2020 - volume 75 (1)
|Cutaneous metastasis in cervix cancer|
Derouane F, Honhon B
Rev Med Liege 2020, 75(1),4-5
Summary : Cutaneous metastases from cervix cancer are rarely described, and can appear years after a complete remission of the cancer. They may have multiple presentation as nodules, papules or telangiectasies. Unfortunately, these are associated with poor prognosis. We here report the case of a woman who developed cutaneous metastasis in the situation of a cervix cancer that appears to be stable under bevacizumab.
|Velamentous cord insertion associated with vasa praevia|
Schoenen S, Emonts P, Van Linthout C
Rev Med Liege 2020, 75(1),6-9
Summary : Velamentous cord insertion is a rare placental abnormality, that may be associated with vasa praevia, i.e. the presence of an umbilical vessel near the internal cervical orifice. In case of spontaneous rupture of the membranes, there is a major risk of fetal haemorrhage, which is often lethal for the unborn baby. The challenge of care is based on the prenatal diagnosis during the 2nd trimester ultrasound. In case a vasa praevia is confirmed during the 3rd trimester, elective caesarean section should be carried out prior to the onset of labour, between 34 and 36 weeks of pregnancy. Corticosteroid treatment for fetal lung maturation is recommended at 32 weeks of gestation because of the increased risk of preterm delivery. Velamentous cord insertion may be associated with other adverse pregnancy outcomes such as intrauterine growth restriction, death in utero, placental abnormalities.
|Critical assessment of long-term proton pump inhibitor use in the elderly|
Delhougne N, Allepaerts S, Gast P, Louis E
Rev Med Liege 2020, 75(1),10-16
Summary : Proton pump inhibitors (PPI) are drugs frequently used for gastric acid-induced conditions. Their use is constantly increasing and due to the apparent absence of side-effects, the treatment is not reassessed, even for the elderly. However, there are many cases of misprescribing while concerns about some side-effects are rising. Old people are weakened by their particular homeostasis and their associated medical conditions. Therefore, it seems useful to particularly insist on side-effects of the PPI, their indications and the ways of withdrawal, first of all for the elderly.
|Preoperative fasting : state of the art|
Javillier B, Fabbro C, Brichant JF, Deflandre E
Rev Med Liege 2020, 75(1),17-22
Summary : Inhalation of gastric content is a significant risk factor for perioperative complications. Preoperative fasting reduces this risk. The preanesthesia fasting time is variable and is subject to recommendations from different scientific societies. The clinician can identify some risk factors for inhalation during the preoperative anesthetic consultation. On the day of the procedure, the gastric ultrasound allows quantitative or semi-quantitative assessment of the gastric content. In that way, the anesthesiologist can adapt the anesthesia, in particular by using a so-called rapid sequence induction and esophageal compression.
|Why and how to treat iron deficiency in heart failure ?|
Tridetti J, Nguyen Trung ML, Ancion A, Oury C, Moonen M, Lancellotti P
Rev Med Liege 2020, 75(1),23-28
Summary : Anemia and iron deficiency are two common comorbidities in heart failure with reduced ejection fraction (HFrEF) and are associated with a poor prognosis. In contrast to iron oral supplementation, administration of intravenous ferric carboxymaltose (Injectafer®) improves quality of life, exercise capacity, and seems to reduce hospitalizations for heart failure. Unfortunately, although anaphylactic reactions are extremely rare, it is recommended to administer Injectafer® in a suitable medical environment. This limitation hinders Injectafer® administration and may cause reluctance from both physician and patient. The aim of this article is to optimize and harmonize management of iron deficiency in heart failure, by proposing a simple solution for the patient and the practitioner.
|Heart transplantation, indications and results at the University Hospital of Liege|
Brüls S, Tchana-Sato V, Lavigne JP, Durieux R, Sakalihasan N, Radermecker MA, Désiron Q, Creemers E, D’Orio V, Nelessen E, D’Orio V, Ancion A, Lancellotti P, Hans G, Lagny M, Blaffart F, Defraigne JO
Rev Med Liege 2020, 75(1),29-36
Summary : Heart transplantation remains undoubtedly the most effective treatment for end-stage heart failure, whatever its cause. Last decade has witnessed significant improvements in terms of morbidity and mortality following heart transplant. The 5-year survival rate is now beyond 70 %. However, the shortage of potential donors limits its use and requires strict criteria before listing a candidate for heart transplantation. Herein, we present a review of current indications and results of the heart transplantation program at the University hospital of Liège.
|Association between exposure to persistent organic pollutants during pregnancy and thyroid function during childhood : a pilot longitudinal study and literature review|
Dufour P, Pirard C, Seghaye MC, Boemer F, Charlier C
Rev Med Liege 2020, 75(1),37-42
Summary : Objective : Perfluoroalkyl substances (PFAS) are chemicals widely employed in the industry. Long term consequences of the newborns’ contamination by PFAS on thyroid function are of concern. The aim of this study is to assess the potential associations between PFAS contamination measured at birth and thyroid function assessed few months later. PFAS levels were previously determined in cord blood from a cohort of newborns recruited in Liege. Method : Parents of the children belonging to the first and the fifth quintiles of exposure to PFAS were contacted in order to measure the thyroid stimulating hormone (TSH) levels in their child few months after birth. Twenty-eight children participated in the study. Moreover, we performed a literature review about associations between pre- or perinatal exposure to persistent organic pollutants and thyroid function during early childhood. Result : No significant difference was highlighted between both groups of contamination (Mann-Whitney, p-value = 0.91). Literature review highlighted the critical need of new longitudinal data about this problematic. Conclusion : Our results suggest that the PFAS levels at birth are not associated with TSH levels later in life. Large scale studies are required to confirm our results.
|Ebstein’s anomaly : from fetal diagnosis to surgical treatment|
Madani S, Van Linthout C, Rondia G, Seghaye MC
Rev Med Liege 2020, 75(1),43-48
Summary : Ebstein’s anomaly is a rare and complex congenital heart disease involving abnormal embryological development of the tricuspid valve. Its exact prevalence remains unknown given the under-diagnosis of minor forms and the broad clinical spectrum of this pathology resulting from the highly variable tricuspid morphology. Echocardiography plays an important role in diagnosis, assessment and prognostic evaluation of this condition. We present the case of a 6-year-old boy born from a twin pregnancy with a severe neonatal EA diagnosed by ultrasound at 29 weeks of gestation and we discuss the management on the light of the recent literature.
|Recovery strategies in elite sport : focus on both quantity and quality of sleep|
Rev Med Liege 2020, 75(1),49-52
Summary : Elite athletes participate in multiple competitions and are exposed to important training load. There is a need to match the recovery process against such a number of competitions and important training load, with the aim of preventing overtraining and injury. Several recovery strategies exist. Some strategies such as hydration, diet, cold water immersion and sleep are effective in their ability to counteract the fatigue mechanisms. Elite athletes regularly display compromised sleep quantity and quality with sleep quality being most vulnerable prior to major competitive events, during periods of high-intensity training and following long-haul travel to competitions. Compromised sleep quantity and/or quality may be detrimental to the outcome of the recovery process after training and competition. Future studies should focus on the interest of sleep hygiene strategies to optimise recovery, performance and preventing injury.
|A somatic disease causing a child psychiatric disorder|
Barrea C, Debray FG, Simon M, Leroy P
Rev Med Liege 2020, 75(1),53-59
Summary : Psychiatric disorders in children may be the expression of underlying organic conditions. These are numerous and varied. The clinical presentation is often frustrating : psychiatric signs can remain isolated for years before other more specific organic signs appear. More recently, new treatments have been developed, making it possible to improve the prognosis of some of these organic diseases; screening them is therefore a daily concern for the child psychiatrist. This literature review discusses various paediatric treatable organic disorders that may have an isolated psychiatric presentation, to finally propose a decision tree algorithm based on somatic and psychiatric complaints reported.
|Which injectable therapy after failure of oral antidiabetic agents in type 2 diabetes ?|
Scheen AJ, Paquot N
Rev Med Liege 2020, 75(1),60-66
Summary : The shift to injection therapy, after failure of oral antidiabetic agents, is often considered as a difficult step by both the patient with type 2 diabetes and the physician, a situation that may lead to clinical inertia. Schematically, two options may be considered, either starting insulin therapy with a preference for basal insulin analogues, or adding a glucagon-like peptide-1 receptor agonist (GLP-1 RA). Each option has its advantages and disadvantages, which opens the road to personalized medicine. Nevertheless, the preference is increasingly given to GLP-1 AR, yet this solution is more limited by reimbursement conditions. A combination of the two approaches is also possible, with the recent commercialisation of fixed-ratio specialities combining a basal insulin analogue and a GLP-1 RA. This clinical case offers the opportunity to discuss all these different therapeutic options in a patient with poorly controlled type 2 diabetes despite a combination of oral antidiabetic agents, taking also into account the current conditions for reimbursement in Belgium.