Autosomal dominant polycystic kidney disease (ADPKD), caused by PKD1 or PKD2 mutations, is the most common inherited kidney disease. Intracranial aneurysms (ICA) and mitral valve prolapses are well-known vascular complications in ADPKD patients. Other reported vascular manifestations include thoracic aortic aneurysms and dissections (TAAD) and cardiomyopathies (CMP).
Mélissa Salavrakos(1), Hubert Piessevaux(1), Mina Komuta(2), Nicolas Lanthier(3), Peter Stärkel(3)Published in the journal : July 2018Category : Mémoires de Recherche Clinique
Transient elastography (TE), or Fibroscan®, has been validated for the diagnosis and staging of liver fibrosis in chronic hepatitis C, but there is no clear consensus on the optimal TE cut-off values in alcoholic liver disease (ALD). The objectives of the study were: (a) to evaluate the cut-off values reported in the literature and determine new ones for the diagnosis of fibrosis in alcoholic patients; (b) to investigate the impact of 2 weeks of abstinence on TE results; (c) to evaluate the diagnostic accuracy of TE for detecting clinically significant portal hypertension; (d) to evaluate the accuracy of non-invasive blood tests (AST-Platelet Ratio Index [APRI], Forns index, Fibrosis-4 [FIB-4]); (e) to study the potential histological (steatosis, alcoholic hepatitis, perisinusoidal fibrosis) and biochemical (transaminases and cholestasis) confounding factors leading to misclassification by TE.
Shabneez Kautbally(1), Pierre Deprez(1), Michel Hermans(2), Tom Moreels(3), Tarik Aouattah(3), Enrique Perez-Cuadrado-Robles(3)Published in the journal : July 2018Category : Mémoires de Recherche Clinique
Studies reporting on pancreatic function after endoscopic treatment of chronic pancreatitis are scarce. This study was aimed at prospectively investigating the evolution of pancreatic endocrine and exocrine function in patients who underwent endoscopic treatment using endocrine function parameters and fecal tests for exocrine function.
In the first months following diagnosis, type 1 diabetes patients frequently experience a transient period of partial remission during which glycemic control can be achieved easily with reduced, or even suspended, insulin requirements. Over the past years, different criteria have been used in the literature to define this period, rendering it sometimes difficult to compare study results. In 2009, Mortensen et al. [1] proposed a new definition of the remission phase: the IDAA1C (Insulin Dose-Adjusted A1C = HbA1C + 4 x insulin doses/day/kg), with an IDAA1C ≤9 indicating that the patient is in remission phase. Though this formula is currently the most widely used in the literature, some authors criticize that it integrates the «insulin doses» parameter, as it may be influenced by several confounding factors.
Knee arthroplasty has been constantly evolving since it was introduced in the late 1960’s as a new treatment option for knee osteoarthritis. Unicompartmental (UKA) and total knee arthroplasty (TKA) have the same treatment objectives, namely relieving symptoms and allowing patients to return as soon as possible to normal life so that they can engage in daily activities, as well as in recreational and social events. Interestingly, several studies demonstrated a better recovery in patients that underwent UKA compared to those who were subjected to TKA. Our study hypothesized that patients eligible for UKA initially have a stronger and more powerful quadriceps muscle and thus a better performing muscle than those eligible for TKA. These preoperative muscle properties may play a major role in the improved recovery process observed in patients operated by UKA.
Key words
Knee, arthroplasty, quadriceps, limb preconditioning.
Flore Tuyumbu MD (1), Andréa Penaloza MD, PhD (2), Said Hachimi-Idrissi MD, PhD (3)Published in the journal : June 2018Category : Emergency
Over the last decades, the use of biomarkers in emergency medicine has considerably increased. While the P S100β protein has been considered as a neurological prognostic factor following cardiac arrest or stroke occurrence, it is principally in the minor head trauma management that the P S100β seems to be of interest. Studies have highlighted its usefulness for excluding neurological lesions, without performing brain computed tomography (CT), and this, with a good sensitivity close to 100% (CI: 50 to 100%). The P S100β analysis could be particularly helpful for clinicians in cases where the patient's neurological examination proves unreliable.
For most patients with lower-extremity deep vein thrombosis (DVT), direct oral anticoagulants (DOAs) can replace safely and effectively vitamin K antagonists (VKAs), with multiple benefits. Some DOAs can be started immediately upon diagnosis, without any previous treatment with low-molecular-weight heparin (LMWH). In some settings and patients, initial LMWH therapy should, however, be favored. Though their use should not be trivialized and precautions are necessary, DOAs facilitate the management of the 3-month anticoagulation that is required in most DVT patients. DOAs, at full or reduced dose, are probably most beneficial in patients requiring prolonged or long-term anticoagulation. This article reviews the current management of DVT using DOAs and summarizes the main criteria for identifying candidates to prolonged or long-term anticoagulation.
Priscila Jijón(1), François Marolleau(2), Polycarpe Shango(3), Thierry Sluysmans(3), Stéphane Moniotte(3)Published in the journal : June 2018Category : Pediatrics
Patients with PAVM may have hypoxemia, orthodeoxia, chest pain, hemoptysis, paradoxical embolizations leading to stroke and brain abscess. Peutz-Jeghers Syndrome is a disease characterized by the development of hamartomatous polyps in the gastrointestinal tract, mucocutaneous melanotic pigmentation and high risk of cancer. This is a case-report of the fortuitous association of these 2 diseases.
Hélène Reul(1), Bernard Vandercam(2), Pascale Grandjean(3), Julien De Greef(4)Published in the journal : June 2018Category : Internal Medicine
Travels and pregnancy are not incompatible. This article sought to provide an overview of the current recommendations on this topic and intends to be a tool for all practitioners, namely general practitioners, gynecologists-obstetricians, as well as midwives. To this end, we have chosen to investigate the following three topics: vaccination, malaria, and Zika virus. Vaccinating a pregnant woman is often possible and at times even recommended. Several vaccines, however, must be avoided, as they are live vaccines. Malaria during pregnancy may be severe, and appropriate prophylactic treatment should therefore be prescribed. Zika virus infection is associated with high risks for pregnant women. Appropriate precautions designed for pregnant women, women who plan to have a child, and partners of pregnant women have been summarized in this article. These guidelines based on national and international recommendations likely evolve over time and should therefore be updated on a regular basis.
Richter’s syndrome is a rare syndrome characterized by the development of aggressive lymphomas in patients with concomitant chronic lymphocytic leukemia. Known for several years, this syndrome is still very heterogeneous and represents a real clinical challenge, given its aggressive nature and very limited prognosis. In the era of targeted therapies and due to the increasingly-thorough characterization of the genetic abnormalities of this condition, there is an unmet need for new molecules in order to better manage patients suffering from this syndrome. This article is a brief literature review as regards diagnosis and management of Richter's syndrome in 2017.