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The market of generic drugs is in continuous development in all countries, including Belgium. Their low cost explains their success in western and developed countries. However, clinical concerns have been raised when generics are used. Indeed, various studies suggest that generic substitution can be associated with reduced efficacy or (and) increased side-effects, particularly with drugs used in severe diseases or pathological states such as epilepsy, cardiac arrhythmia, prevention of graft-rejection, ... The generic drugs must have systemic bioavailability similar to that of the original drug. Thus, they have supposed similar therapeutic bioequivalence. However, similar pharmacokinetics does not imply identical therapeutic activity, particularly with drugs having narrow therapeutic indices such as anti-epileptics, anti-arrythmics ... In this case, switchability rather than prescribability may cause problems. Low pharmaceutical quality is more frequent when drugs are produced in certain countries, in some cases causing a real concern when activity and safety are considered.

Like in other medical specialities, training in internal medicine is confronted with the duty hours regulation. A reduction to a maximum of 48 duty hours has been introduced in Belgium in 1999 for all residents and is still under debate in the European Communities. A reduction of duty hours to a maximum of 80 hours per week was recently adopted in the USA. Several surveys were conducted in this country before and after the introduction of the new system to evaluate its impact on training and patient care. A reduction of duty hours appears to improve the mental health and the security and the quality of life of the trainees. On the other hand, it is suspected that reducing training hours can have a negative effect not only on education but also on patient safety and satisfaction giving the fragmentation of care. This appears to be a key problem, particularly in internal medicine, as it implies more frequent transfers of medical information, a source of medical errors and a loss of responsibility.

Studies in which hypolipidemic therapy were used for preventing cardiovascular diseases are analyzed on the basis of the number of patients to treat to avoid a clinical event, one of the most accepted evidence-based medicine criteria. The benefit of treatment appears to be related to the risk profile of the population and to the reduction of LDL-Cholesterol concentration but not to the type of therapy. Total mortality is decreased only when statins are used. Special groups of patients (women, aged patients, diabetics) also appear to benefit from the treatment.

We report a case of association between genetic haemochromatosis and mixed gonadal dysgenesis. To our knowledge, this case is the first reported in the literature. We discuss the mechanisms of hypogonadism observed in this patient.

Lipoprotein(a) has many similarities to low density lipoproteins but possesses a unique protein moiety called apolipoprotein(a). The plasma concentration of lipoprotein(a) is mainly under genetic control and most of diets and hypolipidemic drugs do not change its level. Only nicotinic acid and neomycin are able to reduce its concentration. Epidemiological studies suggest that high level (greater than 30 mg/dl) of lipoprotein(a) is an independent risk factor for atherosclerosis of the coronary and carotid arteries. The risk is highest in patients with hypercholesterolemia. The atherogenic role of lipoprotein(a) is attributed to the lack of its recognition by the cellular receptors and its consequent diversion to the atherogenic "non receptor" pathway. Due to its strong homology with plasminogen, lipoprotein(a) could also favour thrombosis. It is suggested that its determination is of importance when evaluating a patient with atherosclerosis. Reducing high plasma levels of cholesterolemia appears to be mandatory when plasma lipoprotein(a) concentration is higher than 30 mg/dl.

The case reported is the first description of an unusual form of Klippel-Trenaunay syndrome associating total hemihypertrophy to hemimegalencephaly and bilateral extremity enlargement. The patient complaints are related to her lower limb inequality; she presents dizziness, tinnitus and nystagmus which could be unusual consequences of hemimegalencephaly, disclosed at the EEG. Angiodysplasia is mild in regard to the hypertrophy whose cause is discussed.