Nurcan Yilmaz (1), Daniel Leonard (1), Nora Abbes Orabi (1), Christophe Remue (1), Laurence Annet (2), Cristina Dragean (2), Andrea Penaloza (3), Alexandros Raptis (4), Alex Kartheuser (1)Published in the journal : November 2017Category : Chirurgie digestive
A 39-year-old man presented with a history of fever and acute peri-umbilical pain. A computed tomographic scan of the abdomen revealed inflammation of Meckel’s diverticulum. The treatment was a laparotomic diverticulectomy. A perforation was observed during the procedure. There is no consensus yet on the radiological imaging technology considered to be the gold standard for diagnosis. The treatment is at all times surgical. Moreover, there is no agreement yet on the optimal surgical technique, be it a diverticulectomy or a resection of the segment containing the diverticulum. Although there is still uncertainty about the best approach, laparotomy versus laparoscopy, using the less invasive approach appears preferable.
Key Words
Meckel’s diverticulum, intestinal perforation, surgery
Diane Declaye (1), Dominique Maiter (2), Marie Cuvelier (1), Alexia Vanden Daelen (1), Laurence de Montjoye (1), Marie Baeck (1)Published in the journal : November 2017Category : Dermatology
We report on the “PEAU’se dermatologique” meeting of February 10, 2017, which was organized by the Department of dermatology of the Cliniques universitaires Saint-Luc and addressed the problem of hirsutism, along with the indications of laser hair removal. The speakers were Professor Dominique Maiter, head of the Department of endocrinology of the Cliniques Saint-Luc, and Doctor Diane Declaye, MACCS in Dermatology.
Retinal vein occlusion is the second most common retinal vascular disease, with an increased incidence in elderly patients with cardiovascular risk factors. While ocular hypertension appears to be the main local factor, thrombophilia plays a major role in young subjects, in people without risk factors, in the presence of positive personal history for venous thromboembolic disease, during pregnancy, as well as in the event of bilateral occlusion. In these circumstances, congenital or acquired predisposing factors should be searched for. The role of new local treatments, anticoagulant therapy, and long-term prophylaxis is discussed in the present article.
Florence Dive (1), Dominique Maiter (2), Michel Mourad (3), Jean-Benoit le Polain de Waroux (1), Sébastien Marchandise (1), Cynthia Barbraud (1), Hélène Dano (4), Christophe Scavée (1)Published in the journal : November 2017Category : Cardiology
Amiodarone, a class III antiarrhythmic agent according to the Vaughan-Williams classification, is commonly prescribed to control supraventricular and ventricular arrhythmias, especially in patients with ventricular dysfunction. Amiodarone-induced hyperthyroidism may provoke serious cardiovascular complications, as illustrated by our two clinical cases. The diagnosis of amiodarone-induced thyrotoxicosis may prove tricky at times, and its medical treatment complex.
Surgical management of amiodarone-induced hyperthyroidism appears to be an attractive therapeutic option, particularly for patients with a risk of arrhythmias upon amiodarone discontinuation.
An increasing number of patients benefit from a dual antiplatelet therapy combining a low dose of acetylsalicylic acid and a platelet adenosine diphosphate (ADP) receptor antagonist (Clopidogrel, Prasugrel, Ticagrelor), generally indicated in presence of a coronary artery stent and/or a history of acute coronary syndrome. During invasive procedures (operations, biopsies, punctures, dental care, etc.) carried out electively or urgently, the management of this antiplatelet association is often problematic. It must weigh the thrombotic risks following their cessation against the hemorrhagic risks associated with their continuation. This brief article summarizes the practical strategies for managing antiplatelet associations during invasive procedures.
Stable angina is a common clinical syndrome characterized by discomfort in the chest, jaws, shoulders, back, or arms, typically induced by exercise or stress. The therapeutic management of this condition depends on the patient’s individual prognosis, which itself depends on clinical factors and non-invasive imaging. The treatment is based on managing cardiovascular risk factors and on pharmacological treatments. A certain number of patients may benefit from percutaneous or surgical revascularization techniques
Revisionism and negationism of the benefif/risk balance of statins in atherosclerosis The current, scientifically-unfounded revisionist trend directed against the entire class of statins poses a series of problems with respect to the immediate clinical management, including strengthening of drug adherence, while exposing patients who would interrupt their treatment to a sudden upsurge in fatal and non-fatal risk of incident cardiovascular disease.
A certain number of foodstuff and dietary supplements have been shown to affect lipid levels. Data as to their impact on cardiovascular mortality and morbidity are, however, limited. Red yeast rice contains natural substances that exert HMG-CoA reductase inhibitory activity. The lack of standardization, great variability among different brands, and risk of interaction prompt us to invite you to limit their use. Although vegetable sterols in margarines reduce LDL-C levels, they have not yet been clinically evaluated. In mouse models, there is even some evidence of harmful vascular effects. While the Mediterranean diet definitely reduces the risk of cardiovascular events, there is no single but there are several Mediterranean diets, all rich in fruits, vegetables, whole grains, beans, nuts, and seeds, comprising olive oil as primary source of fat.
The association between cholesterolemia and cardiovascular events decreases with aging, is neutral at the age of 75, and is reversed in octogenarians. To date, no randomized controlled trial has assessed the effects of statins in persons over 80 who, moreover, are a very heterogeneous population. In a patient aged 80 and older, the assessment of functional status, life expectancy, and preferences is essential when considering a preventive therapy (e.g. a statin). While scientific evidence is lacking, common sense suggests that, in patients aged 80 and older, a statin should be prescribed in secondary prevention patients with a life expectancy exceeding 1 year. It also suggests withholding or withdrawing a statin therapy in primary prevention patients (including patients with type 2 diabetes), regardless of their cholesterolemia, which should not be measured.
Myocardial revascularization has long been considered the treatment of choice for patients with multivessel disease. The introduction of stents, however, has altered this paradigm. While the Syntax and Syntax II studies have clarified the risk related to coronary artery lesions, the respective scores have proven instrumental in facilitating the discussion within the medical team, also termed Heart Team, in order to propose the coronary revascularization technique best tailored to each individual patient.