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

EN FR

2022 - volume 77 (11)

 
Endometrial osteoid metaplasia

Galopin C, Michaux N

Rev Med Liege 2022, 77(11),621-623

Summary : Endometrial osteoid metaplasia is a rare condition characterised by the presence of bone in the uterine cavity. The main symptoms are secondary infertility, cycle disorders or dysmenorrhea. The discovery can also be fortuitous. Ultrasound and diagnostic hysteroscopy are diagnostic tools while operative hysteroscopy provides treatment. In the vast majority of cases, it is discovered in the aftermath of pregnancy, especially after curettage or miscarriage. There are several theories as to its etiopathogenesis.

When HbA1c is unreliable : a case report of hereditary spherocytosis

Caglar O, Delmotte P, Ketelslegers O, Radermecker RP

Rev Med Liege 2022, 77(11),624-628

Summary : Glycated haemoglobin (HbA1c) is a biological parameter used in the management of diabetic patients. Independent of the daytime glycaemic variations, but complementary to the measurement of blood glucose or subcutaneous glucose concentrations, it allows both the clinician and the patient to have an appreciation of the glycaemic balance of the last weeks. In this way, anti-diabetic treatment can be adjusted if necessary to achieve the desired goal and hopefully delay or prevent diabetes-related micro- and macroangiopathic complications. Some conditions can alter the glycation of haemoglobin. In this case, the HbA1c level becomes difficult to interpret. Hereditary spherocytosis may be revealed by a dissociation between low HbA1c level and high blood glucose levels. A family history, Coombs-negative haemolytic anaemia, or a finding of spherocytes in the blood smear is suggestive of hereditary spherocytosis. Fructosamine testing may be an alternative. This article will present a patient with hereditary spherocytosis in whom the HbA1c level was not interpretable when compared to the elevated blood glucose measurements.

Haute-Marne (France) experience during the 5th COVID-19 epidemic wave in a geriatric short-stay unit

Zulfiqar AA, Farid L

Rev Med Liege 2022, 77(11),629-634

Summary : Objective: The objective is to study the contribution of vaccination against COVID-19 in elderly subjects infected with COVID-19. Method: a retrospective study with screening of medical records was carried out among patients affected by an infection linked to COVID-19 during the 5th epidemic wave that required admission in a French hospital. Results: 51 subjects were included, with 25 women (49 %), mean age 85 y+/-6 years. Among the 51 patients, 28 patients were hospitalized specifically for the management of COVID-19 infection and 25 (49 %) patients showed signs of severity on admission; 35 patients (68.6 %) were vaccinated, with a complete vaccination schedule (2 doses). We noted 16 deaths (31.4 %). Oxygen saturation on admission was significantly associated with the rates of COVID lesions on chest CT (p = 0.018), yet the correlation remained moderate. Vaccination had a significant protective effect on patient death (p = 0.0236). Conclusion: Vaccination is more than ever the only weapon of prevention against serious complications related to COVID-19 infection, especially in very elderly subjects, exposed to several comorbidities and polymedication. Prevention efforts and dedicated health explanations are the keys to a useful vaccination being targeted on elderly populations at risk.

Subcutaneous emphysema after dental or stomatological treatment, rare complications or consequences of malpractice ?

Bodet C, Jaumotte M, Le Clercq M, Pepinster F, Gilon Y

Rev Med Liege 2022, 77(11),635-636

Summary : The occurrence of pneumomediastinum and subcutaneous emphysema following oral treatment is the result of the inappropriate use of dental equipment using pressurised air. However, their use in oral surgery, including dental extractions, continues nowadays. In addition to being a source of subcutaneous and pneumomediastinum emphysema at risk of infection, pneumatic instrumentation can also be a source of potentially serious gas embolisms. A thorough knowledge of this type of complication by the practitioners and the proper use of the instrumentation will enable a significant reduction of the incidence of theses complications.

Continuous platelet infusion in patient refractory to platelet transfusion : a retrospective study

Devey A, Gothot A

Rev Med Liege 2022, 77(11),637-643

Summary : Platelet transfusion is commonly used for the prevention of bleeding in central thrombocytopenia. It is estimated that 7-34 % of chronically transfused patients become progressively refractory until they no longer have an increase in post-transfusion platelet count. In this case, and in the presence of bleeding, a therapeutic option is continuous transfusion (CT) of platelet concentrates (PC). We performed a retrospective study of patients at the University Hospital of Liege who received a CT between 01/01/2019 and 31/12/2020. We explored the etiology, immune or non-immune, of the refractory state and analyzed the clinical and biological evolution after TC. In our cohort, 13 patients received CT during the study period; for 8 of them, the refractory state was explained by non-immune causes. The mean platelet count increased during CT and in 61 % of cases, an improvement in bleeding symptomatology was obtained.

Diagnostic approach to prolonged fevers amongst adults in primary care

Ginier-Gillet M

Rev Med Liege 2022, 77(11),644-648

Summary : The article seeks to explore: (1) the necessity to import hospital-based fever management tactics into general practice; and (2) the soundness of the principle of parsimony in clinical medicine. The discussion expands on the obstacles leading to an unexplained fever by emphasising on White’s Law and the limitations of academic definitions. The article tries to keep a practical orientation by recalling the difficulty of “functional hyperthermia” as well as the choice of routine diagnostic examinations. The discussion also focuses on the modes of inference in general medicine, on clinical inertia and “substantialism” as a standard of care.

Deep brain stimulation as a treatment for severe multidrug-resistant obsessive compulsive disorder

Janssen C, Salado AL, Kaschten B, Martin D, Scantamburlo G

Rev Med Liege 2022, 77(11),649-654

Summary : Obsessive compulsive disorder (OCD) is a common and disabling psychiatric condition. About 10 % of patients are considered to be severely affected and refractory to the usual treatments, combining antidepressants and psychotherapy. Deep brain stimulation (DBS) is a promising treatment, reserved for specialized university centers. It is based on the implantation of electrodes aimed at modulating dysfunctional cortico-striato-thalamo-cortical circuits. After studying the different targets to be used, it is now proposed to rethink DBS in terms of networks. The improvement of pathophysiological knowledge of OCD and the development of functional neuroimaging techniques should allow the design of individualized treatment protocols.

CT scan in syncope : diagnostic yield and prescription habits

Moïse M, Cousin F

Rev Med Liege 2022, 77(11),655-663

Summary : Syncope is a frequent reason for emergency department admission. Brain imaging is theoretically not recommended. After exclusion of features orienting towards non-syncopal events, we retrospectively included 206 patients who underwent head CT scans in the University Hospital of Liège for transient loss of consciousness between December 2020 and July 2021. We surveyed physicians involved in the emergency department concerning their imaging prescription habits and motivations. CT diagnostic yield is 1 %. The oncologic background is associated with pathological findings (odds ratio 84,1, p = 0,005). Cervical angio-CT scans only lead to incidental findings and increased dose exposure. Only a minority (6.6 %) of physicians systematically prescribe brain imaging. Radioprotection is an important notion for only 10 % of the less experimented physicians. Obligation of means is an occasional justification for resort to imaging. A prospective decisional rule based on the exclusion of features orienting towards non-syncopal loss of cousciousness, old age and oncologic history might reduce the number of useless scans. Radioprotection is too often neglected by less experimented physicians. Obligation of means should not be mingled with reassurance behaviors as part of defensive medicine.

Child abuse within a migratory process: pediatric management and assessment

Pannizzotto S

Rev Med Liege 2022, 77(11),664-666

Summary : When child abuse occurs within a family, it is necessary during a medico-psycho-social assessment to analyze which vulnerability factors have led to a systemic imbalance. The migratory process, like any major modification of family homeostasis, can cause parental difficulties without, however, embodying the cause of the abuse. However, it represents a major event in the life of the child and his parents who, in a situation of child abuse, should neither be trivialized nor be reduced to the sole cause of the abuse inflicted.

Use of central anticholinergics in 2022

Parmentier E, Depierreux F, Maquet P

Rev Med Liege 2022, 77(11),667-671

Summary : Cholinergic antagonists have been used for 60 years in the treatment of movement disorders. Their effect arises from a modulating activity within basal ganglia motor circuitry. Due to diffuse distribution among many organs, anticholinergic medications have numerous adverse effects. Nowadays, the indication of these molecules in the treatment of Parkinson disease is reduced, due to more effective and better tolerated alternatives. Iatrogenic parkinsonism is hardly alleviated by anticholinergics. These medications allow to prevent acute dystonic reactions induced by highly-dosed first generation antipsychotic agents. Once acute dystonia has appeared, parenteral treatment is to be preferred, but oral cholinergic antagonists may be used after the acute phase to prevent relapse. Botulinum toxin is preferred to anticholinergics for focal dystonia. In generalized dystonia, anticholinergic moderately alleviate symptoms.

Coxalgia

Lepiece C, Dunand X, Thirion T

Rev Med Liege 2022, 77(11),672-677

Summary : Coxalgia is one of the most common painful complaints in orthopedic surgery. The management of a “traumatic” hip is relatively well codified, however atraumatic coxalgia is more difficult to diagnose and explore. The history and a well-conducted clinical examination are essential for the management of coxalgia. The diagnosis is already well oriented by a simple X-ray and the presence or absence of inflammatory signs on the blood test. This article aims to provide a guideline for the diagnostic approach to coxalgia.

Apexxnar®, 20-valent pneumococcal conjugate vaccine

Scheen AJ, Louis R, Moutschen M

Rev Med Liege 2022, 77(11),678-683

Summary : Streptococcus pneumoniae infections cause bacteremic and non-bacteremic community-acquired pneumonia and invasive pneumococcal diseases (IPD) such as bacteremia, sepsis and acute meningitis. They are potentially lethal. Although polysaccharide vaccines (PPV23, Pneumovax 23®) have already provided protection in at-risk individuals, they have been imperfect, mainly because the development of anti-polysaccharide antibodies occurs without the help of T cells. The introduction of immunogenic protein conjugate vaccines (ICVs) has overcome this problem and provided better and longer lasting protection. The first available vaccine of this type for adults was Prevenar 13®, targeting 13 polysaccharides of S. pneumoniae (PCV13). A new vaccine, Apexxnar®, targeting 20 polysaccharides (PCV20), the 13 of Prevenar 13®, to which 7 other serotypes considered to be equally responsible for invasive infections have been added, has recently been launched. Clinical studies have demonstrated a good immunogenic response against all 20 serotypes in adult patients who are either vaccine-naive or previously vaccinated with PPV23 and/or PCV13. Furthermore, the tolerance of the PCV20 vaccine was found to be comparable to that of Prevenar 13®. Vaccination with PCV20 involves a single injection. The Belgian Superior Health Council has recently reiterated the importance of vaccinating at-risk individuals against S. pneumoniae (a vaccination that is still under-performed). It now recommends vaccination with PCV20 (Apexxnar®) as the preferred primary vaccination regimen in high-risk adults with co-morbidities or in good health aged between 65 and 85 years.

Prescribing a SGLT2 inhibitor for treating heart failure without inducing hypoglycaemia

Scheen AJ

Rev Med Liege 2022, 77(11),684-688

Summary : Sodium-glucose cotransporter type 2 inhibitors (SGLT2i or gliflozins) improve the prognosis of patients with heart failure, independently of the presence of diabetes. They are now recommended for the treatment of heart failure in international guidelines. The addition of a gliflozin driven by such a cardiological indication may require some adjustment of the antidiabetic therapy. The aim of this concise article is to discuss the potential risk of hypoglycaemia, highly deleterious in fragile patients at risk, following the prescription of a gliflozin in patients with heart failure. Different clinical situations will be considered, both in nondiabetic patients and in patients with type 2 diabetes already treated with a variety of antihyperglycaemic agents, metformin, sulphonylureas, gliptins, GLP-1 receptor agonists and insulin.

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 : 10-11-2022
Université de Liège