Emmanuel Costa, Tevi Morel Lawson, Julie Lelotte, Edward Fomekong, Geraldo Vaz, Nicolas Whenham, Laurette Renard, Christian RaftopoulosPublished in the journal : February 2018Category : Neurochirurgie
Glioblastoma (GBM) is the most aggressive primary tumor of the central nervous system (CNS), and our study sought to identify the characteristics of patients with prolonged overall survival (OS). To this end, we reviewed the records of 127 patients who underwent surgery in our center for GBM between January 2002 and November 2011. We then identified those patients with prolonged survival (>3years). The characteristics of all these patients and their tumors were analyzed, and the anatomic pathological diagnosis was reviewed by a second anatomical pathologist. Of these 127 patients, 101 (79.6%) underwent excisional surgery, with 12 of these surviving longer than 36 months. The GBM diagnosis was confirmed in 11 (11%) patients (F/M: 4.5; mean age: 50 years (31-68); mean Karnofsky preoperative: 82%). The average survival of these 11 patients was 74 months (36-150); seven patients (63.6%) underwent complete resection, three (27.3%) almost complete resection, and the last one (9.1%) partial resection. Only two (18.8%) patients exhibited an IDH1 mutation. Seven (63.6%) patients benefited from a complete Stupp protocol. Eight of these patients had poor prognostic factors regarding prolonged survival (age, low Karnofsky score, or unmutated IDH). In conclusion, for any patient who develops a GBM, there is some hope that survival may be prolonged, even in the presence of poor prognosticators.
Mirela Morisca-Gavriliu, Michel P. Hermans, Dominique Maiter, Vanessa PreumontPublished in the journal : February 2018Category : Diabétologie
Insulin FIASP (for “fast-acting insulin aspart”) is a new original insulin formulation that combines insulin aspart and two excipients, namely a vitamin (niacinamide) and an aminoacid (L-arginine), designed to increase the initial insulin absorption rate following subcutaneous injection, thereby promoting an earlier anti-hyperglycemic effect after meals. Its efficacy and safety profiles have been studied in the Onset clinical trial program. These first clinical studies have shown that using FIASP is associated with improved early post-prandial glycemic control compared to aspart alone in Type 1 and Type 2 diabetic subjects. It is expected that insulin FIASP will soon be available in Belgium.
Marie Baeck, Caroline Colmant, Laurence de Montjoye, Pierre-Dominique Ghislain, Anne Herman, Bernard Leroy, Chloé Algoet, Alison Coster, Liliane Marot, Isabelle TrommePublished in the journal : February 2018Category : Dermatology
The world of biologicals continues to rapidly evolve, whilst diversifying in terms of therapeutic targets, available molecules, and indications. Notably, the way to manage severe atopic dermatitis will substantially change in 2018 following the introduction of dupilumab, an anti-IL-4 and IL-13, with considerable efficacy in Phase III clinical studies. In addition, rituximab was demonstrated to be associated with clinical remission in many patients with pemphigus.
The first total hip prostheses were implanted more than 40 years ago. Over the past 10 years, so-called "mini-invasive" surgeries have emerged, enabling patient's muscle mass to be preserved. This type of surgery is associated with a faster functional recovery and shorter hospital stay. Five years ago, we implemented a clinical course on arthroplasty, titled "Optimal Recovery", at the Cliniques Universitaires Saint-Luc. This protocol seeks to optimize the care of patients throughout their care journey, ensuring that standardized procedures be applied as much as possible. Patients benefit from two information sessions, one individual and one group session, and receive an information leaflet, in order to be actively included in the care process, which reduces their stress. Minimally-invasive surgical techniques, along with the adaptation of pre-, intra- and postoperative protocols, including postoperative analgesia and rehabilitation techniques, have likewise been developed in this setting. Implementing this type of care strategy has been associated with a reduction in both hospital stay and postoperative transfusion rates. The good results thereby observed enable bilateral arthroplasty to be performed at the same time, without any significant impact on either duration of the operation or functional recovery.
Charles Lebrun-Lambeau, Alexandre Stouffs, Victoria Van Regemorter, Philippe Dubois, Thierry Pirotte, Michel Van Dyck, Christine Watremez, Mona Momeni, Cristel Sanchez TorresPublished in the journal : February 2018Category : Anesthesiology
Progress in anesthesia in recent years has not been abrupt but rather progressive. Although there was no real innovation in 2017, we have seen some progress in our practices, due to a better understanding of anatomy, physiology and pharmacology, associated with better intraoperative monitoring. All this now contributes to increased safety throughout the perioperative period.
In patients with type 2 diabetes, sulfonylureas are a therapeutic option as dual antihyperglycemic therapy following metformin failure or as a tritherapy approach.
Stéphanie Olivier, Marie Baeck, Anne Herman, Liliane Marot, Laurence de MontjoyePublished in the journal : January 2018Category : Dermatology
Paucibacillary leprosy generally occurs as one or several hypopigmented macules with sensory loss. Given the small number of Hansen’s bacilli in these lesions, neither the skin smear nor the pathology is able to bring out bacilli. Diagnosis is therefore mainly based on clinical manifestation in association with a compatible granulomatous histopathology.
We have here reported on an elderly patient who developed tetanus in spite of appropriate protective antibody levels. The clinical diagnosis could, however, not be confirmed by laboratory tests. A brief review on tetanus is provided, with the concluding remarks highlighting the necessity of regular vaccinations, even though vaccine escape may at times occur
Anne-Louise Kollegger(1), Vi Doan(2), Geneviève Derue(3)Published in the journal : January 2018Category : Pneumology
Langerhans cell histiocytosis is a rare disease that at times presents as an infiltrative lung disease, especially among smokers. We have herein reported the case of a young woman, who had been treated for histiocytosis in her childhood, presenting with spontaneous pneumothorax. CT scan revealed pulmonary Langerhans cell histiocytosis. A second pneumothorax episode with a permanent air leak made surgical treatment necessary. Given that the pneumothorax recurred, with the lung failing to expand, we conducted a literature review on this issue. This review revealed pneumothorax to occur in 10-20% of adult patients presenting pulmonary histiocytosis, with a high rate of recurrence.
Nathalie Bredohl(1), François Pallatzky(2), Lauranne Goffioul(3), Florence Manto(4), Jean-François Fils(5), Jean-François Kaux(6)Published in the journal : January 2018Category : Physical and Rehabilitation Medicine
Up to 25% of women may be affected by urinary incontinence. Peripheral stimulation of posterior tibial nerve in the retromalleolar region can be proposed in certain cases of urinary incontinence. In this report, we conducted a follow-up on 268 patients suffering from incontinence and treated by the means of neuromodulation. The study analysis demonstrated significant success rates in patients with stress urinary incontinence, as well as in those with mixed incontinence.