Overuse of inhaled corticosteroids in COPD: five questions for withdrawal in daily practice.

Evidence and guidelines are becoming increasingly clear about imbalance between the risks and benefits of inhaled corticosteroids (ICSs) in patients with COPD. While selected patients may benefit from ICS-containing regimens, ICSs are often inappropriately prescribed with - according to Belgian market research data - up to 70% of patients in current practice receiving ICSs, usually as a fixed combination with a long-acting β-adrenoreceptor agonist. Studies and recommendations support withdrawal of ICSs in a large group of patients with COPD.

A Belgian survey on the diagnosis of asthma-COPD overlap syndrome.

Introduction: Patients with chronic airway disease may present features of both asthma and COPD, commonly referred to as asthma-COPD overlap syndrome (ACOS). Recommendations on their diagnosis are diffuse and inconsistent. This survey aimed to identify consensus on criteria for diagnosing ACOS.

New developments in inhaler devices within pharmaceutical companies: A systematic review of the impact on clinical outcomes and patient preferences.

Background: Pharmaceutical companies offer an increasing number of inhaler devices, whether or not together with new substances, for maintenance treatment of patients with COPD or asthma. However, well-designed studies to support these developments are scarce.

Objectives: The aim of this research was to evaluate how far new developments of inhaler devices are scientifically supported and translate into improvements of patient preferences and/or clinical outcomes.

Antineutrophil Cytoplasmic Antibody-Positive Small-Vessel Vasculitis Associated with Antithyroid Drug Therapy: How Significant Is the Clinical Problem?

Background: The aim of this review was to delineate the characteristics of antineutrophil cytoplasmic antibody (ANCA)-associated small-vessel vasculitis associated with antithyroid drugs (ATD). A PubMed search was made for English language articles using the search terms antithyroid drugs AND ANCA OR ANCA-associated vasculitis.

Summary: The literature includes approximately 260 case reports of ANCA-associated small-vessel vasculitis related to ATD, with 75% of these associated with thiouracil derivatives (propylthiouracil [PTU]) and 25% with methyl-mercapto-imidazole derivatives (MMI/TMZ).

Real-time in-vivo microscopic imaging of the cervix using confocal laser endomicroscopy: preliminary observations and feasibility study.

Confocal laser endomicroscopy (CLE) enables in-vivo, real-time, imaging of tissues with a micron-scale resolution through a fiber optic probe. CLE could be a valuable tool for the detection and characterization of suspicious (dysplastic) areas on the uterine cervix in a minimally invasive manner. This study evaluates the technical feasibility and safety of CLE on the cervix.

Pneumococcal lower respiratory tract infections in adults: an observational case-control study in primary care in Belgium.

Background: Serious lower respiratory tract infections (SLRTIs), especially Streptococcus pneumoniae (SP)-related pneumonia cause considerable morbidity and mortality. Chest imaging, sputum and blood culture are not routinely obtained by general practitioners (GPs). Antibiotic therapy is usually started empirically.

Left atrial impression due to lymphadenopathy in an HIV seropositive patient infected with tuberculosis.

We describe a unique case of a 37-year-old patient who was diagnosed with human immunodeficiency virus/tuberculosis co-infection due to a cardiac involvement that consisted in atrial fibrillation as a consequence of a compression of the left atrium by a giant necrotic lymphadenopathy and a pericardial effusion.

Serum TSH determinations in pregnancy: how, when and why?

Improvements in the sensitivity of the serum TSH assay have revolutionized our strategies for investigating thyroid function and firmly established TSH as the first-line thyroid function test for most clinical situations, including pregnancy. As a single hormone determination, serum TSH provides the most sensitive index to reliably detect thyroid function abnormalities. Normal thyroid function is important to ensure the best possible pregnancy outcome; in addition, disorders of the thyroid gland are relatively frequent in women of childbearing age.

Diversity of life-threatening complications due to Mediterranean spotted fever in returning travelers.

Background: Mediterranean spotted fever (MSF) is a tick-borne infection caused by Rickettsia conorii conorii mainly endemic in the Mediterranean Basin. Although usually considered as a benign disease, severe forms of MSF have been sporadically reported.

Methods: We report on three patients who developed severe MSF complications after a stay in Morocco.

Robotically assisted laparoscopic microsurgical tubal reanastomosis: a retrospective study.

Objective: To evaluate the pregnancy and delivery outcome of robot-assisted tubal reanastomosis.

Design: Retrospective cohort study.

Setting: University hospital.

Hantavirus nephropathy as a pseudo-import pathology from Ecuador.

We report a case of hantavirus infection (nephropathia epidemica) diagnosed in a Belgian backpacker returning from a trekking expedition in Ecuador, after likely heavy exposure to rodents. Because of epidemiological inconsistency, molecular investigation was performed and revealed a Puumala infection acquired during very limited exposure in Belgium upon return.

Continuous heart murmur in a 26-year-old woman.

In this report, we describe a continuous murmur heard in a young woman at the beginning of her lactation period, which illustrates a typical example of 'Mammary Souffle', described one century ago. Colour Doppler and pulsed-wave mode echocardiogram allowed to precise, for the first time, the arterial nature of increased systolic and diastolic blood flow in tortuous branches of internal mammary artery, most probably responsible of the murmur, after ruling out any other origin of continuous murmur.

The systematic screening and management of hypothyroidism and hyperthyroidism during pregnancy.

Altogether, thyroid function abnormalities during pregnancy can affect up to 10% of all women. The high prevalence of both hypo- and hyperthyroidism, the obstetrical repercussions associated with thyroid dysfunction in the mothers, as well as the potential role of maternal thyroid dysfunction as an influence on fetal development constitute solid arguments for a further increase of our knowledge of the pathophysiological processes underlying the alterations of thyroid function related to the pregnant state. In this review, the focus will be on the most clinically relevant aspects associated with hypothyroidism [autoimmune thyroid disorders (AITDs), subfertility, risk of miscarriage, risk of hypothyroidism in women with AITD and treatment of hypothyroid women] and with hyperthyroidism (clinical presentations during pregnancy, Graves' disease and its management, fetal hyperthyroidism in women with antithyroid-stimulating hormone receptor antibodies and gestational transient thyrotoxicosis associated with human chorionic gonadotropin stimulation of the maternal thyroid gland).

Clinical and biological consequences of iodine deficiency during pregnancy.

The main change in thyroid function associated with the pregnant state is the requirement of an increased production of thyroid hormone that depends directly upon the adequate availability of dietary iodine and integrity of the glandular machinery. In healthy pregnant women, physiological adaptation takes place when the iodine intake is adequate, while this is replaced by pathological alterations when there is a deficient iodine intake. Pregnancy acts typically, therefore, as a revelator of underlying iodine restriction.

Oral ulceration: an unusual manifestation of Churg-Strauss syndrome.

Churg-Strauss Syndrome (CSS) is a relatively rare entity characterized by asthma, transient pulmonary infiltrates, eosinophilia and systemic vasculitis. Oral ulceration is a possible clinical manifestation of some systemic vasculitides, such as Wegener's granulomatosis (WG) or giant cell arteritis, but has never been reported with Churg-Strauss syndrome. We report the first observation of a palatine ulceration in a 15-year-old girl with Churg-Strauss syndrome.

MR imaging of nodular fasciitis arising in the Hoffa fat pad.

Nodular fasciitis is a benign proliferative fibroblastic tumor arising most often in subcutaneous tissues or deep fascial planes. The lesion is under-reported in radiological literature. There are only a few reports on MR Imaging of nodular fasciitis.

How to interpret a deterioration of split function?

Objective: A drop of split renal function often constitutes a criterion for pyeloplasty in hydronephrosis since it is considered as representing deterioration of the affected kidney. The aim of this work was to determine, in a selected population of patients with a drop of split function of at least 5%, if the evolution of single kidney glomerular filtration rate (SKGFR) was parallel to the one of split renal function.

Methods: From a large data basis, we found retrospectively only 29 children (10 below and 19 above two years of age at first examination) having had at least two Tc-99m mertiatide (Tc-99m MAG3) renographic explorations for various urological diseases, with a decrease of split function of at least 5% between the two examinations.

Safety parameters for pulp temperature during selective ablation of caries by KTP laser in vitro.

Objective: To define the optimal parameters of KTP laser irradiation during a selective caries removal.

Materials And Methods: Twelve decayed human teeth, recently extracted were used. Their root canals were prepared for insertion of a thermocouple probe into the pulp chamber.

The regulation of thyroid function during normal pregnancy: importance of the iodine nutrition status.

The main change in thyroid function associated with the pregnant state is the requirement of an increased production of thyroid hormone that depends directly upon the adequate availability of dietary iodine and integrity of the glandular machinery. Physiologic adaptation takes place when the iodine intake is adequate, while this is replaced by pathologic alterations when there is a deficient iodine intake. Pregnancy acts typically, therefore, as a revelator of underlying iodine restriction.

Increase of enamel fluoride retention by low fluence argon laser in vivo.

Background And Objectives: The aim of this in vivo study was to investigate if argon laser irradiation of enamel can increase the retention of fluoride.

Study Design/materials And Methods: Ninety-eight teeth in 12 patients were randomly divided into three groups: (1) EF group: 40 teeth were only treated by fluoride gel (application for 5 minutes followed by 1 minute rinsing with distilled water). (2) EFL group: 40 teeth were treated the same way as in the EF group but they were lased after fluoridation.

Tinea capitis in Brussels: epidemiology and new management strategy.

Background: We found pre-established directives inadequate to cope with the current increase in anthropophilic tinea capitis in Brussels.

Objectives: To study new epidemiological profiles and to define new strategies for management and prevention.

Patients And Methods: A total of 122 children affected by tinea capitis were followed in our department from October 1, 2001, until September 30, 2002.

Thalidomide in refractory vulvar ulcerations associated with Crohn's disease.

We report a case of recurrent vulvar ulcerations developed on vegetations associated with Crohn's disease. Lesions responded to low-dose thalidomide treatment. A biopsy revealed a neutrophilic infiltrate with rare giant cells.