Revue medicale de Liege最新文献

About 30 % of patients scheduled for surgery present with preoperative anemia. The presence of preoperative anemia increases the likelihood of exposure to allogenic blood transfusions, which carries specific complications. Furthermore, and independently of the transfusion risk, it is associated with an increased risk of postoperative morbidity and mortality. It is now recommended to treat preoperative anemia whenever possible. This article summarizes the prognostic implications of preoperative anemia and proposes a diagnostic and therapeutic strategy for the most common clinical situations. Finally, it illustrates how collaboration between primary care and hospital medicine can provide patients with effective and personalized treatment without the need to alter the surgical planning.

Tirzepatide is a unimolecular dual agonist of both glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptors, which has been developed as once-weekly injection first for the treatment of type 2 diabetes (T2DM), then for the treatment of obesity. Because of the complementarity of action of the two incretins, tirzepatide showed, in a dose-dependent manner (5, 10 and 15 mg), a better efficacy (greater reduction in HbA1c and body weight) compared with placebo, semaglutide 1 mg, basal insulin and preprandial boluses of insulin lispro in six studies of the SURPASS programme. In the SURMOUNT programme, tirzepatide showed a marked reduction in body weight, never reached before with a drug, among people with obesity or overweight associated with complications linked to excess weight. Such weight loss was accompanied by an improvement of comorbidities (as sleep apnea syndrome) and cardiovascular risk factors. Two large cardiovascular outcome trials are ongoing in patients with T2DM (SURPASS-CVOT) and in patients with obesity (SURMOUNT-MMO).

We report the case of a 39-year-old patient who complains about loss of libido and erectile dysfunction. Hormonal diagnosis revealed hypergonadotropic hypogonadism suggesting a primitive testicular cause. Testicular examination, testicular ultrasounds and abdomen-pelvis CT scan made it possible to suspect a right testicular tumor. A stage I seminoma was confirmed at orchiectomy. Testicular cancer is the most common cancer in men before the age of 35. Most testicular tumors initially present with a scrotal mass: a testicular tumor should not be ignored in a patient with hypergonadotropic hypogonadism.

The chloride (Cl-) sweat test remains the reference test in the diagnosis of cystic fibrosis, allowing direct assessment of CFTR (Cystic Fibrosis Transmembrane conductance Regulator) channel function. Under highly effective modulators such as the combination of Elexacaftor, Tezacaftor and Ivacaftor (ETI), the Cl- level in sweat significantly improves, as shown in our cohort of patients when ETI was introduced. In addition to its role in the diagnosis of the disease, the sweat test is also important for individual clinical trials (n-of-1) in patients not eligible for ETI and for newborn screening for cystic fibrosis.

Hyperkalemia is an electrolyte disorder defined as a plasma potassium concentration greater than 5 mmol/L. Plasma potassium represents approximately 2 % of the total body potassium, and its regulation depends mainly on renal excretion and transcellular shifts. Various pathologies can alter potassium homeostasis and lead to acute or chronic hyperkalemia. The rate of change in plasma potassium concentration is critical because the faster it occurs, the faster life-threatening symptoms develop. Therefore, acute hyperkalemia should be urgently treated. There is no «threshold» value defining the severity of the situation, but the electrocardiographic changes appear to be valuable indicators of severity. Several medical associations have issued recommendations regarding the emergency management of hyperkalemia, but there is no scientific consensus. In this article, we summarize the current knowledge and propose a practical management algorithm for the management of acute hyperkalemia.

This retrospective study including 93 patients who presented a new diagnosis of lung cancer at the University Hospital of Liege between January 2023 and April 2023 analyzed the prevalence of smoking cessation following the diagnosis announcement. It was also investigated whether certain factors influenced this rate (stage, histology, type of treatment received, tobacco monitoring,…) and whether the impact of this smoking cessation influenced the progression of the disease and the response to oncological treatments. The results show that 34.8 % of active smokers at diagnosis experienced smoking cessation at 6 months and 32.6 % at 1 year. This success rate of more than 30 % at 1 year is considerably higher than the success rates observed in individuals who attempt to obtain smoking cessation spontaneously and independently, outside of a cancer diagnosis (3-5 %). However, it remains low if one consider that smoking cessation is an important factor for increasing the survival rate for this type of cancer. It should be noted that, among the 51 smokers still active, 42 (82.4 %) did not consult a tobacco specialist. Smoking cessation support should in fact be offered to patients diagnosed with lung cancer more systematically and as early as possible in order to optimize the effectiveness of treatments and to increase the chances of survival.

In the course of several neurodegenerative conditions, the presence of a sensory alteration, even before the appearance of cognitive disorders or complaints concerning autonomy, can potentially lead to earlier diagnosis and more efficient management of these complex patients. The mechanisms underlying the association between sensory impairment and the risk of progression to dementia are increasingly better understood and should ultimately improve the accuracy of the diagnosis process for the most common neurodegenerative conditions, but also participate in the differential diagnosis between these conditions. Finally, early management of these sensory impairments offers a relatively easy way to modify patient's progression by delaying the onset of several symptoms during the progression towards a dementia syndrome.

In a first article we highlighted the importance of serious gaming in physical medicine and in rehabilitation. In this second article on the same topic, we discuss the potential impact of serious gaming in the field of mental health. The technical aspects, advantages and disadvantages, limits and pitfalls are rapidly overviewed in different areas such as addiction, anxiety, autism, depression, schizophrenia, attention disorders, post-traumatic stress syndrome, obsessive compulsive disorders and memory disorders. It is noteworthy that the American Food and Drug Administration awarded its precious label for the very first time to a serious game used for attention-deficit hyperactivity disorder.

The efficiency of minimally invasive aortic valve surgery via right anterior thoracotomy is now well established. As far as coronary artery bypass graft surgery is concerned, many specialized centres are performing minimally invasive procedures with a left mini-thoracotomy either off-pump or on-pump. Multivessel operation is feasible. Up to date, only few authors described both procedures (coronary bypass graft surgery and valve surgery) in the same patient with a minimally invasive approach. We report a case of a female patient undergoing a single arterial coronary bypass surgery on the left anterior descending artery combined with an aortic valve replacement through bilateral anterior mini-thoracotomies.

Tendinopathies are disorders of the tendons, often caused by overuse. They often affect athletes and manual workers and represent a major medical challenge. Current treatments are numerous, including physiotherapy, anti-inflammatory drugs and sometimes surgery. However, because of sometimes disappointing results with these treatments, radiotherapy is emerging as an alternative. Used for its anti-inflammatory properties, it could specifically target the pathological processes of tendinopathy. At low doses, radiotherapy shows beneficial effects on inflammation, neovascularization and tissue regeneration. It thus contributes to tendon repair. Clinical studies suggest that it can relieve symptoms, improve quality of life and often avoid surgery. However, concerns remain about potential risks, particularly the risk of radiation-induced cancer. Despite this small risk, the benefits of radiation therapy make it a promising option.