Publications of Jean DEMONTY
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See detailLesions cerebrales demyelinisantes decouvertes chez un patient immunocompetent VIH-1+.
Nkoghe, D.; Moutschen, Michel ULiege; Demonty, Jean ULiege

in Médecine et Maladies Infectieuses (2008), 38(9), 500-3

We report the case of a 32-year-old immunocompetent HIV patient, presenting with acute demyelinating leukoencephalopathy. The patient displayed clinical and radiological features similar to multiple ... [more ▼]

We report the case of a 32-year-old immunocompetent HIV patient, presenting with acute demyelinating leukoencephalopathy. The patient displayed clinical and radiological features similar to multiple sclerosis. Histology revealed inflammation with necrosis, demyelination and destruction of axons. Serum tests were negative for various infectious agents as well as specific cultures and PCR. Corticotherapy and many antibiotic treatments failed. Resorption of the lesions occurred after partial excision and highly-active antiretroviral therapy (HAART). No recurrence was noted. This demyelinating cerebral disease was considered as the primary manifestation of HIV infection. HIV implication in the genesis of the process and its perpetuating this condition was suspected, but the mechanism is unclear. Dysimmune consequences related to the early course of HIV infection could be prevented by antiretroviral treatment. This study was the first description of tritherapy effectiveness on HIV related multiple sclerosis (MS)-like illness. [less ▲]

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See detailNouvelles approches dans la prise en charge de l'infection a VIH.
Chandrika, K.; Dellot, Patricia ULiege; Frippiat, Frédéric ULiege et al

in Revue Médicale de Liège (2007), 62 Spec No

HIV infection remains a major problem of public health in Belgium as well as globally. The number of new diagnosies of HIV infection in Belgium remains between two and three daily. Given the dramatic ... [more ▼]

HIV infection remains a major problem of public health in Belgium as well as globally. The number of new diagnosies of HIV infection in Belgium remains between two and three daily. Given the dramatic effect of antiretroviral therapy on the mortality due to HIV infection, the number of patients is constantly increasing. The different problems related to HIV care are also changing. Aging of the patients and chronic exposure to antiretroviral medications have induced new complications. We will present in this brief article several new experimental and clinical approaches in which our centre has participated during the last two years. [less ▲]

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See detailL'echinococcose alveolaire: une zoonose d'apparition recente en Wallonie
Wauters, Odile ULiege; Honore, Charles ULiege; Detry, Olivier ULiege et al

in Revue Médicale de Liège (2005), 60(11), 867-74

Alveolar echinococcosis is a serious parasitic disease, leading to large hepatic lesions. It must be distinguished from cystic echinococcosis, or hydatic cyst, caused by Echinococcus granulosus. Early ... [more ▼]

Alveolar echinococcosis is a serious parasitic disease, leading to large hepatic lesions. It must be distinguished from cystic echinococcosis, or hydatic cyst, caused by Echinococcus granulosus. Early diagnosis may allow surgical removal of the lesions by segmental hepatectomy, the only curative treatment. Parasitostatic medical treatment with albendazole may promote stabilization of the disease. Until recently, Belgium was considered a country at very low risk for alveolar echinococcosis, as no human case was reported, despite up to 51% of fox infection in southern Belgium autopsy series. Recently four patients presented with alveolar echinococcosis at the University Hospital Center of Liege, leading to the fear of a possible alveolar echinococcosis endemy in southern Belgium. Two of these patients underwent curative hepatectomy, but the other two had already pulmonary metastases at diagnosis and received palliative albendazole therapy. This article presents these cases, and reviews the clinical features of this parasitic disease. [less ▲]

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See detailEndemic alveolar echinococcosis in southern Belgium?
Detry, Olivier ULiege; Honore, Charles ULiege; Delwaide, Jean ULiege et al

in Acta Gastro-Enterologica Belgica (2005), 68(1, Jan-Mar), 1-4

Until now, Belgium has been considered as a low-risk country for alveolar echinococcosis. However it was recently demonstrated by necropsy series that, in some parts of southern Belgium (Wallonia), up to ... [more ▼]

Until now, Belgium has been considered as a low-risk country for alveolar echinococcosis. However it was recently demonstrated by necropsy series that, in some parts of southern Belgium (Wallonia), up to 51% of the red foxes (Vulpes vulpes) may be infected by E. multilocaris. The authors, working in a university hospital in southern Belgium, described in 2002 the first autoctuthonous Belgian case of hepatic alveolar echinococcosis. More importantly, in 2004, they diagnosed three other patients with alveolar echinococcosis. One underwent surgical resection, but two others had bilateral pulmonary involvement at time of definite diagnosis. Palliative albendazole therapy was initiated. These patients had been diagnosed with hepatic mass from unknown origin for several months. The previous experience with the first case allowed the authors to consider and to confirm alveolar echinococcosis diagnosis, made by pathology and/or serological tests and imaging. These four patients with alveolar echinococcosis were living either in the Liege or the Luxembourg province. Considering the high prevalence of E. multilocaris infection of red foxes and the recent increase of the fox population due to rabies vaccination in southern Belgium, and also the presence of E. multilocaris infection of red foxes in northern Belgium, it is likely that not only Wallonia, but also maybe the whole Belgium, may face endemic alveolar echinococcosis in the next years. [less ▲]

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See detailPrevention du paludisme chez l'adulte
Leonard, Philippe ULiege; Moutschen, Michel ULiege; Demonty, Jean ULiege

in Revue Médicale de Liège (2003), 58(6), 382-7

Great scourge of poor countries, malaria is the most important tropical parasitic disease. It is responsible for a large number of deaths in concerned countries and represents a real danger for travellers ... [more ▼]

Great scourge of poor countries, malaria is the most important tropical parasitic disease. It is responsible for a large number of deaths in concerned countries and represents a real danger for travellers going to endemic regions. So, prophylactic measures are essential. On the one hand protective measures against mosquito bites, by wearing covering clothes, by using repellents and bed net (eventually impregnated with insecticide) will be useful. On the other hand, chemoprophylaxis is most often necessary, adapted to the possibility of chloroquine resistant P. falciparum, to the length or conditions of travel, and to the traveller's antecedents and age. Special concern about pregnant woman is necessary, due to potential severity of malaria. Chemoprophylaxis needs to be continued after coming back, for a duration depending on the drug used. Unfortunately, no prophylaxis is 100% effective, and the appearance of fever during the travel or two to three months after return requires medical advice. In some circumstances, it is necessary to prescribe a stand-by emergency treatment, if no quick medical advice is possible. [less ▲]

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See detailLes anomalies morphologiques et metaboliques liees aux traitements antiretroviraux
Debruyn, X.; Nkoghe, D.; Leonard, Philippe ULiege et al

in Revue Médicale de Liège (2002), 57(1), 23-8

The long term use of antiretroviral therapy is associated with metabolic and morphological abnormalities named lipodystrophy. The understanding of its epidemiology is in progress. NRTIs and Pls are ... [more ▼]

The long term use of antiretroviral therapy is associated with metabolic and morphological abnormalities named lipodystrophy. The understanding of its epidemiology is in progress. NRTIs and Pls are involved in the origin of these abnormalities. So, NRTIs inhibit mitochondrial gamma polymerase and induce body fat distribution disorders. PIs interfere with lipid metabolism, leading to hyperlipidaemia and insulin resistance symptomatology. The diagnosis is made by clinical (far wasting or accumulation, or mixed syndrome) and biological signs (hyperlipidaemia, hyperglycaemia, hyperlactacidaemia). Radiological exams can quantify morphological abnormalities. The management consists in drug substitution, diet and exercise, and corrective drugs. Plastic surgery can be useful. [less ▲]

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See detailA case of hepatic alveolar echinococcosis contracted in Belgium
Delbecque, Katty ULiege; Detry, Olivier ULiege; Hayette, Marie-Pierre ULiege et al

in Acta Gastro-Enterologica Belgica (2002), 65(1, Jan-Mar), 55-60

We report herein the case of a Belgian 76-year-oId woman who developed a hepatic tumour suspected to be a breast cancer metastasis. Radiological imaging and guided biopsies were not contributive. The ... [more ▼]

We report herein the case of a Belgian 76-year-oId woman who developed a hepatic tumour suspected to be a breast cancer metastasis. Radiological imaging and guided biopsies were not contributive. The patient underwent an explorative laparoscopy with frozen sections that did not provide further diagnosis, and an open left bisegmentectomy was performed during the same anaesthesia. Histopathological examination of the hepatic mass showed Echinococcus multilocularis metacestodes, demonstrating alveolar echinococcosis. As our patient denied any travel in foreign countries and has undergone regular abdominal ultrasonographies since her mastectomy, it is highly likely that this alveolar echinococcosis had been contracted in Belgium. If some imported cases may be seldom managed in Belgium, to our knowledge, this case is the first occurrence of alveolar echinococcosis contracted in Belgium. This report, added to the demonstration of E. multilocaris infection of 50% of red foxes in Southern Belgium, and the potential infection of domestic cats and dogs, should attract attention of the medical community on the possible outbreak of endemic alveolar echinococcosis in Belgium, and on the related public health concerns. [less ▲]

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See detailMaladie de Horton et atteintes arterielles extratemporales: utilite de la tomographie par emission de positons au 18FDG. A propos de trois observations et d'une revue de la litterature
Belhocine, Tarik; Kaye, Olivier; Delanaye, Pierre ULiege et al

in Revue de Médecine Interne (2002), 23(7), 584-91

PURPOSE: We report three cases of Horton's disease, in which F18-Fluorine-2-Deoxy-D-Glucose (18FDG) positron emission tomography (PET) demonstrated a clinically unsuspected extra-cranial vessels ... [more ▼]

PURPOSE: We report three cases of Horton's disease, in which F18-Fluorine-2-Deoxy-D-Glucose (18FDG) positron emission tomography (PET) demonstrated a clinically unsuspected extra-cranial vessels hypermetabolism. METHODS: Fully corrected whole-body PET was performed in three patients (two women, one man) for exploring a marked inflammatory syndrome. Scanning was acquired 60 min after i.v. injection of 222 MBq of 18FDG in average. RESULTS: In two patients with histologically proven Horton's disease, PET alone showed increased glucose metabolism involving the carotid and sub-clavian arteries as well as the ascending aorta, aortic arch, thoracic and abdominal aorta, and the iliac and femoral arteries. In the third patient, by detecting cervical, thoracic and abdominal vessel hypermetabolism, PET non-invasively contributed to the diagnosis of giant cell arteritis. All patients had complete clinical and biological response to corticoids. PET controls performed 3- to 6-months post-treatment, confirmed the disappearance of the metabolic stigma. CONCLUSION: 18FDG PET may show an increased glucose metabolism in asymptomatic extracranial vessels locations of Horton's arterities. If these observations are confirmed on controlled trials, PET could be particularly useful for non-invasive diagnosing, staging and monitoring atypical clinical forms of Horton's disease. The metabolic imaging could also contribute to a better understanding of the pathogenesis of GCA. [less ▲]

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See detailLa néphropathie épidémique a Hantavirus
Weekers, Laurent ULiege; Biessaux, Yves ULiege; Lamproye, Anne ULiege et al

in Revue Médicale de Liège (1997), 52(8), 515-519

L'Entre-Sambre-et-Meuse a été le siège d'une épidémie de néphropathie épidémique à Hantavirus (NE) en 199293. Cinq cas ont été rencontrés au CHU de Liège en moins d'un an. Le virus responsable de cette ... [more ▼]

L'Entre-Sambre-et-Meuse a été le siège d'une épidémie de néphropathie épidémique à Hantavirus (NE) en 199293. Cinq cas ont été rencontrés au CHU de Liège en moins d'un an. Le virus responsable de cette affection appartient à la famille dès Hantavirus dont il existe huit sérotypes aux caractéristiques propres en terme de vecteur (rongeurs), de distribution géographique et de pathogénicité. Les pathologies induites chez l'homme vont de la néphropathie épidémique à Hantavirus - d'évolution le plus souvent bénigne- au syndrome pulmonaire à Hantavirus (SPH) - fréquemment mortel - en passant par la fièvre hémorragique avec syndrome rénal (FHSR) de sévérité intermédiaire. Dans nos contrées, on rencontre le sérotype Puumala dont le vecteur est le campagnol roussâtre. L'homme s'infecte par inhalation de particules contaminées et développe dans un pourcentage non précisé des cas, après une période d'incubation de 1 à 3 semaines, un tableau clinique de néphropathie épidémique à Hantavirus. Celui-ci se caractérise par l'apparition brutale d'une fièvre, de myalgies diffuses, de douleurs abdominales et/ou lombaires et de céphalées. Apparaissent ensuite à des degrés divers: nausées et vomissements, oligurie, myopie aiguë, toux,diathèse hémorragique, diarrhée... Biologiquement, on observe l'association d'une insuffisance rénale aiguë et d'une thrombopénie. L'évolution est spontanément favorable dans les deux à trois semaines. Le diagnostic suggéré par la clinique sera confirmé par la sérologie. La physiopathologie de l'insuffisance rénale et de la thrombopénie fait intervenir des interactions complexes entre l'hôte et le virus. Il n'existe pas de thérapeutique spécifique pour la néphropathie épidémique à Hantavirus. Les formes plus sévères (SPH et FHSR) peuvent bénéficierd'un traitement par Ribavirineen iv. [less ▲]

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See detailExtensive Ulcerative Colitis and Extraintestinal Manifestations in a Patient with Hiv Infection and Significant Cd4 T-Cell Lymphopenia
Louis, Edouard ULiege; Moutschen, Michel ULiege; de Marneffe, Pierre et al

in Gastroentérologie Clinique et Biologique (1997), 21(11), 884-7

We report a heterosexual patient with HIV infection and a CD4 T-cell count of 0.45 x 10(9)/L who developed mild ulcerative proctitis, sacroileitis and oligoarthiritis. While he was treated with 5 ... [more ▼]

We report a heterosexual patient with HIV infection and a CD4 T-cell count of 0.45 x 10(9)/L who developed mild ulcerative proctitis, sacroileitis and oligoarthiritis. While he was treated with 5-aminosalicylic enemas, the patient rapidly developed severe pancolitis. An emergency colectomy without procetectomy was performed. A few months later, he suffered recurrence of ulcerative proctitis, aggravation of arthritic pain and developed anterior uveitis. All symptoms disappeared after proctectomy. There was no evidence for opportunistic infection or Kaposi's sarcoma. Antineutrophil cytoplasmic antibodies were positive and the HLA-B27 antigen was present. CD4 counts were lower during the phases of active disease than during remission. This case demonstrates that severe ulcerative colitis can occur in the presence of moderate T-cell defects. In view of a recent report of remission of Crohn's disease under comparable circumstances, it is possible that the extent of T-cell involvement in both diseases is radically different. [less ▲]

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