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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 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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See detailComment j'explore...Une protéinurie
Résimont, Guillaume ULiege; GADISSEUR, Romy ULiege; LUTTERI, Laurence ULiege et al

in Revue Médicale de Liège (2018), 73(10), 519-525

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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), 73(10), 485-487

La localisation cérébelleuse préférentielle des lésions liées à une intoxication sévère à la méthadone s'explique par la concentration élevée des récepteurs opioïdes de type µ dans le cervelet. Si les ... [more ▼]

La localisation cérébelleuse préférentielle des lésions liées à une intoxication sévère à la méthadone s'explique par la concentration élevée des récepteurs opioïdes de type µ dans le cervelet. Si les ganglions de la base sont touchés, cela peut entraîner une évolution neurologique progressivement défavorable. Dans cet article, nous rapportons le cas d'un patient qui a développé une détérioration neurologique avec un mutisme akinétique, un syndrome pyramidal et extrapyramidal avec parkinsonisme et dystonie, dix jours après une intoxication à la méthadone et une rapide réanimation cardio-pulmonaire. La résonance magnétique montre des lésions au niveau des noyaux lenticulaires s'étendant aux noyaux caudés. Notre patient est le premier cas décrit évoluant vers une atteinte isolée et retardée des ganglions de la base dans ces conditions. Les mécanismes physiopathologiques peuvent être discutés: effet toxique direct de la méthadone ou secondaire à l'hypoxie. La prise en charge thérapeutique et les moyens de prévention sont également abordés. [less ▲]

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See detailDepistage neonatal de la mucoviscidose : vers une implementation nationale en Belgique en 2019.
BOBOLI, Hedwige ULiege; BOEMER, François ULiege; MASTOURI, Meriem ULiege et al

in Revue Medicale de Liege (2018), 73(10), 497-501

Cystic fibrosis has in Belgium a prevalence of 1/2.850 births, with a median age at diagnosis of 7 months according to the latest data from the Belgian registry of 2015. In our country, the diagnosis of ... [more ▼]

Cystic fibrosis has in Belgium a prevalence of 1/2.850 births, with a median age at diagnosis of 7 months according to the latest data from the Belgian registry of 2015. In our country, the diagnosis of cystic fibrosis is always based on signs and symptoms of the disease. However, because the scientific literature has largely demonstrated the benefits of neonatal screening for cystic fibrosis, it will be implemented in Belgium before the end of 2019. The screening programme should be framed by strict quality criteria in order to obtain the best performance with the least possible inconvenience. [less ▲]

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See detailComment je traite... L'otite moyenne aiguë chez l'enfant
Heinrichs, V.; Frère, Julie ULiege

in Revue Medicale de Liege (2018), 73(4), 167-172

Acute otitis media (AOM) is very common in early childhood (inferior to 2 years). As a spontaneous recovery occurs in superior to 80 % of cases, antibiotics use should not be systematic. The aim of this ... [more ▼]

Acute otitis media (AOM) is very common in early childhood (inferior to 2 years). As a spontaneous recovery occurs in superior to 80 % of cases, antibiotics use should not be systematic. The aim of this review is to discuss AOM diagnostic criteria based on the latest recommendations, aiming a wiser use of antibiotics. Antibiotics use in a child with AOM should take into account the age, the severity of the disease, uni- or bilateral otitis, the presence or absence of otorrhea, and the presence of possible risk factors. Delayed antibiotics prescription might be considered in some specific circumstances. The first line antibiotic treatment is amoxicillin, and increased dosage is efficient in case of resistant pneumococci. Pain evaluation is important, and, in every treatment protocols for AOM, pain-relievers use is needed. [less ▲]

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See detailPrise en charge multidisciplinaire de l'echinococcose alveolaire : le groupe Echino-Liege.
Cambier, Audrey; GIOT, Jean-Baptiste ULiege; LEONARD, Philippe ULiege et al

in Revue Médicale de Liège (2018), 73(3), 135-142

Alveolar echinococcosis is a zoonotic disease due to the tapeworm Echinococcus multilocularis. The definitive host is the red fox. Until recently, Belgium was considered a country at very low risk for ... [more ▼]

Alveolar echinococcosis is a zoonotic disease due to the tapeworm Echinococcus multilocularis. The definitive host is the red fox. Until recently, Belgium was considered a country at very low risk for alveolar echinococcosis. However, recent studies carried out in southern Belgium have revealed, through post-mortem examination, high prevalences (up to 62 %) in foxes. Cats and dogs can act as definitive hosts. Human are accidentally infected by ingestion of food contaminated by the feces. After a long incubation period, invasive hepatic lesions may appear, as well as extra-hepatic lesions. The disease may be fatal. The diagnosis is based on imaging techniques, serology and nucleic acid detection in tissues. Early diagnosis may allow surgical removal of the lesion associated with at least 2 years of albendazole postoperative treatment. In case of contraindication to surgery, a long term treatment with albendazole is necessary. Liver transplantation is sometimes necessary. This article presents the epidemiologic, clinical, diagnostic and therapeutics features of this zoonotic disease. [less ▲]

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See detailPrise en charge multidisciplinaire d'une volumineuse hydatidose hepatique.
HALLEUX, Danaé ULiege; Juriens, I.; Delwaide, Jean ULiege et al

in Revue Médicale de Liège (2018), 73(2), 65-71

Cystic echinococcosis or hydatidosis, is a zoonosis caused by larval stages of Echinococcus granulosus that can be encountered in Belgium in patients originating from endemic countries. The liver is the ... [more ▼]

Cystic echinococcosis or hydatidosis, is a zoonosis caused by larval stages of Echinococcus granulosus that can be encountered in Belgium in patients originating from endemic countries. The liver is the most commonly affected organ. In this paper, the authors describe the multidisciplinary management of this pathology based on the clinical case of a patient suffering from a 28 cm cystic echinococcosis treated by combination of albendazole and liver resection. Several treatment options are described in the literature although there is currently no clear consensus on the management of this condition. [less ▲]

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