Revue medicale de Liege最新文献

Ocular metallosis is a rare ophthalmologic condition characterized by alterations of all intraocular structures in the setting of a metallic intraocular foreign body. There are two main types: ocular siderosis - the most frequent and most deleterious - and ocular chalcosis. The lesions can lead to total functional loss of the affected eye. We report the case of a young man presenting a late-stage ocular siderosis, for whom surgical removal of the foreign body did not result in functional recovery, given the end-stage lesions. We then summarize the pathophysiological, diagnostic and therapeutic aspects of ocular metallosis. We particularly want to insist on the importance of a prevention policy in at-risk situations, and of quick management in case of a suspected metallic intraocular foreign body, in order to avoid ocular morbidity.

We report a rare case of ethmoidal metastasis from a prostatic carcinoma in an elderly patient. This metastasis was revealed solely by exophthalmos, with no associated nasal symptoms. Radiological and histopathological analyses confirmed the unusual diagnosis of a sinus metastasis from a prostatic adenocarcinoma. This case highlights the importance of a thorough diagnostic approach in the presence of an uncommon unilateral orbitopathy.

Gadolinium-based contrast agents (GBCA) are contrast agents used in magnetic resonance imaging (MRI). In patients with chronic kidney disease (CKD), their use has long been a source of concern due to the risk of nephrogenic systemic fibrosis. However, advances in the choice of GBCA have considerably improved their safety. Since 2017, the European Medicines Agency (EMA) has banned linear GBCA, except for a strict hepato-specific use, due to their instability and increased risk of tissue retention. Macrocyclic GBCA are much more stable and are now widely preferred. Their chemical structure enables stronger chelation of Gd3+, significantly reducing the risk of dissociation and accumulation in the body, even in patients with CKD. Recent studies have demonstrated Gd3+ accumulation in the basal ganglia after repeated administrations of linear GBCAs, even in patients with normal kidney function. To date, no clinical consequences have been demonstrated. After rigorous evaluation of the benefit-risk ratio of a GBCA injection and limitation of injected doses, MRI based on macrocyclic GBCA does not compromise the safety of patients with CKD.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is an underrated and heavy public health problem. Polysomnography (PSG) remains GOLD-standard examination but we also use ambulatory screening tests including Brizzy, which measures mandibular movements. The aim is to report on our experience with the Brizzy and compare it with PSG data. Data from 812 patients clinically suspected of having OSAHS who underwent a Brizzy screening test prescribed at the University Hospital of Liège between 2012 and 2020 were collected and analyzed retrospectively. These data were compared with data from their subsequent PSG, when available. The characteristics of patients with a positive Brizzy test, i.e., a respiratory disturbance index (RDI) > 15 h-1, were those typically described, namely a majority of men over the age of 50 who were obese. Sixty-seven percent of the patients evaluated had an RDI > 15 h-1, and this index correlated with the apnea-hypopnea index (AHI) on PSG (R = 0.47, p < 0.0001). Only 26 % of patients with a positive Brizzy test underwent PSG within two years. A Brizzy IPR > 15 h-1 has a sensitivity of 97 % and a positive predictive value of 90 % for detecting an AHI > 15 h-1 on PSG. Thus, the IPR measured by mandibular movements using the Brizzy is an interesting tool for screening for OSAHS.

Patients with complex care needs present numerous challenges: the care they receive is often associated with more hospital admissions. The care provided to this group could benefit from being more goal-oriented and better integrated. However, strengthening a net-work of care for these patients starting from hospitalization remains a challenge. This is particularly due to the fact that available assessment tools poorly reflect patient overall needs, especially psychosocial ones, and do not help identify their priorities.Therefore, we implemented a care strategy that includes the use of the ELADEB tool combined with the intervention of a case manager. We present the results of a retrospective study using administrative data from 109 hospitalized patients. We measured the effect of this intervention by comparing the number and duration of hospitalizations, as well as the number of readmissions within 30 days of discharge, one year before the intervention and one year after. We observed a statistically significant decrease in unplanned hospitalizations, average lengths of stay, and readmissions in the year following the intervention. These exploratory results highlight the potential value of such an intervention, yet a rigorous prospective evaluation in our context remains to be done.

Type 1 diabetes (T1D) is an autoimmune chronic disease that leads to the destruction of pancreatic beta cells and thus requires lifelong insulin therapy. Constraints and adverse events associated to insulin therapy are well known as well as the risk of long-term complications linked to chronic hyperglycaemia. Symptomatic T1D is preceded by a preclinical asymptomatic period, which is characterized by the presence of at least two auto-antibodies against beta cell without disturbances of blood glucose control (stage 1) or, in addition to immunological biomarkers, by the presence of mild dysglycaemia reflecting a defect of early insulin secretion (stage 2). Recent objectives for the management of this disease are to detect people with auto-antibodies in order to propose an early specific management to delay the shift to clinical stage (stage 3) and to limit its severity as well. The screening concerns as first step relatives of patients living with T1D and individuals presenting other auto-immune diseases, but may be extended to the general population (especially in young people) with the improvement of techniques of auto-antibody assays. Teplizumab, an anti-CD3 monoclonal antibody, slows down the decline of insulin secretion by beta cells, both in people at stage 2 and early stage 3. This medication, which may be considered as a disease-modifying agent of T1D, was approved in November 2022 by the U.S. Food and Drug Administration (FDA) and is currently evaluated by the European Medicines Agency (EMA).

Traumatic pulmonary pseudocysts (TPPs) are rare but clinically relevant complications of thoracic trauma, often misdiagnosed due to their non-specific presentation and resemblance to other cavitary pulmonary lesions. We report the case of a 26-year-old male presenting with delayed symptoms following a fall, ultimately diagnosed with multiple TPPs via thoracic CT scan. The patient experienced a favourable evolution with conservative management, including aerosolized tranexamic acid for minor hemoptysis. This case highlights the importance of thorough clinical history-taking and imaging in establishing the diagnosis, avoiding unnecessary antibiotic therapy, and limiting hospitalization. TPPs generally resolve spontaneously, but complications such as infection or hemorrhage may require intervention. Early recognition and tailored management are essential to optimize outcomes.

Chronic kidney disease (CKD), heart failure (HF) and atherosclerotic cardiovascular disease (ASCVD) are pathologies that may remain silent for a long time and thus are largely underdiagnosed in clinical practice. The use of biomarkers may help detect people already suffering from these diseases at an early stage or at increased risk to develop them in a near future. The aim of this article is to discuss the place of the assays of albuminuria, natriuretic peptide (BNP/proBNP) and high-sensitivity troponin as well as lipoprotein(a) to help in the diagnosis and prognosis assessment of individuals at risk of presenting or developing a CKD, HF or ASCVD. The use of these biomarkers remains too low in clinical practice whereas medications are now available (or will come very soon as for lipoprotein (a) - which allow minimizing the risk and improving the overall prognosis. Notably, it is the case with sodium-glucose cotransporter type 2 inhibitors (gliflozins) as far as CKD and HF are concerned.

Small bowel diverticulosis is a rare and predominantly asymptomatic condition that mainly affects elderly individuals. Hemorrhagic complications, though rare, can be life-threatening. In cases of suspected bleeding, CT angiography is recommended to diagnose, localize, and assess the severity of the hemorrhage. Therapeutic management varies, ranging from conservative treatment to surgical intervention, with embolization in interventional radiology as an alternative option.

Severe emphysema impairs lung function and quality of life in patients with Chronic Obstructive Pulmonary Disease (COPD). Despite optimized medical treatment and rehabilitation, some patients require lung volume reduction interventions (endoscopic or surgical). This study evaluates one-year outcomes of patients managed at the Emphysema Clinic of CHU Liège. This retrospective observational and longitudinal single-center study included 65 patients discussed in multidisciplinary meetings between 2021 and 2023. Patients were divided into two groups: treated (n = 24) with bronchoscopic lung volume reduction (BLVR) using endobronchial valves (EBV), lung volume reduction surgery (LVRS), or referred for lung transplantation (LTx); and non-treated (n = 41). Clinical and functional parameters were compared at baseline (T0) and after one year (T1). At one year, treated patients showed a significant improvement in forced expiratory volume in 1 second (FEV1 : +8.19 %, p = 0.0051), six-minute walk test distance (+54.6 m, p = 0.018), and COPD Assesment Test (CAT score : -5.3 points, p = 0.0017). Advanced interventions for emphysema improve respiratory function, walking distance and quality of life in selected patients based on strict criteria and multidisciplinary consultation.