Revue medicale de Liege最新文献

Cardiogenic shock is characterized by failure of the cardiac pump, requiring early recognition and prompt hemodynamic stabilization. The SCAI-SHOCK classification, which grades severity across five stages, facilitates standardized clinical communication and ensures population homogeneity in clinical trials. In cases of cardiogenic shock refractory to medical treatment, temporary mechanical circulatory support (MCS) is essential to maintain systemic blood flow and preserve end-organ function. This monocentric retrospective study analyzes ten years of experience with temporary MCS at the University Hospital (CHU) of Liège. Data are presented according to ischemic and non-ischemic etiologies. Outcomes of temporary MCS in cardiac arrest refractory to conventional cardiopulmonary resuscitation, as well as the use of monoventricular microaxial pumps, are also evaluated. Close multidisciplinary collaboration is crucial to address reversible causes, limit the duration of low cardiac output, and improve patient prognosis. This study highlights the evolution of management strategies and the importance of integrated care in optimizing clinical outcomes.

The transmission of bacterial, viral, fungal, or parasitic agents from vertebrate animals to humans constitutes a group of diseases called zoonoses. The frequency of these zoonoses is increasing, and new zoonoses are emerging due to travel, factory farming, biodiversity loss, climate change, and deforestation. These diseases have a significant impact on public health, both human and animal, as well as on food, environmental management and the economy. This second article reviews the viral, fungal, and parasitic zoonoses with cutaneous manifestations, known as dermato-zoonoses.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disorder. It is primarily caused by pathogenic variants in PKD1 and PKD2 genes. The natural history of ADPKD is characterized by progressive enlargement of the total kidney volume (TKV) due to continuous cyst development and expansion, ultimately resulting in a gradual decline of glomerular filtration rate (eGFR). ADPKD is a systemic disease that may involve hepatic cystic disease, intracranial aneurysms, and increased cardiovascular risk. The Mayo Imaging Classification, based on height-adjusted TKV and age, is the primary tool for identifying patients with rapidly progressive disease. It may be complemented by the PROPKD score (including the genetic diagnosis) and the longitudinal eGFR slope. These elements guide eligibility for disease-modifying therapy. Tolvaptan has demonstrated efficacy in slowing kidney enlargement and preserving eGFR in high-risk patients. Its use requires careful monitoring of liver enzymes and management of aquaretic side-effects. Comprehensive care includes strict blood pressure control, adequate hydration, dietary sodium restriction, cardiovascular risk reduction, and treatment of cyst-related complications. Extrarenal manifestations, particularly hepatic and neurological, require targeted screening in selected patients. Future perspectives focus on precision medicine, new biomarkers, innovative targeted therapies, and genomic approaches aiming to modify disease trajectory more effectively. This article provides an updated synthesis of the recently published KDIGO international recommendations for the management of ADPKD.

Contrast-enhanced mammography is an increasingly used breast imaging technique that offers significant advantages in terms of accessibility, patient tolerance, and cost. Its diagnostic performance has been shown to be comparable to that of breast magnetic resonance imaging, particularly for the detection and characterization of enhancing lesions. Given its growing clinical relevance, this article aims to illustrate the main enhancement patterns encountered in contrast-enhanced mammography and to compare them with their corresponding appearances on breast MRI.

Cystic fibrosis, the most common genetic disorder in Caucasian populations, is caused by mutations in the CFTR gene (Cystic Fibrosis Transmembrane Conductance Regulator), which disrupts chloride ion transport and leads to the production of viscous mucus, primarily affecting the lungs, digestive system, and liver. Traditional symptomatic treatment has been improved with the advent of CFTR modulators, notably the combination therapy of elexacaftor, tezacaftor, and ivacaftor (ETI), for patients carrying at least one F508del mutation. This retrospective study includes 23 patients treated with ETI, analyzing thoracic CT scan results before and after treatment using the Bhalla score. The results demonstrate a significant improvement in the Bhalla score (17.2 (± 3.8) before ETI vs 18.3 (± 3.4) after ETI, p < 0.001). The score improvement was observed in 78 % of patients, while 13 % remained stable, and 9 % showed deterioration. These results are consistent with other studies, although the effect on the improvement of bronchiectasis remains uncertain. Despite promising results, the study remains limited by its monocentric design and small sample size. Nevertheless, it confirms the beneficial effect of ETI on radiological pulmonary damage in CF patients.

Urethral prolapse is defined as the protrusion of the distal urethral mucosa in a circular shape through the external meatus. It is a rare condition with an estimated incidence of 1 in 3,000 cases. It primarily affects prepubescent girls of African origin and postmenopausal women of Caucasian origin. While generally asymptomatic, this condition can also cause vaginal bleeding, dysuria, hematuria, urinary urgency, urinary retention and dyspareunia. The pathophysiology of this condition is debated. Increases in intra-abdominal pressure (e.g. coughing, constipation or trauma) and a hypo-estrogenic environment are the most common risk factors. In most cases, the diagnosis is clinical. It is important to consider the differential diagnosis, as this condition can include malignant pathologies (such as botryoid sarcoma and rhabdomyosarcoma), as well as sexual violence. Treatment is generally conservative for asymptomatic or paucisymptomatic cases, while more symptomatic or recurrent cases may benefit from surgery. This article presents the case of a three-year-old girl of African origin who was referred to the local Sexual Assault Center (SAC) for suspected sexual abuse, after vaginal bleeding of unknown origin was discovered upon her return from school.

This issue highlights the growing complexity of modern medicine through diverse clinical situations, ranging from rare diseases to everyday practice challenges. It emphasizes the central role of clinical reasoning in data integration and medical decision-making.

Diaphragmatic dysfunction, whether unilateral or bilateral, partial or complete, is often an overlooked cause of dyspnea, sleep disturbances, and, in more advanced stages, chronic alveolar hypoventilation. It may result from injury to the phrenic nerve, the diaphragm muscle itself, or central nervous system pathways. The diagnosis is frequently suspected when an elevated hemidiaphragm is incidentally observed on chest imaging. A comprehensive assessment combining clinical examination, pulmonary function tests, arterial blood gas analysis, and targeted imaging is essential to confirm the dysfunction, identify its underlying cause, evaluate its severity, and guide management. In its advanced form, chronic hypercapnic respiratory failure may occur, often requiring non-invasive ventilation in addition to treatment of the underlying cause. This review outlines a structured and practical approach to the evaluation of diaphragmatic dysfunction, incorporating recent advances and key clinical considerations.

Acquired hemophilia A (AHA) is a rare but potentially life-threatening disorder characterized by the development of inhibitors against factor VIII. In 30-50 % of cases, AHA is associated with an underlying condition. We present a case of acquired hemophilia A secondary to marginal zone lymphoma. The diagnosis of AHA should raise suspicion for an underlying neoplastic process, prompting a thorough diagnostic workup. Although etiology remains unidentified in approximately half of AHA cases, it is crucial to maintain a high index of suspicion for malignancy, as neoplastic diseases may emerge even after treatment of AHA. The management of acquired hemophilia A consists of three main objectives : control of active bleeding, eradication of the inhibitor, and treatment of the underlying disease.

Practices regarding the interruption, substitution, and restart of direct oral anticoagulants (DOACs) during the perioperative period have constantly evolved since the commercialization of those medications. This may lead to uncertainties regarding their adequate management among practitioners, particularly outside the hospital. We propose a review of recent reference publications and guidelines defining DOAC management during the pre- and postoperative period for elective surgery, with the goal of providing a pratical guide for practitioners outside the hospital, including general practitioners and pharmacists. After classifying the bleeding risk of surgery or interventional procedure, we indicate how to proceed. When the bleeding risk is minimal, DOACs should be stopped 24 hours before the procedure (i.e. no intake on the day of the procedure). When the risk is moderate or high, the last intake should occur 60 to 72 hours before the procedure (4 days for dabigatran), without any bridging with low molecular weight heparins. In patients with renal insufficiency, these delays should be extended, specifically for dabigatran.