Hip arthroscopy is a minimally invasive surgical technique, introduced in the 1980s, which has profoundly transformed the management of intra-articular pathologies of this anatomical site. It effectively treats conditions such as labral tears or detachments or femoroacetabular impingement, reducing postoperative pain, complications and recovery times. Initially limited to simple diagnostic procedures, it has evolved thanks to technological advances towards more complex interventions, such as labral reinsertion, femoroplasty or the management of cartilage and ligament lesions. This clinical case illustrates its effectiveness: a 25-year-old young athlete suffering from a labral lesion and a CAM effect (due to an osseous asphericity of the femoral head) underwent arthroscopic labral suture, with complete disappearance of pain and a marked functional improvement (Harris score increased from 65 to 91). Scientific data confirm these results, showing high rates of return to sport, lasting improvement in articular function and a low rate of complications, consolidating arthroscopy as the benchmark in modern orthopedic surgery.
Total hip arthroplasty (THA) is the standard treatment for osteoarthritis of the hip, aseptic osteonecrosis of the femoral head and specific hip fracture. Adverse tissue reactions to metal debris are feared in total hip replacements using the metal-on-metal bearing surfaces. They can result in local and systemic toxicity or local hypersensitivity to metal. Additional investigations, including blood tests, radiography and nuclear magnetic resonance imaging (RMN), are essential to establish the diagnosis. Surgical revision of the prosthesis or the friction torque could be necessary.
Stress fractures of the femoral neck account for 2-5 % of all stress fractures in athletes, and generally affect military recruits and endurance athletes. The initial symptomatology is insidious, with atraumatic coxalgia, not always inguinal, occurring in a context of intensifying sports activity and relieved by rest. After standard X-ray, MRI is the second-line examination of choice for early diagnosis of this type of fracture. Non-surgical management consists of a period of unloading, followed by a gradual resumption of physical activity in the broad sense, and then of the activity in question. Surgical management involves osteosynthesis by triple screw fixation or Dynamic Hip Screw (DHS). If left untreated, secondary displacement may occur, with delayed or non-union callus or avascular osteonecrosis of the femoral head. These fractures are high-risk stress fractures, with a high risk of complications. This underlines the importance of correct, early diagnosis and treatment, given the potentially dramatic consequences, especially in young patients, with a long time to full recovery.
This issue of the Revue Médicale de Liège highlights the diversity of clinical situations encountered in daily practice, ranging from life-threatening emergencies to rare complications of modern therapies. These reports emphasize the importance of rigorous clinical reasoning, multimodality imaging and multidisciplinary management in optimizing patient care and safety.
Austrian syndrome is characterized by the triad of pneumonia, meningitis, and endocarditis due to Streptococcus pneumoniae («pneumococcus»). Endocarditis, often occurring in the background, is frequently diagnosed late and requires prompt medical and sometimes surgical management. We report the case of a 51-year-old man admitted for confusion. The initial evaluation revealed bacterial meningitis documented by purulent cerebrospinal fluid, associated with right basal pneumonia. Blood cultures and cerebrospinal fluid cultures identified Streptococcus pneumoniae. The clinical course was marked by hemodynamic deterioration with circulatory shock, multiorgan failure, and cardiac arrhythmias, prompting the performance of transoesophageal echocardiography. This revealed aortic valve endocarditis complicated by a mitro-aortic curtain abscess and severe aortic regurgitation due to valvular perforation. Intensive care management with targeted antibiotic therapy and urgent valve surgery was required. This case illustrates the importance of systematically investigating for endocarditis in any patient with pneumococcal meningitis, particularly when pneumonia is present, to avoid diagnostic delay with potentially fatal consequences.
Poisoning with Taxus baccata (common yew) is a life-threatening emergency due to its major cardiotoxicity. The taxines it contains block cardiac sodium channels, rapidly leading to severe arrhythmias, cardiogenic shock, and often cardiac arrest. Management is exclusively symptomatic and relies on intensive hemodynamic support, including advanced resuscitation and, in some cases, the use of extracorporeal circulatory support (ECMO). The administration of antidotes such as DigiFab®, although experimental and not formally validated for this indication, may be considered based on pharmacological analogies with digoxin.
Gradenigo's Syndrome is a rare but potentially serious complication of an otitis media. It associates an otitis media, along with retro-orbital pain and abducens nerve palsy. We report the case of a thirtheen-year-old female adolescent, with no particular medical history, who presented with this syndrome in the context of acute otitis media evolving over 8 days. The infection also caused a facial palsy and a mixed hearing loss. Early medical and surgical management led to a favourable outcome. This case highlights the need to keep in mind the potential neurological complications of acute otitis media, even though they have become extremely rare with the advent of antibiotic therapy.
Immunotherapy has become the treatment of choice in a lot of metastatic diseases including melanoma, improving the prognosis. However, there are a lot of specific and multisystemic side effects. We report the case of a 68-year-old woman treated with combined immunotherapy for a metastatic melanoma who presented a severe right eye sight loss due to a papillary edema.
Bicuspid aortic valve (BAV) is the most common congenital heart disease. It is often associated with aortic abnormalities and, more rarely, with coronary anomalies that may influence surgical strategy. We describe a 38-year-old patient with a Sievers type I BAV. Coronary CT angiography revealed an abnormally high proximal origin of the right coronary artery, with a 10 mm ectatic dilation at its origin followed by a return to normal caliber. This feature prompted a change in operative strategy: mechanical aortic valve replacement instead of a Ross procedure, more distal aortic clamping, and a «lazy-S» aortotomy. The procedure was completed without complications. Coronary anomalies are more frequent in patients with BAV than in the general population. Their preoperative identification is essential to prevent intraoperative complications. Multimodal imaging plays a key role in optimizing surgical planning in line with current recommendations. Coronary anomalies associated with BAV should be systematically screened for before any valve surgery. This case highlights the importance of thorough preoperative assessment and appropriate technical adaptation to ensure operative safety.
Carbon monoxide poisoning is one of the most common types of intoxication and is linked to a high mortality rate when not managed appropriately. We are discussing the case of a patient found unconscious after a house fire, presenting a smoke inhalation injury and particularly carbon monoxide poisoning. The clinical course was marked by the development of a massive bilateral pulmonary embolism despite thromboprophylaxis. This case highlights the increased thromboembolic risk, which can persist up to 90 days after carbon monoxide poisoning. We analyse the cardiovascular manifestations while focusing on the thromboembolic risks. Finally, we provide a brief overview of the pathophysiology and management of this condition.
Tibiotalar osteoarthritis, uncommon and often of post-traumatic origin, leads to functional limitations, chronic pain and significantly impairs the quality of life. Both tibiotalar arthrodesis and arthroplasty have been proven effective. Tibiotalocalcaneal (TTC) arthrodesis is generally reserved for ankle osteoarthritis associated with severe degeneration of the subtalar joint and hindfoot. Nevertheless, new data showed good outcomes regardless of the subtalar joint state. We present the clinical case of an 86-year-old female patient with severe tibiotalar osteoarthritis after a failed osteosynthesis. She underwent successfully TTC arthrodesis using a retrograde intramedullary nail.
Each year, in Belgium and Europe, thousands of contraceptive implants are inserted, representing an effective and long-lasting method of contraception. Their ease of use and prolonged duration of action make them a preferred choice for many women. However, although complications are rare, they do exist. Among these, implant migration is one of the most concerning. Its incidence remains extremely low, estimated at approximately 1 case per 100,000. In most cases, this migration is asymptomatic, but it can sometimes cause alarming symptoms. These may include dyspnea, hemoptysis, or, in rare cases, potentially serious vascular injuries. Once the implant becomes endothelialized, its removal becomes more complex. In such situations, therapeutic management must be tailored to the patient's clinical profile and the precise location of the implant. Options range from active surveillance to complex surgical interventions, especially in cases where attempts at removal using endovascular techniques, such as interventional radiology, have failed.
Ankle fractures are among the most common pediatric fractures, especially during the transitional period. They can lead to growth arrest, which is why careful attention is required when interpreting radiographs. This article discusses the case of an 11-year-old patient who sustained a rotational injury to the left ankle. Initially protocoled as negative, a second review of the radiographs supplemented by a CT scan revealed a Salter-Harris type II fracture of the distal tibia with 90° external rotation, associated with a non-displaced fibula fracture. Treatment consisted of a closed reduction and cast immobilization. Follow-up revealed a growth arrest of the tibial physis at 6 months, leading to a preventive epiphysiodesis of the contralateral ankle. This case highlights the diagnostic challenges of rotational fractures, which are often underestimated in imaging. It also underlines the importance of clinical examination, which remains the clinician's primary tool. Finally, close monitoring of this type of fracture is essential due to its high risk of growth disturbance.
Breast cancer is often treated with tamoxifen, a drug that can cause ocular side effects, including toxic retinopathy. Multimodal imaging, particularly optical coherence tomography (OCT), has improved the detection of early lesions such as foveal pseudocysts, thus increasing the prevalence of this complication. We present a case of tamoxifen-induced retinopathy in a patient treated for four years who developed decreased visual acuity with irreversible retinal lesions in the right eye despite discontinuation of the treatment. OCT was essential in characterizing the lesions. The pathophysiology remains poorly understood, but involvement of Müller cells and glutamate accumulation in the retinal pigment epithelium are suspected. Toxicity depends on cumulative dose, duration of treatment, and individual factors. Initial ophthalmologic screening and regular OCT monitoring are recommended to detect retinal damage early. In case of lesions, substitution with an aromatase inhibitor is often considered to limit lesion progression and preserve vision.
Thrombotic thrombocytopenic purpura (TTP) is a rare microangiopathy characterized by mechanical hemolytic anemia, thrombocytopenia, and multiorgan dysfunction, resulting from a severe deficiency of ADAMTS13. Among its rare forms, paraneoplastic TTP remains poorly described. We report here the case of a patient in the intensive care unit presenting with paraneoplastic TTP associated with metastatic prostate cancer. This case illustrates the diagnostic challenge posed by the interplay of multiple mechanisms and allows discussion of the different therapeutic options according to the type of TTP, including the role of plasma exchange in paraneoplastic TTP.
Nearly half of all tumours are attributable to potentially modifiable behavioural, environmental, and occupational risk factors. Strengthening preventive strategies is therefore essential to reduce the morbidity and mortality associated with these cancers. This article summarizes the risk factors on which we can act preventively, both individually and collectively. It then addresses the topics of screening and interception, other cornerstones of cancer care.
In a context characterised by the emergence and re-emergence of infectious diseases, as well as the anticipated recurrence of health crises, vaccination remains a cornerstone of preventive public health. However, its effectiveness continues to be undermined by vaccine hesitancy, a multifaceted phenomenon shaped by a wide range of determinants. This situation underscores the need to design and implement more integrated vaccination strategies that extend beyond a strictly biomedical approach. The operational principles of the One Health approach, which emphasise intersectoral and interdisciplinary collaboration, the sharing of knowledge and resources, and effective communication and information exchange, offer a particularly relevant framework for rethinking vaccination policies and addressing vaccine hesitancy. By fostering more context-sensitive, inclusive, and acceptable strategies, this approach can contribute to improving population vaccination coverage.
Diet is a major determinant of health and an essential lever for preventing non communicable diseases. However, it cannot be understood independently from the food systems that shape food supply, prices, accessibility, and attractiveness, and that simultaneously contribute to environmental pressures. Recent research highlights a growing convergence between public health objectives and ecological sustainability, prompting an expanded analysis of the role of food environments in structuring individual choices. In this context, nutritional guidelines are evolving and now promote a predominantly plant based, minimally processed diet that is compatible with sustainable production methods. Nevertheless, the social sciences remind us that eating practices remain shaped by cultural, economic, and social determinants, and that inequalities in access to healthy and sustainable food persist. For medical practice, these perspectives call for embedding nutritional support within the material and cultural realities of patients and for recognizing food environments as full fledged determinants of health. Understanding these interdependencies strengthens the coherence, effectiveness, and equity of nutritional prevention strategies.
This article examines the prescription of nature as a tool for promoting health in primary care, based on a pilot project conducted in a health center in the Liège region. Although not yet officially recognized by the social security in Belgium, this approach involves healthcare professionals prescribing time spent in nature in order to influence health determinants. The experiment, involving 89 patients, shows that these prescriptions mainly concern mental health and social isolation issues, with significant support from healthcare professionals and patients. It highlights the strategic role of primary care as an interface between healthcare, local areas, and community resources, while revealing the challenges associated with collaboration between the health and environmental sectors. Nature prescriptions thus appear to be an innovative approach, allowing us to question the reorientation of practices towards a more holistic conception of health while opening prospects for co-benefits for human and environmental health.
The environmental impact of pharmaceuticals mainly stems from their carbon footprint across the life cycle and their ecotoxicity once released into ecosystems. Technological advances in the pharmaceutical industry are gradually lowering greenhouse gas emissions. Drug residues found in water, soil, and air arise mainly from industrial discharges, improper disposal of expired or unused medicines and the excretion of active compounds or metabolites, as wastewater treatment remains incomplete. The actual impact of pharmaceutical residues in the environment is still partly unknown. To mitigate ecotoxicity, the development of greener active pharmaceutical ingredients and improved wastewater treatment are being explored. Prescribers and users can also adopt more environmentally responsible practices. This article aims to raise awareness of these environmental concerns and outline pathways toward more sustainable medication use.
