Revue medicale de Liege最新文献

Acute pancreatitis is a rare pathology, whose incidence tends to increase in Western countries, and whose severity is variable; severe forms (10-20 %) are associated with significant mortality, ranging from 13 to 35 % depending on the studies. Alongside the usual complications of such afflictions, rarer complications, especially related to an adjacent or distant organ involvement, can cause unusual symptoms and contribute to life-threatening risks for the patient. This case illustrates one of these uncommon complications, in the form of necrosis of an adrenal gland in the onset of severe necrotizing pancreatitis, which may lead to chronic adrenal insufficiency.

Prosthetic vascular infections are rare, occurring in less than 3 % of cases. If left untreated within the required timeframe, serious complications such septic shock and anastomotic rupture with hemorrhage may occur and lead to the patient's death. Targeted and prolonged intravenous or oral antibiotic therapy is necessary but insufficient without surgical revision and removal of the infected prosthetic material. Once the infected prosthetic material is removed, blood continuity must be restored to ensure downstream vascularization and avoid amputation. There are two types of repair: extra-anatomical and in situ reconstructions. For the latter, it is ideal to avoid using prosthetic material. The solutions described in the literature are most often autologous venous grafts and cryopreserved arterial allografts. These are not always available. An alternative is to use a bovine pericardial patch, shaping it into a tube on the table with a longitudinal suture. We report a case of an infected common femoral artery prosthesis replaced with a pericardial patch and covered with the sartorius muscle.

Corneal melting or corneal keratolysis is described after cataract surgery. It is a rare but serious and potentially vision-threatening condition. It appears as a rapid and severe corneal stromal thinning after cataract surgery, leading in the most severe cases to corneal perforation. The etiologies are multiple and sometimes associated and include neurotrophic keratitis, herpetic keratitis, dry syndrome, postoperative non-steroidal anti-inflammatory drugs, rheumatological pathology of the Sjögren's type or graft versus host disease. The diagnosis is made on the basis of a clinical ophthalmological examination, in which the patient presents with reduced vision and thinning, and in the most serious cases, perforation of the cornea. Once the diagnosis has been made, treatment is primarily medical and sometimes surgical. It is carried out in stages depending on the extent of corneal thinning. this article explains in detail how to investigate and manage corneal thinning following cataract surgery.

Cervical cancer remains the fourth most common cancer in women. Recognition of the involvement of viral infection by human papillomavirus (HPV) in the carcinogenesis of lesions has enabled the evolution and adaptation of screening methods. Early detection of pre-invasive lesions and their treatment ultimately led to a reduction in the incidence and mortality of cervical cancer. In Belgium, the transition to primary screening is validated since January 1st, 2025. Let us nevertheless remember the importance of primary prevention through recommended vaccination for girls and boys.

A culture of safety plays a vital role in improving healthcare quality. This long and complex process of transformation relies on several tools and strategies designed to prevent errors and ensure patient safety. Among the main measures are the reporting of adverse events, the use of structured communication tools, and root cause analysis of incidents. Inclusive leadership, a psychologically safe environment, and the promotion of incident reporting are also essential to encourage the expression of concerns and foster organizational learning. However, barriers persist, such as fear of repercussions and communication difficulties, which hinder the establishment of a genuine safety culture. The aviation-inspired model highlights the importance of transparency, standardized procedures, and learning from errors to reduce risks and improve care. Such an approach, beneficial to patients, also contributes to organizational performance and satisfaction of healthcare teams.

Opioid-induced constipation (OIC) is a common but often overlooked issue in patients undergoing treatment for chronic pain. Effectively managing pain also means paying attention to adverse effects such as OIC, which can impact patients' quality of life. In addition to traditional treatments, therapeutic alternatives like naldemedine, a selective peripherally acting μ-opioid receptor antagonist, are now available to help patients for whom standard solutions are insufficient.

Hepatocellular carcinoma (HCC) is the most common primary hepatic tumour and represents a major diagnostic challenge. Conventional imaging, mainly based on computed tomography (CT) and magnetic resonance imaging (MRI), has some limitations, particularly in characterizing atypical and small lesions. Molecular imaging with [18F]Fluoro-2-deoxy-d-glucose, by positron emission tomography associated with computed tomography ([18F]FDG PET/CT), suffers from variable sensitivity depending on tumour differentiation. Recently, PET/CT imaging with prostate-specific membrane antigen (PSMA) showed growing interest in non prostatic tumours, especially in HCC due to its affinity for tumoural vascular endothelium. A case report illustrates the value of PSMA PET/CT in the staging and therapeutic management of HCC.

A staple in hospitals and doctors' offices worldwide, artificial intelligence (AI) systems, now assist healthcare providers by analyzing massive amounts of medical data and offering personalized diagnoses and treatment recommendations. But beyond these common applications, bolder initiatives are emerging. For example, researchers are exploring how AI could help predict epidemics or personalize treatments based on everyone's unique genetic characteristics. However, these advances are not without challenges. Ethical questions are emerging, such as data privacy and the moral responsibility for decisions made by algorithms. These issues require careful consideration from those involved in change. It is also crucial not to loose sight of the human aspect of healthcare, ensuring that AI complements rather than replaces the doctor-patient relationship. By embracing these technologies with caution and responsibility, we can help shape a future where AI supports healthcare ethically, equitably, and effectively, for the well-being of all.

Faced with chronic overcrowding in emergency departments and a shortage of healthcare staff, new models are being developed to improve patient flow and quality of care. Among them, the «Fast Track» (FT) system, co-managed by a physician-advanced practice nurse (APN) duo, represents an innovative approach still rarely explored in Belgium. This study, conducted at the University Hospital of Liège, aimed to assess the feasibility of such a model prior to implementation. A total of 28 professionals from both hospital sites (Sart-Tilman and Notre-Dame des Bruyères) participated in semi-structured interviews. The analysis, guided by the Consolidated Framework for Implementation Research (CFIR), structured the factors influencing implementation. Approximately 25 elements were identified, including 8 facilitators, 8 barriers, and 9 ambivalent aspects. Participants expressed a generally positive perception of the FT model, emphasizing its flexibility, potential to improve patient management, and recognition of advanced nursing competencies. However, the absence of a clear legal framework, limited resources, and tensions regarding professional roles emerged as significant barriers. Overall, the physician-APN Fast Track appears to be a promising innovation, but its successful implementation will require structured change management, clear role definition, and strong institutional support.

Despite the widespread use of non-invasive imaging modalities, right heart catheterization remains the gold standard for the hemodynamic assessment of various cardiopulmonary disorders. A Swan-Ganz catheter allows the direct measurement of venous, intracardiac, and pulmonary arterial pressures, as well as cardiac output. Its execution and interpretation require technical precision, given the numerous potential sources of error. This review provides an overview of best practices, common pitfalls, and current clinical indications for right heart catheterization.