{"title":"Pathologies proctologiques au cours de la grossesse et en post-partum (hors MICI)","authors":"Charlotte Favreau","doi":"10.1016/j.lpmfor.2024.01.008","DOIUrl":"10.1016/j.lpmfor.2024.01.008","url":null,"abstract":"<div><p>Une femme enceinte sur trois présente des troubles proctologiques au cours de la grossesse et du post-partum.</p><p>La constipation est souvent de mise, facteur de risque pour d’autres pathologies.</p><p>La fissure anale est la lésion la plus fréquemment rencontrée dans le post-partum.</p><p>La thrombose hémorroïdaire externe est également fréquente, souvent trop œdémateuse pour permettre un geste d’incision.</p><p>Les traumatismes obstétricaux peuvent altérer la continence anale, ils ne sont pas toujours évitables et doivent faire l’objet d’une prise en charge spécialisée.</p><p>Il est exceptionnel de devoir opérer en urgence une femme enceinte pour un problème proctologique.</p></div><div><p>One in three pregnant women present proctological disorders during pregnancy or after delivery.</p><p>Constipation is often present; it is a risk factor for proctological pathologies.</p><p>Anal fissure is the most frequent proctological problem during pregnancy and after delivery.</p><p>External hemorrhoidal thrombosis is common, often too edematous to allow an incision procedure.</p><p>Obstetric trauma can impair anal continence; it is not always preventable and must be the subject of specialized care.</p></div>","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"5 1","pages":"Pages 62-66"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139632050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Prise en charge d’une première crise épileptique chez l’adulte","authors":"Stanislas Lagarde , Fabrice Bartolomei","doi":"10.1016/j.lpmfor.2024.01.002","DOIUrl":"10.1016/j.lpmfor.2024.01.002","url":null,"abstract":"","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"5 1","pages":"Pages 70-73"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666479824000028/pdfft?md5=7c79f5c14c0af3fbb12e483f72e503bf&pid=1-s2.0-S2666479824000028-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139455820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bruno Riou , Christian Funck-Brentano , Thomas Similowski , Pierre Corvol
{"title":"SIGAPS, un système dévoyé pour évaluer la recherche en santé","authors":"Bruno Riou , Christian Funck-Brentano , Thomas Similowski , Pierre Corvol","doi":"10.1016/j.lpmfor.2024.01.010","DOIUrl":"10.1016/j.lpmfor.2024.01.010","url":null,"abstract":"","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"5 1","pages":"Pages 3-4"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666479824000107/pdfft?md5=b1e4f557b3c0eb789e6d462f388de0c5&pid=1-s2.0-S2666479824000107-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139539287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Quand et comment traiter des hémorroïdes","authors":"Thierry Higuero","doi":"10.1016/j.lpmfor.2024.01.003","DOIUrl":"10.1016/j.lpmfor.2024.01.003","url":null,"abstract":"<div><p>En cas de maladie hémorroïdaire, on ne traite que les patients qui s’en plaignent.</p><p>Le traitement dépend de la présentation anatomique et des attentes du patient.</p><p>Le traitement médical associant une régularisation du transit, des topiques, et éventuellement des veinotoniques et des antalgiques doit être proposé en première intention pour les grades 1 à 3.</p><p>En cas d’échec, il faut confier le patient au proctologue pour un traitement instrumental qui sera le plus souvent une photocoagulation infrarouge ou une ligature élastique.</p><p>En situation d’échec ou en cas de prolapsus de grade 4, la chirurgie par hémorroïdectomie pédiculaire est le traitement le plus efficace à long terme.</p><p>Les techniques chirurgicales mini invasives ne traitent efficacement que les prolapsus de grade 2 et 3, sont déconseillés en cas de grade 4 et ne fonctionnent pas en cas de maladie hémorroïdaire externe.</p><p>Le choix de la technique opératoire est fait par le chirurgien proctologue en tenant compte des attentes du patient.</p></div><div><p>In the event of haemorrhoidal disease, only symptomatic patients are treated.</p><p>Treatment depends on the anatomical presentation and the patient's expectations.</p><p>First line treatment for grade 1 to 3 haemorrhoids, combines bowel movement regularization, topical treatment and possibly phlebotonics and analgesic.</p><p>In case of failure, the patient has to be referred to the proctologist for an ambulatory procedure that will most commonly be an infrared photocoagulation or a rubber band ligation.</p><p>In case of failure or for grade 4 haemorrhoids, hemorrhoidectomy is the standard of care with the most effective long-term results.</p><p>Minimally invasive surgical techniques only effectively treat grade 2 and 3 prolapses, are not recommended in grade 4 and do not work in case of external hemorrhoidal disease.</p><p>The choice of surgical procedure is made by the proctologist surgeon taking into account the patient's expectations.</p></div>","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"5 1","pages":"Pages 24-30"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139634648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Valentine Marie Ferré , Anne Laurain , Gary M. Clifford , Laurent Abramowitz , Charlotte Charpentier
{"title":"Papillomavirus et cancer anal","authors":"Valentine Marie Ferré , Anne Laurain , Gary M. Clifford , Laurent Abramowitz , Charlotte Charpentier","doi":"10.1016/j.lpmfor.2024.01.011","DOIUrl":"10.1016/j.lpmfor.2024.01.011","url":null,"abstract":"<div><p>– L’incidence des cancers anaux est en augmentation dans les pays à haut niveau de revenu tels que la France.</p><p>– Deux tiers des cancers anaux sont diagnostiqués chez des femmes.</p><p>– Les cancers anaux sont liés dans plus de 90 % des cas à une infection par l’HPV16.</p><p>– Depuis 2023, des recommandations de dépistage systématique de certains groupes à risque de cancer anal ont été émises par Société Nationale Française de Colo-Proctologie :</p><p>• Hommes ayant des relations sexuelles avec des hommes de plus de 30 ans vivant avec le VIH</p><p>• Femmes avec antécédent de lésion pré-cancéreuse ou cancer de la vulve</p><p>• Femmes transplantées d’organe solide depuis plus de 10 ans</p></div><div><p>– Anal cancer incidence is increasing in high-income countries such as France.</p><p>– Two third of anal cancer cases occur in women.</p><p>– HPV16 is responsible for more than 90% of anal cancer cases.</p><p>– Since 2023, new anal cancer screening recommendations have been proposed for asymptomatic patients in at-risk groups by the <em>Société Nationale Française de Colo-Proctologie</em>:</p><p>• Male having sex with men living with HIV older than 30 years-old.</p><p>• Women with previous vulvar lesion or vulvar cancer.</p><p>• Women who have been solid organ transplant recipient for more than 10 years.</p></div>","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"5 1","pages":"Pages 41-52"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139537187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Traiter une fistule anale sans risquer l’incontinence ?","authors":"François Pigot","doi":"10.1016/j.lpmfor.2024.01.006","DOIUrl":"10.1016/j.lpmfor.2024.01.006","url":null,"abstract":"<div><p>Le traitement chirurgical d’une fistule anale est la seule option, qui puisse offrir une guérison sur le long terme.</p><p>Les traitements, essentiellement chirurgicaux, sont très variés dans leur principe.</p><p>Certaines fistules peuvent engendrer des troubles de la continence.</p><p>Les interventions respectant le plus la continence sont celles qui ont le taux de succès le plus bas sur la suppuration.</p><p>L’innovation technique a encore une marge de progression, la chirurgie plus traditionnelle peut s’améliorer.</p></div><div><p>Surgical treatment of an anal fistula is the only option that can offer long-term cure.</p><p>The treatments, essentially surgical, are very varied in their principle.</p><p>Some can cause continence problems.</p><p>The interventions that respect continence the most are those that have the lowest success rate on suppuration.</p><p>Technical innovation still has room for improvement, more traditional surgery can improve.</p></div>","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"5 1","pages":"Pages 36-40"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139633071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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