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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Management of Type 2 diabetes in 2019: the same cost/efficiency ratio? The nephrologist’s perspective

Jean-François Cambier Published in the journal : March 2019 Category : Session de Diabétologie

Diabetic nephropathy is currently the leading cause of chronic end-stage renal disease. Its prevention is essential and implies a multidisciplinary management of the diabetic patient, as based on a strict control of blood glucose levels from the onset of diabetes, control of blood pressure, with a privileged place for either ACE inhibitors or sartans whose anti-proteinuric effect has been well demonstrated, and control of other cardiovascular risk factors. In addition, chronic kidney disease significantly increases the cardiovascular risk of diabetic patients. Recent randomized clinical trials involving the new classes of anti-diabetic agents (DPP4-inhibitors, GLP-1 receptor agonists, and SGLT2-inhibitors) have demonstrated the cardiovascular protection ensured by several molecules (empaglifozin, canaglifozin, dapaglifozin, liraglutide, semaglutide, albiglutide, and dulaglutide), along with an additional nephroprotective effect shown for gliflozins, liraglutide, and semaglutide.

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Type 2 diabetes management in 2019: the same cost-efficiency? The cardiologist’s perspectives

Christophe Beauloye Published in the journal : March 2019 Category : Session de Diabétologie

Diabetes is a major cardiovascular risk factor, as it significantly increases the risk of cardiovascular events, such as myocardial infarction or stroke. In addition, once these last complications have occurred, the patient prognosis is poorer. Recently, as well documented in the scientific literature, diabetes has been demonstrated to be a significant risk factor for heart failure. New anti-hyperglycemic treatments for Type 2 diabetes and, particularly, sodium-glucose-2 co-transporter inhibitors have reduced cardiovascular events both in primary and secondary prevention. This pharmacological class has been proven to protect Type II diabetes patients from heart failure and to reduce their mortality. These medications’ impact on the occurrence of acute coronary syndromes appears to be more marginal.

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Type 2 diabetes management in 2019: the same cost-efficiency ratio? The diabetologist’s perspective

Michel P. Hermans Published in the journal : March 2019 Category : Session de Diabétologie

The results of 14 prospective randomized clinical trials designed to verify the macrovascular safety of various classes of anti-hyperglycemic agents in T2DM, such as DPP4-inhibitors, SGLT2-inhibitors, and GLP-1 receptor agonists, have confirmed their safety for use in all studies; for some molecules, such as empagliflozine, canagliflozine, dapagliflozine, liraglutide, semaglutide, albiglutide and dulaglutide, the data revealed a beneficial pleiotropic effect on the primary endpoint, usually consisting of a composite of CV death, non-fatal infarction, and non-fatal stroke.

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Diabetic Charcot foot: crossed looks on the scientific literature and our 5-year clinical expertise at the University clinics of Saint-Luc

Laura Orioli (1), Dan Putineanu (2), Frank Hammer (3), Bruno Vande Berg (3), Dominique Maiter (1), Bernard Vandeleene (1) Published in the journal : March 2019 Category : Session de Diabétologie

The Charcot foot, a rare medical condition, defines a particular form of the diabetic foot, representing both a diagnostic and therapeutic challenge.

In 2017, we reviewed the medical records of patients with a Charcot foot, who were hospitalized in our diabetic foot unit between 2010 and 2014. In this article, we have combined some of our results with those retrieved from the literature in order to deliver several key messages dedicated to the everyday practice.

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Diagnostic and therapeutic innovations in rheumatology in 2018

Bernard R. Lauwerys Published in the journal : February 2019 Category : Rheumatology

Novel therapeutic developments are increasing in the field of rheumatology, particularly with respect to inflammatory and systemic rheumatisms.

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Innovations in 2018 in the psychiatry field ?

Published in the journal : February 2019 Category : Psychiatrie

Psychiatry occupies a very specific position within the field of medicine, given that it integrates the biological, psychological, and sociological dimensions that all contribute to the expression of mental health disorders. The essential innovations that have taken place within the fields of biology and more particularly, neuroscience, experimental psychology, and social sciences, may all be instrumental in advancing the field of psychiatry. On the other hand, psychiatry appears to be quite preoccupied with the mental health treatment reform that will profoundly modify treatment attitudes, involving an increase in community mental healthcare services, as well as more efficient first-line care facilities for mental health problems. On account of this treatment reform, special attention will be given to limiting desocialization of patients, developing mobile care units that are able to visit isolated patients at home, while promoting care intensification within hospital care units, in addition to creating long-term housing facilities for the most fragile patients. The Department of Adult Psychiatry of the academic Saint-Luc Hospital is heavily involved in this reform, but also in the project of building a new psychiatric hospital in Woluwé, in direct collaboration with the Sanatia Hospital and with our colleagues from the infanto-juvenile psychiatry department. One major challenge inherent to this new project is to not abandon our role and place in the main academic hospital, where specific innovative initiatives are presently being implemented, and this in close collaboration with our colleagues from the somatic medical fields. To end with, we think it essential that all these changes do not make us forget psychiatry’s anthropological roots that must remain its major strengths.

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