Melanoma diagnosis and treatment

Laurine Sacré (1), Isabelle Tromme (1), Jean-François Baurain (2), Benoit Lengelé (3), Marie Baeck (1) Published in the journal : April 2017 Category : Dermatology

We report here on the "PEAU’se dermatologique" meeting, held on January 16, 2016, focusing on melanoma diagnosis and new treatments. Doctor I. Tromme presented her thesis results concerning melanoma detection by means of optical and digital dermoscopy. Professor JF. Baurain provided us with a better understanding of new systemic therapies for metastatic melanomas. Lastly, Professor B. Lengelé shared with us his experience in electrochemotherapy for managing primary or metastatic cutaneous tumors.

Key Words

Melanoma, optical and digital dermoscopy, targeted therapy, elcetrochemotherapy

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When heart failure reveals itself as bronchiolitis

Georges de Bilderling (1), Claire Geurten (1), Jean Evrard (1), François Kanen (1), Laurent Houtekie (2), Alain Poncelet (3), Karlien Carbonez (4), Stéphane Moniotte (4) Published in the journal : April 2017 Category : Pediatrics

A 2-month-old baby is admitted to our unit for bronchiolitis. Due to the infant's prolonged symptoms with predominant feeding difficulties and because of a heart murmur noted on auscultation, cardiac ultrasound is performed, resulting in the diagnosis of ALCAPA syndrome (Anomalous Left Coronary Artery from Pulmonary Artery). ALCAPA is a rare but severe cardiac malformation, with early diagnosis and treatment being key to a good prognosis. Bronchiolitis can provoke heart failure, whereas clinical features of heart failure may mimic bronchiolitis. This clinical case underlines the need for performing a complete clinical examination, along with oriented diagnostic investigations, when confronted with a baby suffering from a respiratory condition whose severity or evolution appears unusual.

Key Words

ALCAPA, coronary malformation, cardiac failure, bronchiolitis, infant

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Unusual complication of Osler-Weber-Rendu disease

Edeline Kaze (1), François D’heygere (2) Published in the journal : April 2017 Category : Rare Diseases

The combined syndrome of juvenile polyposis / inherited hemorrhagic telangiectasia (JD-HHT Syndrome) is rare, caused by mutations in the MADH4 gene. Affected individuals exhibit the clinical manifestations of both pathologies and are at increased risk of gastrointestinal cancer (1).

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Comparative study of collagenase injections versus fasciectomy in Dupuytren's contracture: a 1-year follow-up

Alexandre Hupez (a-b), M.D., Christine Detrembleur (c), Ph.D, Fernand Van Innis (a), M.D., Serge Troussel (a), M.D., Xavier Libouton (b-c), M.D, Ph.D., Thierry Lequint (a), M.D. Published in the journal : April 2017 Category : Orthopedics

This study sought to evaluate the use of collagenase injections for Dupuytren's contracture (19 compared to fasciectomy, with 19 patients assessed in each group. We measured loss of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joint extension at baseline and 12 months post-injection, along with its impact on patients' daily life, pain, and satisfaction. Whereas there was no significant between-group difference observed for loss of MCP joint extension, PIP joint extension proved lower for the surgical group compared to the injection group. The injection group exhibited significant improvements in terms of pain, daily activities, and satisfaction regarding the MCP joints, with no between-group differences observed for the PIP joints.

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Combining bisoprolol and perindopril proves to be an original and useful novelty for numerous patients

Agnès Pasquet Published in the journal : April 2017 Category : Actualité thérapeutique

This article presents the association bisoprolol/perindopril (Bipressil®), along with its indications and advantages, in the cardiovascular disease setting.

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Krukenberg tumors, osteoblastic metastases, and elevated parathormone levels : clinical case report and literature review

Léopold Pirson (a), Yves Humblet (b), Ingrid Ferreira de Castro Moutinho (c), Christine Galant (c), Dominique Maiter (d) Published in the journal : March 2017 Category : Oncologie

Numerous cases of Krukenberg tumors have been described in the literature, with several reviews on this topic published over these last three decades. The precise origin of these metastatic tumors is often unknown, in spite of the availability of biological and immunohistochemical markers. This case-report sought to present the diagnostic and therapeutic challenges raised by Krukenberg tumours in the course of a poorly-differentiated adenocarcinoma of atypical presentation, along with a review of the literature on this topic. We report the case of a 29-year-old patient referred to the endocrinology department for increased bone turn-over and elevated parathormone levels, in the context of chronic lower back pain. Further examinations revealed bilateral Krukenberg tumors, multifocal osteoblastic bone metastases, as well as probable peritoneal dissemination. While the primary origin of the metastases is still unknown, they are likely of gastro-intestinal origin, following careful exclusion of breast carcinoma. Whereas there are no guidelines on the management of Krukenberg tumors, actual therapy primarily consists of bi- or tri-chemotherapy with bilateral adnexectomy, leading to extended survival from a few months to several years. Yet prognosis remains poor with a median survival time of only 16 months, unless both primary tumor and metastases can be fully resected, with then considerably extended survival.

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Modern management of the diabetic foot : the orthopedic surgeon’s view

Dan Putineanu, Thomas Schubert Published in the journal : March 2017 Category : Diabétologie

As part of the multidisciplinary management of the diabetic foot, surgery plays a key role in the prevention and control of infection, in bone and soft tissue reconstruction, in limb preservation, and in the execution of amputation meant to be as distal as possible while offering a correct amputation stump. To achieve these objectives, plenty of surgical techniques are currently available.

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Diagnostic imaging for peripheral artery disease in diabetic patients

Frank Hammer Published in the journal : March 2017 Category : Diabétologie

Duplex sonography is still regarded as the first-choice imaging technique for the work-up of diabetic patients with suspected peripheral artery disease. Should additional information be required prior to digital subtraction angiography (DSA), computed tomography angiography (CTA) or magnetic resonance angiography (MRA) can be performed. The article has outlined in a comprehensive manner both the advantages and shortcomings of these techniques. DSA, an invasive technique, is still considered the gold standard, offering the highest spatial resolution and image quality, in addition to the possibility of performing endovascular revascularization of the limb within the same session.

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Management of the diabetic foot - The need for a multidisciplinary team

Laura Orioli, Bernard Vandeleene Published in the journal : March 2017 Category : Diabétologie

The ulcer of the foot is a complication occurring in 20% of diabetic patients. Diabetic neuropathy is the primary cause, with infection and arteritis profoundly influencing its management and prognosis. Evaluation should be systematically conducted using the PEDIS classification. The evaluation and management of the diabetic foot ulcer require a multidisciplinary and interprofessional medical and paramedical team. The dialogue between the different lines of care, along with the respect of their respective roles, proves equally crucial. Therefore, deep and extensive infection, Charcot foot, and severe arteritis all require patient management in a reference center.

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Use of synthetic glucocorticoids : undesirable effects in clinical practice

Dominique Maiter Published in the journal : March 2017 Category : Endocrinology

Multiple factors may account for the chronic toxicity of synthetic glucocorticoids (GCs), which are (too) widely prescribed in clinical practice. The relative potency of the GCs used, daily dose administered, duration of treatment, route and time of administration, as well as individual factors like age, genetic factors, or significant co-morbidity, such as renal or hepatic failure, determine the delay in the occurrence of potentially serious complications, including the suppression of the corticotropic axis. The concomitant use of drugs affecting the metabolism and/or the action of these glucocorticoids must also be considered. While the selected treatment strategy should take into account all these factors, it must also consider the desired effects and proofs of efficacy. Whenever possible, short-term treatment or non-systemic administration of glucocorticoids should be preferred. Iatrogenic Cushing's syndrome is characterized by specific complications, including posterior subcapsular cataract, benign intracranial hypertension, osteonecrosis of the femoral and humeral heads, tendon ruptures, pancreatitis or psychotic crisis. Suppression of the hypothalamus-pituitary-adrenal (HPA) axis can be assumed in patients receiving over 16mg of methylprednisolone per day (or equivalent dose) for at least 6 weeks and in those exhibiting clinical Cushing’s syndrome. On the contrary, this condition is rather unlikely in patients receiving nonparenteral corticosteroids for less than 3 weeks. In other situations, adrenal function must be assessed before considering glucocorticoid withdrawal. This comprises the measurement of morning plasma cortisol levels, in addition to a short corticotropin (ACTH) stimulation test. If the results confirm either complete or partial suppression of the HPA axis, treatment with hydrocortisone (20mg/day in the morning) should be administered until recovery of adrenocortical function.

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