[Cardio-oncology, why is it a new specialty ?] / Cardio-oncologie, pourquoi est-ce une nouvelle spécialité ?

Cardio-oncology is a new interdisciplinary specialty that has emerged over the past ten years. With the development of increasingly potent cancer therapies which improve cancer survival, but at the cost of cardiovascular toxicity, the demand for specialized cardio-oncology services has emerged. Also, cardiovascular diseases are more common and more serious in cancer patients than in the general population. Cardio-oncology focuses on the prevention, detection, monitoring, and treatment of cardiovascular diseases in cancer patients, mostly those occurring as a side effect of chemo- and radiotherapy.

La cardio-oncologie est une nouvelle spécialité interdisciplinaire apparue au cours des dix dernières années. Avec le développement de thérapies anticancéreuses de plus en plus puissantes qui améliorent la survie au cancer, mais régulièrement au prix d'une toxicité cardiovasculaire, est apparue une demande de services spécialisés en cardio-oncologie. Par ailleurs, les maladies cardiovasculaires sont plus fréquentes et plus graves chez les patients atteints de cancer que dans la population générale. La cardio-oncologie se concentre sur la prévention, la détection, la surveillance et le traitement des maladies cardiovasculaires survenant chez les patients atteints de cancer et, principalement, la prise en charge des effets secondaires de la chimiothérapie et de la radiothérapie.

[Multiple myeloma in an elderly patient with history of breast cancer : the value of multidisciplinary oncogeriatric collaboration]. / Cas clinique. Prise en charge d'un myélome multiple chez une patiente âgée aux antécédents de néoplasie mammaire : intérêt d'une collaboration multidisciplinaire onco-gériatrique.

As the prevalence of cancers increases with age, some elderly patients are confronted with multiple tumoural pathologies. The clinical case of a 70-year-old patient with adenocarcinoma of the breast and multiple myeloma complicated by severe renal failure illustrates the complexity of oncogeriatric management. The geriatric assessment makes it possible to detect frailty and provides assistance in the development of a personalized care plan while respecting the quality of life.

Comme la prévalence des cancers augmente avec l'âge, certains patients âgés se trouvent confrontés à plusieurs pathologies tumorales. Ce cas clinique d'une patiente de 70 ans, avec un adénocarcinome du sein et un myélome multiple compliqué d'une insuffisance rénale sé-vère, illustre la complexité de la prise en charge oncogériatrique. En effet, l'évaluation gériatrique permet de dépister la fragilité et apporte une aide à l'élaboration d'un plan de soins personnalisé en respectant la qualité de vie.

[How Itreat ... extended duration of anticoagulation in lower-limb deep venous thrombosis]. / Comment je traite... par anticoagulants la thrombose veineuse profonde des membres inférieurs après la phase aiguë.

Treatment of lower-limb deep vein thrombosis comprises three phases : the initial phase that includes the first 5 to 21 days, the long-term phase that includes the following 3 to 6 months and a potential extended phase (indefinite duration). After 3 to 6 months of anticoagulation, the treatment must be re-evaluated. Full or reduced dosage or complete cessation of anticoagulants can be proposed according to the individual benefit-risk balance. Risk assessment of recurrence may be challenging in the case of unprovoked venous thrombosis. Similarly, risk assessment of bleeding may be difficult. Consequently, a personalized decision must be made and regularly reassessed. As far as possible, it should also take into account the patient's preferences and lifestyle (dangerous sports, sedentary lifestyle, drug adherence,...). Further studies are still needed in order to better assess the individual risks and adapt the treatment.

Le traitement de la thrombose veineuse profonde des membres inférieurs comprend trois étapes : le traitement initial qui inclut les 5 à 21 premiers jours, le traitement au long cours qui dure 3 à 6 mois et un éventuel traitement prolongé, d'une durée non définie. Après 3 à 6 mois d'anticoagulation, se pose le problème de l'arrêt éventuel du traitement ou de la réduction de posologie. Evaluer le risque de récidive à l'arrêt du traitement est parfois une gageure en cas de maladie thromboembolique non provoquée. De même, l'évaluation du risque hémorragique peut être difficile. La décision doit donc être personnalisée et réévaluée régulièrement. Dans la mesure du possible, elle doit aussi tenir compte des préférences et du mode de vie des patients (sports à risque, sédentarité, observance,...). Des études ultérieures sont nécessaires afin de mieux évaluer les risques individuels et d'adapter la prise en charge.

[Erdheim-Chester disease : a case report]. / Cas clinique. Maladie d'Erdheim-Chester.

We report the case of a 47-year-old woman with unexplained inflammatory syndrome and asthenia. Imaging findings show bilateral abnormalities of femurs and tibias, suggesting an Erdheim-Chester disease, which is confirmed by a bone marrow biopsy of the left femur. The BRAF V600E mutation is detected, allowing the administration of targeted therapies such as BRAF and MEK inhibitors that lead to the improvement of symptoms.

Nous rapportons le cas d'une patiente de 47 ans explorée pour un syndrome inflammatoire inexpliqué et une asthénie chronique. Les examens en imagerie démontrent la présence d'importants remaniements osseux au niveau du périoste des deux fémurs et tibias, évoquant une maladie d'Erdheim-Chester. Celle-ci est confirmée par l'analyse d'une biopsie ostéomédullaire réalisée au niveau du fémur gauche. La détection de la mutation V600E du gène BRAF permet à la patiente de bénéficier d'un traitement ciblé anti-BRAF et anti-MEK, améliorant sa symptomatologie.

[Why and how to treat iron deficiency in heart failure ?] / Pourquoi et comment traiter la carence martiale du patient insuffisant cardiaque ?

Anemia and iron deficiency are two common comorbidities in heart failure with reduced ejection fraction (HFrEF) and are associated with a poor prognosis. In contrast to iron oral supplementation, administration of intravenous ferric carboxymaltose (Injectafer®) improves quality of life, exercise capacity, and seems to reduce hospitalizations for heart failure. Unfortunately, although anaphylactic reactions are extremely rare, it is recommended to administer Injectafer® in a suitable medical environment. This limitation hinders Injectafer® administration and may cause reluctance from both physician and patient. The aim of this article is to optimize and harmonize management of iron deficiency in heart failure, by proposing a simple solution for the patient and the practitioner.

L'anémie et la carence martiale sont deux comorbidités fréquentes dans l'insuffisance cardiaque à fraction d'éjection réduite (HFrEF) et sont associées à un moins bon pronostic. Contrairement à la supplémentation martiale per os, l'administration de carboxymaltose ferrique intraveineux (Injectafer®) améliore la qualité de vie, la capacité à l'effort et semble réduire les hospitalisations pour insuffisance cardiaque. Bien que les réactions anaphylactiques soient extrêmement rares, il est recommandé d'administrer l'Injectafer® dans un environnement médical adapté. Ceci entraîne des contraintes d'administration qui peuvent susciter une réticence de la part du médecin et du patient. Cet article a pour objectif d'optimaliser et d'harmoniser la prise en charge de la carence martiale dans l'insuffisance cardiaque, en proposant une solution simple pour le patient et le soignant.

[Lower extremity artery disease. Angioplasty and stenting in 2019.] / Artériopathie oblitérante des membres inférieurs. Angioplastie et stenting en 2019.

Lower extremity artery disease (LEAD) is frequent and too often neglected. The ongoing evolution of endovascular techniques has revolutionised its management. Vascular surgery is still recommended in specific clinical situations. It can be performed alone or combined with angioplasty-stenting in a hybrid procedure. Various parameters related to the patient, his pathology and to the medical team must be considered especially as randomized trials comparing devices and techniques are lacking. Technical progress should not mask the high cardiovascular morbi-mortality risk of these patients. Therefore LEAD must be detected as soon as possible and optimally managed by a multidisciplinary team. According to clinical stage and comorbidities, the team can include a general practitioner, an angiologist, a cardiologist, a nephrologist, a diabetologist, an oncologist, a radiologist, a vascular surgeon, a dermatologist, etc. Medical treatment of atherosclerosis and prevention are mandatory, as well as walking exercise. Due to its high cardiovascular and amputation risk, chronic limb-threatening ischemia must be quickly and optimally managed by a multidisciplinary team.

L'artériopathie oblitérante des membres inférieurs (AOMI) est une pathologie fréquente, trop longtemps négligée. L'évolution constante des techniques endovasculaires a révolutionné sa prise en charge. La chirurgie vasculaire conserve aussi des indications bien établies, qu'elle soit réalisée seule ou associée à l'angioplastie-stenting (procédure hybride). Différents paramètres liés au patient, à sa pathologie et à l'expérience de l'équipe médicale doivent être pris en considération, d'autant qu'on déplore l'absence d'études randomisées permettant de comparer les différents matériels et techniques entre eux. Les progrès techniques ne doivent pas faire oublier que l'AOMI chronique comporte un très haut risque de morbi-mortalité cardio-vasculaire. Elle doit donc être dépistée le plus tôt possible et prise en charge de façon optimale par une équipe multidisciplinaire, associant en fonction du stade clinique et des comorbidités, médecin généraliste, angiologue, cardiologue, diabétologue, néphrologue, cancérologue, radiologue, chirurgien vasculaire, etc. Le traitement médical de la maladie athéromateuse et la prévention restent incontournables, sans oublier le rôle du réentraînement à la marche. En raison du risque cardiovasculaire élevé et du risque d'amputation, l'ischémie critique chronique doit être rapidement prise en charge de façon optimale par une équipe multidisciplinaire.

[Update on myocarditis]. / La myocardite.

Myocarditis is an illness characterized by myocardial infiltration with inflammatory cells and non-ischemic myocytic necrosis. The clinical presentation of myocarditis varies widely and diagnosis is sometimes difficult to establish. The current incidence of myocarditis is also difficult to determine as endomyocardial biopsy, the diagnostic gold standard, is unfrequently used, or even not justified. The leading causes are infections, immune-mediated injury and toxins. Prognosis is most often good but, in some patients, the disease can be fulminant with progression to cardiogenic shock, or occurrence of sudden cardiac death. Prognosis in myocarditis patients varies according to the underlying aetiology. Treatment is generally symptomatic, but in some cases, a specific therapy is appropriated as a function of the corresponding aetiology. This paper aims to review current knowledge concerning myocarditis, with particular emphasis on «urgent¼ situations.

La myocardite est une maladie inflammatoire du myocarde responsable d'une nécrose myocytaire non ischémique. Il s'agit d'une entité nosologique de présentation protéiforme, dont le diagnostic peut, en conséquence, se révéler difficile. L'incidence actuelle de l'affection est, par ailleurs, également difficile à établir car le diagnostic de certitude dépend, en l'état, de la réalisation de biopsies myocardiques et celles-ci ne sont pas systématiquement réalisées, ni même justifiées. L'atteinte myocardique inflammatoire peut être secondaire à une infection, une substance toxique ou un processus auto-immun. Lorsque la présentation clinique ne comporte pas de signe de gravité, la maladie est généralement spontanément résolutive sans traitement spécifique. Néanmoins, l'affection peut également se présenter sous la forme d'un choc cardiogénique ou d'une mort subite. L'étiologie de la myocardite possède une valeur pronostique prédictive et oriente, dans certains cas, vers un traitement spécifique. Cet article de synthèse revoit les données actuelles concernant les myocardites, en insistant particulièrement sur la problématique «urgente¼.

[Osteoarticular tuberculosis nosology and diagnostic pitfalls]. / Tuberculose ostéoarticulaire : nosologie et pièges diagnostiques.

Osteoarticular or skeletal tuberculosis is a clinical manifestation of extrapulmonary tuberculosis, occurring during the lympho-hematogenous spread of Mycobacterium tuberculosis from a pulmonary primary infection or reactivation of latent infection, years or even decades after the initial infection. Bone and joint tuberculosis is a rare disease with non-specific symptoms and radiological characteristics, often delaying diagnosis for more than a year after clinical onset. First-line hospital departments should develop a clinical suspicion when confronted with a subacute inflammatory bone or joint pathology in patients with underlying comorbidities, especially when coming from tuberculosis-endemic countries. We report a clinical case characterized by lumbar and pelvic abscesses, before addressing in detail the different types of skeletal involvement related to tuberculosis, through a review of the literature.

La tuberculose ostéoarticulaire ou osseuse est une manifestation clinique de la tuberculose extra-pulmonaire, apparaissant lors de la dissémination lympho-hématogène de Mycobacterium tuberculosis à la suite d'une infection pulmonaire primaire ou la réactivation d'une infection latente, des années, voire des décennies après une primo-infection. Il s'agit d'une maladie rare dont les symptômes ainsi que les signes radiologiques sont non spécifiques, ce qui retarde souvent le diagnostic de plus d'un an après les premiers signes cliniques. Les services hospitaliers de première ligne doivent suspecter le diagnostic en cas de pathologie inflammatoire subaiguë des os ou des articulations chez des patients avec comorbidités, surtout s'ils sont originaires de régions endémiques pour la tuberculose. Nous rapporterons un cas clinique caractérisé par des abcès lombaires et pelviens avant d'aborder en détail les différents types d'atteintes squelettiques de la tuberculose au travers d'une revue de la littérature.

[Cancer therapy-induced cardiotoxicity]. / La cardiotoxicité des traitements anti-cancéreux.

The incidence of cancer is raising and the treatments are increasingly aggressive. Consequently, physicians are regularly facing side effects of cytotoxic therapies. Cancer- therapy-induced cardiotoxicity is a serious complication because it can be fatal and causes a temporary or permanent cessation of the treatment. In this article, we summarize the mechanisms, the monitoring and the multidisciplinary management of patients with cancer-therapy induced cardiotoxicity.

Les cancers sont de plus en plus fréquents et leurs traitements de plus en plus agressifs. En conséquence, les médecins se trouvent régulièrement confrontés aux effets secondaires des traitements cytotoxiques. La cardiotoxicité induite par les traitements anti-cancéreux est une complication gravissime, car elle peut être mortelle et provoque un arrêt temporaire, voire définitif, des traitements. Dans cet article, nous décrivons les mécanismes, le dépistage et la prise en charge multidisciplinaire de la cardiotoxicité des agents anti-cancéreux.

[2011 European Society of Cardiology guidelines for the management of cardiovascular diseases during pregnancy. Part 1]. / Recommandations Européennes 2011 pour la prise en charge des maladies cardiovasculaires pendant la grossesse. Partie 1: valvulopathies et anticoagulation.

In this article, we describe the 2011 European guidelines on the management of cardiovascular diseases during pregnancy, with particular attention to the management of valvular heart disease and anticoagulation.We will also describe cardiologic conditions in which pregnancy is contraindicated and the preferred way of delivery.

[2011 European guidelines for the management of cardiovascular diseases during pregnancy. Part II: management of hypertension]. / Recommandations Européennes 2011 pour la prise en charge des maladies cardiovasculaires pendant la grossesse. Partie 2: Prise en charge de l'hypertension artérielle.

In this article, we report the 2011 European guidelines on the management of cardiovascular diseases during pregnancy, with particular attention to the management of hypertension as hypertensive disorders are the most frequent cardiovascular complications in pregnancy.

[2011 ESC guidelines for the management of acute coronary syndromes without ST segment elevation]. / Recommandations Européennes 2011 pour la prise en charge du syndrome coronarien aigu sans elévation du segment ST (Partie 2). Revascularisation coronaire: indications.

New European guidelines about the management of non-ST elevated acute coronary syndromes emphasize the importance of early risk stratification. This article summarizes the modifications in the guidelines about risk stratification and invasive management of these syndromes.

Cardiac amyloidosis: a review of the literature.

Cardiac amyloidosis is a rare disease associated with severe morbidity and mortality. There are three main types of amyloidosis associated with cardiac involvement: light chain (AL), familial or senile (ATTR) and secondary amyloidosis (AA). Cardiac amyloidosis often results in heart failure with preserved left ventricular ejection fraction, may display echocardiographic features of restrictive cardiomyopathy associated with left ventricular hypertrophy or mimic hypertrophic obstructive cardiomyopathy. However, left ventricular systolic dysfunction and normal wall thickness can sometimes be encountered. Imaging studies (echocardiography, bone scintigraphy, cardiac magnetic resonance) and blood and urine analysis are usually the main tools for the diagnosis. Sometimes, a tissue biopsy may be necessary. Treatment, which is constantly improving, will be carried out on two fronts: treatment of the symptoms and complications that the disease already caused and prevention of additional amyloid deposits while managing the concomitant complications. The purpose of this article is to review the management of cardiac amyloidosis.

Study on the applicability of instrumental measures for black-box evaluation of static feedback control in hearing aids.

Presented is a report on black-box evaluation of feedback control systems for commercial hearing aids. The aim of the study is to examine the ability of existing instrumental measures to quantify the performance of the feedback control system in black-box settings and on realistic signals, when more than one element of the signal processing chain may be active (compression, noise suppression, microphone directionality, etc.). The evaluation is carried out on 6 different hearing aids and for 10 measures. Thereby it is possible to see which measure is best suited to measuring which specific characteristic of the feedback control system, and serves as a beginning for conducting perceptual tests. The study uses static (but variable) feedback paths and is based on signals recorded from the in-ear microphone of an artificial head, on which the hearing instruments are mounted.

Treatment of a nephrotic syndrome by endoscopic removal of a villous adenoma of the duodenum.

We report the case of a patient diagnosed with a villous adenoma of the duodenum showing high degree dysplasia who developed a nephrotic syndrome (NS) due to a membranous nephropathy (MN), demonstrated by renal biopsy. Only the endoscopic resection of the duodenal adenoma could control the NS. The first manifestation of a MN is often the development of a NS. Up to 20% of patients older than 65 years who develop a MN have cancer. Tumours most often identified are those of lung, prostate and digestive tract. A renal biopsy is required to identify this type of nephropathy. If a diagnosis of MN is made, an associated tumour should be looked for.

[Clinical inertia and treatment adherence in the management of chronic valvular heart diseases]. / Inertie clinique et observance thérapeutique dans les valvulopathies chroniques du coeur gauche.

Valvular heart diseases are of increasing importance among the general adult population. When compared with other heart diseases, there are few trials in the field of valvular heart disease and randomized clinical trials are particularly scarce. Two sets of guidelines exist: one in the USA and the other in Europe. However, they are not always consistent due to the lack of randomized data and it appears that, frequently, there is a gap between the existing guidelines and their effective application.

[Choosing a modality for renal replacement therapy]. / Quelles méthodes de suppléance au stade de l'insuffisance rénale chronique terminale?

End-stage renal disease is a real public health problem. The late referral of patients with chronic renal failure may adversely affect outcomes of dialysed patients and include an additional cost for the society. In this article, the authors review end-stage renal disease in Belgium, and then describe the different modalities of renal replacement therapy currently available: hemodialysis, peritoneal dialysis and kidney transplantation.

[Regeneration of hair cells and auditory neurons in the ear]. / Régénération des cellules ciliées et des neurones auditifs de l'oreille.

Most of deafness have a neuro-sensory origin and are characterized by a loss of hair cells and auditory neurons in the spiral ganglion. At the moment, hearing aids are the only treatment available. To restore hearing in a patient suffering from deafness, it is necessary to study the mechanisms that might lead to the regeneration of neurosensory structures of the inner ear. HAIR CELL REGENERATION: The production of hair cells and supporting cells is terminated during embryonic development of the cochlea in mammals. However, several recent arguments suggest that new hair cells can be produced by the sensory epithelium of mammals. We first identified the presence of progenitor cells in the organ of Corti. In a second approach, the molecular mechanisms underlying the production of new hair cells have been studied. NEURONAL REGENERATION: The study of the development of the ear, cultures of neurons and analysis of animals invalidated for specific genes reveal that a number of growth factors are important for the maintenance and repair of neurons in the inner ear. These molecules induce the survival of auditory neurons in vitro and in vivo. The signaling pathways intra-cellular are analyzed with a better understanding of the mechanisms that lead to survival or death of neurons hearing and with the identification of new pharmacological agents that promote survival of neurons hearing in diseases of the inner ear. These molecules can be administered locally in the inner ear. IN CONCLUSION: Recent studies on the regeneration of neurosensory structures of the inner ear suggest that eventually it will be possible to replace the hair cells in the cochlea of mammals and to reinnervate them by auditory neurons in order to restore hearing in patients suffering from deafness.

[Ischemic mitral regurgitation]. / L'insuffisance mitrale ischémique.

Mitral regurgitation (MR) is a serious complication of coronary heart disease. The functional form is the most frequent, often presenting with a dynamic character. The presence, and in particular the severity of MR and its dynamic character have a major impact on the medium and long term prognosis. The mechanisms responsible for MR are complex and occur in a state of disequilibrium between traction forces and closing forces, for which the significance is partly affected by the presence of asynchrony in left ventricular contraction. The therapeutic management of these patients is difficult. In cases of proven asynchrony, implantation of a biventricular pacemaker is justified. A mitral surgical procedure may be envisaged in cases of severe MR where bypass surgery is planned. In cases of moderate MR at rest, an evaluation of its dynamic character on effort can assist with the decision to undertake combined surgery. Mitral regurgitation (MR) is a common and serious complication of ischemic heart disease. Three general forms are distinguished: MR related to acute rupture of the mitral pillar, ischemic MR and functional MR.

[Beriberi]. / Béribéri.

We discuss the case of a 49 year old man who was admitted to the emergency department with acute heart failure. He suffered from severe alcoholism and malnutrition. His heart failure was of the high output type and the diagnosis beriberi, a disease caused by thiamine (vitamin B1) deficiency. The treatment consisted of intravenous administration of thiamine. The clinical response was spectacular with normalization of cardiac function within a few hours.