Coronary angioplasty has so far crossed several different borders. Thrombotic occlusions were the first to be treated by this novel approach, then acute myocardial infarctions by means of acute de-occlusion of the “culprit” artery. With time, the lesions treated by this method have become increasingly complex. Nowadays, bifurcation lesions and stenoses of the left main coronary artery can successfully be managed using coronary angioplasty. Lastly, coronary angioplasty has also proven able to address chronic total occlusions.
Percutaneous coronary intervention, or PCI, plays a central role in the treatment of acute coronary syndrome, including myocardial infarction, thereby reducing patient’s mortality. In patients with ST segment elevation myocardial infarction (STEMI), primary PCI is the recommended reperfusion strategy. It should be performed within 60 to 90 min from the first medical contact, which is considered as a good care quality indicator in this setting.
Since its introduction back in 1977 by Andreas Grüntzig in Zurich, percutaneous transluminal coronary angioplasty (PTCA) has taken a major place among myocardial revascularization techniques due to constant technical and pharmacological improvements. The introduction of metal stents, about 10 years after the first balloon catheters, has not only allowed the incidence of acute complications and delayed restenosis to be reduced, but the technique has since been applied to acute coronary syndrome patients. Owing to the development of drug-eluting stents a decade later, percutaneous coronary interventions have meanwhile been proven effective and reliable in coronary disease patients, as compared to surgery. This paper provides a brief review on these four last decades, pointing out the major stages and victories but also the doubts and difficulties inherent to these medical advances.
Jean-Luc Kambire1, Souleymane Ouedraogo1, Fagnima Traore2, Salam Ouedraogo1, Tioulé Mamadou Traore3Published in the journal : September 2017Category : Dermatology
While cutaneous melanoma is rare in Africa, it is most often of nodular or acral lentiginous histology, with plantar location. Its diagnosis is late and its prognosis poor. Improving the survival rate in case of melanoma requires promoting an early diagnosis. We here report the case of a 30-year-old female patient suffering from an ulcerated-budding tumor of the heel that had evolved for 2 and a half years, reaching 4 cm at the time of diagnosis. Histological examination of the resection specimen revealed a Clark’s level V nodular melanoma.
Mehdi Bsilat ¹, Daniel Leonard ², Sandy Van Nieuwenhove ³, Catherine Lambert ⁴Published in the journal : September 2017Category : Hematology/Oncology
We here present a case of diverticulitis complicated by a pylephlebitis of the portal and superior mesenteric vein, requiring treatment with heparin and antibiotics. The patient subsequently developed a splenic vein thrombosis and suffering bowels. A large resection of the small bowel was performed, with subsequent ileostomy and parenteral nutrition. Following anticoagulation therapy initiation, a thrombocytopenia was observed, and the patient was found to have developed heparin-induced thrombocytopenia (HIT), as evidenced by high levels of anti-heparin/PF4 antibodies. Furthermore, he had a contributory family history of thrombophilia, and molecular tests confirmed that he was carrying a thrombophilic G20210A factor II mutation. To our knowledge, this is the first case report of a bowel ischemia in a context of pylephlebitis treated with heparin, leading to another rare thrombophilic syndrome: heparin-induced thrombocytopenia and thrombophilia (HITT).
This article illustrates how a rare complication of a common disease and its treatment can aggravate the primary condition. We discussed the pylephlebitis and the HITT as the explanation for such a rare consequence on the bowel in the context of inherited thrombophilia.
Henrianne Levie, Itziar Clement Corral, Anne Van de Vyvere, Christophe DumontPublished in the journal : September 2017Category : Geriatry
The article describes two cases of chronic intestinal pseudo-obstruction (CIPO). This rare intestinal motility disease is associated with high morbidity and mortality. The obstruction is functional, without any radiologically or surgically detectable obstacle, in contrast to volvulus that is a purely mechanical obstruction. Symptoms are recurrent and evolve over several months or years. Based on a literature review, we here present a coherent pluridisciplinary approach used to optimize the diagnosis and treatment necessary to help an elderly multimorbid and often polymedicated population. Since CIPO is an incurable disease, the main therapeutic objectives are the control of symptoms and ionic disorders, enteral nutrition, and maintenance of mobility.
In asplenic patients, fever should never be trivialized. The clinical presentation of a severe infection can be unspecific (fever, chills, sore throat, diarrhea, vomiting, and muscle aches). If an antibiotherapy is not given rapidly, the evolution can be abrupt, and patients can develop a disseminated intravascular coagulation. We here describe the case of a 77-year-old splenectomized female patient. Given the unspecific clinical presentation, the diagnosis of acute gastro-enteritis was made; however, the patient developed a severe pneumococcal infection. With this case report, we would like to remind the adequate management of fever in asplenic patients in order to avoid severe, potentially life-threatening, complications
Kawasaki disease is the leading cause of acquired heart disease in children. Its incidence is underestimated in infants aged less than 1 year. In this population, clinical manifestations are atypical. The diagnosis should therefore be suspected in infants with persistent fever, even if not all clinical signs are present, in order to avoid delaying the diagnosis and treatment and prevent harmful cardiovascular consequences. Echocardiography is a helpful diagnostic tool and should be performed promptly in case of Kawasaki disease suspicion.
Over the past few years, clinical research dedicated to preclinical Alzheimer’s disease has considerably intensified. In vivo markers of Alzheimer’s disease paved the way for (1) studies investigating the association between pathology and cognitive decline and (2) the launch of the very first preventive trials. Besides brain autopsy, cerebrospinal fluid analyses along with amyloid- and tau-specific radiotracers are now used to detect Alzheimer’s disease. Further advances are expected in coming years, with an improved specificity of tau tracers, novel therapeutic targets, and a continuing increase in our understanding of Alzheimer’s biological processes.
A fixed combination product, composed of atorvastatin, perindopril and amlodipine, such as that used in the ASCOT study, has just been marketed by the Servier company under the trade name LIPERTANCE®. This provides us the opportunity to recall the usefulness of this double approach targeting both high blood pressure and high cholesterol levels in cardiovascular prevention. The ASCOT study has definitely proven the remarkable cardiovascular benefit of this combination in primary prevention for hypertensive patients with moderately-high cholesterol levels. Key Words cardiovascular disease, cardiovascular prevention, hypercholesterolemia, high blood pressure, LDL cholesterol, atherosclerosis