Complete auriculo-ventricular block secundary to an exceptionnal aetiology

Justine Vereeke, Christophe Scavée (1) Published in the journal : April 2019 Category : Observations cliniques

The occurrence of atrio-ventricular conduction disorders calls for further investigations. Differential diagnoses comprise infections, infiltrative diseases, and neoplasiae. Primary cardiac lymphoma is a rare condition, often associated with delayed diagnosis. Nevertheless, complete tumor response and, therefore, disappearance of the conduction disorder may be achieved through an appropriate treatment.

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Nicolau syndrome following glucocorticoid injection

Stéphanie Bouvy, Sophie Fossoul (1) Published in the journal : April 2019 Category : Observations cliniques

This article sought to present a rare iatrogenic complication occurring after a relatively common drug injection in medical practice. We have reported a "Nicolau syndrome" following a glucocorticoid injection. This term refers to a syndrome manifested by painful livedoid dermatitis, potentially associated with serious complications. This article aims to emphasize the relevance of preventing this syndrome, by providing technical recommendations for injections, along with the correct indications of glucocorticoid use. This paper ends by emphasizing the need of promptly diagnosing this syndrome, as accurately as possible, in order to limit its complications.

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Prosthesis for upper limb amputee's

Published in the journal : April 2019 Category : Médecine Physique et Réadaptation

More than for other amputations, the upper limb prosthesis requires setting up a project. Established between the multi-disciplinary team and patient, this project must clearly match the patient's esthetic and functional wishes.

Following lower limb amputation, though it presents other difficulties, the primary aim is to enable the patient to regain the walking capacity. Given that the function of the upper limb is more complex, it is our responsibility to pay additional attention in order to prevent the patient from dropping the prosthesis.

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Prosthesis for upper limb amputee's

Julie Jacques (1), Ellen Verbraeken (2), Jean-Marie Vanmarsenille (1) Published in the journal : April 2019 Category : Médecine Physique et Réadaptation

More than for other amputations, the upper limb prosthesis requires setting up a project. Established between the multi-disciplinary team and patient, this project must clearly match the patient's esthetic and functional wishes. Following lower limb amputation, though it presents other difficulties, the primary aim is to enable the patient to regain the walking capacity. Given that the function of the upper limb is more complex, it is our responsibility to pay additional attention in order to prevent the patient from dropping the prosthesis.

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Is type 1 diabetes auto-immune disease?

Caroline Daems, Juliette Vanderroost, Philippe A. Lysy Published in the journal : April 2019 Category : Diabétologie

Type 1 diabetes (T1D) is a medical condition characterized by insulin secretion deficiency, inducing chronic hyperglycemia, and subsequent autoimmune destruction of insulin-producing pancreatic β cells. This destruction is primarily mediated by CD4+ helper T cells and CD8+ cytotoxic T lymphocytes that induce β cell death, also termed apoptosis. Recently, several research teams have challenged the purely autoimmune origin of the disease. Indeed, insulitis is not systematically found in all pancreatic samples analyzed, whereas immune therapies aimed to suppress autoimmunity and restore the immune tolerance have not always achieved the expected success. Inflammation, undeniably, plays a key role in the trigger and development of T1D, and in particular the pro-inflammatory cytokines IL-1β, IFN-γ, and TNF-α. By activating inflammatory cascades and endoplasmic reticulum stress in β cells, these cytokines ultimately lead to cellular apoptosis. The condition’s true cause, whether autoimmunity or inflammation, is, however, still unknown. In this review, we have summarized the different pathophysiological aspects of T1D, whether autoimmune or inflammatory.

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Evolution of glycemic control and quality of life of diabetic patients after using Flash glucose self-monitoring: a prospective study involving 248 patients

Stéphanie Rouhard, Vanessa Preumont Published in the journal : March 2019 Category : Session de Diabétologie

In a population of Type 1 diabetic patients, we have evaluated the medium-term impact following the introduction of the FreeStyle Libre (FSL) glucose self-monitoring system on glycemic control, number of hypoglycemia episodes, and patient satisfaction with respect to the device.

A total of 248 patients were included and followed-up for 6 months following the introduction of FSL. The HbA1c levels were 8.1 ± 1.3% at inclusion.

HbA1c was found significantly improved at 6 months, especially in patients with poor glycemic control at inclusion. The number of daily controls was shown to have significantly increased. We have noticed a correlation between the number of scans and time spent within the target levels. The number of hypoglycemia episodes, however, was increased at both 3 and 6 months, despite a reduction in insulin doses. The satisfaction score with respect to the system significantly increased as well, especially in the event of improved glycemic control. The behavior score with respect to the occurrence of hypoglycemia episodes improved as well, with no change in the hypoglycemia fear score.

The FSL use induced an improvement in the glycemic balance of the included Type 1 diabetic patients, especially in case of prior poor glycemic control, which was associated with an improved glycemic control compliance. Satisfaction scores for the system were shown to have improved as well, with patients changing less their daily-life behavior, in an effort to avoid hypoglycemia episodes.

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How to treat insulinomas without surgery? The revolution brought about by pancreatic EUS-guided radiofrequency ablation

Pierre H. Deprez, Ivan Borbath Published in the journal : March 2019 Category : Session de Diabétologie

Radiofrequency (RF) is a technique aimed at localized tissue destruction by means of thermal effects. Digestive endoscopy offers multiple potential applications for RF ablation, with some of which currently well-validated. One of its best indications is possibly the ablation of pancreatic insulinomas, given that this technique has revolutionized their management. This easy and simple procedure, associated with a low rate of complications, renders it possible to avoid pancreatic surgery, which is associated with a certain degree of morbidity. However, the technique’s limitations and long-term efficiency still require further validation in prospective trials.

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Active surveillance of papillary thyroid microcarcinomas

Maria-Cristina Burlacu Published in the journal : March 2019 Category : Session de Thyroïdologie

The recent increase in the incidence of differentiated thyroid cancers has been reported worldwide, attributed to an overdetection of asymptomatic papillary microcarcinomas. Active surveillance has meanwhile emerged as a safe alternative to immediate surgery of microcarcinomas presenting with low-risk clinical, radiological, and cytological features. Given this cancer category, the risk of disease progression appears to be higher in third and fourth decades. Deferred surgical intervention has not been shown to modify disease recurrence and survival rates. A multidisciplinary approach proves to be critical for appropriate patient selection and follow-up.

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Should we be worried about PET-scan-positive thyroid nodules?

Cédric Reichel, Maude Berckmans, François Jamar Published in the journal : March 2019 Category : Session de Thyroïdologie

The serendipitous detection, also called incidentaloma, of focal hypermetabolic abnormalities at 18F-fluorodeoxyglucose PET-CT of the thyroid gland is relatively frequent, estimated to be around 1.5-2% of the cases investigated. The prevalence of cancer cases appears to be very low, well below 1%. Considering that PET-CT is mainly performed in patients with –sometimes advanced- cancer, it is essential to refrain from extensive workups, with often limited impact as for the patient’s prognosis. To summarize, the work-up of focal abnormalities is similar to that of the usual workup of thyroid nodules, including rigorous ultrasound evaluation and, if deemed appropriate, fine-needle aspiration biopsy, as recommended by current guidelines. In patients with diffuse uptake, a general endocrinology workup, based on clinical and laboratory data, is recommended.

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Are thyroid nodules with a diameter size > 3 cm an indication for surgery ?

Rébecca Fischler, Bernard Corvilain Published in the journal : March 2019 Category : Session de Thyroïdologie

Excepting the presence of a compressive syndrome, there are no objective reasons for proposing a surgical resection exclusively based on size alone for large (3-4 or 5cm), cytologically benign nodules. A large size itself is neither a risk factor for malignancy nor does it result in a significantly larger number of false-negative results based on fine-needle aspiration cytology. Only a suspicious ultrasound appearance is likely to significantly increase the risk of false-negative results and should, in some cases, suggest performing either a new fine-needle aspiration cytology or diagnostic surgery.

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