Revue medicale de Liege最新文献

Hypertensive disorders of pregnancy and recommendations for their management are currently well defined. However, postpartum manifestations are considerably less so. Postpartum preeclampsia is a poorly studied pathological entity. It is not certain whether it is a distinct entity from antenatal preeclampsia. Diagnostic criteria include the new onset of hypertension within 48 hours to 6 weeks after delivery, associated with at least one other clinical or biological criterion. Most cases of postpartum preeclampsia occur within 7 to 10 days after delivery. Risk factors are similar to those of antenatal preeclampsia. Neurological signs such as headaches are the most common clinical manifestations. Atypical symptoms such as dyspnea should prompt consideration of different diagnoses, including postpartum cardiomyopathy and pulmonary embolism. Management of postpartum preeclampsia is essential to limit its impact on maternal morbidity and mortality. It primarily relies on antihypertensive treatment, possibly including diuretics and magnesium sulfate. Here we report a case of postpartum preeclampsia revealed by worsening dyspnoea, leading the patient to the emergency department on the 9th day postpartum.

The number of patients who survive a stay in intensive care unit (ICU) is increasing. It is our ethical responsibility to consider their quality of life after discharge. A risk factor for post-intensive care syndrome (PICS) is the perceived suffering during the ICU stay. Preventing this syndrome is a public health concern because of its secondary costs for both the patient and the society. Advanced practice registered nurses, in an environment where efficiency is required, could help in PICS prevention and management. Perspectives include individualized care during and after intensive care as well as improved coordination with primary care.

Background: There is limited evidence regarding the long-term functional outcomes of anterior lumbar interbody fusion (ALIF) or posterior lumbar interbody fusion (PLIF) in patients with refractory active lumbar discopathy (ALD).

Methods: We retrospectively surveyed 194 patients who underwent lumbar fusion for ALD using the Roland-Morris Disability Questionnaire (RMDQ) and Modified MacNab's Criteria (MMCQ) and reviewed medical records for complications.

Results: The cohort included 54 patients (median age: 53.5 years). Thirty underwent ALIF (L4L5: 4, L5S1: 20, L4S1: 6) and 24 had PLIF (L4L5: 8, L5S1: 12). Median follow-up was 83 (66-114) months. Excellent outcomes were more frequent in the ALIF group (34 % vs 21 %). RDQ scores were higher in the PLIF group (9 (3-17) vs 5 (0-11)). ALIF patients had fewer cases of proximal junctional kyphosis (7 % vs 25 %) but higher chronic analgesic use (33 % vs 17 %) and documented failed back surgery syndrome (13 % vs 0 %). No major complications were observed.

Conclusions: Both ALIF and PLIF are safe for treating recalcitrant ALD. ALIF may offer better long-term function and less disability, albeit with potentially higher analgesic use.

The frequency of occurrence of ano-perineal fistulas, especially in the context of inflammatory bowel diseases, makes them a subject of growing interest, mainly because of the discomfort and medico-social impact they induce in patients who carry them. Their treatment depends on their extent and potential for evolution. MRI appears as the technique of first choice for their assessment and follow-up. After a brief technical review, we'll look at the anatomy and imaging assessment of ano-perineal fistulas in terms of inflammatory activity and healing, two important characteristics that could influence both the prognosis and the therapeutic strategy.

This work describes a case of hepatocellular adenoma with β-catenin mutated discovered during imaging follow-up of hyperplastic regeneration nodules in patient with cirrhosis due to a a Budd-Chiari syndrome. This case highlights the importance of using imaging protocols in the follow-up of patients with hepatic vascular diseases to identify adenomas at an early stage and differentiate them from large regenerative nodules, as well as to provide a complete immunohistochemical profile of all biopsied hepatocellular lesions. Indeed, since the early 2000s, the identification of genetic alterations associated with immuno-histochemical markers has allowed the classification of hepatocellular adenomas into six molecular subtypes. Each subtype presents different histological, clinical, radiological and evolutionary characteristics, all important for the management of the lesion. Furthermore, the risk of malignant transformation of an adenoma is not limited to the subtype β-mutated catenin, lesion size and male sex, but hepatic vascular disorders also appear to be another major risk factor.

Non-tuberculous mycobacterial (NTM) infections present a major challenge in both diagnosis and treatment. The management of NTM varies based on the species involved and the host's risks factors. With their prevalence continuing to rise, healthcare professionals are likely to encounter these infections more often in the years ahead. It is therefore essential to be aware of the predominant NTM species in our environment, as well as the associated risk factors. In this context, we present a study conducted at the University Hospital of Liège between 2016 and 2020, aimed at identifying the NTM species responsible for infections in the Liège area. We also explore the immune mechanisms involved in fighting these infections, focusing on primary immunodeficiencies that should be considered in adult patients with NTM infections.

Ectopic pancreas (EP) and pancreas divisum are well-known anatomical abnormalities of the pancreas. Although pancreas divisum is the most common birth defect of the pancreas, EP is not such a rare anomaly. It is defined as the presence of pancreatic tissue outside the pancreas with no anatomical connection to the orthotopic pancreas. We present the case of a patient who combined these two anomalies that were discovered by chance with an abdominal CT scan.

The placement of a chest drain is one of the most common surgical procedures in the hospital setting. It is performed by a large number of physicians of different specialties. Some techniques have made chest drainage more accessible through their speed and simplicity, such as the Seldinger technique. Nevertheless, it is an act that can, like any surgical technique, be the cause of significant morbidity and even mortality. We report the case of a patient who was treated with a thoracic drain using the Seldinger technique for a traumatic pneumothorax secondary to rib fractures. This procedure was complicated by a left ventricular perforation requiring urgent surgical management. We wish to highlight the risk associated with certain techniques described as minimally invasive, as is the case with the Seldinger technique, and to remind that this is not an innocuous procedure that may lead to serious complications. For this reason, it is necessary that the placement of a chest drain be performed by someone experienced, familiar with the equipment, after having read the clinical and radiological information concerning the patient and in compliance with the available guidelines.

Ectopic pregnancy (EP) affects 1-2 % of all pregnancies and is a significant risk of maternal morbidity and mortality. Treatment with methotrexate (MTX) is well established. However, certain aspects, such as the acceptable serum hCG threshold for considering medical treatment or the usefulness of predictive scores to guide therapeutic decisions, remain controversial. The aim of this multicenter retrospective study was to evaluate the efficacy of MTX in the treatment of EPs at the Gynaecology Department in Liège and the impact of two predictive scores. Of 256 patients included, 206 (80.5 %) were successfully treated with MTX alone. Three predictive factors for success were identified: the type of EP, an initial hCG level below 1500 IU/L and the absence of fetal cardiac activity. The use of these two scores in this cohort did not significantly improve the success rate.

Practitioners are increasing confronted to the management of type 2 diabetes (T2DM) among older patients. Specificities of the elderly should be considered, especially fragility and geriatric syndromes, and glycaemic objectives should be adapted according to the patient's individual profile, «vigorous», «fragile» or «ill», being stricter in individuals with the longer life expectancy. The basics of the therapy of T2DM are similar in older patients as in younger patients with, however, some specificities. A key objective is to avoid hypoglycaemic episodes that are particularly feared among older patients. The therapeutic approach should be personalized. It should take into account both patient's quality of life and environment as well as the presence of comorbidities that could influence the drug choice, for instance atheromatous cardiovascular disease, heart failure and chronic kidney disease.