Thrombosis and haemostasis in women

Cédric Hermans, Catherine Lambert Published in the journal : October 2022 Category : Résumés des webinaires

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.

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Antiphospholipid syndrome, an unrecognized cause of multiple and varied thrombotic events

Camille Desender (1), Pascal Fajardo (2), Nicolas Eppe (3), Fleur André-Mathieu (4), Ludivine Hougardy (5) Published in the journal : October 2022 Category : 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.

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Medium-term survival rate of dual mobility Polarcup® cup in primary hip arthroplasty

Juan Toussaint (1), Julien Vanderplasschen (1), Didier Postlethwaite (2) Published in the journal : October 2022 Category : Orthopédie et Traumatologie

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).

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Patient support in case of inability to drive a car

Laurent Levecq, Margot D’Affnay, Alice Bughin Published in the journal : October 2022 Category : 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.

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The financing of hospital activity in Belgium

Guy Durant Published in the journal : October 2022 Category : Médecine et société

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.

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Islet transplantation: cell therapy for type 1 diabetes

Antoine Buemi Published in the journal : September 2022 Category : Diabétologie

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.

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Bariatric surgery: a cure for type 2 diabetes mellitus?

Jean-Paul Thissen Published in the journal : September 2022 Category : Diabétologie

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.

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Are F. Banting and Ch. Best really the "discoverers" of insulin 100 years ago? Synthesis of a rereading of history

Martin Buysschaert (1), Alberto de Leiva-Hidalgo (2) Published in the journal : September 2022 Category : 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".

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New indications of SGLT2-inhibitors

Michel Jadoul Published in the journal : September 2022 Category : Diabétologie

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.

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Pitfalls of pituitary biology

Damien Gruson Published in the journal : September 2022 Category : Endocrinology

The biological work-up of the pituitary gland is primarily aimed to detect an excess or deficit of hormone production. The assay methods for the different tests of this workup have significantly evolved over recent years, both through the automation of immunoassays and development of liquid chromatography-mass spectrometry methods. The clinico-biological relationship plays a fundamental role in the evaluation and optimization of these assays, and in the interpretation of their results, as well.

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