La Presse Médicale Formation最新文献

{"title":"Quand et comment traiter une fissure anale et ses facteurs déclenchant","authors":"Agnès Senéjoux","doi":"10.1016/j.lpmfor.2024.01.007","DOIUrl":"10.1016/j.lpmfor.2024.01.007","url":null,"abstract":"<div><p>Toute douleur anale nécessite un examen clinique.</p><p>La fissure anale est une cause très fréquente de douleur anale et ne doit pas être confondue avec une crise hémorroïdaire.</p><p>La fissure anale est habituellement aiguë, bénigne et d’évolution spontanément favorable mais elle peut parfois devenir chronique.</p><p>Le diagnostic de fissure anale est suspecté très facilement dès l’interrogatoire devant une douleur anale déclenchée par la défécation.</p><p>Le traitement d’une fissure anale est médical en première intention et associe la régularisation du transit, les antalgiques et les topiques cicatrisants.</p><p>Les crèmes visant à traiter l’hypertonie sphinctérienne aux dérivés nitrés ou aux inhibiteurs calciques sont des traitements de deuxième intention, proposés pour les fissures chroniques.</p></div><div><p>Anal pain always requires a clinical examination.</p><p>Anal fissure is a very common cause of anal pain and should not be confused with hemorrhoidal crisis.</p><p>Anal fissure is usually acute, benign and spontaneously regressive but it can sometimes become chronic.</p><p>The diagnosis of anal fissure is suspected very easily when anal pain is triggered by defecation.</p><p>Treatment of anal fissure is medical in first instance and combines regularization of transit, analgesics and healing topicals.</p><p>Creams targeting sphincter hypertonia with nitroglycerin or calcium channel blockers are second-line treatments, proposed for chronic fissures.</p></div>","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"5 1","pages":"Pages 31-35"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139633084","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":"Recommandations vaccination du voyageur : quoi de neuf en 2023?","authors":"Nathalie Dournon ,&nbsp;Elisabeth Rouveix ,&nbsp;Ségolène Perrineau ,&nbsp;Christel Mamona Kilu","doi":"10.1016/j.lpmfor.2023.11.003","DOIUrl":"10.1016/j.lpmfor.2023.11.003","url":null,"abstract":"<div><p>1. Encéphalite japonaise: élargissement des indications et schéma accéléré</p><p>2. Rage: Schéma de vaccination accéléré</p><p>3. Typhoïde : vaccination par voie orale</p><p>4. Fièvre jaune : pas de rappel nécessaire</p><p>5. N’oublions pas l’hygiène des mains et la lutte anti vectorielle</p></div><div><p>Japanese encephalitis: expanded indications and accelerated schedule</p><p>Rabies: accelerated vaccination schedule</p><p>Typhoid: oral vaccination</p><p>Yellow fever: no booster required</p><p>Don’t forget hand hygiene and vector control</p></div>","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"5 1","pages":"Pages 5-9"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139021304","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 des lésions anopérinéales de la maladie de Crohn","authors":"Aurore Carlo ,&nbsp;Charlène Brochard","doi":"10.1016/j.lpmfor.2024.01.009","DOIUrl":"10.1016/j.lpmfor.2024.01.009","url":null,"abstract":"<div><p>Vingt-cinq pour cent des patients porteurs d’une maladie de Crohn développeront des lésions anopérinéales.</p><p>Les lésions anopérinéales de la maladie de Crohn impactent fortement la qualité de vie des patients.</p><p>Le traitement des fistules anopérinéales est médicochirurgical. Il repose notamment sur une combothérapie associant anti-TNF alpha et immunosuppresseurs en première intention.</p><p>Il est préconisé de réaliser une IRM pelvienne afin d’évaluer l’efficacité du traitement à 6/12 mois de la prise en charge.</p><p>Les techniques d’épargne sphinctérienne sont à privilégier mais reste décevantes.</p><p>Les injections de cellules souches adipocytaires semblent être une piste intéressante pour traiter les fistules anales en lien avec une maladie de Crohn.</p></div><div><p>Twenty-five percent of patients with Crohn's disease will develop anoperineal lesions.</p><p>Anoperineal lesions in Crohn's disease have a major impact on patients’ quality of life.</p><p>Anoperineal fistulas are treated medico-surgically. It relies in particular on a combination of anti-TNF alpha and immunosuppressants as first-line therapy.</p><p>Pelvic MRI is recommended to assess treatment efficacy six to twelve months after treatment.</p><p>It is preferable to perform sphincter-sparing techniques but results are disappointing.</p><p>Adipose-derived stem cells are an interesting alternative in the treatment of complex anoperineal fistulas in Crohn's disease.</p></div>","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"5 1","pages":"Pages 53-61"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139539480","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":"Ours redaction","authors":"","doi":"10.1016/S2666-4798(24)00014-4","DOIUrl":"https://doi.org/10.1016/S2666-4798(24)00014-4","url":null,"abstract":"","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"5 1","pages":"Page i"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666479824000144/pdfft?md5=8ebdeaeb745ba0f222ea1b6022a4809f&pid=1-s2.0-S2666479824000144-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139744289","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":"Les IEC sont contre-indiqués dans le traitement de l’HTA chez l’insuffisant rénal","authors":"Léo Drapeau ,&nbsp;Guillaume Lamirault","doi":"10.1016/j.lpmfor.2024.01.012","DOIUrl":"https://doi.org/10.1016/j.lpmfor.2024.01.012","url":null,"abstract":"","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"5 2","pages":"Pages 161-164"},"PeriodicalIF":0.0,"publicationDate":"2024-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140321644","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":"Syndrome de Poland : une entité rare à connaître","authors":"Meryem Benmoussa,&nbsp;Abir Lemrabet,&nbsp;Siham El Haddad,&nbsp;Nazik Allali,&nbsp;Latifa Chat","doi":"10.1016/j.lpmfor.2023.12.001","DOIUrl":"10.1016/j.lpmfor.2023.12.001","url":null,"abstract":"","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"5 2","pages":"Pages 168-169"},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139013103","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":"Cardiologie connectée : sommes-nous à l’aube d’un changement de paradigme ?","authors":"Claude Kouakam ,&nbsp;Gérard Lorette ,&nbsp;Claire Mounier-Vehier ,&nbsp;Francis Bonnet ,&nbsp;Geneviève Plu-Bureau ,&nbsp;Corinne Challeton","doi":"10.1016/j.lpmfor.2023.11.001","DOIUrl":"10.1016/j.lpmfor.2023.11.001","url":null,"abstract":"","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"4 6","pages":"Pages 503-506"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135509912","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":"CV1 / Sommaire","authors":"","doi":"10.1016/S2666-4798(23)00225-2","DOIUrl":"https://doi.org/10.1016/S2666-4798(23)00225-2","url":null,"abstract":"","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"4 6","pages":"Page CO1"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666479823002252/pdfft?md5=3e1338764e0a79c3c131743643924bee&pid=1-s2.0-S2666479823002252-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138471836","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":"Prédispositions génétiques aux cancers du sein et de l’ovaire : quand y penser ? Comment les rechercher ? Pour quelle prise en charge ?","authors":"Claire Saule,&nbsp;Emmanuelle Mouret-Fourme","doi":"10.1016/j.lpmfor.2023.10.019","DOIUrl":"10.1016/j.lpmfor.2023.10.019","url":null,"abstract":"<div><p></p><ul><li><span>•</span><span><p>Les prédispositions génétiques au cancer du sein et/ou de l’ovaire sont rares : expliquant environ 5–10 % des cancers du sein et 10–20 % des cancers de l’ovaire.</p></span></li><li><span>•</span><span><p>En cas de suspicion de prédisposition héréditaire, l’analyse génétique actuellement recommandée correspond à une analyse en panel de gènes incluant 13 gènes de prédisposition aux cancers du sein et/ou de l’ovaire. Lorsque qu’un variant pathogène est identifié, il s’agit le plus souvent des gènes <em>BRCA1</em>, <em>BRCA2</em> puis <em>PALB2</em>. Les autres prédispositions génétiques sont beaucoup plus rares.</p></span></li><li><span>•</span><span><p>Les variants pathogènes constitutionnels des gènes <em>BRCA1</em> et <em>BRCA2</em> confèrent un risque de cancer du sein très élevé au cours de la vie de 69 à 72 % et un risque élevé de cancer l’ovaire de 17 à 44 %.</p></span></li><li><span>•</span><span><p>Le dépistage radiologique mammaire renforcé commence à 30 ans et comprend une IRM mammaire annuelle associée dans le même temps à une mammographie (1 incidence oblique externe par sein)<!--> <!-->±<!--> <!-->échographie mammaire. L’IRM mammaire annuelle systématique est poursuivie jusqu’à 65 ans. La mastectomie bilatérale préventive est une option dans la prise en charge à partir de 30 ans.</p></span></li><li><span>•</span><span><p>Il n’existe pas à ce jour de dépistage d’efficacité démontrée pour le cancer ovarien. Aussi, une annexectomie bilatérale préventive (chirurgie pelvienne de réduction de risque) est recommandée à 40 ans pour les femmes porteuses d’une prédisposition <em>BRCA1</em>, pouvant être différée à 45 ans dans le cadre de <em>BRCA2</em>.</p></span></li><li><span>•</span><span><p>Pour les femmes indemnes de cancer, porteuses d’un variant constitutionnel de <em>BRCA1/2</em>, le statut génétique ne constitue pas à soit seul une contre-indication à une contraception hormonale, à une prise en charge en Assistance médicale à la procréation ou à la prise d’un traitement hormonal de la ménopause.</p></span></li></ul></div><div><p></p><ul><li><span>•</span><span><p>Hereditary breast and/or ovarian cancer is rare: 5–10% of breast cancers and 10–20% of ovarian cancers.</p></span></li><li><span>•</span><span><p>Panel of 13 genes of predisposition for breast and/or ovarian cancer: the most common are <em>BRCA1</em>, <em>BRCA2</em> and <em>PALB2</em>. The others are very rare.</p></span></li><li><span>•</span><span><p>Germline <em>BRCA1</em> pathogenic variant and <em>BRCA2</em>: cumulative lifetime risk of breast cancer 72 and 69% and cumulative risk of ovarian cancer 44 and 17% respectively.</p></span></li><li><span>•</span><span><p>Enhanced breast radiological surveillance starting at age 30 with annual breast MRI combined with 1 breast incidence mammography<!--> <!-->±<!--> <!-->breast ultrasound at the same time. Systematic MRI is stopped at age 65. Preventive bilateral mastectomy is an option in","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"4 6","pages":"Pages 541-549"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136009108","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":"Analyse génétique tumorale : intérêt, principales indications et risque d’identification de variants constitutionnels","authors":"Camille Tlemsani ,&nbsp;Eric Pasmant","doi":"10.1016/j.lpmfor.2023.10.024","DOIUrl":"10.1016/j.lpmfor.2023.10.024","url":null,"abstract":"<div><p>L’identification de variants génétiques somatiques par séquençage de nouvelle génération sur prélèvements tumoraux guide de plus en plus la prise en charge des patients atteints de cancers, avec l’identification de potentielles cibles thérapeutiques. Cette analyse est recommandée en première intention pour de nombreux cancers comme les cancers coliques métastatiques, les cancers du sein, de l’ovaire, les mélanomes ou encore les cancers pulmonaires. Pour d’autres localisations tumorales, ces analyses peuvent être recommandées en seconde intention ou après épuisement de l’ensemble des ressources thérapeutiques conventionnelles. Le séquençage du matériel génétique tumoral peut conduire à l’identification d’un variant constitutionnel prédisposant au cancer. Le risque de retrouver une anomalie constitutionnelle prédisposant au cancer est estimé de 2 % à 10 %, quel que soit le cancer, en fonction des séries publiées. Différentes situations en analyses tumorales peuvent faire suspecter un variant constitutionnel pathogène et nécessitent d’informer les patients.</p></div><div><p>The identification of somatic variants by next-generation sequencing on tumor samples is increasingly guiding the management of patients with cancers in clinical routine with the identification of potential personalized treatments. This molecular analysis are recommended at the beginning of the treatment for certain cancers such as metastatic colon cancers, breast cancers, ovarian cancers, melanomas and lung cancers. For other tumor locations, these analyzes may be recommended in second intention or after exhaustion of all conventional therapeutic resources. Sequencing tumor genetic material may lead to the identification of a constitutional variant predisposing to cancer. Tumor sequencing can lead to the identification of a germline variant predisposing to cancer. The risk to identify a tumor-predisposing variant is estimated from 2% to 10%, whatever the subtype of cancer. Different situations may suggest that a pathogenic germline variant should be suspected and an information should be provided to patients.</p></div>","PeriodicalId":100859,"journal":{"name":"La Presse Médicale Formation","volume":"4 6","pages":"Pages 535-540"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136009634","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}