Atrioesophageal fistula after radiofrequency ablation: a rare and often fatal complication

Emilie Evrard (1), Dan Gusu (2), Pierre Hausman (3), Denis Glorieux (4) Published in the journal : December 2018 Category : Cardiovasculaire

The atrioesophageal fistula (AEF) is a rare complication of the atrial fibrillation (AF) ablation procedure. This complication is mostly fatal, with a mortality rate exceeding 80% (1), while its incidence does not exceed 0.3% (1). It is the second cause of death after tamponade following this procedure (2). The AEF results from the proximity between the esophagus and left atrium (3), as well as fromthermal esophageal mucosal lesions (4). We have here reported the case of a 65-year-old man who developed neurologic and septic symptoms 31 days after a second AF ablation. Upon admission, a cerebral scanner revealed a small ischemic lesion in the right temporal lobe. Initially hospitalized in a stroke unit, the patient was then transferred to an ICU because of his rapid neurologic deterioration. Upon the intubation maneuver, massive hemorrhaging from an upper digestive site occurred, with patient reanimation required. Confronted with an unknown diagnosis, a gastric endoscopy was performed, revealing two sluices on the anterior esophagus surface, opposite the left atrium. Thoracic CT scan corroborated the AEF diagnosis with an air bubble observed in the mediastinum, between esophagus and left atrium. Nevertheless, the patient died owing to massive cerebral air embolism.

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Management of chronic hepatitis C in children

Pauline Van Gyseghem, Etienne Sokal (1) Published in the journal : December 2018 Category : Pediatrics

With about 11 million children suffering from chronic hepatitis C infection worldwide, hepatitis C remains a major concern in pediatrics. In children, the main source of transmission is vertical, from the mother to the child around birth. Overall, 80% of infected children will develop a chronic infection, with about 1-2% evolving into hepatic cirrhosis. Pediatric treatments aim to eradicate the virus in order to reduce the transmission risk and prevent tissue damage in the long-term. Classical treatments based on pegylated interferon and ribavirin allow sustained virologic response to be achieved in about 45 to 95% of cases (1). In adults, new direct-acting antiviral (DAA) regimens have been approved in recent years and are now being used in the first-line setting. The first successful study that tested their efficacy in a pediatric population reported a sustained virological response in 97 to 100% of cases (2). If this rate is confirmed in other ongoing studies, disease eradication in the pediatric population should be feasible, enabling us to eradicate the virus reservoir, a latent source of new contaminations and chronic liver diseases.

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Alcohol at work, what can the occupational physician do?

Françoise Verstraete Published in the journal : December 2018 Category : Médecine du travail

In Belgium, drug and alcohol consumption at the workplace is regulated by a Collective Labor Agreement called CCT 100. In theory, all employers are required to assume a preventive policy concerning this issue. Yet, in the field, employers sometimes call on occupational physician as a matter of urgency, distraught by one of their employee’s excessive alcohol consumption. During the medical consultation, the occupational physician should attempt to provide preventive information and guidance to the employee or, in case of highrisk activity, to assess the employee’s ability to perform the specific duties. The role of the occupational physician is strictly regulated by labor legislation, although he is invited to collaborate with all medical stakeholders, while observing professional secrecy. This article presents a few practical cases that precisely outline the role of the occupational physician as regards to alcohol consumption at work.

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History of the youngest medical specialty : (Part 3 of 4 parts)

Yves Pirson Published in the journal : November 2018 Category : Ama Contacts

Between the half of the 19th and the half of the 20th centuries, Richard Bright’s successors have a profound problem classifying diseases leading to uremia. The advent of immunology around the onset of the 20th century sheds new light on this issue, with the identification of immune-complex and antibody mediated disorders.

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Liver transplantation for hepatocellular carcinoma: role of immunosuppression and rejection treatment in cancer recurrence - results of a multicenter study

Maxime Foguenne, Samuele Iesari, Jan Lerut Published in the journal : November 2018 Category : Mémoires de Recherche Clinique

Liver transplantation (LT) was initially dedicated to the treatment of cirrhosis. Nowadays, it is playing an increasingly important role in the treatment of hepatocellular carcinoma (HCC). Surgery, in the form of partial or total (i.e., transplantation) liver resection, represents the only curative treatment of HCC. It is important to keep in mind that a patient affected by HCC has in fact two diseases: the cancer itself and the underlying cirrhosis. LT thus represents a very interesting approach that treats both of them, but is really challenging.

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Glucocorticoid withdrawal in an incident cohort of lupus nephritis patients

Séverine Wautier, Farah Tamirou, Séverine Nieuwland-Husson, Frédéric Houssiau Published in the journal : November 2018 Category : Mémoires de Recherche Clinique

Nephritis is one the most frequent and severe manifestation of systemic lupus erythematosus. Treatment of lupus nephritis (LN) is based on the use of glucocorticoids (GC) and other immunosuppressants on the one hand, and on optimal renal protection on the other hand. The objective is to induce renal remission while avoiding cumulative damages. In this respect, chronic GC use is associated with many severe adverse events leading to increased morbidity. A prompt stop and withdrawal of GC is therefore of paramount importance.

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Machine learning applied to imaging: validation of the radiomics approach in a population of non-small-cell lung cancer patients treated by (chemo-)radiotherapy at the Cliniques universitaires Saint-Luc

Madeleine Scrivener Published in the journal : November 2018 Category : Mémoires de Recherche Clinique

An increasing number of advances have been achieved in the field of medical imaging, namely the conversion of standardof- care images into mineable data. Radiomics refers to the high-throughput extraction of quantitative image features from medical images (watch the video on https://youtu.be/ Tq980GEVP0Y and visit www.radiomics.world). These image features can be divided into four groups depending on the tumor characteristic they describe: tumor intensity, tumor shape, tumor texture, or wavelets. This study consisted in a radiomics analysis of 18’026 features extracted from standard-of-care, pretreatment, 4D computed tomography (CT) images from a cohort of 44 non-small-cell lung cancer (NSCLC) patients treated with chemoradiotherapy at the Cliniques Universitaires St-Luc. A radiomics signature was created using machine learning algorithms in order to preselect a small group of radiomics features based on their correlation with the studied endpoint (survival, histological types, etc.). The signature was created by analyzing the features of a patient cohort, and its robustness was then tested and validated on an external independent dataset.

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Rapid objective assessment of contrast sensitivity and visual acuity with sweep visual evoked potentials and an extended electrode array*

Coralie Hemptinne(1), Joan Liu-Shuang(2), Demet Yuksel(1,3), Bruno Rossion(2,4) Published in the journal : November 2018 Category : Mémoires de Recherche Clinique

Sweep visual evoked potentials (sVEPs) provide an implicit, objective, and sensitive evaluation of low-level visual functions such as visual acuity and contrast sensitivity. For practical and traditional reasons, sVEPs in ophthalmologic examinations have usually been recorded over a single or a limited number of electrodes over the medial occipital region. Here we examined whether a higher density of recording electrodes improves the estimation of individual low-level visual thresholds with sVEPS, and to which extent such testing could be streamlined for clinical application.

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Characterization of inter- and intrafamilial variability in autosomal dominant polycystic kidney disease

Henry Gaspard Published in the journal : November 2018 Category : Mémoires de Recherche Clinique

Autosomal dominant polycystic disease (ADPKD) is the most common inherited renal disease, accounting for 5 to 10% of patients requiring renal replacement therapy. ADPKD is characterized by the development of multiple cysts in both kidneys, leading to end-stage renal disease (ESRD) before the age of 60 years in approximately half of patients. This multisystem disorder can potentially affect the liver, pancreas, heart, and intracerebral arteries. ADPKD is a genetically heterogeneous disease caused by mutations in the PKD1 and PKD2 genes.

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Endoscopic management of postoperative pancreatic fistula

Gabriela Gujda, Catherine Hubert, Tom Moreels, Julie Navez, Enrique Perez Cuadrado-Robles, Pierre-Henri Deprez Published in the journal : November 2018 Category : Mémoires de Recherche Clinique

Postoperative pancreatic fistula (POPF) is one of the most prevalent clinically relevant complications following partial pancreatic resection. Endoscopic approaches have proven successful, but the literature regarding the best route of drainage is scarce. Our study was aimed at comparing the efficacy and safety of transpapillary (endoscopic retrograde cholangiopancreatography [ERCP]-based) and transmural (endoscopic ultrasound [EUS]-guided) endoscopic treatment of POPF occurring after distal pancreatectomy.

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