[Pregastroplasty psychological assessment at the CHU of Liege using the BIPASS]. / Le bilan psychologique prégastroplastie au CHU de Liège inspiré du BIPASS.

Obesity is a chronic disease that has become a major public health problem with a prevalence that has doubled in the past two decades in most industrialized and developing countries. Currently, bariatric surgery represents the most effective treatment for extreme or severe overweight (BMI ? 40 kg/m² or ? 35 kg/m2 with weight-related comorbidities). Pre-operative bariatric surgery psychiatric and psychological assessment is essential for various reasons. In addition to the selection of candidates for the operation, its objectives are to prepare patients for future postoperative changes as well as to optimize their psychological and psychiatric care. This article describes a standardized tool, the BIPASS (Bariatric Interprofessional Psychosocial Assessment Suitability Scale), which allows a quality assessment in the field.

L'obésité est une maladie chronique devenue un problème de santé publique majeur, avec une prévalence qui a doublé au cours des deux dernières décennies dans la majaorité des pays industrialisés et en voie de développement. Actuellement, la chirurgie bariatrique représente le traitement le plus efficace afin de remédier à cette problématique de surcharge pondérale sévère (IMC ? 40 ou ? 35 kg/m² avec complications). L'évaluation psychiatrique et psychologique préopératoire dans le cadre d'une chirurgie bariatrique s'impose pour divers enjeux. Outre la sélection des candidats à l'opération, ses objectifs sont, notamment, de préparer au mieux les patients aux changements futurs postopératoires ainsi que d'optimiser leur prise en charge psychologique et, éventuellement, psychiatrique. Cet article décrit un outil standardisé, le BIPASS (Bariatric Interprofessional Psychosocial Assessment Suitability Scale), qui permet une évaluation de qualité dans le domaine.

Results of kidney transplantation from donors after cardiac death.

Confronting the organ donor shortage, many transplant centers around the world increasingly use donors after cardiac death (DCD). Over the past 20 years, follow-up studies in kidney recipients comparing DCD and donors after brain death (DBD) have shown comparable long-term graft function and survival. As a consequence, DCD programs should be continued and expanded, for these donors constitute a potential solution to the imbalance between the numbers of end-stage kidney disease patients on waiting lists versus available kidney grafts. DCD kidneys do not necessarily signify suboptimal grafts; they may merit to be allocated the same as DBD grafts.

[Palliative management of hepatocarcinoma with sorafenib (Nexavar). Results of the SHARP study (sorafenib hepatocarcinoma assessment randomized protocol trial)]. / L'étude clinique du mois traitement de l'hépatocarcinome au stade palliatif par sorafénib (Nexavar). Résultats de l'étude SHARP (sorafenib hepatocarcinoma assessment randomized protocol).

Curative management of early-stage hepatocarcinoma may include partial hepatic resection, liver transplantation or tumoral necrosis using radiofrequency ablation or alcoholisation. Until recently, no efficient therapeutic mean was available for advanced hepatocarcinoma. Sorafenib (Nexavar, Bayer) is a multikinase inhibitor that decreases tumoral proliferation and angiogenesis, and increases apoptosis in many cancer models. The results of a phase 3 randomized, multicentric, study, entitled SHARP, have now demonstrated that sorafenib increases survival in patients with advanced hepatocarcinoma developed in Child A cirrhosis. Mean survival gain was a little less than 3 months, without any radiologic response or improvement in the delay before symptomatic progression of the disease. The monthly cost of sorafenib is a little more than 5,000 euros. It is now crucial to evaluate the potential role of sorafenib in adjuvant therapy after liver resection or radiofrequency ablation of hepatocarcinoma. The CHU of Liège is taking part to a randomized, multicentric study evaluating the use of sorafenib after liver resection or radiofrequency ablation for hepatocarcinoma. Another future evaluation could be the association of sorafenib with other antitumoral agents.