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Liège, Belgium

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

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. Source

Magis D.,University of Liege | Gerardy P.-Y.,University of Liege | Remacle J.-M.,CHR Citadelle | Schoenen J.,University of Liege

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. Source

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

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. Source

Bawin I.,University of Liege | Troisfontaines E.,CHR Citadelle | Nisolle M.,University of Liege
Revue Medicale de Liege

Ureteral endometriosis is a rare entity, especially when it occurs in the postmenopausal period. In certain circumstances, this severe disease can cause obstruction, leading to ureterohydronephrosis and, finally, to a progressive and often silent loss of renal function. The symptomatology is variable and non specific, making preoperative diagnosis difficult. The treatment is mainly surgical. Its aim is the relief of obstruction to preserve the renal function. We report the case of a 39 year old patient, hysterectomised for endometriosis nine years earlier, who developed a recurrence demonstrated by ureteral endometriosis and revealed by ureterohydronephrosis. Robot-assisted laparoscopic ureterolysis allowed a complete resection of the lesion and resolved the obstruction. No recurrence of ure-terohydronephrosis was found at the fifth and ninth postoperative month ultrasonographic controls. Source

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

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. Source

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