Revue medicale de Liege最新文献

Idiopathic pulmonary arterial hypertension (iPAH) is a rare, rapidly progressive disease associated with high morbidity and mortality. It is characterized by endothelial dysfunction within the pulmonary vascular bed and gradually leads to an increase in the pulmonary vascular resistances. Its non-specific symptomatology delays the diagnosis and brings the most severe forms to right ventricular failure. Management is based on haemodynamic assessment and specific vasodilator treatment. In iPAH, the vasoreactivity test during right heart catheterization is critical in order to identify a potential benefit of calcium channel blockers therapy leading to significant improvement of pulmonary haemodynamics.

In 1849, Thomas Addison discovered alterations in the adrenal glands at autopsy of three patients who had died with idiopathic anemia. Struck by Addison's work, Charles-Edouard Brown-Séquard demonstrated in 1851 that bilateral adrenalectomy in dogs was fatal. It was not until 1950 that the discovery of the hormones of the adrenal cortex, their structure and their biological effects allowed Kendall, Reichstein and Hench to win the Nobel Prize in Physiology or Medicine. Nowadays, autoimmune adrenalitis accounts for almost 80 % of cases diagnosed with Addison's disease. The causes of this serious condition, which doubles the mortality rate of affected patients compared to the general population, have been expanded by genetic and iatrogenic causes. The latter are increasingly associated with immunological cancer therapies. It is essential to educate the patients with Addison's disease to improve the management of their condition and to remain responsive to the many triggers such as stress, infections or surgery. The management of Addison's disease is of interest not only to endocrinologists but also to general medical practitioners and critical care specialists. Recent studies aim to improve the understanding of the physiological and therapeutic effects of hydrocortisone, mineralocorticoids and adrenal androgens.

We conducted a retrospective study of 83 cases of immune thrombocytopenia (IT) in patients under 20 years of age. The aim was to provide an overview of IT in our young patients. The median age was 10 years, with a predominance of females (71 %). The most common reason for consultation was cutaneous (65 %) or mucocutaneous (24 %) haemorrhagic syndrome of moderate severity (Buchanan grade 3) in 54 % of cases. Initial thrombocytopenia ≤ 20000/mm³ was noted in 77 % of cases, with a median of 8000/mm³. Myelograms were requested in 51 patients. Corticosteroids continued to be the most commonly prescribed drug (87 %), with intravenous immunoglobulins used immediately in 5 patients. Rituximab and eltrombopag were used in 18 patients (22 %) after failure of first-line treatment. Splenectomy was performed in 11 patients, with a good response rate of 82 %. Chronic disease progression was seen in 31 % of patients. The overall prognosis was good, with male gender and Buchanan haemorrhagic grade 3 suggesting a more favourable outcome.

Infraclusion is a consequence of dentoalveolar ankylosis. Associated complications include extrusion of the opposing tooth, open bites, and tilts. Early detection and management are crucial to limit and/or correct these complications. Different therapeutic options exist when a deciduous tooth is ankylosed : preservation or extraction (with or without space closure). The goal of this article is to highlight the advantages of the injected composite technique for restoring the tooth when preservation has been chosen.

Spontaneous cervical swelling syndrome is a rare, benign, and recurrent condition, most commonly affecting middle-aged women. Although its etiology is not fully understood, it is thought to be associated with intermittent occlusion of the thoracic duct, caused by increased pressure in the head and neck region. It occurs as an acute, limited swelling of the left supra-clavicular region and regresses, in most cases, spontaneously, in less than a week. We report the case of a 57-year-old woman who contracted a left cervical swelling a few days after air travel.

Breast cancer is a complex disease influenced by genetic and environmental factors. Molecular profiling research has revealed significant diversity within the disease, including among tumours with similar morphological features. This diversity can lead to significant differences in tumour behaviour. Scientists have turned their attention to molecular biomarkers to predict cancer behaviour and/or response to treatment, and to ensure personalised, optimal management of breast cancer patients. This article presents four examples of molecular biomarkers and genetic tests used in the field of breast cancer, highlighting their latest advances and their clinical use as predictive and/or prognostic markers.

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The prevalence of chronic low back pain is high and rising. Chronic low back pain is «non-specific» in approximately 90 % of cases. In addition to age, risk factors include smoking, obesity, physical and psychological stress, as well as demographic factors. The initial treatment approach involves non-steroid anti-inflammatory medications in the absence of contraindications, and active rehabilitation. If this conservative treatment fails, infiltrative and/or surgical techniques may be considered. A thermocoagulation, or denervation by radiofrequency, can be performed after a positive result has been obtained from a diagnostic block of the medial branch of the dorsal ramus, and can be used to relieve pain associated with a facet syndrome. An epidural or radicular infiltration can be used to relieve radicular pain. Surgical approaches such as lumbar canal decompression or arthrodesis are the most common. There are, however, abandoned or less common techniques such as nucleolysis or nucleotomy. In conclusion, when it comes to the treatment of chronic low back pain, conservative methods are preferred, with infiltrative options available if necessary. Indications for surgical interventions should be carefully evaluated during a multidisciplinary consultation.

In the event of a prevascular mediastinal mass, knowledge of the anatomy and content of the mediastinum is an essential prerequisite to establish a differential diagnosis. The «4T» rule is applicable because it is a simple and effective mnemonic. It groups together; thyroid goiter, terrible lymphoma, teratoma and thymoma. The reference imaging technique is computed tomography with injection of iodinated contrast media, allowing the analysis of the lesion as well as its topography and its relationship with adjacent structures. Concerning the case of a lymphoma, PET/CT is the reference examination, as it allows a precise assessment of extension and can establish a target lesion for excisional biopsy which will make the definitive diagnosis. PET/CT is also used for therapeutic monitoring.

Chronic kidney disease (CKD) is a common and severe complication in patients with type 2 diabetes (T2D). While inhibitors of the renin-angiotensin system remained for a long time the only medications that had proven nephroprotective effects, several other pharmacological classes also recently showed such a benefit : sodium-glucose cotransporter type 2 (SGLT2) inhibitors (gliflozins), glucagon-like peptide-1 receptor agonists (semaglutide), and mineralocorticoid receptor antagonists (MRA, finerenone). This clinical vignette aims at explaining the pharmacotherapy strategy for a patient with T2D who presents a progressive CKD. The interest of prescribing a combination of several medications with complementary actions that had proven a nephroprotection is emphasized.