Sternal osteomyelitis in a 15-month-old child: clinical case and review of clinical, radiological, and therapeutic features

Letizia Vega (1), Jean-Philippe Stalens (2), Jean-Luc Dutrieux (3), Chloé Brunelle (2) Published in the journal : May 2019 Category : Observations cliniques

Osteomyelitis is an infection that affects the bone tissue via hematogenous dissemination, direct post-traumatic or post-surgical inoculation, or a contiguous local infection, such as cellulitis or sinusitis. It is preferentially localized in the metaphyseal region of long bones. Short bones are more rarely affected. Sternal involvement is observed in about 1% of all pediatric osteomyelitis cases. Initial symptoms are often nonspecific, thus resulting in delayed diagnosis. Once the infection is established, symptoms of local inflammation appear. The treatment consists of a targeted antibiotic therapy depending on the child’s age and germs responsible for the infection.

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Hypercalcemia secondary to vitamin D intoxication: clinical vignette and literature review

Adrien De Voeght (1), Eric Godon (1), Alfred Chachati (1), Etienne Cavalier (2), Benoit Buysschaert (1) Published in the journal : May 2019 Category : Observations cliniques

We have reported a case of hypercalcemia with acute renal failure secondary to vitamin D intoxication induced by chronic use of calcitriol. In this article, diagnosis and treatment approaches have been discussed.

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Cardiac toxicity of 5-fluorouracil

Anne-Catherine Claikens, François D’Heygere (1) Published in the journal : May 2019 Category : Observations cliniques

A 53-year-old patient attended the emergency department, on two occasions, because of angina symptoms following the administration of 5-fluorouracil. This treatment was employed in a preoperative neoadjuvant approach in the setting of a recent diagnosis of colorectal cancer (T3N1M0).

Overall, 5-fluorouracil can be associated with cardiac toxicity that manifests itself as pectoral angina, infrequently resulting in irreversible, potentially lethal, cardiac pathologies. While multiple risk factors and action mechanisms have been proposed in the literature, they are still largely unknown among practitioners.

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Giant basal cell carcinoma successfully treated by photodynamic therapy

Muriel Creusot (1), Anne Le Pillouer-Pros (t)2 Published in the journal : May 2019 Category : Observations cliniques

Giant basal cell carcinomas, defined as lesions with a diameter reaching 5cm or more, are rare. They are usually treated by surgery, which can prove mutilating, depending on the size of basal cell carcinoma, or even impossible, depending on the patient’s age or presence of co-morbidities. Since 2003, dynamic phototherapy has become a non-invasive therapeutic alternative for basal cell carcinomas, proven effective. As early as 2010, research revealed the value of intensifying conventional phototherapy sessions with multiple methods, including fractionated CO2 laser, in order to enable trans-epidermal delivery of methyl aminolevulinate (MAL), thereby amplifying the therapeutic response.

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Immunotherapy: successes and prospects

Jean-Francois Baurain Published in the journal : May 2019 Category : ECU-Congrès de médecine générale

Immune checkpoint inhibitors, such as anti-PD1/PD-L1 antibodies, have changed the treatment of several cancers.The survival of cancer patients has drastically improved, with some of them showing complete and durable responses. A number of patients are likely to be cured of their metastatic cancer. This should encourage further research from academic or pharmaceutical teams in an effort to increase the efficacy of modern immunotherapy.

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Monoclonal gammopathy of undetermined significance

Julien Depaus Published in the journal : May 2019 Category : ECU-Congrès de médecine générale

Monoclonal gammopathy of undetermined significance (MGUS) is commonly diagnozed in the general population, particularly the elderly. The condition carries a risk of progression to myeloma or other lymphoproliferative disorders and, thus, warrants regular follow-up. MGUS patients can be risk-stratified based on both the amount and type of the monoclonal protein and light-chain ratio.

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Cardiac stress test: For whom? Why? How?

Agnès Pasquet Published in the journal : May 2019 Category : ECU-Congrès de médecine générale

This article reviews the main indications for stress testing and the different kinds of stress tests that can be performed in patients in the cardiological setting.

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Direct oral anticoagulants: How to choose?

Christophe Scavée Published in the journal : May 2019 Category : ECU-Congrès de médecine générale

Atrial fibrillation (AF) is a major cause of stroke. To prevent this devastating complication, anticoagulants are recommended in some patients. Two classes of oral anticoagulants can be used for this indication: anti-vitamin K (AVK) agents, such as warfarin, and direct-acting non-vitamin K oral anticoagulants, also called new oral anticoagulants (NOACs). NOACs include agents with two distinct modes of action: direct factor Xa inhibitors (apixaban, rivaroxaban, edoxaban) on the one hand and direct thrombin inhibitors (dabigatran) on the other hand. These molecules have been compared individually to warfarin: While showing similar efficacy, they had a better safety profile in terms of bleeding, with a lower risk of hemorrhagic stroke and intracranial hemorrhage. They are therefore preferred over AVKs.

The choice of the anticoagulant is made on a case-by-case basis, always taking into account the risk of stroke (using anticoagulants in patients without thromboembolic risk factors is currently not recommended) and bleeding (dosage!). These two aspects should be assessed prior to any prescription. When choosing an anticoagulant agent, the physician should also consider the presence of coronary artery disease (concomitant use of antiplatelet therapy), the patient's age and weight (dose adjustment!), renal function (important for dabigatran), the patient’s preference (once daily vs twice daily administration), and the patient’s understanding of the treatment, which is decisive for therapeutic compliance. It should be noted that dabigatran is currently the only NOAC for which a specific reversal agent is available that can be used in some cases when emergency surgery is required or major bleeding has to be controlled.

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Arterial hypertension: new guidelines

Jean-Michel Pochet (1), Alexandre Persu (2) Published in the journal : May 2019 Category : ECU-Congrès de médecine générale

The latest ESC/ESH guidelines recommend ambulatory blood pressure monitoring or self-measurement for diagnosing hypertension and advocate early drug therapy using a fixed combination of a renin-angiotensin system blocker and a calcium channel blocker or a thiazide diuretic. Blood pressure should be reduced to 120-129/70-79 mmHg in patients aged <65 years who tolerate it. In patients aged >65 years, blood pressure should be reduced to 130-139/70-80 mmHg, if tolerated.

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Biotherapies in the management of moderate-to-severe psoriasis

Deborah Debois, Marie Baeck, Pierre-Dominique Ghislain (1) Published in the journal : May 2019 Category : Actualité thérapeutique

Psoriasis, a very common systemic inflammatory disease, is potentially disabling from a functional and aesthetic point of view. In recent years, treatments for managing moderate- to-severe psoriasis have significantly evolved since the advent of biologic therapies. Undoubtedly, these latter have favorably impacted the patient quality of life.

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