Innovations in nephrology : what 2016 brought us

Michel Jadoul, Selda Aydin, Sylvie Goletti, Johann Morelle, Eric Goffin, Michel Mourad, Nathalie Demoulin, Anh Ho, Nathalie Godefroid, Caroline Clerckx, Laurence Annet, Yves Pirson, Olivier Devuyst Published in the journal : February 2017 Category : Nephrology

Here we present three important innovations in the nephrology field. The first one concerns the management of autosomal dominant polycystic kidney disease, and in particular the treatment by tolvaptan, a drug that slows down disease progression and is reimbursed in Belgium since 2016. The other two innovations presented are, on one hand, the progress made in the diagnosis and follow-up of idiopathic membranous nephropathy, which is often of autoimmune nature, and on the other hand, the hope raised by living kidney donor exchange programs for patients awaiting transplantation. 

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Contribution of new technologies in motor and cognitive rehabilitation of brain-injured patients

Stéphanie Dehem, Gaëtan Stoquart, Vincenza Montedoro, Martin Edwards, Sophie Heins, Bruno Dehez, Thierry Lejeune Published in the journal : February 2017 Category : Physical and Rehabilitation Medicine

Following cerebral injury, motor and cognitive disorders are common, and rehabilitation can prove challenging, for both patients and therapists. In recent years, robotics and serious games have been widely developed in this area in order to increase the functional recovery of patients. Robotics enable an intensification of therapy, assist patients in moving, and provide prompt feedback. As for the serious games, they make reeducation more funny and motivating; furthermore, the game’s difficulty level continuously adapts to the patient’s performances. These two complementary technologies do appear promising for the rehabilitation of brain-injured patients 

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Innovations in Hematology

Marie-Christiane Vekemans Published in the journal : February 2017 Category : Hematology/Oncology

The development of proteasome inhibitor (PI) and immunomodulatory drugs (IMiDs) have considerably changed the treatment paradigm of multiple myeloma (MM), while significantly improving survival. Nevertheless, many patients exhibit disease relapse and develop drug resistance. The better understanding of disease biology will likely influence our approach to myeloma treatment, resulting in the advent of newer drug classes, such as monoclonal antibodies and adoptive cellular therapies. There is much hope that MM will soon become a chronic illness with sustained complete response in a significant number of patients. 

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Next-Generation Sequencing (NGS): a new molecular biology tool for the patient's benefits

Anne-France Dekairelle*, Delphine Hoton**, Julie Lelotte**, Christine Galant**, Pascal Van Eeckhout**, Pamela Baldin**, Yves Guiot**, Louis Libbrecht**, Anne Jouret Mourin** Published in the journal : February 2017 Category : Anatomie pathologique

The characterization of tumor molecular markers, along with the development of targeted therapies. Over half of these therapies can only be prescribed after determination of the status of a biomarker, rendering it necessary to carry out molecular tests. Recent technological advances enable us to simultaneously analyze numerous genes or portions of genes of interest by means of next-generation sequencing (NGS). Since January 2016, NGS has been applied in the Cliniques universitaires Saint-Luc (CUSL) as part of clinical routine analyzes related to diagnosis, prognosis, or therapeutic response prediction. At present, the panel used at CUSL allows mutations in different exons of eight genes (BRAF, c-Kit, EGFR, IDH1, IDH2, KRas, NRas, and PDGFRA) to be identified, such as those involved in metastatic colorectal cancers, non-small-cell lung cancers, melanomas, gliomas, and gastro-intestinal stromal tumors. This method has become an excellent diagnostic and prognostic tool, which also enables oncologists to individually determine the best treatment modality for each patient, with better chances of therapeutic success while diminishing unnecessary treatments.

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Innovations in endocrinology, diabetology, and nutrition: what 2016 brought us ?

Martin Buysschaert, Chantal Daumerie, Michel Hermans, Vanessa Preumont, Jean-Paul Thissen, Bernard Vandeleene, Dominique Maiter, Stéphanie Rouhard, Laura Orioli, Raluca Maria Furnica, Audrey Loumaye, Maria-Cristina Burlacu, Orsalia Alexopoulou, Sonia Brichard Published in the journal : February 2017 Category : Endocrinologie, diabétologie et nutrition

The year 2016 was again full of novelties, with numerous diagnostic and therapeutic innovations in the fields of endocrine diseases, diabetes, and metabolic disorders. In this article, we deliberately chose to only discuss those which have already improved the current management of such diseases, be it for specialists or general practitioners. The article should therefore be interesting for every reader. In the field of diabetes, we have here reported on the main features of the new agreement between social security system, physicians, and diabetic patients (“Convention INAMI”). We have also reported on a newly reimbursed system for continuous measurement of interstitial glucose through a sensor, on the impressive technological advances in modern insulin pumps, as well as on the significant cardiovascular and renal benefits of SGLT2 transporter inhibitors in Type 2 diabetes patients. As for metabolic pathologies, the PCSK9 inhibitors are now reimbursed in heterozygous familial hypercholesterolemia, and specific GLP-1 analogues are available for an effective treatment of obesity. In the field of thyroid diseases, isolated maternal hypothyroxinemia during pregnancy is now better characterized, and new recommendations have been issued regarding the diagnosis and treatment of Grave’s ophthalmopathy. Finally, as regards general endocrinology, new recommendations clarify and simplify the management of adrenal incidentaloma, whose detection frequency continually increases in the era of common and more efficient abdominal imaging. 

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Retroperitoneal lymph nodes revealing a tuberculous epididymitis: a case report

Félix Kwizera (1), Stéphanie Hublet (1), Antoine Bufkens (1), Jean-Pierre Chami (2), Stéphane Rysselinck (1) Published in the journal : January 2017 Category : Urology

Genito-urinary tuberculosis (GUTB) is a severe form of extra-pulmonary tuberculosis (EPTB). The most commonly affected organs are the epididymis and testis. GUTB diagnosis may prove difficult and is often delayed given that symptoms are non-specific. We have here reported the case of a patient with no history of pulmonary TB, who presented with acute right scrotal pain mimicking an epididymo-orchitis. After failure of antibacterial therapy, we completed the patient's work-up by means of a CT scan that showed progressive retro-peritoneal lymph nodes. Correct diagnosis was made using laparoscopic lymphadenectomy (histology: granulomatous necrotizing lymphadenitis, culture: M. Turberculosis). A tuberculosis treatment was initiated after diagnosis.

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Hepatic insufficiency under antidepressant therapy with phenelzine

Véronique Delugeau, Julian Muguerza, Alain Cohen, Serge Goffinet Published in the journal : January 2017 Category : Hépato-gastroentérologie

Depression is a major public health concern, with an increasing proportion of the population under antidepressants. Depending on depression severity, different drug regimens are proposed. Among them, monoamine oxidase inhibitors are indicated in the event of resistance to other treatments. We report a case of drug-induced subfulminant hepatitis occurring 2 months after the first use of phenelzine.

Key Words

IMAO, antidepressant, acute hepatic insufficiency

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Posttraumatic stress disorder (PTSD) in the South Kivu Province of the Democratic Republic of the Congo

Marie Liégeois(*), Eric Constant(**) Published in the journal : January 2017 Category : Psychiatrie

Based on the observations made during hospital care of a victim of sexual violence in South Kivu and suffering from PTSD, the authors stress the relevance of considering cultural and socio-political aspects, as well as the nature of the violence experienced for a better understanding of the situation. Given that in this very context, patients with PTSD only partially respond to the reference treatment, it is primordial to install a management that is adapted to the specificities of patient's situation. Based on the concepts of dehumanization and resilience, the authors emphasize the necessity of respecting the expression mode of suffering in PTSD patients and of setting up a network for the short- and long-term support to resilience.

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Case report of a scarcely-known entity: peripartum cardiomyopathy

Charlotte d’Odémont (1), Michel Henry (2), Pascale Grandjean (1) Published in the journal : January 2017 Category : Cardiology

Peripartum cardiomyopathy (PPCM) is defined as a non-familial form of peripartum heart failure and described as an “idiopathic cardiomyopathy presenting with heart failure secondary to left-ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery”. We have here reported the case of a young woman suffering from peripartum cardiomyopathy 2 months after delivery. This case provided us the opportunity to review etiology, diagnosis, and treatment of this little-known medical condition with occasionally serious outcome.

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Tuberous sclerosis complex : establishing the correct diagnosis and treatment

Yves Pirson¹, Thien-Anh Ho¹, Nathalie Demoulin¹, Nathalie Godefroid², Valérie Dekeuleneer³, Kenou van Rijckevorsel⁴, Marie-Cécile Nassogne⁵, Riëm El Tahry⁴, Yves Sznajer⁶ Published in the journal : January 2017 Category : Rare Diseases

Tuberous sclerosis complex (TSC) is a genetic disease characterized by the development of hamartomas in several organs, including the brain, kidney, and skin.

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