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Degreef I.,HK Orthopedie | Tejpar S.,Dienst IG Gastro enterologie | De Smet L.,HK Orthopedie
Tijdschrift voor Geneeskunde | Year: 2011

Dupuytren's disease is a highly prevalent disorder, which is also the case in Flanders (Belgium). The flexion contractures of the fingers are often treated successfully by means of surgical procedures. Still, in a subgroup of patients a fast and in some cases severe recurrence is seen. The latter patients present a fibrosis diathesis. Based on clinical parameters they can easily be identified. At this moment, segmental strand resection is one of the most efficient surgical treatment methods as it is minimally invasive and easy for the patient, with a fast rehabilitation and no increased recurrence risk. In high-risk patients with fibrosis diathesis pioneer studies on cellulose implantation in segmental fasciotomy have demonstrated to be superior as well as the association with systaemic neoadjuvant highly-dosed tamoxifen. Still, the surgeon should realise that he can cut out the strands but not the disease itself. Therefore, it is of the utmost importance to continue the quest for a maximal efficiency of surgical procedures in Dupuytren's disease as well as to strive towards disease control.

Vanhemelryck T.,Dienst IG Algemene Interne Geneeskunde | Achten R.,Dienst Pathologische Ontleedkunde | Drijkoningen M.,Dienst Pathologische Ontleedkunde | Van Assche G.,Dienst IG Gastro enterologie | Geboes K.,Universitair Ziekenhuis
Tijdschrift voor Geneeskunde | Year: 2010

Ménétrier's disease is a gastric giant folds disease syndrome including gastric protein loss resulting in a clinical picture of protein-losing enteropathy and decreased gastric acid production. Pathologically foveolar hyperplasia, distortion and glandular atrophy is observed. Not all elements of the syndrome may be present at the same time. A Helicobacter pylori co-infection has been found in many patients, leading to the view that Ménétrier's disease is a variant of a Helicobacter pylori infection thus acquiring a premalignant character. However, hypertrophic gastropathies may mimic the clinical picture of Ménétrier's disease. Moreover, in the historically first reported cases only a scarce inflammatory infiltrate was observed pathologically in the lamina propria, but no real gastritis. Thus, it would be more appropiate to differentiate Ménétrier's syndrome - which can have different causes - from idiopathic Ménétrier's disease. Several theoretical concepts support the idea that idiopathic Ménétrier's disease is a precursor of gastric cancer. A case of familial Ménétrier's disease is reported here, one family member being diagnosed with both an adenocarcinoma of the stomach and a Helicobacter pylori co-infection.

Jacobs A.,Catholic University of Leuven | Van Assche G.,Dienst IG Gastro enterologie | Van Olmen A.,Dienst Gastro enterologie
Tijdschrift voor Geneeskunde | Year: 2013

The medical history of a 57-year-old female patient is reported. She presented at the emergency department with an exacerbation of her previously diagnosed ulcerative colitis (UC). The serology revealed positive titers of the cytomegalovirus (CMV), but the immunohistochemistry and histopathology of the colonic biopsy disclosed no other abnormalities apart from signs of UC. The clinical dilemma associated with this case consisted in the exact pathogenic role of CMV: was this a classic flare of UC with signs of recent viral replication in the blood or aCMV colitis superimposed on the UC? The combination of a clinically severe exacerbation along with a CMV-positive serology, histopathology and immunohistochemistry appears to be reliable evidence for the diagnosis of CMV colitis. From a literature search on the pathogenic role of CMV colitis, several studies were found showing that the prevalence of CMV colitis is higher in steroid-refractory patients with inflammatory bowel disease (IBD), and that both the steroids and the steroid resistance constitute risk factors. The outcome of patients with IBD and CMV colitis is also worse compared to that of patients without CMV colitis. Open-label evidence suggests that antiviral therapy is efficacious. The treatment of CMV colitis consists of ganciclovir or - as a second choice - foscarnet. Finally, a temporary interruption of the immunosuppressive medication should be considered.

Casteleyn I.,Dienst Inwendige Geneeskunde | Hiele M.,Dienst IG Gastro enterologie | De Hertogh G.,Dienst Pathologische Ontleedkunde
Tijdschrift voor Geneeskunde | Year: 2013

Duodenal intraepithelial lymphocytosis (DIL) is diagnosed in 2.2% of all duodenal biopsies. Glutensensitive enteropathy may be possible, but the lymphocytosis may also be provoked by infectious agents, medication, food intolerance and autoimmune diseases. Exclusion of coeliac disease remains important, but not easy. Assessment of the global clinical picture is fundamental. Serology has a limited role because of its low sensitivity in mild mucosal damage. HLA typing has merely a negative predictive value, but may be helpful in case of discordant findings or doubt concerning the clinical effect of a gluten-free diet. The clinician is the one who should solve the puzzle of histopathology, serology, and genetics and pass a final judgment concerning the diagnosis of coeliac disease. Follow-up of the evolution in due course is often an important tool. © 2013 Tijdschrift voor Geneeskunde.

Holvoet A.,Dienst IG Gastro enterologie | Verhaeghe L.,Dienst Radiologie | Decock S.,Dienst Radiologie | Arts J.,Dienst Gastro enterologie | Van Hootegem P.,Dienst Gastro enterologie
Tijdschrift voor Geneeskunde | Year: 2011

We report a rare case of a 70-year-old woman presenting with fever, jaundice and abdominal pain. CT of the abdomen revealed diffuse metastases of the liver and an anaerobic abscess. Clostridium perfringens bacteremia was demonstrated by means of blood cultures. This case illustrates the dramatic nature of a C. perfringens sepsis with associated hemolysis.

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