Jehovah witnesses refuse transfusion of labile blood products. This is the reason why blood conserving procedures must be implemented when high bleeding risk surgery is required. Management of these patients consists in a multidisciplinary approach involving the anesthesiologist, intensivist, surgeon, and general practitioner. The procedures have to be initiated as soon as possible and be pursued during the entire hospitalization, while following a specific legal framework. This article provides a series of rules enabling doctors to properly care for their patients.
Marie-Bénédicte Benats, MD, Anne-Catherine Pouleur, MD, PhD, Agnès Pasquet, MD, PhD (1)Published in the journal : December 2017Category : Cardiology
Right ventricular dysfunction is a strong predictor of mortality in patients with heart failure. Due to the configuration right ventricle, assessing the function of the right ventricle proves complex. Cardiac RMN is actually considered the gold standard to evaluate right volumes and right heart dysfunction. There is limited information available to date on the optimal management of right ventricular dysfunction, except in arterial pulmonary hypertension cases (Group 1). Future research is needed to determine specific treatments, improve prognosis, and increase quality of life of patients with right-sided heart failure.
This case report describes a metastatic small cell neuroendocrine carcinoma (SCNC) of the right maxillary sinus, which first manifested as atypical low back pain. Due to the rarity of this localization, specific therapeutic recommendations for SCNC of paranasal sinuses are still lacking. Current treatment modalities are extrapolated based on similar tumors of pulmonary origin. This contribution comprises a case description, along with a review of clinical presentations, imaging characteristics, and treatments available to date. This article will eventually end with a series of practical recommendations.
Small cell neuroendrocrine carcinoma, paranasal sinus, extra-pulmonary, metastatic
Jeremy Marchal(1), Zaynab Ouadi(1), Benjamin Alexandre(2), Aude Schillaci(1), Didier Deltour(1)Published in the journal : November 2017Category : Gastroenterology
GIST are rare mesenchymal tumors, and their pre-operative diagnosis may prove challenging. This can be accounted for by less accessible anatomical localizations, and particularly the duodenum and angle of Treitz, in addition to the fact that the biopsies obtained may turn out to be poorly contributory. Surgical intervention that usually allows for a formal diagnosis remains the cornerstone of treatment. When a GIST is suspected, surgery must be encouraged and this, even in the absence of histologically confirmed disease.
Nurcan Yilmaz (1), Daniel Leonard (1), Nora Abbes Orabi (1), Christophe Remue (1), Laurence Annet (2), Cristina Dragean (2), Andrea Penaloza (3), Alexandros Raptis (4), Alex Kartheuser (1)Published in the journal : November 2017Category : Chirurgie digestive
A 39-year-old man presented with a history of fever and acute peri-umbilical pain. A computed tomographic scan of the abdomen revealed inflammation of Meckel’s diverticulum. The treatment was a laparotomic diverticulectomy. A perforation was observed during the procedure. There is no consensus yet on the radiological imaging technology considered to be the gold standard for diagnosis. The treatment is at all times surgical. Moreover, there is no agreement yet on the optimal surgical technique, be it a diverticulectomy or a resection of the segment containing the diverticulum. Although there is still uncertainty about the best approach, laparotomy versus laparoscopy, using the less invasive approach appears preferable.
Meckel’s diverticulum, intestinal perforation, surgery
Diane Declaye (1), Dominique Maiter (2), Marie Cuvelier (1), Alexia Vanden Daelen (1), Laurence de Montjoye (1), Marie Baeck (1)Published in the journal : November 2017Category : Dermatology
We report on the “PEAU’se dermatologique” meeting of February 10, 2017, which was organized by the Department of dermatology of the Cliniques universitaires Saint-Luc and addressed the problem of hirsutism, along with the indications of laser hair removal. The speakers were Professor Dominique Maiter, head of the Department of endocrinology of the Cliniques Saint-Luc, and Doctor Diane Declaye, MACCS in Dermatology.
Retinal vein occlusion is the second most common retinal vascular disease, with an increased incidence in elderly patients with cardiovascular risk factors. While ocular hypertension appears to be the main local factor, thrombophilia plays a major role in young subjects, in people without risk factors, in the presence of positive personal history for venous thromboembolic disease, during pregnancy, as well as in the event of bilateral occlusion. In these circumstances, congenital or acquired predisposing factors should be searched for. The role of new local treatments, anticoagulant therapy, and long-term prophylaxis is discussed in the present article.
Florence Dive (1), Dominique Maiter (2), Michel Mourad (3), Jean-Benoit le Polain de Waroux (1), Sébastien Marchandise (1), Cynthia Barbraud (1), Hélène Dano (4), Christophe Scavée (1)Published in the journal : November 2017Category : Cardiology
Amiodarone, a class III antiarrhythmic agent according to the Vaughan-Williams classification, is commonly prescribed to control supraventricular and ventricular arrhythmias, especially in patients with ventricular dysfunction. Amiodarone-induced hyperthyroidism may provoke serious cardiovascular complications, as illustrated by our two clinical cases. The diagnosis of amiodarone-induced thyrotoxicosis may prove tricky at times, and its medical treatment complex.
Surgical management of amiodarone-induced hyperthyroidism appears to be an attractive therapeutic option, particularly for patients with a risk of arrhythmias upon amiodarone discontinuation.
An increasing number of patients benefit from a dual antiplatelet therapy combining a low dose of acetylsalicylic acid and a platelet adenosine diphosphate (ADP) receptor antagonist (Clopidogrel, Prasugrel, Ticagrelor), generally indicated in presence of a coronary artery stent and/or a history of acute coronary syndrome. During invasive procedures (operations, biopsies, punctures, dental care, etc.) carried out electively or urgently, the management of this antiplatelet association is often problematic. It must weigh the thrombotic risks following their cessation against the hemorrhagic risks associated with their continuation. This brief article summarizes the practical strategies for managing antiplatelet associations during invasive procedures.
Stable angina is a common clinical syndrome characterized by discomfort in the chest, jaws, shoulders, back, or arms, typically induced by exercise or stress. The therapeutic management of this condition depends on the patient’s individual prognosis, which itself depends on clinical factors and non-invasive imaging. The treatment is based on managing cardiovascular risk factors and on pharmacological treatments. A certain number of patients may benefit from percutaneous or surgical revascularization techniques