 73(9),442-446
Summary : For about twenty years, extensive cytoreduction surgery associated to hyperthermic intraperitoneal chemotherapy (HIPEC) has been used to treat rare peritoneal tumors (mesothelioma, pseudomyxoma) and some digestive and gynecological neoplasias infiltrating the peritoneum. This heavy technique is associated to significant morbi-mortality but allows to increase lifetime and to improve quality of life of patients with these tumours. Complications of this technique are principally surgical, but hyperthermic intraperitoneal chemotherapy can result in toxic effects, especially for kidney and bone marrow. Lung injury due to toxicity of chemotherapeutic agents, sometimes serious and potentially leading to acute distress respiratory syndrome (ARDS) has already been described in the postoperative period of HIPEC, but never intraoperatively. We report the case of an ARDS developing intraoperatively during an extensive cytoreduction surgery associated to HIPEC, due to the toxicity of the chemotherapeutic agents.
|«KCE Trials» : innovation based on practice oriented clinical trials|
Hulstaert F , Verleye L , Harrison J , Nevens H , Vrijens F , Devis M , Briat G , Rondia K
Rev Med Liege 2018, 73(9),447-453
Summary : Many questions in healthcare can only be answered after the conduct of clinical trials. For medicinal products and medical devices the industry finances most studies to bring their products to market. However, there is a need for further research in certain areas e.g. children, older people and comparative research of different treatment options (comparative effectiveness). In addition, interventions that are less industry-driven such as surgery, radiotherapy, psychotherapy, diet, physical medicine, needappropriately funded large scale clinical trials. Such clinical trials can be a good investment for the government and the healthcare payer. At the end of 2015 the Belgian Healthcare Knowledge Centre (KCE) received the mission and budget to run a programme of practice-oriented comparative clinical trials. Two years later the recruitment of patients in the first trials is ongoing. In addition to its yearly national calls for trial proposals, early in 2018 KCE launched its first international common call for comparative clinical trials with its Dutch counterpart ZonMw (BeNeFIT).
|The urgent need for a new ecosystem in healthcare|
Coucke PA , Coucke-Gilson L
Rev Med Liege 2018, 73(9),454-461
Summary : The key performance indicators in healthcare illustrate that the system we run nowadays is no longer sustainable. There is an urgent need for fundamental changes within the current ecosystem, if we want to maintain or improve the levels of quality, security and equity in healthcare. Disruptive technologies profoundly modify all domains of our society. Those changes, driven by technical convergence, are particularly rapid and extensive in the fields such as big data and analysis, artificial intelligence, cloud and blockchain. These continuously evolving technologies could potentially offer opportunities to efficient problem solving in the health care sector. The culture of our organizations needs major changes and especially adaptability and fast speed integration to a process which is inevitable.
|Inflammatory bowel disease and venous thromboembolisms|
Delhougne N , Colard A , Louis E
Rev Med Liege 2018, 73(9),462-467
Summary : Inflammatory Bowel Diseases (IBD) are associated with lots of extra-intestinal complications. Among them, venous and arterial thromboembolisms lead to high rates of morbidity and mortality. They often occur during an IBD flare and seem to be mostly provoked by acquired factors. The prevention mainly resorts to heparin, which is not used enough in spite of its effectiveness. Its indications have recently been upgraded to outpatients. In this review, we describe the epidemiological and ætiological features of these manifestations, as well as their prevention and management. Only venous thromboembolisms are considered.
|What’s new in the treatment of suppurative hidradenitis in 2018 ?|
Giet G , Lebas E , Libon F , Dezfoulian B , Nikkels AF
Rev Med Liege 2018, 73(9),468-473
Summary : Hidradenitis suppurativa (HS), also known as Verneuil’s disease and acne inversa, is a chronic inflammatory skin disease characterized by a dysfunction of the pilosebaceous structures resulting in occlusion and inflammation. The disease usually starts after puberty, on average between twenty and thirty years, with subcutaneous painful inflammatory nodules, abscess collections, fistulization and scars mainly in the axillary, inguinal, sub-mammary, perineal and perianal regions. It is a multifactorial disease with the most commonly cited risk factors or aggravating factors being smoking, obesity, and HS family history. The first line of treatment relies on antibiotics, including tetracyclins, clindamycin and rifampycin. In case of non-response, TNF? antagonists, more specifically adalimumab, may be considered.
|Meckel’s diverticulum : state of the art|
Tomagra F , Jamblin P , Demarche M , Mercken B
Rev Med Liege 2018, 73(9),474-479
Summary : The persistence of the embryonic vitelline duct can lead to omphalomesenteric duct anomalies. A wide variety of anomalies, depending on the remnant segment and its degree of involution, may occur as a result of the omphalomesenteric duct failing to obliterate completely. The most frequent omphalomesenteric duct anomaly is Meckel’s diverticulum, which is present in approximately 2-3 % of the population. Despite the progress in medical imaging, conventional abdominal computed tomography and endoscopy have limitations for the diagnosis of Meckel’s diverticulum. The laparoscopic exploratory remains the best choice for diagnosis and treatment.
|Trimbow® : twice-daily triple combination for the treatment of COPD|
Corhay JL , Bonhomme O , Guiot J
Rev Med Liege 2018, 73(9),480-484
Summary : Single-inhaler triple therapy in extrafine solution combining an inhaled corticostéroid (ICS), the dipropionate of beclométasone, a long acting ß2-agonist (LABA), the fumarate of formoterol and an long-acting muscarinic antagonist (LAMA), the bromide of glycopyrronium, was developed for the treatment of the chronic obstructive pulmonary disease (COPD). Trimbow® is the first triple therapy in spray with fixed dose and containing 3 pharmacological agents (LABA-LAMA-ICS). Clinical trials show that Trimbow® improves numerous parameters such as the respiratory function, the quality of life, the symptoms and the rate of moderate to severe exacerbations while being tolerated well. These results justify its use in severe and very severe COPD with exacerbations in spite of treatment by LABA-LAMA or LABA-ICS. In this article, we present a brief synthesis of the main recent clinical trials on Trimbow®, its comparison with other pharmacological agents/associations regularly used in the treatment of COPD, as well as some practical information on its use in routine.