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de Vroey B.,Gastroenterology | Schapira M.,Gastroenterology | Peny M.O.,Center Hospitalier Jolimont Lobbes | Ghilain J.M.,Gastroenterology
Acta Gastro-Enterologica Belgica | Year: 2011

Collagenous colitis is a cause of chronic diarrhea of incompletely elucidated origin, defined by normal laboratory tests, a normal endoscopic appearance of colonic mucosa and specific microscopic inflammatory features on colonic biopsies. We report two cases of macroscopic endoscopic lesions observed in patients suffering from chronic diarrhea, whose biopsies confirmed a diagnosis of collagenous colitis and who were successfully treated in that setting, achieving clinical and endoscopic remissions. By means of a literature review, we summarize what is known about collagenous colitis. We particularly discuss macroscopic findings in that context, drawing attention on the so called "microscopic colitis" in the differential diagnosis of that type of lesions.

Van Mieghem W.,Genk Inc | Billiouw J.-M.,Onze Lieve Vrouw Ziekenhuis | Brohet C.,Cliniques universitaires Saint Luc | Dupont A.G.,Universitair Ziekenhuis Brussel | And 10 more authors.
Acta Clinica Belgica | Year: 2010

The HOPE and EUROPA clinical studies have shown that treatment with the angiotensin-converting enzyme (ACE) inhibitors, ramipril and perindopril, may reduce the occurrence of major cardiovascular events in patients with proven atherosclerotic disease. The recently published results of the PRoFESS and TRANSCEND trials completed the much needed information concerning the use of an angiotensin receptor blocker for patients at high risk of cardiovascular events. PRoFESS compared a therapy of telmisartan 80 mg daily with placebo in patients with a recent ischemic stroke. The difference in the primary outcome of first recurrent stroke was not statistically significant between telmisartan and placebo. The secondary outcome of major cardiovascular events showed a relative risk reduction (RRR) of 7% in favour of telmisartan. This tended to be significant (p= 0.06) despite a rather short follow-up period of only 28 months. In TRANSCEND 5,926 patients at high risk for cardiovascular events were randomized to a treatment with telmisartan 80 mg daily or placebo for a mean duration of follow-up of 56 months. The primary composite outcome of cardiovascular death, myocardial infarction, stroke or hospitalization for heart failure showed a non-significant 8% RRR in favour of the telmisartan treated patients. The main secondary outcome of cardiovascular death and myocardial infarction or stroke as used in the HOPE trial showed a non-significant RRR of 13% in favour of telmisartan treated patients (p= 0,068 adjusted for multiplicity of comparisons). In comparing the Kaplan-Meier curves for the endpoint of major cardiovascular events used in HOPE, EUROPA, TRANSCEND and PRoFESS, the trends are similar. Results of most of the recently published trials have been neutral. This could partly be explained by major improvements in the optimal background therapy of the patients included. Nevertheless, the results of PRoFESS and TRANSCEND do not contradict the results from previous studies with the ACE inhibitors ramipril and perindopril and the ARB telmisartan.

Marchandise S.,Cliniques Universitaires St Luc | Scavee C.,Cliniques Universitaires St Luc | Badot D.,Center Hospitalier Jolimont Lobbes | Deceuninck O.,Catholic University of Louvain | And 4 more authors.
Journal of Cardiovascular Electrophysiology | Year: 2012

Adenosine and Ablation of Typical Atrial Flutter. Introduction: Early recovery of conduction (ER) after cavotricuspid isthmus (CTI) ablation for typical atrial flutter (AFl) occurs in approximately 10% of the patients. If not recognized, ER might lead to AFl recurrences. In this study, we hypothesized that intravenous adenosine (iADO) can be used to predict ER in the CTI immediately after RF ablation and distinguish functional block from the complete destruction of the CTI myocardium. Methods: We prospectively included 68 consecutive patients (age: 65 ± 14 years; male: 78%) referred in our centers for AFl ablation. Immediately after bidirectional isthmus block validation, a bolus of iADO was given during continuous pacing from the proximal coronary sinus. Patients with functional block revealed under iADO (iADO+) and those without (iADO-) were subsequently observed for a 30-minute waiting period (ER-) or until sustained recovery of the conduction through the CTI (ER+). Results: Seven patients presented a persistent recovery (ER+, 10.3%, mean time to recovery: 14 ± 9 minutes). None of them presented even a transient resumption of conduction under iADO (iADO+: 0). With univariate analysis, we identified a heavy patient weight (>95 kg) as a predictor of ER (sensitivity: 71%). Conclusions: Adenosine does not predict early recovery in the CTI after linear ablation for atrial flutter. We found that a patient weight over 95 kg predicted early recovery of conduction through the CTI with a sensitivity of 71%. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1201-1206, November 2012) © 2012 Wiley Periodicals, Inc.

Heller F.,Center Hospitalier Jolimont Lobbes
Acta Clinica Belgica | Year: 2013

Differences in response to medications both in terms of clinical activity and side-effects have long been recognised by physicians. Genetics has been recently considered as a potential factor to explain part of this variability. Pharmacogenetics focuses on the variants within one or more candidate genes while pharmacogenomics evaluates the entire genome for associations with pharmacologic phenotypes. Genetic variants can effect drug metabolism, drug transport or drug targets. Drug metabolism is responsible 1. for the conversion of prodrugs into active compounds or conversion of drugs to toxic or inactive metabolites mostly through reactions mostly catalysed by cytochromes (CYP) P450 (phase I reactions) and 2. for transforming drugs to compounds that are more water soluble and more easily excreted (phase type II reactions). Genetic polymorphisms can modify the activity of several CYPs such as CYPs 2D6, 2C9, 2C19 with altered responses to codeine, tamoxifen, clopidogrel, warfarin, ̇ or of enzymes of the phase II reactions with abnormal responses to drugs like irinotecan, 5-fluorouracil, azathioprine, ̇ Proteins involved in the transport of drugs in or out the cells such as chemiotherapeutic agents, simvastatin, ̇ can also be affected by genetics. Genetics can also modify drug targets by mutations affecting tumour cells rending these latter more or less responsive to drugs. Genetic tests have been launched for screening polymorphisms before giving drugs such as warfarin and several biomarkers are available in oncology. However, many challenges exist. For example, we need more prospective studies to have a better knowledge of the clinical impact and the cost-effectiveness of these tests. It remains that in the future pharmacogenetics/ genomics will probably help to personalise medicine by conferring to the clinician the possibility of giving the right drug to the right patient and by this way improving efficacy and safety of medications.

Lemaire J.,Cliniques universitaires Saint Luc | Delaunoit T.,Center Hospitalier Jolimont Lobbes | Molle G.,Cliniques universitaires Saint Luc
Acta Chirurgica Belgica | Year: 2014

A sixty years-old patient was admitted with a gastric tumor corresponding to an adenocarcinoma developed in ectopic pancreatic tissue. Hundred cases of gastric heterotopic pancreas are shown in literature. This entity may remain asymptomatic. Symptoms such abdominal pain are described as the result of tumour growth. Carcinogenesis of ectopic pancreas (EPa) is however rare. Diagnosis is rarely pre-operative because modern imaging depicts a gastric tumour with no more information. The only treatment is surgery, with a best interest in frozen sections to direct the procedure, in this case a total gastrectomy with D2 lymphadenectomy. Based on this case report, an analysis of the literature focusing on diagnosis and treatment is presented. © Acta Chirurgica Belgica.

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