Radiation-Induced Breast Angiosarcoma

Charlotte Charlier (1), Stanislas Laurent (2) Published in the journal : April 2023 Category : Clinical Report

Breast angiosarcoma is a rare primary or secondary endothelial tumour. Optimal management differs according to the etiology.

The authors illustrate the diagnostic and therapeutic complexity of this type of cancer, based on two clinical cases. A recent review article sheds light on the management of this pathology.

The two types of angiosarcomas have different macroscopic appearances. An anatomopathological analysis enables a real diagnosis of this tumour, as do the immunohistological markers such as c-Myc and FLT4, which allow to differentiate between a primary or secondary angiosarcoma. (1)

Imaging tests such as ultrasound, mammography and (magnetic resonance imaging) MRI are not specific but can detect distant metastases and make the differential diagnosis with breast cancer recurrence. (2)

The specificity of post-radiation angiosarcoma surgical treatment lies in the width of the procedure. It is imperative to resect the entire irradiated skin area. Primary angiosarcoma, on the other hand, should be resected with a margin of 1cm to 2cm for tumours which are ≤ 5cm in diameter. (3) Indeed, the irradiated bed is the breeding ground for subsequent recurrence.

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Male Perpetrators of Domestic Violence. Qualitative Study on the Experience of Belgian General Practitioners in their Care

Antoine Chaumont (1), Yasmin Abid (2), Ségolène de Rouffignac (2) Published in the journal : April 2023 Category : Médecine Générale

Despite the prevalence of domestic violence (DV) in Belgium, few studies have examined the role of general medicine practice in the management of perpetrators of DV. What is the experience of Belgian general practitioners in the management of male perpetrators of domestic violence?
A qualitative study examined the history of Belgian general practitioners in the supervision of men who commit domestic violence. Through a snowball sampling and individual semi-directed interviews, we were able to collect information from five general practitioners. The heterogeneity of profiles in terms of gender, age, years of experience, type, and location of practice was preferred to obtain a rich and diversified sample. These five interviews were marked out by an interview guide and then strictly transcribed.
Three main themes related to the physicians' experience were identified: [1] by what means do the physicians identify male perpetrators of violence against women (VAW) and how can they be considered as patients? Their identification is mostly made by the female victims. There is little self-identification by the perpetrators of VAW. This is a victim-centered approach. The importance of the therapeutic relationship with the male perpetrators of violence is emphasized. [2] The second theme highlights a generalized taboo among respondents towards male perpetrators of sexual violence, which has an impact on their treatment. It proposes communication and verbalization in order to include [3] general medicine in a network- centered system on the male perpetrators of violence. This system is necessary to provide support and adequate multidisciplinary management of male perpetrators of domestic abuse.
There is a general taboo around male perpetrators of DV. General medicine practice contributes to this taboo. There is a lack of responsibility on the part of general practitioners, leading to a poor care for male perpetrators of domestic abuse. A network system is essential for their appropriate management. Further studies are needed to evaluate the role of the front liners in preventing domestic violence.

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A 360-degree overview of the effects of alcohol consumption

Pauline Gérard, Thomas Calozet, Léo Moreau, Audrey Bonnelance, Thomas Orban Published in the journal : March 2023 Category : Médecine Générale

Report of the RESUMES symposium of 21/01/2023

This article summarizes the most relevant messages shared during the annual RESUMES asbl (Multidisciplinary Network for Scientific Exchange) symposium on alcohol consumption. This theme was addressed through 12 disciplines, such as gastroenterology, gynecology, internal medicine, general medicine, etc.

Considering that at least 25% of the population consumes alcohol in a risky or even excessive way, each health professional is regularly confronted with the consequences of alcohol consumption, which this article attempts to review in its multiple dimensions and in a practical way.

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Finerenone: Towards better cardio- vascular and renal protection in chronic kidney disease associated with type 2 diabetes

Johann Morelle, Nathalie Demoulin, Michel Jadoul Published in the journal : March 2023 Category : Actualité thérapeutique

The kidney is undoubtedly a major target for microvascular damage in diabetes, and approximately half of patients with type 2 diabetes develop chronic kidney disease. The presence of chronic kidney disease increases the risk of death, cardiovascular events, and progression to kidney failure, which may require dialysis or transplantation. For diabetic patients, these complications obviously have a major impact, both on their outcomes and quality of life.

Reimbursed in Belgium since February 1, 2023, finerenone (Kerendia®, Bayer) is a novel non-steroidal mineralocorticoid receptor antagonist that has recently been shown to be effective in preventing cardiovascular events and the progression of chronic kidney disease in type 2 diabetes patients.

This review summarizes the current state of knowledge and provides clinicians with the necessary tools to prescribe finerenone to patients at high cardiovascular and renal risk, who require holistic and multidisciplinary management.

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Some novelties in the 2021 recommendations for the management of dyslipidemia in cardiovascular prevention

Olivier S. Descamps (1), Fabian Demeure (2), Ann Mertens (3), Ann Verhaegen (4), Michel Langlois (5), Caroline Wallemacq (6), Ernst Rietzschel (7) au nom du Belgian Atherosclerosis Society/Belgian Lipid Club Published in the journal : March 2023 Category : Actualité thérapeutique

In terms of treatment decision-making for dyslipidemia, the new 2021 European recommendations for the prevention of atherosclerotic cardiovascular diseases provide some nuances compared to the previous 2019 recommendations. These nuances notably concern the use of a new primary prevention risk assessment based on more recent epidemiological data and some changes in risk classification: the SCORE2. Changes include the use of non-HDL cholesterol rather than total cholesterol to estimate the risk, as well as a risk expressed as morbi-mortality rather than mortality alone as previously. Changes in risk thresholds to categorize patients as being at “very high”, “high”, or “low-to-moderate” risk also better identify younger patients who may benefit from cardiovascular prevention early enough to avoid cardiovascular problems that may occur in their 50s or 60s. Conversely, in elderly patients, the cardiovascular risk classification has been revised upwards so as not to treat these more drug-sensitive patients aggressively. The recommendations are also timely to better define the use of new molecules that have been introduced in Belgium during the year 2022.

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Gonarthrosis in obese patients: practical recommendations

Barbora Bocankova, Stéphanie Meirlaen, Emmanuel Thienpont Published in the journal : March 2023 Category : Orthopédie et Traumatologie

Obesity prevalence is rapidly growing and becoming a critical health issue, especially in developed countries. Obesity and life expectancy increase are the main reasons for the rising incidence of osteoarthritis (OA). Obese patients greatly benefit from surgical OA treatment and should therefore not be denied any intervention, including knee arthroplasty, regardless of their body mass index.

Conservative measures, such as lifestyle modification, exercise, and pharmacological treatment with systematic slow-acting drugs for OA (SYSADOA) like glucosamine sulphate, chondroitine sulphate or curcumine, topical or oral non-steroidal anti-inflammatory drugs, and intra-articular steroids or hyaluronic acid injections should be tried before resorting to knee surgery. Minimally invasive knee prosthesis, respecting soft tissue as much as possible, might be particularly beneficial for obese patients, reducing complication rates and improving outcome. However, further studies are needed to confirm this trend.

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Hallux valgus: What to tell the patient in the first line?

Maxime Fasseaux, Olivier Cornu, Dan Putineanu, Karim Tribak Published in the journal : March 2023 Category : Orthopédie et Traumatologie

Hallux valgus is the most common disease of the forefoot. Its etiology remains unclear, but is influenced by genetics. This condition can cause incapacitating and even disabling problems. It can have several presentations, the clinical and radiological severity of which will guide the treatment.

The level of evidence regarding first-line management remains poor. This article aims to explore the conservative treatment possibilities and their limits, and attempts to provide answers to the questions most frequently asked by patients.

Patients with mild to moderate hallux valgus, or severe hallux valgus, can have their pain relieved without surgical management. It is not yet established that conservative treatment can actually slow down disease progression, but future studies could explore this possibility.

Conservative treatment is based on adapting the footwear, wearing insoles or orthoses, physiotherapy, level I analgesics, as well as lifestyle and dietary adaptations.

In patients who do not respond to conservative treatment and have significant deformity, surgical treatment can be proposed. This treatment yields a satisfaction rate of approximately 80%

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Innovations 2022 in rheumatology

Frédéric A. Houssiau, Farah Tamirou Published in the journal : February 2023 Category : Rheumatology

Rheumatologists are internists who specialize in the treatment of systemic diseases. The Rheumatology Department of the Cliniques universitaires Saint-Luc has gained an international reputation in this field, particularly in the management of systemic lupus erythematosus (SLE), systemic sclerosis (scleroderma), and idiopathic inflammatory myopathies. The department is officially recognized in Europe through the European Reference Network ReCONNET. We would like to summarize herein some of the recent therapeutic innovations in our fields of excellence

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Innovations 2022 in the field of Child and Youth Psychiatry

Stéphanie Mazzone1, Anne Wintgens2, Valentine d’Aspremont3, Adeline Hanzir4, Estelle Mousset5, Sophie Vanhalewyn6, Emmanuel de Becker7 Published in the journal : February 2023 Category : Psychiatrie infanto-juvénile

Two clinical aspects are discussed this year for the Child and Adolescent Psychiatry Service of the Cliniques universitaires Saint-Luc. They describe the help and care offers implemented to cope with the increase of mental distress situations of children, adolescents, and their families. The first part concerns the deployment of the reference center for Autism Spectrum Disorder, namely the establishment of an early stimulation group for young children awaiting diagnosis and a “parent training” group after diagnosis. The second part encompasses the consolidation of legal time within the SOS-Children team of the Clinics; where we will show the merits and contributions of this specific function in complex cases of child abuse.

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Innovations during 2022 in pulmonology

Charlotte Smetcoren, Gimbada Benny Mwenge, Thierry Pieters, Françoise Pirson, Gregory Reychler, Giuseppe Liistro, Sophie Gohy, Antoine Froidure, Charles Pilette Published in the journal : February 2023 Category : Pneumology

Respiratory medicine is progressively becoming a personalized care due to a better understanding of the pathophysiological mechanisms underlying the endotypes of pulmonary diseases, either frequent (sleep apnea syndrome, lung cancer, chronic obstructive pulmonary disease, asthma, and allergies) or rarer (interstitial lung diseases, cystic fibrosis), in addition to more generic care benefiting to most patients (e.g., environmental avoidance measures, physical exercise). This article describes those inspiring concepts applied to major respiratory diseases by presenting major advances made in 2022.

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