Revue médicale de Liège (Rev Med Liege)

Publications in this journal

• Article: [Macro replantation of upper extremity. Update and review of the long-term functional results].

  A Datco, C Duysens, P Massagé, A Carlier
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  ABSTRACT: Confronted with increasing problems of financing in health care, some question the relevance of certain interventions of high technicality. Today, the limiting factor for practitioners is not any longer situated at the technical and technological level (the survival of macro replantations is assured in 85-90%) but moves slowly and surely towards the economic level. It is true that medicine has a price and that if a technique is expensive, it should at least be justified at the human level and superior to other less expensive therapeutic options which are available. In this article, we will first focus on the long-term outcome of patients and also on the functional benefit which brings them replantation compared to patients who underwent a regularization of their stump and possibly a reconstruction enabling them to be correctly fitted with a prosthesis.
  Revue médicale de Liège 03/2013; 68(3):122-7.
• Article: [Is my child normal, doctor? The specifics of child psychiatric examination].

  A Malchair
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  ABSTRACT: The psychiatric assessment of a child requires to integrate the symptoms presented, for example, the child's suffering, in an array of complex family interactions The consultation process is difficult for parents and child, but also for the physician. Many pitfalls exist for everyone, namely the stigma attached to a disease, the search for normality at any price, the seduction of a reductive explanatory theory, and especially the oversight of the child's evolutionary potential. Finally, the characteristics of examination vary at each age; the differences may be major and depend on the development of the child in the process of empowerment.
  Revue médicale de Liège 03/2013; 68(3):134-40.
• Article: [Pigmented villonodular synovitis of the knee].

  F Smets, W Kurth, J M Crielaard, J F Kaux
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  ABSTRACT: This case report is concerned with a 30 year old patient diagnosed with pigmented villonodular synovitis (PVNS) in the knee. The patient underwent an orthopedic surgical operation to remove the lesions. PVNS is a rare proliferative disorder, mostly benign and affecting the knee; its aetiology remains unclear. It represents a medical challenge because of non-specific symptoms that delay the diagnosis with a very high rate of recurrence. MRI imaging is necessary to explore the lesions, but the final diagnosis can only be made after anatomopathologic analysis of the excised lesions. When multiple lesions are present, the treatment consists of their excision by arthrotomy, or by arthroscopy if the disease is localized.
  Revue médicale de Liège 03/2013; 68(3):104-9.
• Article: [Imaging-guided percutaneous spinal biopsy].

  J Stulko, V Alvarez Miezentseva, L Gerard, M Delacolette, J Joskin, P Simoni
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  ABSTRACT: The aim of this article is to present the value and limitations of image-guided percutaneous biopsy in spinal disorders. The indications and contraindications of percutaneous spinal biopsy and the different techniques and materials used are discussed. The decision for this type of biopsy and the choice of technique should be made by a multidisciplinary team. Percutaneous spinal biopsy is a safe, inexpensive and possible as an outpatient. The effectiveness of percutaneous spinal biopsy is around 70%.
  Revue médicale de Liège 03/2013; 68(3):128-33.
• Article: [How I explore ... the skin functional involvement in scleroderma].

  T Hermanns-Lê, C Piérard-Franchimont, G E Piérard, B André, C De Roover, L Renwart, P Delvenne
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  ABSTRACT: Scleroderma refers to distinct clinical presentations sharing in common a sclerotic process most often clinically obvious on the skin. The involvement possibly affects the skin alone in morphea or in combination with internal lesions in systemic sclerosis. Some objective and non-invasive functional assessments are useful for better appreciating the severity and evolution of the disease, as well as to monitor the therapeutic efficacy. In this endeavour, in vivo measurements of the skin mechanical properties are unsurprisingly informative.
  Revue médicale de Liège 03/2013; 68(3):141-7.
• Article: [Malabsorption of thyroid hormones ... or simply poor patient compliance?].

  A Benoit, A Bouquegneau, P Petrossians, A Beckers
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  ABSTRACT: We report the case of a patient presenting with L-thyroxine pseudomalabsorbtion, a figure in which patients are in a state of biological, and, frequently, clinical hypothyroidism secondary to a lack of adherence to substitutive thyroid treatment. We then review the different causes of true thyroid hormones malabsorption and the different approaches to these situations. We also suggest diagnostic and therapeutic attitudes for clinicians facing suspicious cases of hormone malabsorption.
  Revue médicale de Liège 03/2013; 68(3):118-21.
• Article: [Laryngeal metastasis of a colonic adenocarcinoma].

  A Somja, E Panosetti, J Keghian, M Delos, G Lawson
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  ABSTRACT: We report the case of a 63 year old man with laryngeal metastasis of a colonic adenocarcinoma recurrent after partial cordectomy by CO2 Laser microlaryngoscopy. This patient was followed for this condition between 2009 and 2010. The rarity of metastatic laryngeal metastases, particularly when the primary tumor is colic, justifies this presentation.
  Revue médicale de Liège 03/2013; 68(3):101-3.
• Article: [A trans-hospital pilot programme for onco-geriatry. The experience of the CHC-Liege].

  C Focan, E Warzee, G Demolin, G Houbiers, F Kreutz, G Matus, L Longree, C Sondag, F Dammel, Th Guillaume, M P Graas
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  ABSTRACT: The authors offered to 296 consecutive cancer patients aged > or = 70 to undergo a joint comprehensive geriatric and oncological assessment. After pluridisciplinary discussion, several reflections have emerged: the need in 15 - 32% of cases to reinforce the role of the paramedical staff; the correlation between age, low clinical indices, alteration of renal function as well as geriatric characteristics; 67% of evaluated cases presented a significant geriatric profile; recommendations for patients' management in relation to their pattern of frailty and health aging (standard, adapted or palliative treatment).
  Revue médicale de Liège 03/2013; 68(3):110-7.
• Article: [Clinical evaluation of an obese person].

  J De Flines, M Rorive, N Esser, N Paquot, F Luyckx, A J Scheen
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  ABSTRACT: Obesity is increasingly prevalent in our society and medical consultations for evaluation and management of weight excess are frequent. Before considering a therapeutic strategy, a careful initial clinical assessment is mandatory. The diagnostic approach of an obese person should be similar as for any other chronic pathology. The objectives of the present clinical description are to report the main steps of an exhaustive anamnesis, the signs to be more specifically detected at the clinical examination and the other useful investigations to be programmed at first glance in a person who is visiting his/her medical doctor because of obesity. Based upon the data collected during this careful evaluation, therapeutic modalities may be defined, ideally in the frame of a multidisciplinary approach.
  Revue médicale de Liège 03/2013; 68(3):148-53.
• Article: [Reticence to vaccination: an approach to the phenomenon through a literature review].

  F Ketterer, P Trefois, M-C Miermans, M Vanmeerbeek, D Giet
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  ABSTRACT: Although it exists since vaccination appeared, reticence towards vaccination seems to be increasing. Through a literature review, this article first analyses the reasons for this reticence. The decline of infectious diseases leads to greater attention to side effects of vaccines; on the other hand, the social evolution leads patients to search for zero risk in different aspects of life. Suspiciousness towards the State and the influence of media emphasizing potential deleterious effects of each vaccine are additional phenomena explaining people's hesitations. Anti-vaccination movements using Internet to disseminate their ideas are also responsible. Secondly, the article aims at assessing the public opinion about vaccination. It is still predominantly positive, even if questions remain. A typology of four patients' profiles based on statistical results is proposed. Finally, after having examined the medical doctors' opinion concerning vaccination, this article ends with some pieces of advice on how to deal with vaccination in the patient-doctor relationship.
  Revue médicale de Liège 02/2013; 68(2):74-8.
• Article: [Atypical clinical presentation of a neuroblastoma in an infant].

  G Dauphin, P Costa de Araujo, P Forget, P Leroy, L Rausin, M Demarche
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  ABSTRACT: A babygirl, aged six weeks, was hospitalized for rectal prolapse and isolated constipation. The investigation revealed a neuroblastoma (NB) inducing a medullar compression responsible for the sphincter disorders. NB is second among pediatric solid tumors, but is the most frequent cancer among infants. Its diagnosis is difficult because of its rarity and the variety of its symptoms. A new stadification, based on imaging, has recently been proposed by the International Neuroblastoma Risk Group. With the exception of its localized, easily resectable forms, NB is best treated by chemotherapy.
  Revue médicale de Liège 02/2013; 68(2):56-60.
• Article: [Is there a place for the physician's hopelesness in the treatment of depression?].

  W Pitchot
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  ABSTRACT: In the treatment of depression, the main objective is to reach complete remission. Unfortunately, this objective remains difficult in clinical practice. In fact, complete remission is frequently considered as an unrealistic objective. It is clear that recovering from major depression is a complicated objective, but it is realistic. In the present paper, we describe the case of a patient suffering from treatment-resistant chronic depression that remitted with a combination of duloxetine (Cymbalta) and aripiprazole (Abilify).
  Revue médicale de Liège 02/2013; 68(2):61-4.
• Article: [Orthostatic hypotension: definition, symptoms, assessment and pathophysiology].

  M Tyberghein, J-C Philips, J-M Krzesinski, A J Scheen
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  ABSTRACT: Orthostatic hypotension (OH) is defined by a drop in arterial blood pressure (BP) of at least 20 mmHg for systolic BP and 10 mmHg for diastolic BP after standing. Symptoms are generally quite typical, but may also be rather vague. Diagnosis may be easily made by the physician in his/ her office, and confirmed, if necessary, by more sophisticated measurements. Pathophysiology is generally rather complex, but mostly involves a defect in the autonomic nervous system, in its sympathetic component. Failure of peripheral vasoconstriction seems to play a more important role than the defect in reflex tachycardia. Causes of OH are multiples. OH may occur in healthy subjects, when exposed to exceptional circumstances, but is more generally associated with various diseases, either neurological disorders or pathologies characterized by hypovolemia. Medications can also aggravate the risk of OH, among which some antihypertensive or psychotropic agents. Elderly people, especially frailty subjects, are exposed to a high risk of OH, whose origin is often multifactorial, and this complication may have serious medical consequences.
  Revue médicale de Liège 02/2013; 68(2):65-73.
• Article: [Recent advances in nutritional support and postnatal growth in premature infants].

  T Senterre, J Rigo
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  ABSTRACT: Nutrition has always been described as challenging in premature infants, especially in very low birth weight (VLBW, < 1500 g) infants. Therefore, postnatal malnutrition is frequently observed in these infants and most develop a severe postnatal growth restriction with a very high incidence of hypotrophy at term corrected age. Otherwise, both insufficient nutritional intakes and postnatal growth restriction during the perinatal period have been associated with adverse developmental outcomes. In this article, an optimized nutritional policy characterized by a standardization of nutritional support is discussed. This policy implies the use of one standardized parenteral nutrition solution and a rapidly enriched feeding regimen. Recent studies in VLBW infants have demonstrated that this approach is associated with significant improvement of nutritional support, postnatal growth and biological homeostasis. Only 6% of appropriate for gestational age infants at birth were described small for gestational age at discharge. This policy has recently been reproduced by the industry that developed the first manufactured triple-chamber parenteral nutrition bags specifically designed for premature infants. It represents a great opportunity for premature infants to improve their development and long-term outcomes.
  Revue médicale de Liège 02/2013; 68(2):79-85.
• Article: [In Process Citation].

  F Cousin, V Alvarez, C Beckers, R Hustinx, P Simoni
  Revue médicale de Liège 02/2013; 68(2):53-5.
• Article: [New treatments for castration-resistant prostate cancer].

  B Sautois, C Gennigens
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  ABSTRACT: Docetaxel chemotherapy is a standard treatment for fit men with symptomatic castration-resistant prostate cancer. Unfortunately docetaxel resistant disease will systematically develop and second-line treatment may be appropriate. Until recently no standard treatment was approved in this setting and mitoxantrone was commonly used. Three new drugs have shown benefit in randomised phase 3 multicenter clinical trials published since 2010. Cabazitaxel, abiraterone and enzalutamide were shown to prolong overall survival of men with metastatic castration-resistant prostate cancer previously treated with chemotherapy. Although still modest these results were deemed clinically significant and led to the reimbursement of Jevtana (cabazitaxel) and Zytiga (abiraterone) in Belgium in 2012.
  Revue médicale de Liège 02/2013; 68(2):94-6.
• Article: [Multimodal cardiovascular imaging before aortic valve transcatheter replacement].

  L Davin, P J Bruyère, P Lancellotti, L Piérard, V Legrand
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  ABSTRACT: Calcified aortic valve stenosis is the most frequent valvular heart disease in developed countries with a very poor outcome when symptoms develop. However, several of these patients are denied for surgery. The main reasons are their advanced age (elderly patient), co-morbidities, technical limitations and a very high surgical risk. It is currently possible to propose a Transcatheter Aortic Valve Implantation (TAVI). After selection of candidates, the feasibility of the intervention is analysed. The size of the aortic bioprosthesis must be selected according to the cardiac anatomy. Several cardiac imaging modalities (echocardiography, computed tomography and cardiac MRI) can be used to identify unsuitable situations. Heavy calcifications or tortuosity can thwart the retrograde approach use. The sub-clavian arteries (for the CoreValve) and trans-apical approach (for the Edwards-Sapien) constitute alternatives ways.
  Revue médicale de Liège 02/2013; 68(2):86-93.
• Article: [Fibromyalgia: an unrecognized Ehlers-Danlos syndrome hypermobile type?].

  T Hermanns-Lê, G E Piérard, Ph Angenot
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  ABSTRACT: Some patients suffering from fibromyalgia present with clinical signs and alterations in the histopathology, immunohistochemistry and ultrastructure of the dermis similar to the Ehlers-Danlos syndrome, hypermobile type (EDSH). Some types of fibromyalgia possibly represent an undiagnosed EDSH.
  Revue médicale de Liège 01/2013; 68(1):22-4.
• Article: [Allogeneic hematopoietic stem cell transplantation: what is the upper age limit?].

  S Servais, E Willems, Y Beguin, F Baron
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  ABSTRACT: In the last decades, the upper age limit for allogeneic hematopoietic cell transplantation has increased from 50-60 years to 70-75 years of age, in part due to the development of allogeneic transplantation following reduced-intensity or truly nonmyeloablative conditioning. This review describes challenges and opportunities of allogeneic hematopoietic cell transplantation in the elderly.
  Revue médicale de Liège 01/2013; 68(1):38-43.
• Article: [Horner's syndrome revealing a spontaneous carotid artery dissection].

  V Verdin, C Holemans, B Otto, H Van Damme, J O Defraigne
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  ABSTRACT: We report a case of spontaneous carotid artery dissection suspected by the appearance of Horner's syndrome. Under medical treatment, the intramural hematoma resolved within 3 months. The patient had an uneventful recovery, without any residual neurologic deficit. Spontaneous arterial dissection is responsible for a hematoma in the arterial wall without significant trauma. The pathogenesis remains unknown. Predisposing factors seem to exist. The clinical presentation is variable mainly due to local compression of adjacent structures which can precede a transient or permanent neurological deficit. The diagnosis is confirmed by Doppler US, CT angiography or magnetic resonance angiography, the best optional investigations. The treatment mainly consists of stroke prevention by anticoagulation versus antiplatelet therapy. The role of surgery and/or endovascular techniques has not yet been confirmed.
  Revue médicale de Liège 01/2013; 68(1):11-5.