Revue medicale de Liege最新文献

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.

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.

Bariatric endoscopy is an increasingly recognized alternative to surgery for obesity treatment. Recent guidelines from leading medical societies (IFSO, ASMBS, ASGE, ESGE) have included endoscopic sleeve gastroplasty (ESG) and the intragastric balloon (IGB) in their recommendations. These procedures are indicated for patients with a body mass index (BMI) between 27 and 40 kg/m² who cannot or do not wish to undergo surgery. ESG reduces stomach volume through endoscopic suturing of the gastric wall, leading to early satiety and an average total weight loss of 16 % within 12 months. While less effective than surgical sleeve gastrectomy, it carries significantly fewer severe complications. The IGB, temporarily placed in the stomach, allows for moderate weight loss (10-15 % of total weight), but weight regain is almost inevitable after removal. However, it can be useful preoperatively or as an adjunct to other treatments. Other emerging endoscopic devices (EndoBarrier, duodenal resurfacing, etc.) show promise, but their safety and efficacy remain to be confirmed. The future of these techniques will depend on their long-term efficacy/risk recognition and reimbursement, particularly in Belgium, where they are not yet covered by health insurance.

Tirzepatide is a unimolecular dual agonist of both glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptors, recently commercialized and reimbursed in Belgium for the treatment of type 2 diabetes (T2D). Because of the complementarity of action of the two incretins, tirzepatide showed, in a dose-dependent manner (5, 10 and 15 mg as a once-weekly subcutaneous injection), 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. Tirzepatide tolerance is almost similar to that of pure GLP-1 receptor agonists, with digestive adverse events, most often during the first weeks after initiation, which justifies the recommendation of progressive titration every four weeks. Tirzepatide is now refunded under conditions in Belgium for the treatment of TD2 in patients with a body mass index ≥ 30 kg/m² and a HbA1c level > 7.5 % with antihyperglycaemic therapy including metformin. These reimbursement conditions are similar to those of pure GLP-1 receptor agonists but are more restrictive than the indications validated by the European Medicines Agency and the latest guidelines by international scientific societies.

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.

ANCA-associated vasculitis, such as granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), are rare systemic diseases causing necrotizing inflammation of small blood vessels. Renal involvement is common, leading to acute kidney injury with hematuria and proteinuria. Diagnosis is based on serological tests (PR3-ANCA, MPO-ANCA) and renal histology via biopsy, which helps assess the extent of lesions. Scores and classifications have been validated to predict the progression toward end-stage renal disease. Therapeutically, induction treatment (3 to 6 months) relies on corticosteroids combined with immunosuppressants such as cyclophosphamide or rituximab. Maintenance therapy (24 to 48 months) aims to prevent relapses, with rituximab proving superior to azathioprine. Avacopan, a C5a receptor inhibitor, offers a promising alternative by reducing dependence on corticosteroids in the induction phase. The KDIGO 2024 guidelines recommend early kidney biopsy and advise the use of these immunosuppressive treatments according to standardized protocols. These guidelines also integrate innovative therapeutic options like avacopan, providing new perspectives in the management of ANCA-associated vasculitis.

This review aims to describe the role of poly-ADP-ribose polymerase inhibitors (PARPi) in the treatment of metastatic castration-resistant prostate cancer (mCRPC), an aggressive and lethal form of the disease. The introduction of PARPi has led to improved prognosis, particularly in patients with at least one somatic or germline mutation in DNA damage repair genes such as BRCA1 or BRCA2. Several recent studies have shown that PARPi, used alone or in combination with abiraterone or enzalutamide, improve progression-free survival and overall survival in patients with mCRPC. However, whether the three PARPi evaluated in phase 3 trials are therapeutically equivalent, and whether combination therapies should be recommended as first-line treatment for all mCRPC patients or reserved for those carrying mutations, particularly BRCA1/2, remain to be determined.

Non infectious thrombotic endocarditis represent 2.5 % of negative blood culture endocarditis cases. These conditions are most often diagnosed post-mortem, but can be revealed following a complication. Among the most common causes are cancers, specifically pancreatic, pulmonary, colon and prostate adenocarcinomas. We present the case of a 59-year old woman with a diagnosis of endocarditis during an etiological assessment of stroke. She underwent aortic valve replacement due to a major embolic risk. During this etiological assessment, a hypermetabolic site was found in the pancreas on PET-scan, which turned out to be a pancreatic adenocarcinoma. Paraneoplastic non-infectious endocarditis complicates 19 % of cancers and has a poor prognosis due to late diagnosis, often revealing advanced cancer. Treatment relies on low molecular weight heparin anticoagulation, combined with treatment of the underlying cancer. We present an updated review of the literature and most recent data accounting for the formation of valve thrombus.

Lemierre's syndrome is a growing disorder that is little known in emergency department. However, its diagnosis can prevent from a fatal outcome. It is a septic venous thrombosis of the neck complicating an acute oropharyngeal infection, and can give rise to multiple septic emboli. It most often occurs among young, healthy patients in the aftermath of bacterial angina, a condition which is frequently encountered in daily practice. The aim of this article is to explain this syndrome to clinicians so that they know when to look for it, how to diagnose it and what its therapeutic implications are.

Tularemia, a zoonosis caused by Francisella tularensis, is highly virulent and classified as a category A bioterrorism agent. Although rare in Belgium, tularemia is likely underdiagnosed, due to its frequent unfamiliarity among clinicians. This article reports two cases treated at the University Hospital of Liège. The first case involves a 61-year-old man presenting with oropharyngeal symptoms and cervical lymphadenopathy, diagnosed after the failure of conventional antibiotic treatments and confirmed by PCR. The second case concerns a 70-year old woman with systemic symptoms and mediastinal lymphadenopathy, initially suspected to be neoplastic, before tularemia was confirmed by serology and PCR. Without treatment, tularemia can become chronic and debilitating, and lead to complications such as suppuration of lymph nodes. Besides describing the two clinical cases, we will cover the epidemiology, diagnosis, and treatment of the disease. Early recognition of tularemia remains challenging due to the lack of awareness among clinicians and the diverse clinical manifestations of the disease.