Acute mesenteric ischemia (AMI) is a frequent cause of acute abdomen in the elderly, which is commonly encountered in the intensive care unit (ICU). AMI has a high mortality rate of between 60 and 80%, as well as a high morbidity rate among survivors. One of the reasons for this poor prognosis is the lack of accurate diagnostic tools for the clinician, with a delayed diagnosis as the main consequence. The characteristics of AMI diagnosed in the ICU often differ from those found in the general population, which results in a real diagnostic challenge. In the ICU, the interpretation of clinical, biological, and radiological signs of AMI proves more difficult. Furthermore, the poor prognosis is also accounted for by the numerous comorbidities of intensive care patients.
Given the aging population and increasing prevalence of degenerative diseases of the spine, neurosurgeons need to perform more lumbar fusions with pedicle screw fixations. As these interventions are currently carried out percutaneously, surgeons are dependent on intraoperative imaging to replace the anatomical landmarks found in open procedures. In our institution, we recently acquired a neuronavigation system based on intraoperative 3D fluoroscopy.
Autosomal dominant polycystic kidney disease (ADPKD), caused by PKD1 or PKD2 mutations, is the most common inherited kidney disease. Intracranial aneurysms (ICA) and mitral valve prolapses are well-known vascular complications in ADPKD patients. Other reported vascular manifestations include thoracic aortic aneurysms and dissections (TAAD) and cardiomyopathies (CMP).
Transient elastography (TE), or Fibroscan®, has been validated for the diagnosis and staging of liver fibrosis in chronic hepatitis C, but there is no clear consensus on the optimal TE cut-off values in alcoholic liver disease (ALD). The objectives of the study were: (a) to evaluate the cut-off values reported in the literature and determine new ones for the diagnosis of fibrosis in alcoholic patients; (b) to investigate the impact of 2 weeks of abstinence on TE results; (c) to evaluate the diagnostic accuracy of TE for detecting clinically significant portal hypertension; (d) to evaluate the accuracy of non-invasive blood tests (AST-Platelet Ratio Index [APRI], Forns index, Fibrosis-4 [FIB-4]); (e) to study the potential histological (steatosis, alcoholic hepatitis, perisinusoidal fibrosis) and biochemical (transaminases and cholestasis) confounding factors leading to misclassification by TE.
Shabneez Kautbally(1), Pierre Deprez(1), Michel Hermans(2), Tom Moreels(3), Tarik Aouattah(3), Enrique Perez-Cuadrado-Robles(3)Published in the journal : July 2018Category : Mémoires de Recherche Clinique
Studies reporting on pancreatic function after endoscopic treatment of chronic pancreatitis are scarce. This study was aimed at prospectively investigating the evolution of pancreatic endocrine and exocrine function in patients who underwent endoscopic treatment using endocrine function parameters and fecal tests for exocrine function.
In the first months following diagnosis, type 1 diabetes patients frequently experience a transient period of partial remission during which glycemic control can be achieved easily with reduced, or even suspended, insulin requirements. Over the past years, different criteria have been used in the literature to define this period, rendering it sometimes difficult to compare study results. In 2009, Mortensen et al.  proposed a new definition of the remission phase: the IDAA1C (Insulin Dose-Adjusted A1C = HbA1C + 4 x insulin doses/day/kg), with an IDAA1C ≤9 indicating that the patient is in remission phase. Though this formula is currently the most widely used in the literature, some authors criticize that it integrates the «insulin doses» parameter, as it may be influenced by several confounding factors.
Knee arthroplasty has been constantly evolving since it was introduced in the late 1960’s as a new treatment option for knee osteoarthritis. Unicompartmental (UKA) and total knee arthroplasty (TKA) have the same treatment objectives, namely relieving symptoms and allowing patients to return as soon as possible to normal life so that they can engage in daily activities, as well as in recreational and social events. Interestingly, several studies demonstrated a better recovery in patients that underwent UKA compared to those who were subjected to TKA. Our study hypothesized that patients eligible for UKA initially have a stronger and more powerful quadriceps muscle and thus a better performing muscle than those eligible for TKA. These preoperative muscle properties may play a major role in the improved recovery process observed in patients operated by UKA.
Knee, arthroplasty, quadriceps, limb preconditioning.
Flore Tuyumbu MD (1), Andréa Penaloza MD, PhD (2), Said Hachimi-Idrissi MD, PhD (3)Published in the journal : June 2018Category : Emergency
Over the last decades, the use of biomarkers in emergency medicine has considerably increased. While the P S100β protein has been considered as a neurological prognostic factor following cardiac arrest or stroke occurrence, it is principally in the minor head trauma management that the P S100β seems to be of interest. Studies have highlighted its usefulness for excluding neurological lesions, without performing brain computed tomography (CT), and this, with a good sensitivity close to 100% (CI: 50 to 100%). The P S100β analysis could be particularly helpful for clinicians in cases where the patient's neurological examination proves unreliable.
For most patients with lower-extremity deep vein thrombosis (DVT), direct oral anticoagulants (DOAs) can replace safely and effectively vitamin K antagonists (VKAs), with multiple benefits. Some DOAs can be started immediately upon diagnosis, without any previous treatment with low-molecular-weight heparin (LMWH). In some settings and patients, initial LMWH therapy should, however, be favored. Though their use should not be trivialized and precautions are necessary, DOAs facilitate the management of the 3-month anticoagulation that is required in most DVT patients. DOAs, at full or reduced dose, are probably most beneficial in patients requiring prolonged or long-term anticoagulation. This article reviews the current management of DVT using DOAs and summarizes the main criteria for identifying candidates to prolonged or long-term anticoagulation.
Priscila Jijón(1), François Marolleau(2), Polycarpe Shango(3), Thierry Sluysmans(3), Stéphane Moniotte(3)Published in the journal : June 2018Category : Pediatrics
Patients with PAVM may have hypoxemia, orthodeoxia, chest pain, hemoptysis, paradoxical embolizations leading to stroke and brain abscess. Peutz-Jeghers Syndrome is a disease characterized by the development of hamartomatous polyps in the gastrointestinal tract, mucocutaneous melanotic pigmentation and high risk of cancer. This is a case-report of the fortuitous association of these 2 diseases.