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Acta Clinica Belgica

Anneleen Moeyersoons, Patrick Verschueren, Thomas Tousseyn, Ellen De Langhe
Granulomatous disease and pachymeningitis rarely occur in rheumatoid arthritis patients and confer a challenging differential diagnosis. Our patient, treated with a tumor necrosis factor alpha inhibitor, presented with meningitis and diffuse granulomatous adenopathies. Opportunistic infections and malignancy were excluded after confirmation of negative broath serologic, molecular analysis, and negative cytology. Because of the time frame and the clinical presentation, this case was considered as a rare systemic manifestation of RA...
September 13, 2017: Acta Clinica Belgica
Annelies Deldycke, Christel Haenebalcke, Youri Taes
OBJECTIVES: Paraneoplastic Cushing syndrome is a rare condition, representing a small fraction of the adrenocorticotropic hormone (ACTH)-dependent cases of Cushing syndrome Methods: Four case descriptions and literature review, highlighting the diagnostic challenges and treatment options are presented. RESULTS: Different tumor types can be associated with ectopic ACTH secretion. The most common types are bronchial carcinoids and small cell lung carcinoma (SCLC)...
September 12, 2017: Acta Clinica Belgica
Christine Quentin, Nicolas Lefevre, Eddy Bodart, Laurence Hanssens
Objective and importance Mounier Kuhn syndrome is usually diagnosed in adulthood, and only a few cases have been described in childhood. Clinical presentation We present the case of a seven-year-old boy suffering from recurrent pneumonia and atelectasis. Intervention Previously performed chest X-rays showed bilateral hyperinflation and tracheobronchomegaly. Chest computed tomography (CT) confirmed the presence of distal enlargement of trachea and bronchi. Tracheobronchomegaly associated with recurrent respiratory tract infections is consistent with Mounier Kuhn syndrome...
September 11, 2017: Acta Clinica Belgica
Karin Melsens, Els Vandecasteele, Ellen Deschepper, Valérie Badot, Daniel Blockmans, Guy Brusselle, Ellen De Langhe, Michel De Pauw, Claire Debusschere, Saskia Decuman, Liselotte Deroo, Frédéric Houssiau, Jan Lenaerts, Yves Piette, Kristof Thevissen, Marie Vanthuyne, René Westhovens, Sara Wijnant, Filip De Keyser, Vanessa Smith
OBJECTIVES: Following results in open-label studies of rituximab in patients with systemic sclerosis, a Belgian three-centre initiative was launched to explore safety and efficacy of rituximab in early, diffuse cutaneous systemic sclerosis (dcSSc). METHODS: Open-label study of 17 patients with early dcSSc, treated with two courses of rituximab, at month 0 and 6. Clinical examination, lung function testing, echocardiography, disease activity score (DAS) and functional status were performed at baseline and over 24 months of follow-up...
September 11, 2017: Acta Clinica Belgica
Tess Van Meerhaeghe, Steven Droogmans, Shane Hanon, Jeroen Sonck
BACKGROUND: Platypnea-orthodeoxia syndrome (POS) is an uncommon disorder characterized by dyspnea (=platypnea) and desaturation (=orthodeoxia) in upright position and improvement of symptoms and blood oxygenation in supine position. Clinical presentation is heterogeneous and often confuses the clinician. OBJECTIVES: The present case report illustrates a complicated presentation of the underlying syndrome. METHODS: Description of a POS case in a 73-year-old female with thorough workup and tailored treatment...
August 17, 2017: Acta Clinica Belgica
Sanne Steyaert, Jo Van Dorpe, Anne Hoorens, Wim Van Biesen, Steven Van Laecke
OBJECTIVES: Recurrence of membranous glomerulonephritis after transplant is common and is an important cause of loss of renal graft. This case supports the effect of immunoglobulins in the treatment of this disease after transplantation. It is the first report in the literature with a follow-up of more than 10 years and because of the sustained effect of the immunoglobulins, it strengthens the idea that this can alter long-term outcome. METHODS: Single case study and search of the literature...
August 14, 2017: Acta Clinica Belgica
Benoit Pétré, Nicolas Gillain, Nadine Jacqmin, Jef Adriaenssens, Kristel Vandenbosch, Pierre Gillet, Robert Vander Stichele, Geert Thienpont, Michèle Guillaume
BACKGROUND/OBJECTIVES: Despite recommendations to integrate evidence-based practice into nursing care, evidence-based nursing (EBN) implementation is generally lacking. Strategies for developing an EBN implementation plan require an evaluation of nurses' needs and expectations. The aim of this study was to evaluate how Belgian nurses perceive EBN. METHODS: Descriptive qualitative data were obtained via focus groups. Fifty-six nurses took part in the study and were assigned to one of seven focus groups based on their work setting and the local language...
August 2, 2017: Acta Clinica Belgica
Laura Heireman, Boris Mahieu, Mark Helbert, Wim Uyttenbroeck, Jan Stroobants, Marian Piqueur
INTRODUCTION: Frequent causes of high anion gap metabolic acidosis (HAGMA) are lactic acidosis, ketoacidosis and impaired renal function. In this case report, a HAGMA caused by ketones, L- and D-lactate, acute renal failure as well as 5-oxoproline is discussed. CASE PRESENTATION: A 69-year-old woman was admitted to the emergency department with lowered consciousness, hyperventilation, diarrhoea and vomiting. The patient had suffered uncontrolled type 2 diabetes mellitus, underwent gastric bypass surgery in the past and was chronically treated with high doses of paracetamol and fosfomycin...
July 27, 2017: Acta Clinica Belgica
Çağdaş Kalkan, Irfan Soykan
OBJECTIVES: Patients with autoimmune gastritis may have symptoms suggestive of delayed gastric emptying. The aim of this study was to explore the predictive value of two scoring systems in the differentiation of delayed gastric emptying in patients with autoimmune gastritis. METHODS: About 154 patients (106 women) with autoimmune gastritis whose gastric emptying test were available, were analyzed using two laboratory-based scoring systems: 'global score' (hemoglobin, mean corpuscular volume, gastrin, vitamin B12, and chromogranin A) and 'simple score' (hemoglobin, mean corpuscular volume, and gastrin) in order to discriminate delayed and normal gastric emptying...
July 24, 2017: Acta Clinica Belgica
Tine Loyson, Thomas Van Cann, Patrick Schöffski, Paul M Clement, Oliver Bechter, Isabel Spriet, Ruxandra Coropciuc, Constantinus Politis, Raf O Vandeweyer, Joseph Schoenaers, Herlinde Dumez, Patrick Berteloot, Patrick Neven, Kristiaan Nackaerts, Feng J S H Woei-A-Jin, Kevin Punie, Hans Wildiers, Benoit Beuselinck
OBJECTIVES: Osteonecrosis of the jaw (ONJ) is a serious adverse event of bone resorption inhibitors (BRIs), such as bisphosphonates and denosumab. Bisphosphonates and denosumab inhibit osteoclast function through different pharmacological effects and bisphosphonates are retained in bone for several months to years. Sequential treatment with bisphosphonates and denosumab might lead to an overlapping treatment effect, due to the addition of the effect of denosumab on the residual bisphosphonate effect...
July 10, 2017: Acta Clinica Belgica
Melissa Desmedt, Jochen Bergs, Benjamin Willaert, Annemie Vlayen, Johan Hellings, Ward Schrooten, Neree Claes, Dominique Vandijck
INTRODUCTION: Primary healthcare differs from hospitals in terms of - inter alia - organisational structure. Therefore, patient safety culture could differ between these settings. Various instruments have been developed to measure collective attitudes of personnel within a primary healthcare organisation. However, the number of valid and reliable instruments is limited. OBJECTIVES: Psychometric properties of the SCOPE-Primary Care instrument were tested to examine the instrument's applicability in home care services in Belgium...
July 9, 2017: Acta Clinica Belgica
Michel P Hermans, Nicolas Dath
OBJECTIVES: Most patients with type 2 diabetes mellitus (T2DM) have at least one comorbid chronic disease. These comorbidities increase disease burden and costs and may impact the selection of glucose-lowering therapies. The aim of our study was to describe the prevalence and co-prevalence of comorbidities in patients with T2DM in Belgium. METHODS: This was a single centre, transversal, descriptive study performed at Saint-Luc University Hospital, Brussels, Belgium...
July 5, 2017: Acta Clinica Belgica
Sebastian Vermeersch, Steven Callens, Stéphane De Wit, Jean-Christophe Goffard, Marie Laga, Dominique Van Beckhoven, Lieven Annemans
OBJECTIVES: We developed a pragmatic modelling approach to estimate the impact of treatment as prevention (TasP); outreach testing strategies; and pre-exposure prophylaxis (PrEP) on the epidemiology of HIV and its associated pharmaceutical expenses. METHODS: Our model estimates the incremental health (in terms of new HIV diagnoses) and budget impact of two prevention scenarios (outreach+TasP and outreach+TasP+PrEP) against a 'no additional prevention' scenario. Model parameters were estimated from reported Belgian epidemiology and literature data...
July 3, 2017: Acta Clinica Belgica
Elisa Larrieu-Ardilouze, Luc Christiaens, Nicolas Varroud-Vial, Coralie Madico, Jamil Hajj-Chahine, Michaela B Rehman
Pancarditis is a rare condition with a poor prognosis combining endocarditis, myocarditis with abscess formation, and purulent pericarditis. Diagnosis is often delayed and the clinical signs are predominantly those of the embolic complications. Literature is scarce. We present a unique and rare case of pancarditis, complicating a Streptococcal B infection in an immunocompetent, healthy, 54 year-old woman. The evolution was favourable under medical therapy alone and thanks to multimodality cardiac imaging diagnosis and follow-up...
June 28, 2017: Acta Clinica Belgica
Jana Van Wabeke, Eric Dhondt, Isabelle Peene, Yves Piette
Gout is a common cause of inflammatory arthritis. The classical treatment options in an acute gout attack are non-steroidal anti-inflammatory drugs, colchicine, and corticosteroids. Interleukin-1 inhibition has been shown to be an effective alternative when non-biologic therapies are ineffective or contraindicated. Herein, we report the case of a 69-year-old female who presented with polyarticular tophaceous gout treated successfully with anakinra.
August 2017: Acta Clinica Belgica
Ula Maniewski, Marie-Christine Payen, Marc Delforge, Stephane De Wit
OBJECTIVES: A decreasing incidence of tuberculosis (TB) among HIV patients has been documented in high-income settings and screening for tuberculosis is not systematically performed in many clinics (such as ours). Our objectives are to evaluate whether a same decline of incidence was seen in our Belgian tertiary center and to evaluate whether systematic screening and prophylaxis of tuberculosis should remain part of routine practice. METHODS: Between 2005 and 2012, the annual incidence of tuberculosis among adult HIV patients was measured...
August 2017: Acta Clinica Belgica
Celine Detremerie, Frank Timmermans, Michel De Pauw, Peter Gheeraert, Dimitri Hemelsoet, Jonas Toeback, Thierry Bové, Els Vandecasteele
We present a case of a 71-year-old woman with recurrent stroke episodes due to non-bacterial thrombotic endocarditis (NBTE) leading to the diagnosis of an early-stage breast carcinoma. NBTE is associated with a variety of inflammatory states, including malignancy. NBTE presents itself with systemic embolization, mostly stroke. Treatment consists of treating the underlying condition and start of systemic anticoagulation therapy. Cardiac surgery is restricted to highly selected cases, since prognosis usually is limited by the neoplasm, which usually is in an advanced stage at time of diagnosis of NBTE...
August 2017: Acta Clinica Belgica
Jasna Bacalja, Čedna Tomasović Lončarić, Suzana Kukulj, Igor Nikolić
Synchronous occurrence of multiple lung cancers in the same lobe of the lung is very rare. Most of the tumors diagnosed in this way have the same histologic type. With imaging methods it is difficult to determine if the multiple lung lesions present hematogenous spread of lung cancer (or cancer from other origin) or these lesions present the second primary lung cancer. We report a rare and unusual case of synchronous occurrence of primary adenocarcinoma and squamous cell carcinoma in the same lobe of the lung...
August 2017: Acta Clinica Belgica
Zdravko Kosjerina, Marija Vukoja, Dejan Vuckovic, Vesna Kosjerina Ostric, Marija Jevtic
BACKGROUND: Despite improvements in clinical practice, pneumonia remains one of the leading causes of death worldwide. Pathologic findings from autopsy reports could provide more precise and valid data on characteristics of pneumonia patients. METHODS: We retrospectively reviewed autopsy reports of deceased patients admitted to the Institute for Pulmonary Diseases of Vojvodina in Sremska Kamenica, Serbia, between 1994 and 2003. The patients were classified into two groups: group 1 (n = 161) comprised patients in whom pneumonia was the main cause of death, while group 2 (n = 165) consisted of patients in whom pneumonia was confirmed at autopsy but had various different causes of death...
August 2017: Acta Clinica Belgica
Lucas Steverlynck, Nele Baert, Walter Buylaert, Peter De Paepe
We describe a nonlethal, delayed onset case of combined acute inhalation of hydrofluoric acid (HFA) and nitric acid (NA) together with a review of the literature. Our patient was exposed to fumes of a 12% HFA and 22% NA solution in a closed environment and suffered during several months after the incident from exertional dyspnoea but recovered completely. Since HFA and NA are dangerous and widely used substances, preparedness for exposure is mandatory. After inhalational exposure, the principles of decontamination with attention to treatment of the skin for HFA burns together with general medical incident management should be applied...
August 2017: Acta Clinica Belgica
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