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Hépato-gastroentérologie

2019 innovations In hepato-gastroenterology and hepatic...

Overall, 30% and 3% of the Belgian population suffer from fatty liver and its severe form, non-alcoholic steatohepatitis (NASH), respectively. To date, there is no pharmacological treatment in the NASH field. Nevertheless, encouraging results have been described with obeticholic acid in a Phase 3 study. As a consequence, obeticholic acid is considered a promising therapeutic strategy. In the area of chronic inflammatory bowel disease, tofacitinib (Xeljanz®) is reimbursed since September 2019 in case of first-line treatment failure in ulcerative colitis patients, providing new perspectives to patients affected by this disease. Poorly known 10 years ago, the hepatitis E virus has recently gained interest. In Europe and more particularly in Belgium, genotype 3 is responsible for the majority of cases. Hepatitis E virus infection should be checked for in each acute hepatitis case. The disease can be more severe in two sub-populations, namely patients suffering from chronic liver disease that can decompensate in this context and immunocompromised patients in whom the infection can become chronic. Great advances in the field of enteroscopy were also confirmed in 2019, due to the techniques enabling the biliopancreatic system to be accessed in patients with an altered anatomy of the upper digestive tract (gastric bypass,etc.) or through the use of motorized spiral enteroscopy. All of these techniques are employed at the Cliniques universitaires Saint-Luc. Finally, the last part of this review will be devoted to liver transplantation and the UCL-ALDAPT clinical study, whose objective is to assess the validity of a 2-stage total hepatectomy surgical procedure associated with a left-liver transplantation, so as to minimize risks in adult-to-adult living donor liver transplantation.

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Chirurgie orthopédique et traumatologie

2019 innovations in orthopaedic surgery and traumatology

The year 2019 has provided us three major themes: the contribution of 3D imaging in the planning of shoulder replacements, joint reconstruction of the elbow by mirrored osteoarticular graft, and finally scoliosis surgery by modulation of growth, without vertebral fusion. Shoulder disease is one of the most common conditions involving the musculoskeletal system, affecting about half of the patients with musculoskeletal complaints. Gleno-humeral osteoarthritis, whatever its etiology, may justify prosthetic replacement. However, the fate of these implants does not attain the survival rates of prosthetic hip and knee implants. The severity of bone loss, particularly within the scapula, and the difficulty of precisely orientating implants both account for a large part of common and too early failures. Planning surgery using planning software from 3D reconstruction scans can anticipate these problems and enable us to establish an appropriate surgical strategy.

The fate of elbow replacements remains limited over time, especially in the young and active subject. Using osteochondral reconstruction allows us to postpone arthroplasty for several years. The need for perfect joint congruence is currently made possible via mirror planning from the healthy joint and selection of the most appropriate allograft based on scanner imaging. Surgery is made possible by the surgeon's provision of cutting guides for the injured joint and allograft, ensuring accurate correction, in accordance with preoperative planning.

Scoliosis mainly affects a young population, tending to worsen with growth. Until now, surgery has been aimed at restoring the spine’s sagittal balance by fusion of the bony segments to prevent further deformation. This strategy has implemented constraints on the spine segments left free of instrumentation and bone fusion with potentially secondary discoradicular pathologies at these levels. The concept of using residual spine growth to correct deformation has recently been introduced. Rather than permanently fusing the column, the material is positioned to slow the growth on the curvature’s convex side and let the concave side continue to grow and correct the deformation. This is growth modulation. In this configuration, the column is no longer blocked and retains its flexibility.

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STOPP/START.v2

The tool STOPP / START.v2 allows evaluation of drug treatments prescribed to patients age 65 and older.

 

This tool, designed for all care settings, stimulates thinking and challenging medication taken by patients, especially drugs forcardiovascular and nervous system.

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