Unrecognized complication of gastric bypass: a rare case of intraabdominal desmoid tumor

Geoffrey Jacqmin (1), Geanina Curca (1), Mikhael Janssen (2), Christophe Boland (3), David Heuker (1) Published in the journal : November 2019 Category : Chirurgie digestive

Desmoid tumors are rare monoclonal myofibroblastic proliferations with varying clinical courses depending on the disease location and extent. Despite being comprised of histologically benign stromal cell proliferations, these growths can, at times, become locally aggressive and have a high rate of local reccurence, even following complete resection. To date, there are no reports of metastases in the literature. Although various risk factors have been described, the etiologies and pathways of these cell growths are not completely understood. Desmoid tumors occur either as sporadic lesions or as part of familial adenomatous polyposis, which is caused by germ line mutations in the adenomatous polyposis coli gene. Due to their different clinical presentations, no standard approach for desmoid tumors has been recommended so far. Herein, we describe the case of a 46-year-old female who had undergone gastric bypass three years earlier, whilst being diagnosed with a mesenteric desmoid tumor that compressed her Roux-en-Y jejunal limb. To our knowledge, this is the first reported case of desmoid tumor in a patient having undergone a Roux-en-Y gastric bypass.

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Mental disease: open door to euthanasia?

Marc Brusselmans Published in the journal : November 2019 Category : Ethics

In 2002, Belgium adopted a law decriminalizing euthanasia in certain situations. One of this law’s particularities is that it opens the physician’s possibility to practice euthanasia following a patient’s request, which can be based on a constant and unbearable psychic suffering, in the context of a serious accidental or pathological affection, even without a fatal outcome in the short-term. However, this law raises serious ethical issues in the field of mental health, both concerning the concept of diagnosis in psychiatry as well as the incurability of mental illness. This may result in dangerous interpretations. The psychiatric function itself appears to be rather destabilized and challenged by the application of this law. Excesses are possible, and an in-depth reflection is thus paramount concerning the need to better protect the rights of the most vulnerable, such as, among others, the mentally ill.

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Dual antiretroviral therapy as initial treatment for people living with HIV-1?

Emilie Dupont (1,2), Jean Cyr Yombi( 2) Published in the journal : November 2019 Category : Maladies infectieuses

Combined antiretroviral therapy (cART) has significantly improved the prognosis and life expectancy of people living with human immunodeficiency virus (PLWHIV). Current international guidelines recommend a triple therapy that conventionally combines two nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) and a third agent that is either a ritonavir- or cobicistat-boosted protease inhibitor (PI), either a non-nucleoside reverse transcriptase inhibitor (NNRTI), or a boosted or unboosted integrase inhibitor (INI). Due to the toxicity of NRTIs, alternative non-NRTI-based therapeutic regimens have been proposed. They initially had limited success compared to the standard triple therapy due to low efficacy, particularly in patients with high viral load and low CD4 cell counts. A new strategy combining lamivudine (3TC) with boosted PI or INI has yielded promising results, suggesting that modern dual therapies will become a reliable first-line treatment option for PLWHIV. Recently, the European AIDS Clinical Society guidelines have recommended dual therapy as the preferred regimen in treatment-naive patients in certain circumstances.

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A dry extract of Passiflora incarnata L. used for the management of benzodiazepines withdrawal

Published in the journal : November 2019 Category : Médecine psychosomatique


Benzodiazepines withdrawal management is often accompanied by anxiety, resulting in a risk of relapse and the prescription of additional medications. A dry extract of Passiflora incarnata L. has previously demonstrated its usefulness in the first-line treatment of anxiety symptoms.

Subjects and methods

We performed a longitudinal study over a 3-month period wherein we initiated this medication in patients who were discontinuing long-term benzodiazepine use. Patients included in the study were all sufficiently stable and had been followed-up for at least three months in consultation. The benzodiazepine decrease scheduled was 25% of the initial dose every second week. Specific psychiatric interviewing was not used either before or during the study. We assessed the evolution of the anxiety score and the number of sexual intercourses in the course of drug withdrawal.


Overall, 91 patients participated to this study, including 27 men (36.5%) and 47 women (63.5%). The mean age was 44.1 ± 11.0 years. The withdrawal success rate was 78.4% (95% CI: 69.0-87.8%). There was a clear and highly significant decrease in the Hamilton scale's anxiety scores, while the monthly frequency of intercourse was shown to slightly, though significantly, increase. Treatment with Passiflora incarnata L. was pursued in 70.3% of patients following total withdrawal of or reduction in benzodiazepine dosing.


A dry extract of Passiflora incarnata L. was shown to be safe, with significant favorable effects on anxiety scores. This product, therefore, may likely be used to improve benzodiazepine withdrawal symptoms.

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Cystic fibrosis newborn screening implemented in Belgium in 2019

Patrick Lebecque (1), Olivier Lebecque (2), Marijke Proesmans (3), Teresinha Leal (4) Published in the journal : November 2019 Category : Pneumologie pédiatrique

In 2019, a national program of cystic fibrosis newborn screening is scheduled to be eventually implemented in Belgium. An IRT/DNA algorithm has been chosen, pretty similar to the French algorithm. In both countries, R117H is almost always combined in cis with a 7T sequence in the intron 8 acceptor splice site. It was included in the initial panel of CFTR variants looked for. This paper critically describes the program’s steps, while emphasizing the crucial roles of general practitioners and local pediatricians.

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Endocrine disruptors

Corentine Vanlier (1), Marie Baeck (1), Anne-Simone Parent (2), Christine Lafforgue (3), Caroline Peeters (1), Anne Herman (1) Published in the journal : October 2019 Category : Dermatology

We herein report on the “PEAU’se dermatologique” meeting focused on endocrine disruptors, which was held on October 22, 2018 and organised by the Department of dermatology of the Cliniques universitaires Saint-Luc. Doctor AS. Parent first described the interactions taking place between endocrine disruptors and child development. Next, Doctor CH. Laforge presented the legislation on endocrine disruptors and talked about absorption mechanisms. Finally, the experts provided us with advice on how to limit exposure to and, thus, avoid the undesirable effects of these products.

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A rare cause of hypercalcemia

Charlotte Lepere (1), Jean-Cyr Yombi (1), Eric Van den Neste (2), Philippe D’Abadie (3), Halil Yildiz (1) Published in the journal : October 2019 Category : Internal Medicine

Hypercalcemia is a condition that must not be mistaken, because it can be life-threatening. Its severe form must be rapidly treated. We present the case of 66-year-old man presenting with neurologic symptoms and cardiac alterations secondary to severe hypercalcemia. The diagnostic work-up revealed excessive production of calcitriol secondary to Richter’s syndrome. After treatment of hypercalcemia and chemotherapy, the neurological symptoms and electrocardiographic changes completely disappeared. The aim of this article is to discuss the main etiologies of hypercalcemia, its clinical manifestations, and the principles of its management.

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A rare cause of hypokalemia

Jean Henry (1), Eugénie Lagneaux (1), Michel Lambert (2), Jean-Christophe Marot (1), Jean-Charles Coche (3) Published in the journal : October 2019 Category : Internal Medicine

Introduction. Hypokalemia is often discovered accidentally during routine check-ups. In some cases, however, it may be accompanied by severe symptoms like rhabdomyolysis, potentially leading to life-threatening cardiac rhythm disturbances.

Clinical case. We report the case of a 60-year-old woman admitted to the emergency department with marked anorexia, general weakness, diarrhea, and abdominal pain, which had progressively worsened over the last few weeks. Initial blood analyses showed hypokalemia (1.44mmol/L) as well as rhabdomyolysis (CK 6561 U/L). The cause of her condition could not be identified based on etiological investigations, whereas thorough history taking revealed massive chronic ingestion of cola (10 liters a day).

Discussion. The consumption of high quantities of cola can lead to hypokalemia through the effects of caffeine, glucose, and fructose. Caffeine induces severe hypokalemia by two mechanisms: intracellular redistribution of potassium and increased renal excretion of potassium. Additionally, substances with high fructose content cause osmotic diarrhea with secondary hypokalemia. The high glucose concentration in cola also induces hyperinsulinism, which is associated with intracellular redistribution of potassium.

Conclusion. Chronic and massive consumption of cola can lead to hypokalemia through intracellular potassium shifts, along with osmotic diarrhea caused by high fructose concentrations. Primary care physicians should inquire about soda consumption among their patients when confronted with unexplained cases of refractory hypokalemia.

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Predictive factors of macroangiopathy in type 2 diabetic patients

Imen Sebai, Ibtissem Oueslati, Nadia Khessairi, Meriem Yazidi, Emna Talbi, Fatma Chaker Mélika Chihaoui Published in the journal : October 2019 Category : Diabétologie

Cardiovascular complications are the first cause of mortality in patients with type 2 diabetes mellitus. The aim of our study was to determine the risk factors related to diabetic macroangiopathy. To meet this purpose, we conducted a cross-sectional study among 71 patients with type 2 diabetes mellitus. Patients were divided into two groups according to presence or absence of macroangiopathy. The examination included full medical histories, somatic examination and laboratory tests, in particular brain natriuretic peptide (BNP) measurements. The univariate analysis showed a significant association between macroangiopathy and male gender (p = 0.029), HbA1c > 9.5% (p = 0.008), a cumulative number of cardiovascular risk factors>5 (p <10-3), hypertension, presence of microangiopathy (p <10-3) and BNP plasmatic level > 24 pg/mL (p=0.007). In multivariate analysis, predictor factors were a cumulative cardiovascular risk factors > 5 (OR=13.9 [95%CI:1.4 -137.6], p = 0.024), presence of microangiopathy (OR=22 [95%CI: 2.2 - 215.4], p = 0.008) and HbA1c>9.5% (OR = 36.6 [95%CI:2.6 - 505]; p = 0.007). Thus, cardiovascular diseases were the consequence of the entanglement of traditional risk factors with the involvement of chronic hyperglycemia.

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35 recommendations for end-of-life support at the Grand Hôpital de Charleroi

Emmanuelle Claes (1), Vanessa Baio (2), Yannick Courtin (3) Published in the journal : October 2019 Category : Soins palliatifs

Caregivers in charge of end-of-life patients are often helpless and experience difficulty when their patients do approach death. Heavy emotions manifest and several questions come up. This is a common observation.

Most naturally, this emphasizes the necessity of a project involving caregivers’ knowledge of death outside palliative care. Such a project was built over 3 years of meetings, consultations with eight teams of caregivers, questions, seminar sessions and presentations, transcripts, proofreading, in addition to numerous corrections.

The outcome is a set of 35 recommendations stemming from the «practical wisdom» of caregivers. This document bears witness to a process of care within this field, a process which designates a movement, bringing one towards the other in order to meet him on his own path [6]. This approach brought together caregivers from eight disciplines around the same questioning in order to broaden and ameliorate their own skills, while sharing them with the different stakeholders working on the quality of care within an institution.

This project is now evolving and primarily designed to encourage consultation and implementation of the recommendations, while further seeking for partnerships in this field.

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