2020 - volume 75 (3)
|Lipoleiomyoma : rare tumor of the uterus|
Jamoulle JF, Brisbois D
Rev Med Liege 2020, 75(3),137-139
Summary : Uterine lipoleiomyoma is a rare and benign pathology whose etiopathogenesis is still poorly understood. Benign cystic teratoma of the ovary constitutes its main and primordial differential diagnosis because of the different treatments. Pelvic MRI is the best imaging technique to confirm the diagnosis.
|How I treat... choledocholithiasis by retrograde cholangiopancreatography in a patient with gastric bypass|
Bruwier L, Colard A, Plomteux O, Bastens B
Rev Med Liege 2020, 75(3),140-144
Summary : Performing endoscopic retrograde cholangiopancreatography (ERCP) in bariatric patients with gastric bypass is often challenging. Many techniques have been described. Recently, Endoscopic ultrasound (EUS) - direct transgastric ERCP (EDGE) by using lumen-apposing metal stent (LAMS) has shown efficacy to reach biliary orifice and perform conventional ERCP with good safety profile and low risk of adverse events.
|Epithelioid trophoblastic tumour with pulmonary metastasis|
Berg J, Bonduelle Y, Golinval O
Rev Med Liege 2020, 75(3),145-150
Summary : Epithelioid trophoblastic tumours are rare kind of gestational trophoblastic disease. Their detection is made by repetitive measurement of ?HCG after any gestational period (including spontaneous abortion). Epithelioid trophoblastic tumour can cause pulmonary metastasis. We describe the clinical case of a 44-year old woman with a cystic lesion of the right pulmonary apex following a miscarriage which was an epithelioid trophoblastic tumour. She’s still in complete remission after surgery and careful follow up.
|ACE-inhibition and bradykinin-mediated angioedema|
Ndjekembo Shango D, Simonet O, Vallot F, Defendi F, De Kock M
Rev Med Liege 2020, 75(3),151-153
Summary : Angiotensin converting enzyme inhibitors (ACE-i) are the most common cause of bradykininin angioedema. These bradykinin-mediated angioedemas are sometimes confused with histamine-induced angioedema, which may cause a late diagnosis and hence poor initial management, deleterious to the patient. This report describes a patient with a bradykinin-mediated angioedema soon after the initiation of perindopril, with laryngeal involvement requiring orotracheal intubation in emergency. The diagnosis was confirmed later and the assay of the activity of the enzymes involved in the catabolism of kinins - aminopeptidase P (APP), carboxypeptidase N (CPN) and Angiotensin-Converting Enzyme (ACE) - demonstrated a decrease of activity of both APP and ACE. As the diagnosis was not made initially, the specific treatments - concentrate of C1 inhibitor or antagonist of the B2 receptor of bradykinin (Icatibant) - were not administered. Any angioedema occurring during a treatment with ACE-i should be considered as a bradykinin-mediated angioedema.
|Recommendations in the diagnosis and management of syncope due to orthostatic hypotension|
Antole N, Scheen AJ, Ancion A, Marechal P, Lancellotti P
Rev Med Liege 2020, 75(3),154-158
Summary : Syncope is a frequent reason for admission to emergency department or consultations. The common pathophysiological mechanism is a drop in systemic blood pressure leading to cerebral hypoperfusion, and ultimately to total loss of consciousness. The causes are multiple, with varying degrees of severity, classified into three main types : reflex syncope, syncope due to orthostatic hypotension and cardiac syncope. Among these, orthostatic hypotension can be easily detected, particularly by performing an orthostatic challenge with active standing, which is recommended in the presence of any syncope. Simple measures can reduce the recurrence of this type of syncope, even if sometimes drug treatments are necessary. In this article, we will detail the characteristics, diagnostic methods and therapies recommended by the latest guidelines of the European Society of Cardiology.
|New method to regulate unscheduled urgent care : the ODISSEE interactive self-triage platform|
Gilbert A, Brasseur E, Ghuysen A, D’Orio V
Rev Med Liege 2020, 75(3),159-163
Summary : The regulation of the unscheduled care takes part of the different methods engaged to better organize the global demand for unscheduled urgent care among the different levels of care. Indeed, the first level of care equally with the emergency departments are facing major patient inflows often exceeding their available resources. Technological advances in healthcare and spreading of medical information reveal themselves as precursors of new adaptive strategies and daily challenges. The creation of an interactive app for patients self-triage through the different levels of care involves those different concepts. We created a new interactive platform, the ODISSEE mobile application (Outil Décisionnel et Informatif des Structures de Soins Efficientes Existantes), to allow patient’s self-triage to the best level of care. The protocols used were directly based on a previously validated tool with a 5-year experience in our institution, the SALOMON algorithm (Système Algorithmique Liégeois d’Orientation pour la Médecine Omnipraticienne Nocturne). Establishment of interactive self-triage platform to guide patients to the best level of care could potentially be a promising tool to improve the regulation of unscheduled urgent care.
|Osteo-odonto-keratoprosthesis: a tooth to regain sight|
Grobet P, Duchesne B, Jaumotte M, Pepinster F, Gilon Y
Rev Med Liege 2020, 75(3),164-170
Summary : As the leading cause of blindness in the world, corneal diseases are second only to cataracts. However, the epidemiology of corneal disease is complex and includes a wide variety of infectious and inflammatory eye diseases (trachoma), immune sequelae (cicatricial pemphigoid on Lyell’s disease) of after trauma (chemical burn). The general treatment for severe corneal disease is the corneal transplantation with penetrating keratoplasty. However, the failure of this treatment is virtually certain when the ocular surface is severely compromised. Keratoprosthesis is therefore the only viable option to restore vision in these patients. Only practiced by less than a dozen teams in the world, the osteo-odonto-keratoprosthesis (OOKP) is regularly practiced at the University Hospital of Liège, thanks to a close collaboration between the ophthalmology and maxillofacial surgery teams. Thanks to removal of a tooth and his bone support, patients suffering from bilateral dry eye following pathologies such as burns or cicatricial pemphigoid can benefit from this technique in order to recover an optimal visual acuity in a sustainable way.
|Semiology and pathophysiology of vertigo and dizziness : guide for evaluating invalidity and incapacity|
|Is diabetes a risk factor of urinary tract infection in patients with ureteral obstruction? Results of a retrospective study|
Moreau E, Jorion JL, Dardenne E, Rahier O, Tombal B
Rev Med Liege 2020, 75(3),176-179
Summary : The goal of this retrospective study is to assess if diabetic patients are more likely to develop urinary tract infection (UTI) within the context of ureteral obstruction. 804 patients that had received an emergency treatment by double J placement for ureteral stone were selected between January 2004 and December 2014 at the Clinique Saint Pierre d’Ottignies, Ottignies-Louvain-La-Neuve,Belgium. They were divided in two groups : patients with UTI associated and the control group with the non infected ones. In the group of infected patients, 82 were diabetic whereas they were 46 in the control group. There was a significant difference regarding the presence of diabetes between the group of patients with UTI and the control group (p < 0.001). This study demonstrates that diabetic patients are at higher risk of urinary tract infection in case of ureteral obstruction, thus an invasive treatment could be considered faster.
|Psychomotor disadaptation syndrome|
Manckoundia P, Mourey F
Rev Med Liege 2020, 75(3),180-184
Summary : Psychomotor disadaptation syndrome (PDS) was first described by the Geriatrics School of Dijon (France), three decades ago, under the name «psychomotor regression syndrome». Over time, the original clinical features remained unchanged. However, progress has been made in its pathophysiology understanding and care, hence the new name, PDS, appeared in the 1990s. The PDS is also called sub-cortico-frontal dysfunction syndrome since the 2000s. It corresponds to a decompensation of posture, gait and psychomotor automatisms, related to an alteration of the postural and motor programming, which is a consequence of sub-cortico-frontal lesions. The clinical features of PDS associate backward disequilibrium, nonspecific gait disorders and neurological signs (akinesia, reactional hypertonia, impaired reactive postural responses and protective reactions, etc.). Psychological disorders of PDS are a fear of standing and walking in its acute form (the post-fall syndrome), or a bradyphrenia and anhedonia in its chronic form. The PDS occurrence results from the combination of three factors implicated in the reduction in functional reserves related to the alteration of the sub-cortico-frontal structures: ageing, chronic afflictions and acute situations, which induce a decrease in cerebral blood flow. The PDS management must be multidisciplinary, including the physician, the physiotherapist, the psychologist, nurses and care assistants.
|Retrospective cohort study of rituximab biosimilar (Rixathon®) adverse events in adult hematology and pediatric nephrology|
Videau M, Cotteret C, Sibon D, Schlatter J
Rev Med Liege 2020, 75(3),185-189
Summary : The purpose of this study was to describe rituximab biosimilar safety in adult hematology and pediatric nephrology units. Adverse events were classified using the Common Terminology Criteria for Adverse Events (CTCAE) classification. Fifty adult patients were enrolled for a total of 126 cures and 11 pediatric patients for a total of 24 biosimilar cures. Among adults, three infusion-related reactions of biosimilar occurred : a bronchospasm, a reaction at the injection site and emesis. Among children, infusion-related reactions were: a bronchospasm, an injection site reaction, an emesis, and diarrhea. For adults, the most common adverse events included neutropenia (13.5 %) with 9 severe grade 3/4 cases, anemia (8.7 %), grade 1 thrombocytopenia (6.3 %), asthenia (2.4 %), infection (2.4 %), and chills (1.6 %). For children, a case of severe grade 4 neutropenia, a fever and conjunctivitis were observed. Results of this study show a confident safety profile of rituximab biosimilar in adults and children in «real life».
|Progressive ataxia and falls in a 62 year old woman|
Jedidi Z, Bianchi E, Moonen V, Jedidi H, Serre CH, Maquet P, Moonen G
Rev Med Liege 2020, 75(3),190-198
Summary : We discuss the diagnostic workup of a 62 year old woman without any significant past medical history. We take this opportunity to point out three aspects : 1. The necessary contextualization of the whole process allowing to avoid unrealistic differentials; 2. The requirement to prioritize the diagnostic tests as a function of their expected contribution to the diagnosis, their invasive characteristic and their availability, including their cost and 3. The evolving character of the diagnostic process that, if needed, has to be reconsidered to integrate the information obtained from the first diagnostic tests and the evolution of the patient.