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Introduction Tout patient souffrant d’une insuffisance renale severe est confronte a un bouleversement de son quotidien necessitant un changement de comportement, adoption d’un mode de vie sain et observance de schemas therapeutiques. Il est crucial de proposer un accompagnement efficace et humain qui permet de s’impliquer. Description Le service avant de lancer un projet de co-construction a donne la parole aux patients. De nouvelles evaluations de la compliance therapeutiques basees sur la participation et l’engagement des patients et mesurees par le Patient Activation Mesure (PAM) sont a l’aube d’un changement de paradigme. Methodes Etude quantitative par questionnaire auto-declare, propose aux patients repartis en 3 categories : insuffisants renaux stade 3B-5, dialyses, ou greffes renaux d’un service de nephrologie. Le questionnaire est anonyme et comportait 33 items. Les besoins dans le cadre de l’autogestion ont ete evalues par 4 questions. Les resultats sont accompagnes de tests statistiques (t de Student et le Chi2). Le seuil de signification est p Resultats Au total, 510 questionnaires ont ete analyses entre juin et aout 2019. Taux de remplissage a 91 %. Les relations humaines sereines et respectueuses sont les plus importantes (80 %) et conditionnent l’implication du patient suivent la qualite et la securite dans les soins (66 %), l’education et l’autonomie (47 %). Pres de 20 % ont coche l’ensemble des besoins. On n’observe pas de difference statistiquement significatives pour ces 3 groupes selon le stade de l’IRC (p = 0,64). Les patients greffes comprennent mieux les enjeux de l’autogestion et sont plus motives a s’engager que les patients IRC 3B-5 et les patients dialyses. L’âge, le niveau socioprofessionnel et les comorbidites impactent fortement le score PAM ( Tableau 1 ). Conclusion Ameliorer la prise en charge demande aux soignants d’aider les patients a identifier les enjeux, les impliquer en les ecoutant, favoriser l’autonomie et activer leur motivation par des relations humaines et respectueuses.

Introduction L’utilisation des outils numeriques semble envahir toutes les spheres de notre societe, mais connaissons-nous reellement la perception des patients atteints d’insuffisance renale (insuffisance renale chronique de stade 3B a 5, en dialyse ou greffe) a l’ information delivree par les outils numeriques (internet, smartphone, tablette) ? Description Nous avons distribue un questionnaire evaluant l’utilisation des outils numeriques par les patients. Methodes Etude quantitative par questionnaire auto declare realisee du 01 juin au 31 aout 2019, propose aux patients repartis en 3 categories : insuffisants renaux stade 3B-5, dialyses, ou greffes d’un service de nephrologie. Le questionnaire est anonyme et comportait 33 items. Nous avons recolte 498 reponses. Les resultats sont accompagnes de tests statistiques (t de Student et le Chi2). Le seuil de signification est p Resultats L’acces a une connexion internet est de 70 % (IRC) 68 % (dialyses) et 86 % (greffes). Le stade d’insuffisance renale influence les differents resultats ( Fig. 1 ). Le sexe n’influence pas ces resultats. Les patients avec un niveau etude plus haut sont plus connectes (p Conclusion Exceptes les patients greffes plus connectes, les patients en insuffisance renale chronique et dialyses n’ont pas demontre un interet fort quant au souhait d’utiliser ce type de technologie et prefere meme parfois l’utilisation d’un support papier.

Introduction L’informatique est incontournable dans le secteur de la sante. Notre DPI interne est un systeme structure et developpe en .net selon une methode AGILE. Il est etroitement interface avec le Hub regional (RSW). Un projet d’education therapeutique est actuellement co-construit avec les patients dialyses. Description Les outils d’autoevaluation PAM-13, EQ5D3L ainsi que le POS renal ont ete choisis comme indicateurs de suivi des 330 patients traites en dialyse. Methodes Les evaluations ont ete soit auto-administrees par le patient directement dans le DPI, soit encodees par un soignant ou un aidant. Elles ont ete realisees de novembre 2019 a janvier 2020. L’accord du comite d’ethique et le consentement des patients ont ete obtenus. Resultats Cent cinquante-trois PAM et 156 EQ3D3L-POS ont ete encodes (47 % des dialyses). Dix-sept patients ont complete eux meme leurs formulaires. Chaque autoevaluation est visible dans le DPI et partagee avec le patient et son generaliste. Les scores PAM et EVA de sante sont integres dans la vue des parametres vitaux. Le premier graphique montre la distribution des PAM selon les 4 niveaux d’activation, le deuxieme presente les reponses au EQ5D3L-POS. La PAM moyenne est de 55,2 (13,9). L’EVA de sante moyenne est de 53,55/100 (21,84). Les difficultes rapportees sont : la sensation de faiblesse, la mobilite et l’accomplissement des AVQ. La PAM moyenne de notre etude est superieure a celle de l’etude belge de Van Bulck (2018). Nous avons plus de dialyses au niveau 4, mais l’EVA sante de notre centre est inferieure. Par rapport aux bornes NHS (2014), ce dernier niveau reste sous-represente tandis que les deux premiers sont sur-representes ( Fig. 1 , Fig. 2 ). Conclusion Cette premiere photographie de la situation permettra le suivi du projet de co-construction. Les mesures d’autoevaluations, informant les soignants du ressenti des patients, sont a considerer au meme titre qu’un signe vital et donc a monitorer chez les patients dialyses.

Recent advances in methodology allow the mass concentration of creatine kinase MB isoenzyme (CK-MB), and of lactate dehydrogenase isoenzyme 1 (LD1) to be determined quickly and easily as routine, emergency tests. We evaluated these tests as diagnostic criteria of perioperative myocardial infarction (PMI) after coronary bypass surgery. These tests were compared with the usual measurements of CK-MB activity by immunoinhibition and LD1 by electrophoresis and with other biological markers of myocardial infarction such as total CK, total LD, and aspartate aminotransferase. Sixty-one patients who underwent coronary bypass grafting were followed pre- and postoperatively by enzyme determinations and electrocardiography; a subgroup was monitored by myocardial scintigraphy. CK-MB mass appeared to be the best marker of PMI during the first 48 h, although LD1 was the marker of choice from days 2 to 4.

Cardiac valve replacement with use of only the Björk-Shiley prosthesis was performed in 1253 patients between January 1973 and December 1982. There were 828 patients having aortic valve replacement, 280 patients having mitral valve replacement, and 145 patients having double valve replacement with aortic and mitral valve prostheses. Patient outcome was stratified according to multiple variables, including valve position and valve model (spherical versus convexo-concave discs). No valve failure due to strut fracture was identified in 26 high-risk patients (mitral valve replacement with greater than or equal to 29 mm implanted in patients less than or equal to 50 years of age) followed up for a mean of 10 years postoperatively. Fifteen patients had late thrombosis of their Björk-Shiley prosthesis (0.28 per 100 patient-years), but there was no significant difference in risk of valve thrombosis comparing the spherical and convexo-concave discs (0.27 per 100 patient-years versus 0.27 per 100 patient-years). One hundred two patients had 128 thromboembolic episodes; rates of thromboembolism after aortic valve replacement, mitral valve replacement, and double valve replacement were 2.1, 4.3, and 4.6 per 100 patient-years, respectively. Percentages of patients free from thromboemboli after aortic valve replacement, mitral valve replacement, and double valve replacement were 93% +/- 1%, 86% +/- 2%, and 89% +/- 3% at 5 years postoperatively and 87% +/- 2%, 79% +/- 5%, and 77% +/- 8% 10 years postoperatively. There was no significant difference in the rates of thromboemboli for spherical and convexo-concave discs for all patients and for each of the subgroups. Ten-year actuarial survival estimates for patients dismissed alive from the hospital after aortic valve replacement, mitral valve replacement, and double valve replacement with the Björk-Shiley valve were 65% +/- 4%, 63% +/- 5%, and 55% +/- 8%, respectively. Overall event-free survival (freedom from death, thromboembolism, anticoagulant-related bleeding, endocarditis, and reoperation) was similar for the three patient groups. Performance of the Björk-Shiley valve as judged by late patient follow-up is similar to other mechanical valves, and modifications in disc design do not appear to have reduced the threat of late valve thrombosis and thromboemboli. Evidence does not support elective explantation of this prosthesis.

Cyclosporine (CsA) hepatotoxicity has been reported but has not been studied systematically. This study includes 17 patients undergoing heart transplantation (HTx) and being treated with CsA, azathioprine, and corticosteroids. We assessed liver function in these patients before HTx and during the following month by five biological tests: total bile acids (BA), alkaline phosphatase (AP), gamma-glutamyltransferase (GGT), and total bilirubin in serum, and the aminopyrine breath test (ABT). With these tests we could classify the patients into three groups before HTx: normal (group I), mildly altered (group II), and severely altered (group III) liver function. During CsA therapy we did not observe any changes in any test results except for BA and GGT, and these only in group III. The ABT improved significantly in this group. During kinetic studies in patients without liver dysfunction, we confirmed a direct interference of CsA on BA secretion mechanism, but not the GGT increase, which remains to be explained.

Cyclosporine (CsA) hepatotoxicity has been reported but has not been studied systematically. This study includes 17 patients undergoing heart transplantation (HTx) and being treated with CsA, azathioprine, and corticosteroids. We assessed liver function in these patients before HTx and during the following month by five biological tests: total bile acids (BA), alkaline phosphatase (AP), gamma-glutamyltransferase (GGT), and total bilirubin in serum, and the aminopyrine breath test (ABT). With these tests we could classify the patients into three groups before HTx: normal (group I), mildly altered (group II), and severely altered (group III) liver function. During CsA therapy we did not observe any changes in any test results except for BA and GGT, and these only in group III. The ABT improved significantly in this group. During kinetic studies in patients without liver dysfunction, we confirmed a direct interference of CsA on BA secretion mechanism, but not the GGT increase, which remains to be explained.

Ergospirometry was performed on 51 patients before their discharge from hospital, that is between the seventh and tenth days after myocardial revascularization by cardiac bypass surgery. The aim of our study is to show that this type of measurement can be performed with reasonable safety and that it gives an accurate assessment of the patient's ability to withstand exercise. It employs a metabolic approach: study of oxygen consumption (V'O2), carbon dioxide release (V'CO2), the respiratory quotient (RQ), the minute ventilation (V'E) and the respiratory equivalent for oxygen (REO2). The patients withstood a mean load of 82 +/- 17.7 watts for a mean V'O2 of 1.186 +/- 0.258 l/min STPD and a mean V'E of 46.5 +/- 10 l/min BTPS. Changes in respiratory and metabolic parameters as a function of load are discussed, as is the advice that can be given to the patient regarding physical rehabilitation.

Three patients who had undergone an orthotopic cardiac transplantation followed a course of supervised intermittent physical training (60 to 80 per cent of the maximum load) involving three weekly sessions of thirty minutes, for a period of 150 +/- 80 days. During maximal effort, we observed increases of 50 per cent in the load in watts (0.05 less than p less than 0.1), 40 per cent in oxygen consumption (0.1 less than p less than 0.2), 10 per cent in heart rate (p = 0.5) and 21 per cent in systolic blood pressure (0.7 less than p less than 0.8). The respiratory equivalent for oxygen decreased by 21 per cent (0.025 less than p less than 0.05) and the respiratory quotient by 5 per cent (0.4 less than p less than 0.05). For a given submaximal effort (30 watts) the following decreases were observed: 9 per cent in oxygen consumption (V'O2) (0.1 less than p less than 0.2), 32 per cent in the minute ventilation (V'E) (0.05 less than p less than 0.1), 22 per cent in the respiratory equivalent for oxygen (REO2) (0.025 less than p less than 0.05), 8 per cent in the respiratory quotient (RQ) (0.2 less than p less than 0.3) and 11 per cent in the heart rate (HR) (0.1 less than p less than 0.2). The systolic blood pressure (SBP) increased by 6 per cent (0.2 less than p less than 0.3). No changes were observed in these parameters in the postoperative follow-ups (10 to 24 months) of two patients who did not undergo physical training. Physical training is, therefore, necessary in the process of physical readaptation of patients after orthotopic cardiac grafts.

The authors report a case of a Buschke-Loewenstein tumor located at the anus. Initial treatment with Bleomycin was remarkably effective. A recurrence 3 months later did not respond any more to Bleomycin. Multiple surgical resections were performed in association with this form of chemotherapy.

Introduction Des le debut de l’epidemie du COVID-19, les centres de dialyse de Belgique francophone ont enregistre les cas de maniere a etablir un bulletin epidemiologique en temps reel sur base d’un questionnaire sur support papier d’abord, annexe au registre regional ensuite. Description Epidemiologie du COVID-19 en Belgique francophone entre mars et mai 2020. Methodes Questionnaire patient portant sur la symptomatologie, le diagnostic et les dates-cle de l’evolution : date des premiers symptomes, du test de diagnostique, de l’hospitalisation eventuelle, du deces eventuel et de la sortie d’hospitalisation. Resultats Parmi 3619 patients dialyses au 1/1/2020 en Belgique francophone, 287 (7,9 %) ont presente le COVID-19 avec une repartition tres variable selon les sous-regions et les centres. Deux centres ont enregistre le plus grand nombre de cas (40 sur 64 patients [62,5 %] pour l’un, 35 sur 185 patients pour l’autre [19 %]). Cinquante-deux patients sont decedes (18 %). Suivant les centres, la strategie diagnostique etait la RT-PCR ou la culture virale de depistage systematique. Les deux groupes d’âges les plus atteints etaient les 65–74 ans et 75–84 ans, la toute grande majorite etant des patients en hemodialyse, seuls 8 cas ont ete observes en dialyse a domicile. Chez les patients atteints, les nephropathies primitives les plus frequentes etaient le diabete et les nephropathies hypertensives et les comorbidites principales etaient les cardiopathies ischemiques et congestives (64 %), les troubles de l’autonomie (28 %), les neoplasies sous-jacentes (22 %) et les pathologies pulmonaires, principalement la BPCO (15 %). La duree mediane d’evolution depuis le diagnostic des patients decedes a ete de 8 jours. Conclusion En Belgique francophone entre mars et mi-mai 2020, 7,9 % de la population dialysee a contracte le COVID-19 dont 18 % sont decedes. Le moment d’apparition du virus, des politiques differentes en termes de depistage ou d’isolement, la disponibilite en materiel sont probablement a l’origine de la grande heterogeneite d’incidence observee entre les centres.