Revue medicale de Liege最新文献

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.

Acute pyelonephritis is a potentially serious kidney infection that mainly affects women, children and the elderly. It may or may not be symptomatic (fever, pain, urinary disorders), and is most often caused by Escherichia Coli. Its incidence and cost are increasing, particularly in connection with the overuse of imaging. In 2018, clinical criteria were introduced to help identify cases requiring urgent imaging. A retrospective study was carried out at Liège University Hospital to analyse the reliability of these criteria for diagnosing complicated pyelonephritis (abscess or upper urinary tract obstruction). At the same time, prescribing practices were assessed.

Hemorrhages occurring in the vitreous body have multiple etiologies. They cause an immediate and severe loss of visual acuity and sometimes require urgent surgical management by vitrectomy. We report in a retrospective series the clinical data of 76 patients treated at the University Hospital of Liège, highlighting the high incidence of retinal tears caused by posterior detachment of the vitreous body, the predominance of proliferative diabetic retinopathy in young patients, and that of age-related macular degeneration in older patients. Surgical intervention allows a very significant and fast improvement in visual acuity while avoiding the natural history of retinal tears which, in a hemorrhagic context, lead to retinal detachment with a very bad prognosis.

Type 2 diabetes management evolved considerably over the past few decades. The present article summarizes three successive key steps : the glucocentric target, the multirisk approach and the organ protection strategy.

Trisomy 18, also known as Edwards syndrome, is the second most common autosomal trisomy. The phenotype includes dysmorphia, congenital malformations and severe neurological impairment. The most common malformation is congenital heart disease. With a median survival of 2 to 14.5 days, trisomy 18 has been historically considered as lethal and care has long been palliative. This approach was proposed to a little girl with postnatal diagnosis. Initially, the child's parents disagreed with the management strategy. After further discussions, the parents agreed on a therapeutic approach based on comfort care. Intensive care is, however, offered in selected patients in other countries. Multiple studies have recently shown that measures such as cardiac repair increase survival. Impact on quality of life remains, however, highly uncertain. The therapeutic orientation for these children remains the subject of ethical dilemma. A multitude of arguments are developed around the four fundamental principles of bioethics: autonomy, beneficence, nonmaleficence, and justice. Not only the choice of care (interventional or palliative) but also the person responsible for this decision are controversial.

Semaglutide (Ozempic®), administered as a weekly subcutaneous injection up to 1.0 mg, holds a privileged place in the international guidelines for the management of type 2 diabetes. Commercialized under the trade name Wegovy®, semaglutide is also indicated at a weekly dose up to 2.4 mg for the management of obesity or over-weight with at least one weight-related comorbidity, after failure and in combination with life-style interventions. Its efficacy and tolerance were investigated in the STEP clinical research programme. Gastrointestinal adverse events after initiation of therapy, as with all glucagon-like peptide-1 receptor agonists, requires a progressive titration every 4 weeks from 0.25 mg to 2.4 mg/week. It is the first anti-obesity medication that has shown a significant reduction of major cardiovascular events and all-cause mortality in the large placebo-controlled SELECT trial. Wegovy® is commercialized in Belgium (currently not reimbursed) according to the indications supported by the European Medicines Agency (EMA) both in adults and adolescents suffering from obesity or overweight with at least one weight-related complication, ideally within a holistic multidisciplinary approach.

We report the case of an 18-year-old man admitted to the emergency department with suspected herpes simplex encephalitis. He presented with headaches, memory disorders, and a low-grade fever at home, not found in the emergency room. The clinical examination revealed minimal temporal disorientation, contrasting with the cerebral MRI showing bilateral temporo-insular lesions suggestive of herpes simplex encephalitis. Because of ineffective aciclovir treatment and negative HSV-1 PCR in the cerebrospinal fluid, a search for serum anti-MOG antibodies was carried out, confirming autoimmune encephalitis. High-dose corticosteroid treatment allowed progressive neurological improvement. Anti-MOG antibody encephalitis is an autoimmune central nervous system disorder with a broad clinical spectrum. Diagnosis is based on anti-MOG antibody detection and cerebral MRI. First-line treatment is high-dose corticosteroid therapy. This case illustrates the complexity of the differential diagnosis of acute encephalitis and the importance of considering autoimmune etiologies, even in cases with a presentation suggestive of herpes simplex encephalitis. Close collaboration between emergency physicians, neurologists, and immunologists is necessary to optimize patient management.

This article aims to provide an update on the use of CBD in the fields of psychiatry, neurology and pediatrics. It details the pharmacological properties of cannabidiol (CBD), a non-psychoactive molecule of cannabis, and its interaction with various receptors in the nervous system. This article explores its potential therapeutic applications, especially for the treatment of epilepsy, chronic pain, anxiety disorders and neurodegenerative diseases. It also presents the CBD-based medications available in Belgium, the regulatory challenges and the scientific uncertainties surrounding their long-term efficacy and safety. Although CBD shows promise, further studies are needed to validate its clinical use and better understand its side effects and drug interactions.

Rivaroxaban, an oral direct anticoagulant that is a selective inhibitor of Xa factor, was commercialized in Belgium in 2009 with as unique reimbursed indication the prevention of thromboembolic events before a programmed hip or knee prosthesis. Since that time, both the efficacy and safety of rivaroxaban have been validated in a variety of indications : prevention and treatment of venous thromboembolic disease with or without pulmonary embolism, non valvular atrial fibrillation, symptomatic coronary disease and peripheral arteriopathy. Different presentations are currently available from 2.5 mg to 20 mg to allow the practitioner adjust the dosage of rivaroxaban to the specific indication (for instance, in patents with symptomatic atheromatous cardiovascular disease, 2 x 2.5 mg/day in combination with a antiplatelet agent).

Ectopic pregnancy is a gynecological emergency that can be life-threatening if not diagnosed and treated promptly. This review discusses therapeutic options, comparing medical and surgical management based on clinical and biological data of patients, aiming to guide practitioners in selecting the optimal treatment according to hCG (human chorionic gonadotrophin) levels and patient hemodynamics. Approximately 1-2 % of pregnancies are ectopic, with an associated mortality rate that has decreased in recent decades due to advancements in diagnosis and treatment.