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See detailNeuropathie optique étendue en présence d’anticorps
«anti-myelin oligodendrocyte glycoprotein»

Gillard, Florence ULiege; ANDRIS, Cécile ULiege; LOMMERS, Emilie ULiege

in Revue Médicale de Liège (2019), 74(4), 179-184

The discovery of autoantibodies targeting aquaporin-4 (AQP4) of astrocytes has improved the understanding and management of Neuromyelitis Optica Syndrome Disorders (NMO-SD), previously considered as a ... [more ▼]

The discovery of autoantibodies targeting aquaporin-4 (AQP4) of astrocytes has improved the understanding and management of Neuromyelitis Optica Syndrome Disorders (NMO-SD), previously considered as a variant of multiple sclerosis. Later, the detection of MOG IgG1 antibodies, directed against an oligodendrocyte myelin glycoprotein, made it possible to distinguish pathologies with different clinical and prognostic particularities, then helping the clinician in his diagnostic and therapeutic approach. This clinical case aims to feature the clinical differences, prognosis and therapeutic solutions of these pathologies. [less ▲]

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See detailŒdème aigu du poumon et traitement par tocolytiques chez la femme enceinte
Hardy, Pierre-Yves ULiege; Depierreux, Frédérique ULiege; Ferretti, Christian

in Revue Médicale de Liège (2019), 74(3), 129-133

Nous rapportons le cas d’une patiente traitée par nifédipine puis par atosiban pour une menace d’accouchement prématuré qui développe un œdème aigu du poumon non cardiogénique. La gravité des symptômes et ... [more ▼]

Nous rapportons le cas d’une patiente traitée par nifédipine puis par atosiban pour une menace d’accouchement prématuré qui développe un œdème aigu du poumon non cardiogénique. La gravité des symptômes et de l’hypoxémie ont mené à une césarienne en urgence et une hospitalisation aux soins intensifs. Ce cas clinique nous permet de faire une revue de littérature et d’aborder les différents diagnostics différentiels à évoquer et rechercher face à une dyspnée aiguë survenant chez une femme enceinte et la prise en charge d’un œdème pulmonaire aigu dans de telles circonstances. Les mécanismes physiopathologiques qui sont à l’origine de cette affection et l’implication du traitement tocolytique seront également discutés. [less ▲]

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See detailComment je traite … les tendinopathies de l’appareil extenseur du genou
Brilmaker, Thomas ULiege; Kaux, Jean-François ULiege

in Revue Médicale de Liège (2019), 74(2), 63-67

Knee tendinopathies account for a large number of sports dropping, especially in sports requesting jumps and running. There is actually no consensus about the management of those injuries. Nevertheless ... [more ▼]

Knee tendinopathies account for a large number of sports dropping, especially in sports requesting jumps and running. There is actually no consensus about the management of those injuries. Nevertheless, new therapies may offer possibilities to the non-responding ones. This review aims to actualise the treatment of knee tendinopathy, to discuss the most recent forms of treatment and their clinical use, limited by our current knowledge of the disease. [less ▲]

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See detailComment je traite... Les toxicités mucocutanées des thérapies ciblées en oncologie
DAMSIN, Thomas ULiege; COLLIGNON, Joëlle ULiege; LEBAS, Eve ULiege et al

in Revue Médicale de Liège (2019), 01

Le spectre des effets indésirables mucocutanés des thérapies ciblées (hors immunothérapies), comme les anti-EGFR, anti-VEGF, anti-TK et anti-BRAF, présente des similarités avec celui des traitements ... [more ▼]

Le spectre des effets indésirables mucocutanés des thérapies ciblées (hors immunothérapies), comme les anti-EGFR, anti-VEGF, anti-TK et anti-BRAF, présente des similarités avec celui des traitements chimiothérapeutiques classiques, mais également des lésions plus spécifiques. Cet article abordera les toxicités dermatologiques des thérapies ciblées, à l'aide de 11 illustrations cliniques : les mucites et toxicités endobuccales, les éruptions acnéiformes, les modifications et complications unguéales, le syndrome main/pied, la radiosensibilisation, les alopécies, la xérose et les fissures cutanées. Après une brève description clinique et quelques notions théoriques, la prise en charge dermatologique est détaillée. [less ▲]

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See detailEpidémiologie des cancers de l'enfant, une étude monocentrique (1985-2016)
Jankowski, M.; Dresse, Marie-Françoise ULiege; FORGET, Patricia ULiege et al

in Revue Medicale de Liege (2019), 74(3), 146-151

Cancer is the second leading cause of death among children aged 5 to 14, after accidents. We conducted a study on the epidemiology of childhood cancer in the university pediatric oncology department of ... [more ▼]

Cancer is the second leading cause of death among children aged 5 to 14, after accidents. We conducted a study on the epidemiology of childhood cancer in the university pediatric oncology department of the CHU-CHR in Liège, Belgium. We studied a cohort of 662 patients between the ages of 0 and 17 whose malignancy diagnosis was made between 1985 and 2016. The analyzes were performed retrospectively using medical files. The number of new cases, the proportion of different cancers, sex ratio, age at diagnosis and survival at 5 and 10 years were the epidemiological factors studied.We have been able to show an increase in the number of new diagnoses per year. More than 40 % of childhood cancers occur before the age of five. The most common neoplasias are leukemias, tumors of the central nervous system and lymphomas. This distribution is influenced by age. All malignant tumours combined, we observed a slightly larger proportion of affected boys than girls. Overall survival at 5 years reaches 80.2 %. However, it varies according to the type of tumour from 59.3 % for malignant soft tissue tumors up to 100 % for hepatoblastomas. © 2019 Revue Medicale de Liege. All Rights Reserved. [less ▲]

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See detailComplications metaboliques et carences nutritionnelles liees a une consommation excessive d'alcool.
De Flines, J.; Scheen, André ULiege; Paquot, Nicolas ULiege

in Revue medicale de Liege (2019), 74(5-6), 304-309

Metabolic disturbances associated with chronic alcohol consumption, among which those affecting glucose regulation, lipid profile, uric acid and nutritional status, are described. In fact, alcohol abuse ... [more ▼]

Metabolic disturbances associated with chronic alcohol consumption, among which those affecting glucose regulation, lipid profile, uric acid and nutritional status, are described. In fact, alcohol abuse can lead to overweight and obesity, but also to protein-caloric malnutrition. Finally, we will discuss concerns about vitamin and mineral deficiencies that may be observed in alcoholic people and can contribute to aggravate somatic complications. [less ▲]

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See detailL'alcool, facteur protecteur ou facteur de risque pour les maladies cardiovasculaires ?
Scheen, André ULiege

in Revue medicale de Liege (2019), 74(5-6), 314-320

Alcohol may exert both positive and negative effects on cardiovascular system. Several factors may modulate these effects, among which, most importantly, the daily dose but also consumption modalities ... [more ▼]

Alcohol may exert both positive and negative effects on cardiovascular system. Several factors may modulate these effects, among which, most importantly, the daily dose but also consumption modalities (type of beverage, regular or hectic consumption, for instance). Many epidemiological studies showed a J curve, with a greater risk of cardiovascular disease in non-consumers compared with light to moderate regular drinkers, but with a higher risk in heavy drinkers, in a dose-dependent manner. This article analyses the complex relationships between alcohol consumption and the risk of coronary and cerebrovascular diseases, including cardiovascular mortality. Owing to the remaining uncertainties, in absence of controlled trials, and the difficulty not to overcome the positive threshold, it is not currently recommended to drink alcohol in order to benefit of a cardiovascular protection. [less ▲]

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See detailAlcool et conduite automobile.
Scheen, André ULiege

in Revue medicale de Liege (2019), 74(5-6), 258-264

Alcohol intoxication during car driving represents a well-recognized danger and is responsible for numerous accidents leading to premature death or infirmities. The objectives of this article are to ... [more ▼]

Alcohol intoxication during car driving represents a well-recognized danger and is responsible for numerous accidents leading to premature death or infirmities. The objectives of this article are to describe some epidemiological data about driving under alcohol influence and associated car accidents, to remind which alcohol blood concentrations are acceptable from a legal point of view, to analyse the acute effects of alcohol on cortical function that could alter driving capacities and, finally, to consider some conditions that may reduce or increase the effects of alcohol on the performances during car driving. Keywords : Alcohol - Car accident - Driving - Brain. [less ▲]

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See detailEditorial. L'alcool, probleme de sante publique : de la consommation hedonique a la decheance physique et psychologique.
Scheen, André ULiege

in Revue medicale de Liege (2019), 74(5-6), 237-240

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See detailAnalyse comparative entre la thérapie manuelle orthopédique et l’ostéopathie : une mise au point sur la situation en Belgique
Hidalgo, Benjamiin; Demoulin, Christophe ULiege

in Revue Médicale de Liège (2019), 74(4), 204-211

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See detailImpact de la fonction thyroïdienne sur le résultat des inséminations artificielles avec sperme de donneur chez des femmes fertiles
Labye, Laurianne ULiege; WENDERS, Frédéric ULiege; Nisolle, Michelle ULiege et al

in Revue Médicale de Liège (2019)

Cette étude rétrospective, incluant 526 patientes, s’intéresse à l’effet de la fonction thyroïdienne sur le résultat des inséminations artificielles avec sperme de donneur chez des patientes a priori ... [more ▼]

Cette étude rétrospective, incluant 526 patientes, s’intéresse à l’effet de la fonction thyroïdienne sur le résultat des inséminations artificielles avec sperme de donneur chez des patientes a priori fertiles. Il n’existe aucune différence significative dans les caractéristiques des patientes et leur bilan de fertilité. Bien que la fertilité soit influencée par la fonction thyroïdienne, cette étude montre que les taux de grossesse et de naissance obtenus ne sont pas influencés par le taux de TSH dosé avant le début des inséminations. Toutefois, les hormones thyroïdiennes jouent un rôle dans le bon déroulement de la grossesse et le développement cérébral foetal. Il est donc important d’évaluer la fonction thyroïdienne en début de grossesse et d’instaurer un traitement substitutif si nécessaire (si TSH > 2,5 mUI/l). En effet, la grossesse est considérée comme un stress pour la thyroïde et une fonction thyroïdienne limite avant la grossesse peut décompenser pendant celle-ci. [less ▲]

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See detailApports de la cohorte liégeoise SENIOR dans l’étude de la fragilité en maison de repos.
Buckinx, Fanny ULiege; Charles, Alexia ULiege; Reginster, Jean-Yves ULiege et al

in Revue Médicale de Liège (2019), 74(4), 212-217

Au cours des deux dernières décennies, la documentation traitant de la fragilité s’est faite de plus en plus abondante. Toutefois, il n’existe toujours pas de définition opérationnelle et de critères ... [more ▼]

Au cours des deux dernières décennies, la documentation traitant de la fragilité s’est faite de plus en plus abondante. Toutefois, il n’existe toujours pas de définition opérationnelle et de critères universellement reconnus pour décrire la fragilité. Les critères cliniques de fragilité doivent être prédictifs du risque de déclin fonctionnel et d’événements péjoratifs de santé. Dans cette optique, identifier précocement les sujets fragiles permet d’agir sur les facteurs de risque et d’éviter les évolutions défavorables. La cohorte SENIOR, une étude longitudinale de personnes âgées résidant en maison de repos initiée en 2013, a pour objectif de contribuer à la compréhension des facteurs de risque, des conséquences et de la trajectoire de la fragilité. Elle a aussi pour but d’apporter des pistes de prise en charge. Cette cohorte suscite beaucoup d’intérêt dans le monde de la recherche scientifique. En effet, grâce aux nombreuses données démographiques, cliniques et anamnestiques récoltées annuellement, elle permet d’apporter des éléments de réponses aux problématiques liées à la fragilité des personnes âgées. [less ▲]

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See detailFocus sur l'empagliflozine. Synthese des analyses post hoc de l'etude cardiovasculaire empa-reg outcome.
Scheen, André ULiege

in Revue medicale de Liege (2019), 74(4), 185-191

EMPA-REG OUTCOME trial studied the cardiovascular safety of empagliflozin, a sodium-glucose cotransporter type 2 (SGLT2) inhibitor, compared to placebo, in patients with type 2 diabetes and high ... [more ▼]

EMPA-REG OUTCOME trial studied the cardiovascular safety of empagliflozin, a sodium-glucose cotransporter type 2 (SGLT2) inhibitor, compared to placebo, in patients with type 2 diabetes and high cardiovascular risk. It showed a significant reduction of major cardiovascular events (-14 %), cardiovascular mortality (-38 %), all-cause death (-32 %), hospitalisations for heart failure (-35 %) and progression of renal disease (-39 %). This article proposes an update, almost 4 years after the original publication, of recent post hoc analyses of this landmark study. [less ▲]

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See detailLe medicament du mois. Insuline basale degludec (Tresiba(R)).
Scheen, André ULiege; Mathieu, Chantal

in Revue medicale de Liege (2019), 74(4), 226-232

Insulin degludec (Tresiba(R)) is characterized by an original mode of prolonged and continuous insulin release after its subcutaneous injection. Thereby, it has a very long glucose-lowering effect, around ... [more ▼]

Insulin degludec (Tresiba(R)) is characterized by an original mode of prolonged and continuous insulin release after its subcutaneous injection. Thereby, it has a very long glucose-lowering effect, around 42 hours, and a better reproducibility from both a pharmacokinetic and pharmacodynamic point of view. Its efficacy and safety have been assessed in the phase 3 clinical programme BEGIN as compared with insulin glargine U100, in patients with type 1 diabetes (T1D) and type 2 (T2D). For a similar glucose control (reduction in glycated haemoglobin), less hypoglycaemic episodes were recorded, including severe hypoglycaemia, during the nocturnal period, with insulin degludec than with insulin glargine U100. This clinical benefit has been confirmed in the complementary SWITCH programme in T1D and T2D patients at higher risk of hypoglycaemia, in the double-blind cardiovascular outcome trial DEVOTE in T2D patients at high cardiovascular risk and in real-life conditions in the observational European EU-TREAT study in patients with T1D and T2D. Insulin degludec (Tresiba(R)) is indicated and reimbursed for the treatment of patients with T1D, combined with a prandial insulin, and T2D, alone or combined with oral antidiabetic agents, a glucagon-like peptide-1 receptor agonist or a short-acting insulin. [less ▲]

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See detailEtude des motifs d'admission au service des Urgences d'une cohorte de patients
Pirotte, Benoit; FRIPPIAT, Frédéric ULiege; DARCIS, Gilles ULiege et al

in Revue Médicale de Liège (2019)

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See detailLe medicament du mois. Combinaison a ratio fixe insuline basale glargine-lixisenatide (Suliqua(R)).
Scheen, André ULiege

in Revue Médicale de Liège (2019), 74(2), 111-116

Suliqua(R) (iGlarLixi) is a fixed ratio combination of basal insulin glargine U100 and the glucagon-like peptide-1 (GLP-1) receptor agonist lixisenatide. Both molecules exert complementary ... [more ▼]

Suliqua(R) (iGlarLixi) is a fixed ratio combination of basal insulin glargine U100 and the glucagon-like peptide-1 (GLP-1) receptor agonist lixisenatide. Both molecules exert complementary antihyperglycaemic effects : insulin glargine mainly targets fasting glycaemia while lixisenatide mainly targets postprandial hyperglycaemia. Thus, iGlarLixi is associated with a greater reduction in glycated haemoglobin (HbA1c) than each individual component and thereby results in a greater percentage of patients reaching HbA1c ? 7 %. It has a good tolerance profile, with a more favourable effect on body weight compared with insulin glargine alone and less gastrointestinal adverse effects when compared with lixisenatide alone, because of a more progressive titration of the GLP-1 receptor agonist component. iGlarLixi (Suliqua(R)) is presented as two different prefilled pens, one allowing to titrate glargine up to 40 IU/day, the other up to 60 IU/day, both with lixisenatide uptitrated to a maximum of 20 microg/day. This dual presentation facilitates a personalized approach according to patient's needs. Suliqua(R) is currently reimbursed, under conditions, for the management of type 2 diabetes not well controlled with basal insulin associated or not with oral antidiabetic agents. [less ▲]

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See detailComment j'explore... Un traumatisme du rachis cervical chez l'enfant.
CAJGFINGER, Nathalie ULiege; Jamblin, P.; Gilis, N.

in Revue Medicale de Liege (2018), 73(12), 645-649

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 ... [more ▼]

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. [less ▲]

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See detailAtteintes osseuses des leucemies lymphoblastiques aigues pediatriques : experience monocentrique et revue de la litterature.
Pécheux, Lucie ULiege; FORGET, Patricia ULiege; Geurten, Claire ULiege et al

in Revue medicale de Liege (2018), 73(11), 575-582

Bone pain associated with bone marrow infiltration is often present at diagnosis of pediatric acute lymphoblastic leukemia (ALL). It sometimes signs the presence of pathological fracture, lytic lesions ... [more ▼]

Bone pain associated with bone marrow infiltration is often present at diagnosis of pediatric acute lymphoblastic leukemia (ALL). It sometimes signs the presence of pathological fracture, lytic lesions, arthritis, or osteitis associated to ALL that can delay the diagnosis. During treatment, bone complications (pain, osteopenia, fracture, avascular necrosis, ...) are also reported. In order to describe bone involvement (BI) of pediatric LLA, we reviewed the records of 104 patients followed in our unit. The overall incidence of BI was 67 %. At diagnosis, 50 % of patients had BI and in 19 %, the diagnosis of ALL was delayed. During and after treatment, respectively 28 % and 37 % of patients presented bone complications (pain, fractures, avascular necrosis, osteopenia). Patients with BI had a lower leukocytosis inferior to 10x109/l (p = 0.005) and an ALL of average risk (p = 0.019). 38 % of patients with BI during treatment were over 10 years old and 55 % were girls (vs. 21 % and 38 % in the entire cohort, respectively). Osteoporosis was more severe at diagnosis than during treatment, suggesting the presence of constitutional promoting factors. In our cohort, the majority of BI was resolved at the end of treatment with no long-term sequelae. [less ▲]

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See detailL'image du mois: Atteinte isolée et retardée des ganglions de la base après intoxication à la méthadone
ALKAN, Serpil ULiege; DEMONCEAU, Nathalie; LEWIN, Michel

in Revue Médicale de Liège (2018), 10(73), 485-487

Preferential cerebellar localization during a severe methadone intoxication is explained by the high µ-opioid's receptors concentration in the cerebellum. If basal ganglia are affected, that may result in ... [more ▼]

Preferential cerebellar localization during a severe methadone intoxication is explained by the high µ-opioid's receptors concentration in the cerebellum. If basal ganglia are affected, that may result in unfavorable progressive neurological evolution. Here, we report the case of a patient who developed neurological deterioration with akinetic mutism, pyramidal and extrapyramidal syndrome with parkinsonism and dystonia, ten days after methadone intoxication and rapid CPR. Magnetic resonance shows lenticular nuclei damage extending in caudate nuclei. Our patient is the first case reported with isolated basal ganglia’s injury in this conditions. It asks the question of physiopathological mechanisms: direct toxic effect of methadone or secondary to hypoxia. Therapeutic and neuroprotective management are also discussed. [less ▲]

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