CHR Citadelle

Liège, Belgium

CHR Citadelle

Liège, Belgium
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Zairi F.,Lille University Hospital Center | Remacle J.M.,CHR Citadelle | Allaoui M.,Lille University Hospital Center | Assaker R.,Lille University Hospital Center
Journal of Neurosurgery: Spine | Year: 2013

The authors report the case of a 53-year-old woman who underwent placement of a metal-on-metal total disc replacement (TDR) device for the treatment of discogenic back pain. The initial postoperative course was normal, but 2 months after surgery she started to complain of a recurrence of pain and she progressively developed cauda equina syndrome. Radiological and biological findings showed an inflammatory polyneuropathy associated with an epidural mass. A diagnosis of cell-mediated hypersensitivity reaction (Type IV) was made after patch testing showed positive reactions for 1% cobalt chloride and chromium. A decision was made to remove the TDR device and to perform a circumferential fusion. This report is intended to inform the reader that systemic metal release and hypersensitivity reaction are possible complications of metal-on-metal TDR. © AANS, 2013.

Collignon L.,CHR Citadelle | Pruvo J.-P.,Roger Salengro University Hospital | Bruneau M.,Erasme University Hospital | De Witte O.,Erasme University Hospital | Leclerc X.,Roger Salengro University Hospital
Stroke | Year: 2010

Background And Purpose-: The purpose of this study is to report our preliminary experience with the flow-diverter Silk stent for the endovascular treatment of intracranial aneurysms. Methods-: This prospective study was approved by the authors' ethical committees. Twenty-nine patients with 34 fusiform or wide-necked unruptured aneurysms were included and treated by Silk stent placement alone by 2 physicians in 3 different centers. Technical issues, immediate findings, delayed complications, clinical follow-up, and imaging follow-up at 3 and 6 months were assessed. Results-: Endovascular treatment was successfully performed in 26 patients (90%). In 3 patients, the stent could not be delivered. Mortality and morbidity rates were of 4% (1 of 26) and 15% (4 of 26), respectively; 1 patient died from a delayed aneurysm rupture related to stent migration, 3 experienced a thromboembolic event, and 1 patient developed progressive visual disturbances related to an increased mass effect. Clinical outcome in 25 patients was unchanged (n=19), improved (n=2), or worsened (=4). Angiographic follow-up in 24 patients (29 aneurysms) showed 20 complete occlusions (69%), 1 neck remnant (3.5%), and 8 incomplete occlusions (27.5%). Significant parent artery stenosis at 6 months occurred in 8 cases (33%). Conclusions-: Despite the potential interest of the Silk flow-diverter stent to treat complex intracranial aneurysms without coils, the delayed complication rate is quite high and leads to use this technique only in selective cases. © 2010 American Heart Association, Inc.

Magis D.,University of Liège | Boon E.,Leiden University | Coppola G.,Gb Bietti Eye Foundation Irccs | Daron A.,CHR Citadelle | Schoenen J.,University of Liège
Cephalalgia | Year: 2012

Background: The mechanisms subtending migrainous features, like sensoriphobia, remain poorly understood even though recent works have shed new light on their mechanisms. Case report: A 24-year-old woman consulted the headache clinic because of frequent paroxysmal attacks of strong sensoriphobia, digestive signs, moderate ataxia and a need to lie in the dark, without any headache. The symptoms had begun in infancy and the patient had been treated for hysteria, then for epilepsy. As she had some typical features of episodic ataxia type 2, an analysis of CACNA1A gene was performed and demonstrated a novel c3995+1G≤A mutation. The same mutation was also discovered in her young son, who had an ataxia of unknown origin. Both remarkably improved under acetazolamide. Conclusions: This observation suggests that paroxysmal sensoriphobia and digestive signs can occur together in bouts in neurological conditions other than migraine, and in the absence of head pain. It raises interesting hypotheses about the central pathways driving these symptoms. © 2012 International Headache Society.

Deflandre E.,Clinique Saint Luc and Cabinet Medical ASTES | Degey S.,Cabinet Medical ASTES | Brichant J.-F.,CHU Liege | Poirrier R.,CHU Liege | Bonhomme V.,CHR Citadelle
Anesthesia and Analgesia | Year: 2016

BACKGROUND: Obstructive sleep apnea (OSA) is a common and underdiagnosed entity that favors perioperative morbidity. Several anatomical characteristics predispose to OSA. We developed a new clinical score that would detect OSA based on the patient's morphologic characteristics only. METHODS: Patients (n = 149) scheduled for an overnight polysomnography were included. Their morphologic metrics were compared, and combinations of them were tested for their ability to predict at least mild, moderate-to-severe, or severe OSA, as defined by an apnea-hypopnea index (AHI) >5, >15, or >30 events/h. This ability was calculated using Cohen κ coefficient and prediction probability. RESULTS: The score with best prediction abilities (DES-OSA score) considered 5 variables: Mallampati score, distance between the thyroid and the chin, body mass index, neck circumference, and sex. Those variables were weighted by 1, 2, or 3 points. DES-OSA score >5, 6, and 7 were associated with increased probability of an AHI >5, >15, or >30 events/h, respectively, and those thresholds had the best Cohen κ coefficient, sensitivities, and specificities. Receiver operating characteristic curve analysis revealed that the area under the curve was 0.832 (95% confidence interval [CI], 0.762-0.902), 0.805 (95% CI, 0.734-0.876), and 0.834 (95% CI, 0.757-0.911) for DES-OSA at predicting an AHI >5, >15, and >30 events/h, respectively. With the aforementioned thresholds, corresponding sensitivities (95% CI) were 82.7% (74.5-88.7), 77.1% (66.9-84.9), and 75% (61.0-85.1), and specificities (95% CI) were 72.4% (54.0-85.4), 73.2% (60.3-83.1), and 76.9% (67.2-84.4). Validation of DES-OSA performance in an independent sample yielded highly similar results. CONCLUSIONS: DES-OSA is a simple score for detecting OSA patients. Its originality relies on its morphologic nature. Derived from a European population, it may prove useful in a preoperative setting, but it has still to be compared with other screening tools in a general surgical population and in other ethnic groups. © 2016 International Anesthesia Research Society.

Lubicz B.,Erasme University Hospital | Collignon L.,CHR Citadelle | Raphaeli G.,Erasme University Hospital | De Witte O.,Erasme University Hospital
World Neurosurgery | Year: 2011

Objective: To report our preliminary experience with the Pipeline flow-diverter stent for the endovascular treatment (EVT) of intracranial aneurysms. Methods: Between September 2009 and October 2010, 20 patients with 27 fusiform or wide-necked unruptured aneurysms were included and treated by Pipeline stent placement alone. Technical issues, immediate findings, delayed complications, and clinical and imaging follow-up at three and six months were assessed. Results: EVT was successfully performed in all patients. Clinical outcome was excellent in all but one patient who died. This latter patient developed a massive infarct due to a delayed stent thrombosis. Other complications without permanent deficit included one perimesencephalic subarachnoid hemorrhage and one retroperitoneal hematoma. Minor technical issues without clinical consequence were encountered in nine patients and included stent migration, stent misplacement, unanticipated stent shortening, and the impossibility to recapture the distal coil tip of the supporting device. Angiographic follow-up in 19 patients with 25 aneurysms showed 21 complete occlusions, one neck remnant, and three incomplete occlusions. No significant parent artery stenosis was seen. Conclusion: This study shows that the Pipeline stent is useful for EVT of fusiform and wide-necked intracranial aneurysms. Moreover, the stent is well tolerated with a low rate of intra-stent stenosis at short-term follow-up. However, technical improvements are needed to ensure safe and precise use of the device. © 2011 Elsevier Inc. All rights reserved.

Chantraine F.,CHR Citadelle | Chantraine F.,University of Liège | Braun T.,University Hospital Berlin | Gonser M.,Horst Schmidt Kliniken | And 3 more authors.
Acta Obstetricia et Gynecologica Scandinavica | Year: 2013

Objective Abnormally invasive placenta (AIP) poses diagnostic and therapeutic challenges. We analyzed clinical cases with confirmed placenta increta or percreta. Design Retrospective case series. Setting Multicenter study. Population Pregnant women with AIP. Methods Chart review. Main outcome measures Prenatal detection rates, treatment choices, morbidity, mortality and short-term outcome. Results Sixty-six cases were analyzed. All women and all but three fetuses survived; 57/64 women (89%) had previous uterine surgery. In 26 women (39%) the diagnosis was not known before delivery (Group 1), in the remaining 40 (61%) diagnosis had been made between 14 and 37 weeks of gestation (Group 2). Placenta previa was present in 36 women (54%). In Groups 1 and 2, 50% (13/26) and 62% (25/40) of the women required hysterectomy, respectively. In Group 1 (unknown at the time of delivery) 69% (9/13) required (emergency) hysterectomy for severe hemorrhage in the immediate peripartum period compared with only 12% (3/25) in Group 2 (p = 0.0004). Mass transfusions were more frequently required in Group 1 (46%, 12/26 vs. 20%, 8/40; p = 0.025). In 18/40 women (45%) from Group 2 the placenta was intentionally left in situ; secondary hysterectomies and infections were equally frequent (18%) among these differently treated women. Overall, postpartum infections occurred in 11% and 20% of women in Groups 1 and 2, respectively. Conclusions AIP was known before delivery in more than half of the cases. Unknown AIP led to significantly more emergency hysterectomies and mass transfusions during or immediately after delivery. Prenatal diagnosis of AIP reduces morbidity. Future studies should also address the selection criteria for cases appropriate for leaving the placenta in situ. © 2013 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

El Hayderi L.,University of Liège | Delvenne P.,University of Liège | Rompen E.,University of Liège | Senterre J.M.,CHR Citadelle | Nikkels A.F.,University of Liège
Clinical Oral Investigations | Year: 2013

Objectives: Dental extraction is reported to trigger recurrent herpes labialis (RHL). Aim: This aims to prospectively study the clinical occurrence of RHL and the oral herpes simplex virus type 1 (HSV-1) viral shedding before and 3 days after different dental procedures. Materials and methods: Oral HSV-1 DNA was measured by real-time PCR before and 3 days after dental procedures of the inferior dentition in 57 immunocompetent patients (mean age 32.4 years) who were selected and divided into four distinct subgroups (dental inspection without anesthesia, n = 19; dental filling under local anesthesia, n = 14; molar extraction under local anesthesia, n = 15; and molar extraction under general anesthesia, n = 9) and compared to 32 healthy controls (mean age 33 years). Results: None of the patients suffered from RHL at day 3. Oral HSV-1 DNA was detected before and after procedure in 1.7 % (1/57) and 5.3 % (3/57), respectively [dental inspection without anesthesia, 5.3 % (1/19); molar extraction under local anesthesia, 6.7 % (1/15); and molar extraction under general anesthesia, 11 % (1/9)]. None of the controls presented RHL or detectable oral HSV-1 DNA. There was no statistically significant difference between the study groups and controls. Conclusion: Molar extraction increases the risk of oral HSV-1 shedding but not of RHL. Procedure-related nerve damage probably accounts for HSV reactivation. Clinical relevance: Antiviral prophylaxis for RHL is not routinely recommended for dental procedures, regardless of a prior history of RHL. © 2013 Springer-Verlag Berlin Heidelberg.

Debray F.-G.,University of Liège | De Halleux V.,CHR Citadelle | Guidi O.,CHR Citadelle | Detrembleur N.,University of Liège | And 5 more authors.
Pediatrics | Year: 2012

Gestational alloimmune liver disease has emerged as the major cause of antenatal liver injury and failure. It usually manifests as neonatal liver failure with hepatic and extrahepatic iron overload, a clinical presentation called neonatal hemochromatosis. We report on a newborn in whom fetal hepatomegaly was detected during pregnancy and who presented at birth with liver cirrhosis and mild liver dysfunction. Liver biopsy showed the absence of iron overload but strong immunostaining of hepatocytes for the C5b-9 complex, the terminal complement cascade neoantigen occurring specifically during complement activation by the immunoglobulin G-mediated classic pathway, which established the alloimmune nature of the hepatocyte injury. The infant survived with no specific therapy, and follow-up until 36 months showed progressive normalization of all liver parameters. This case report expands the recognized clinical spectrum of congenital alloimmune liver disease to include neonatal liver disease and cirrhosis, even in the absence of siderosis. Such a diagnosis is of utmost importance regarding the necessity for immunotherapy in further pregnancies to avoid recurrence of alloimmune injury. Copyright © 2012 by the American Academy of Pediatrics.

Magis D.,University of Liège | Gerardy P.-Y.,University of Liège | Remacle J.-M.,CHR Citadelle | Schoenen J.,University of Liège
Headache | Year: 2011

Background.- Drug-resistant chronic cluster headache (drCCH) is a devastating condition for which various invasive therapeutic procedures have been tempted without any satisfactory effect. Recent studies suggest that occipital nerve stimulation (ONS) could be an efficient preventive treatment of drCCH. Objective.- We conducted a prospective pilot trial of ONS in 8 subjects suffering from drCCH with encouraging results at 15 months. However, studies on a larger population with a longest follow-up were warranted. Methods.- We recruited 15 patients with drCCH according to the previously published criteria of intractability. They were implanted with suboccipital stimulators on the side of their headache. Long-term follow-up was achieved by questionnaires administered during a headache consultation and/or by phone interviews. Results.- Mean follow-up time post surgery is 36.82 months (range 11-64 months). One patient had an immediate post-operative infection of the material. Among the 14 remaining patients, 11 (ie, ∼80%) have at least a 90% improvement with 60% becoming pain-free for prolonged periods. Two patients did not respond or described mild improvement. Intensity of residual attacks is not modified by ONS. Four patients (29%) were able to reduce their prophylaxis. The major technical problems were battery depletion due to the use of high current intensities (N = 9/14, 64%) and immediate or delayed material infection (N = 3/15, 20%). Significant electrode migration was only seen in 1 patient. Clinical peculiarities during the ONS follow-up period were side shift with infrequent contralateral attacks (N = 5/14, 36%), and/or isolated ipsilateral autonomic attacks without pain (N = 5/14, 36%). Two patients found ONS-related paresthesias unbearable: one had his stimulator removed, and the other switched it off although he was objectively ameliorated. Subjectively, 9 patients are very satisfied by ONS and 3 patients moderately satisfied. Effective stimulation parameters varied between patients. Conclusions.- Our long-term follow-up confirms the efficacy of ONS in drCCH, which remains a safe and well-tolerated technique. The occurrence of contralateral attacks and isolated autonomic attacks in nearly 50% of ONS responders may have therapeutic and pathophysiological implications. © 2011 American Headache Society.

Hubin G.,CHR Citadelle | Daele J.J.,CHR Citadelle
B-ENT | Year: 2010

The literature includes few publications dealing with the measurement of rhinoplasty outcomes. We also lack reliable instruments for such measurements. In a population of 228 patients who underwent rhinoplasty performed by the same surgeon, we evaluated patient satisfaction using Alsarraf's questionnaire and an evaluation of cosmetic improvement using standardised pre- and post-operative photographs (Photograph Score from 1- great to 7- monstrous). We correlated these data with the severity of the pre-operative nasal deformities, (Predictable Difficulty Score) with the complexity of the surgical procedure, (Surgical Complexity Score) and with four specific surgical procedures (Spreader Grafting, Domal Interruption, Grafting of the Dorsum, Tip Grafting). Both Alsarraf's questionnaire and the photograph score identified a significant difference between the pre-operative and post-operative data and appear to be reliable instruments for measuring patient satisfaction. The questionnaire takes into account the functional outcome that the PS did not. In our hands, the mean improvement evaluated by the questionnaire was 50.2%, and 2.8 according to the PS, regardless of primary or revision surgery, traumatic or non-traumatic nose, mixed cosmetic/functional or purely cosmetic goals. The relative size of the difference between the pre- and post-operative scores was linked more to the satisfaction of the patient than to the absolute post-operative level. These two instruments (the questionnaire and the photograph score), although they are in agreement, did not allow for the establishment of any correlation between the satisfaction of the patient and the predicted difficulty score (PDS), the surgical complexity score (SCS), or three of the four specific procedures that were considered (SG, DI, GD and TG). Domal interruption was the only procedure in which we found that patient satisfaction was higher than with the other procedures (65.6% for the questionnaire and 3.8 for the photograph score). Copyright © by B-ENT.

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