Charline Bronchain (1), Thérèse Leroy (2), Ségolène de Rouffignac (3)Published in the journal : October 2022Category : Médecine Générale
Due to the increasing prevalence of obesity, bariatric surgery has become an effective treatment option, resulting in a significant weight loss and reduction in associated comorbidities. Nevertheless, this procedure is an invasive therapeutic act, inducing rapid physical and psychological changes and requiring serious post-operative discipline. Seven patients who had undergone bariatric surgery were interviewed via individual semi-structured interviews. These were aimed to better understand their experiences and clarify the role that the general practitioner could play in managing obesity through bariatric surgery. The qualitative analysis of the testimonies reveals different emotional phases that patients may go through once the surgical process has been performed. The general practitioner (GP), present on the front line, exerts a crucial role in accompanying the patients through the associated changes and identifying the early signs of psychological suffering, provided that the GP is continuously attentive to the patient’s emotional evolution. In addition, the GP could be a relay contact concerning the help that is available by informing the patient about it.
Coagulation disorders, both thrombotic and haemorrhagic, affect many women throughout their lives. We provide a summary of a Webinar on the risks of thrombosis favoured by hormonal treatments, the relevance of thrombophilic assessments and finally the diagnosis and management of haemorrhagic diseases, the presence of which should be suspected in any woman presenting unusual haemorrhages, particularly from haematological reasons.
Camille Desender (1), Pascal Fajardo (2), Nicolas Eppe (3), Fleur André-Mathieu (4), Ludivine Hougardy (5)Published in the journal : October 2022Category : Clinical Report
The antiphospholipid syndrome is an acquired autoimmune thrombotic disorder that has been known since 1906, with an incidence of 40 to 50/100,000 people. Its complex pathophysiology remains poorly understood at present, with all organs potentially affected. Symptoms are very variable and most commonly associated with multiple thrombotic or thromboembolic events. If such manifestations including obstetric events occur in young patients, we should consider the diagnosis of antiphospholipid syndrome. Owing to its morbidity and mortality, this syndrome constitutes a diagnostic and therapeutic emergency.
The purpose of this study was to evaluate the medium-term survival of a dual mobility (D.M.) new generation cup: Polarcup® (Smith&Nephew, Fort Worth, Texas) in primary hip arthroplasty, in a population over the age of 70 (mean in our study: 80 years old). In comparison with other studies, our results are similar in terms of medium-term implant survival (100% after 9 years of follow-up, with the occurrence of nine periprosthetic femur fractures long after the operation). This type of cup is indicated for patients with a high risk of dislocation, aged between 70 and 75 years old, with neurological pathologies, alcoholism, low muscle trophicity and prosthesis revision, as well as tumor pathology requiring cementing of the cup in a Kerboull cross-type reconstruction ring. Wear problems occurred at the beginning of the first-generation DM cups use because the surface condition and the geometry of the prosthetic neck are involved in these wear phenomena. This led to the current preference for stems with smooth necks without extraction notches and highly cross-linked polyethylene. Currently, despite a wear and survival rate comparable to that of fixed polyethylene, the risk of intra-prosthetic dislocation (2%) specific to this type of implant should make their use cautious, especially in young and active patients (1). A more widespread use in patients over 70 years of age, supported by the significant reduction in the dislocation risk, as well as the very favorable medium-term survival results of new generation D.M. implants demonstrated by the Australian 2021 registry, could lead to a significant economic advantage (2).
Laurent Levecq, Margot D’Affnay, Alice BughinPublished in the journal : October 2022Category : Ophtalmology
The physician’s role is no longer limited to trying to make his patient aware of his physical or cognitive impairment, hoping that he will partially or fully give up on driving. The physician must support the patient and point out that there might be solutions, whether in the form of restrictions or conditions, likely to save him from financial and legal setbacks. In rare cases, it may happen that the dialogue is not possible anymore, the incapacity is proven and puts at risk both the patient and the third parties. In this specific situation, the physician might free himself from medical confidentiality without risk of ethical or criminal penalties, provided progressive and proportional actions.
How are our Belgian hospitals, including the physicians who work in them, being funded? How are these funds calculated and allocated? Herein, the article’s author has presented his book covering this topic. In brief, he has further explained the components of Belgian hospital financing, comparing it to what is done abroad, exposing both its strengths and weaknesses, and discussing the ambitious reform that is being scheduled by Minister Vandenbroucke.
Islet transplantation holds great promise for the treatment of type 1 diabetes (T1DM), as it offers the potential to restore euglycaemia in a reliable manner, protects against hypoglycaemia and glycaemic lability in a way that exogenous insulin administration has thus far been unable to achieve, and is associated with far fewer risks than whole-pancreas transplantation. Moreover, for patients requiring total pancreatectomy for benign disease, isolation of islets from the diseased pancreas with intrahepatic transplantation of autologous islets can prevent or ameliorate postsurgical diabetes and improve quality of life. We, therefore, seek to add this alternative treatment to the therapeutic modalities proposed within our institution.
Obesity surgery or bariatric surgery has significantly grown over recent years. Given that obesity plays a key role in the pathophysiology of type 2 diabetes mellitus, it is no surprise that bariatric surgery, along with its impressive weight loss, has been shown to dramatically improve diabetes mellitus. The observation that numerous diabetic patients remain poorly controlled despite recent advances in drug therapy has been associated with an increased interest in this surgical approach to the treatment of diabetes mellitus. The primary purpose of this review has been to summarize the place of bariatric surgery within the therapeutic arsenal for type 2 diabetes mellitus.
Martin Buysschaert (1), Alberto de Leiva-Hidalgo (2)Published in the journal : September 2022Category : Diabétologie
The aim of this article has been to revisit the history of the discovery of insulin, "officially" attributed to F.G. Banting and Ch. Best. The first administration of their pancreatic extract to humans was performed in January 1922 in Toronto. In reality, history has made these two names sacred, whereas others, in Canada and Europe, have also contributed in a decisive way to this discovery. Given this context, we wish to untangle the skeins by describing the essential role and major impact of other researchers from both Canada (J. Macleod and J.B. Collip) and Europe (M. Gley in France, G. Zuelzer in Germany, and N. Paulescu in France and Romania). This article thus primarily seeks to "render to Caesar what belongs to Caesar".
Inhibitors of the sodium-glucose cotransporter 2 (SGLT2) are dramatically changing the management of heart failure and, especially, chronic kidney disease. Indeed, this class of drugs, which was initially developed to improve glycemia control in Type 2 diabetics, is now widely recommended by global/international guidelines as part of the standard care for both diabetics and non-diabetics presenting with heart failure and/or albuminuric chronic kidney disease. Indeed, large outcome trials have conclusively demonstrated their efficacy and safety, with some undesirable effects that are easily manageable in clinical practice, such as mycotic genital infection. The key challenge for the coming years is to ensure that the broad population of patients susceptible to benefit from SGLT2-i is actually treated by these drugs. In the near future, additional trials may further enlarge the population targeted by this drug class.