CHU Ambroise Paré

About: CHU Ambroise Paré is a healthcare organization based out in Mons, Belgium. It is known for research contribution in the topics: Population & Interventional radiology. The organization has 129 authors who have published 112 publications receiving 5880 citations. The organization is also known as: Hopital Ambroise Pare.

“Bedside echocardiography evaluation of hemodynamics in sepsis: is qualitative evaluation sufficient?”: reply to Russell

Abstract: We thank Dr Conn Russell for his interesting comment. We totally agree with him when he calls for wide use of echocardiography in the everyday hemodynamic management of the acutely ill patient. This has actually been our practice for the past 20 years! [1]. However, we disagree with him when he suggests that using transthoracic echocardiography (TTE), rather than transesophageal echocardiography (TEE), may even further simplify such management. A qualitative approach, as described in our paper [2], is only possible when the quality of the examination is optimal. Such a condition is infrequent in mechanically ventilated patients when using TTE. An optimal examination does not only mean “good” visualization of cardiac chambers, it also means the right visualization, using the optimal views, which can be identically reproduced over time, whoever the physician. Moreover, we believe that the best parameter to detect hypovolemia is the superior vena cava collapsibility index [3]. This requires a transesophageal route and must be used in mechanically ventilated patients. However, the most severely ill patients in intensive care units (ICUs), needing optimal hemodynamic management, are actually mechanically ventilated. Dr Russell suggests that TEE could be an invasive procedure. In the medical dictionary, an invasive procedure is “a technique in which the body is entered by puncture or incision”. This is, of course, not the case for TEE. Moreover, a recent paper reported a low incidence of complications of TEE in 21 previous studies and 2,508 procedures [4]. In our practice, we have performed TEE more than 3,000 times since 1993 in mechanically ventilated patients, and we have never observed serious side effects. Lessons can probably be learned from emergency medicine, as Dr Conn says. However, this then regards a diagnostic approach only, as previously proposed in injured patients in the form of the FAST (Focused Assessment with Sonography for Trauma) concept [5]. For echocardiography, this amounts to quick detection of pericardial effusion or recognition of marked dilation of the right or left ventricle. In these situations, it’s true that TTE is of great interest. In ICUs, however, TEE is more than a diagnostic approach; it is a true monitoring procedure permitting complete assessment of hemodynamics before and after treatment.

UEGW 2014, Vienne, 20-22 octobre 2014 Hémorragies digestives

Abstract: Les varices gastriques sont plus rares que les varices œsophagiennes mais la gravité des hémorragies par rupture de varices gastriques est supérieure à celle des varices œsophagiennes. Après un premier épisode hémorragique, une prophylaxie s’impose donc particulièrement mais la nature de cette prophylaxie (injections de colle, bêtabloquant ou l’association des deux) fait encore débat. Dans le travail de Muzzaffar et al. [1] réalisé au Pakistan dans un centre expert, 100 patients vus consécutivement et traités par injections de colle l’étaient jusqu’à disparition des varices. Cinquante-deux des patients recevait en plus un traitement bêtabloqueur avec, dans tous les cas, obtention de la fréquence cardiaque souhaitée. La durée actuelle du suivi était de deux ans. Pendant ce suivi, une récidive hémorragique survenait chez 20 % des malades en cas de traitement mixte et chez 40 % des patients traités exclusivement par colle (p=0,05). Les temps moyens sans récidive hémorragique étaient de respectivement 70 et 40 mois (p=0,05) et les médianes de survie de respectivement 60 vs 40 mois (p=0,001). Comme cela est déjà démontré pour les varices œsophagiennes, l’association bêtabloqueur et traitement endoscopique est donc supérieure en termes de prise en charge des varices gastriques après une première hémorragie et ce tant en ce qui concerne le risque de récidive hémorragique que la survie. Des essais prospectifs randomisés sont maintenant nécessaires. Hémorragies basses

Probability of a Beneficial, Dose-Dependent, Immunosuppressive Action of Carbimazole in Graves’ Disease

Abstract: It is known that the mean titre of the serum anti-TSH receptor autoantibodies (ATRA) progressively decreases in patients with Graves’ disease treated with carbimazole.1,2It has been suggested that this decrease may be due to the lowering by carbimazole of thyroid hormones synthesis,3,4 In order to test whether there is also a direct, dose-dependent, immunosuppressive action of carbimazole, we have compared the evolution of ATRA levels between two groups of patients with Graves’ disease at first attack. The patients of the two groups differed by the daily dosage of carbimazole, but were maintained at similar levels of serum T3.

Continuous Pain Control in Patients with Cancer

Abstract: Pain associated with cancer affects about 80% of patients in the terminal phases of the disease, and should be treated according to its intensity. Nonsteroidal anti-inflammatory drugs and paracetamol, although associated with potentially serious adverse effects, are important in the treatment of mild to moderately severe pain. For mild to moderate pain that cannot be managed with these drugs alone, codeine may be administered. Oral morphine is the drug of choice for severe pain. Treatment should start with titration of immediate release formulations, progressing to sustained release formulations for control of continuous pain. Immediate release morphine should be used for breakthrough pain. Adjuvant drugs may be used alone or in combination with analgesic drugs. Psychological therapy, physiotherapy and other techniques also have a place in the management of cancer-related pain.

Huge Pneumoretroperitoneum as the First Sign of Colorectal Cancer

Abstract: Colorectal cancer is a common form of neoplasia, and it is a major source of morbidity and mortality in the elderly population. Surgery, whether palliative or curative, is often the only definitive management option. The incidence of carcinoma of the colon and rectum peaks in the seventh and eighth decades of life, with only 5 % recorded in those younger than 40 years. Up to 30% of colon cancers may present with an obstruction or perforation [1]. The incidence of colon cancer presenting with perforation is about 2.1–9.5 % of all cases [2]. The majority of patients with rectal cancer present with abdominal pain, weight loss, altered bowel habits, chronic blood loss or acute bleeding. Patient with perforated colon usually show signs of peritonitis, owing to intra-peritoneal perforation. Retroperitoneal perforation is less common, and frequently, abdominal signs and symptoms are minimal or atypical [2]. Late diagnosis and treatment could result in highmorbidity andmortality.We report the case of a woman admitted to hospital with no clear abdominal symptoms, but an important pneumoretroperitoneum at plain abdominal X-ray and CT scan.