Revue De Medecine Interne最新文献

{"title":"Interpréter un antibiogramme en pratique clinique à l’hôpital","authors":"Rémi Grandvincent ,&nbsp;Caroline Demeule ,&nbsp;Lucie Amoureux ,&nbsp;Mathieu Blot","doi":"10.1016/j.revmed.2025.12.006","DOIUrl":"10.1016/j.revmed.2025.12.006","url":null,"abstract":"<div><div>The antibiotic susceptibility test (antibiogram) is an essential tool in the treatment of bacterial infections. By guiding the choice of antibiotic based on bacterial susceptibility, it plays a key role in determining therapeutic success. This practical update is intended for clinicians. It covers the principles of how antibiograms are performed, along with the foundations for interpreting their results. Recent changes in EUCAST categorization (S, SFP, R) are explained, with particular emphasis on the concept of “increased exposure” for antibiotics classified as SFP (Susceptible, Increased exposure). The second part focuses on interpreting the antibiogram in a clinical context, taking into account bacteriological, clinical (site of infection, severity, comorbidities), and pharmacological parameters (PK/PD, antibiotic concentration at the infection site). Practical examples of how to use the minimum inhibitory concentration (MIC) are provided to help guide therapeutic decisions. Finally, the specific features of the most frequently encountered bacteria in both outpatient and hospital settings are discussed. This review aims to strengthen prescribers’ competencies in adopting a rational and individualized approach to antibiotic therapy, in the face of the growing challenge of bacterial resistance.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 4","pages":"Pages 200-212"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitesse de sédimentation : repose en paix","authors":"Maxime Samson,&nbsp;Sylvain Audia","doi":"10.1016/j.revmed.2026.02.009","DOIUrl":"10.1016/j.revmed.2026.02.009","url":null,"abstract":"","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 4","pages":"Pages 171-173"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147489111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Un purpura nécrotique","authors":"Manon Hergott,&nbsp;Florence Granel-Brocard,&nbsp;Anne-Claire Bursztejn","doi":"10.1016/j.revmed.2026.02.007","DOIUrl":"10.1016/j.revmed.2026.02.007","url":null,"abstract":"","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 4","pages":"Pages 234-235"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"L’aspergillose bronchopulmonaire allergique pour l’interniste","authors":"Colombe Chedal-Anglay ,&nbsp;Grégoire Martin de Frémont ,&nbsp;Clairelyne Dupin","doi":"10.1016/j.revmed.2026.01.008","DOIUrl":"10.1016/j.revmed.2026.01.008","url":null,"abstract":"<div><div>Allergic bronchopulmonary aspergillosis (ABPA) is a rare respiratory disease. Unlike other pulmonary aspergilloses resulting from an invasive infection by <em>Aspergillus fumigatus</em>, ABPA is a symptomatic colonization due to the allergic and inflammatory reaction. The presence of an underlying bronchial disease and an atopic background predispose to the development of ABPA. The most common clinical manifestation is a productive cough with excretion of bronchial mucus, but other presentations are possible, including poorly controlled asthma with corticosteroid dependence. Diagnosis is based on a combination of clinical, biological and imaging evidence. Internists come across this pathology as a differential diagnosis to the pathologies usually followed in internal medicine, but also as an aggravating factor in the respiratory problems of our patients. Joint management with a respirologist is necessary to avoid irreversible structural and functional sequelae. Treatments target inflammation (corticoids) and/or aspergillosis (antifungals). Biotherapies, currently being evaluated, could in the future complete the therapeutic arsenal.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 4","pages":"Pages 184-193"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147489138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atteinte vasculaire inflammatoire sans aortite dans l’artérite à cellules géantes : à propos de 4 cas","authors":"Jeremy Antoniadis ,&nbsp;Audrey Benyamine ,&nbsp;Estelle Jean ,&nbsp;Pierre-Yves Jeandel ,&nbsp;Aurelie Daumas ,&nbsp;Brigitte Granel ,&nbsp;Quentin Gomes de Pinho","doi":"10.1016/j.revmed.2026.01.006","DOIUrl":"10.1016/j.revmed.2026.01.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Giant cell arteritis (GCA) is the most common vasculitis after the age of 50. Large vessel vasculitis (LVV) is frequently observed in 40 to 70% of cases, primarily affecting the aorta. Extracranial LVV is scarcely described.</div></div><div><h3>Observation</h3><div>We present four cases of LVV-GCA without aortitis. LVV was found in 3 cases on PET-CT showing limb involvement, for the last case, CT scan revealed involvement of mesenteric artery. The diagnosis of GCA was confirmed in three of the four cases by temporal artery biopsy. In the last case, the diagnosis was made after PET-CT analysis and ophthalmological examination with a pathognomonic angiography. Three patients developed corticosteroid dependence and the last one was lost to follow-up.</div></div><div><h3>Conclusion</h3><div>LVV without aortitis evolution is rarely described. We report here 4 cases, 3 of whom became corticosteroid dependent. Larger cohort studies are needed to assess the prognosis and therapeutic impact of this particular phenotype of GCA.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 4","pages":"Pages 224-228"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chez les sujets avec sténose carotidienne sévère asymptomatique, est-ce que la pose d’une endoprothèse carotidienne ou l’endartériectomie carotidienne associée à un traitement médical intensif est plus efficace qu’un traitement médical intensif seul pour prévenir les accidents vasculaires cérébraux ?","authors":"Luc Lanthier ,&nbsp;Alexandre Mutchmore ,&nbsp;Marc-Émile Plourde ,&nbsp;Michel Cauchon","doi":"10.1016/j.revmed.2026.01.011","DOIUrl":"10.1016/j.revmed.2026.01.011","url":null,"abstract":"","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 4","pages":"Pages 231-233"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146260594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Faecal incontinence in systemic sclerosis: A narrative review","authors":"Mickaël Martin ,&nbsp;Van-Minh Nguyen ,&nbsp;Mathieu Puyade ,&nbsp;Florent Broca ,&nbsp;Pascal Roblot","doi":"10.1016/j.revmed.2026.02.001","DOIUrl":"10.1016/j.revmed.2026.02.001","url":null,"abstract":"<div><div>Although associated with impaired health-related quality of life, faecal incontinence (FI) is underscreened in cases of systemic sclerosis (SSc). Its pathophysiology is complex and multifactorial, encompassing vasculopathy, fibrosis and probably (autoimmune) neuropathy. FI prevalence in SSc seems to be 5–6-fold higher than in the age- and sex-matched general population and is severe in nearly 15% of cases. FI is associated with diarrhoea, small intestinal bacterial overgrowth, constipation, urinary incontinence, anticentromere positivity and some features of vasculopathy. FI should be regularly screened in all SSc patients. Simple self-questionnaires are useful tools, completed by meticulous digital rectal exam for anal and puborectalis tone and by neurological examination. In case of unexplained chronic constipation or diarrhoea, endoscopic explorations are mandatory first to search for organic cause. Anorectal manometry is recommended in case of suspected anorectal dysfunction. Management should be multidisciplinary and, in general, follows the recommendations applied to the general population. It consists mainly in diet and lifestyle modifications and biofeedback therapy. Loperamide or laxative/transanal irrigation could be proposed as options in case of chronic diarrhoea or terminal constipation respectively. Nerve stimulation and faecal microbiota transplantation require further studies before conclusions can be drawn.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 4","pages":"Pages 194-199"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147319366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Une calcification dans la fosse nasale","authors":"Ouijdane Zamani,&nbsp;Bassel Saber,&nbsp;Rachida Saouab,&nbsp;Jamal El Fenni,&nbsp;Meriem Boui,&nbsp;Meryem Edderai","doi":"10.1016/j.revmed.2025.10.468","DOIUrl":"10.1016/j.revmed.2025.10.468","url":null,"abstract":"","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 4","pages":"Pages 229-230"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Charge de travail, reconnaissance institutionnelle et sommeil : enquête sur le burn-out des internistes en France","authors":"Thomas El Jammal,&nbsp;Pascal Sève,&nbsp;Yvan Jamilloux","doi":"10.1016/j.revmed.2026.01.001","DOIUrl":"10.1016/j.revmed.2026.01.001","url":null,"abstract":"<div><h3>Objective</h3><div>To estimate the prevalence of burnout among internists practicing in France, identify its determinants, and describe their professional experience based on free-text comments.</div></div><div><h3>Methods</h3><div>A national cross-sectional online survey was conducted at the end of 2024 through the French National Society of Internal Medicine (SNFMI). The questionnaire included a modified burnout inventory (mMBI) and contextual items related to work organization, sleep, and mental health. Severe burnout was defined by a high emotional exhaustion (EE) score<!--> <!-->≥<!--> <!-->27 or a high depersonalization (DP) score<!--> <!-->≥<!--> <!-->10. “Triple impairment” was defined as the combination of high EE, high DP, and low personal accomplishment (PA<!--> <!-->≤<!--> <!-->33). Analyses included comparisons across professional profiles and multivariable logistic regressions. A thematic analysis of free-text comments complemented the quantitative findings.</div></div><div><h3>Results</h3><div>Among 434 respondents (123 residents, 244 attending physicians, 67 academic staff), 58% met criteria for severe burnout and 19% for triple impairment. In the adjusted model, severe burnout was associated with<!--> <!-->≥<!--> <!-->55 working hours per week (aOR 1.82; <em>P</em> <!-->=<!--> <!-->0.018), insufficient recognition (aOR 3.24; <em>P</em> <!-->&lt;<!--> <!-->0.001), altered sleep (aOR 4.37; <em>P</em> <!-->&lt;<!--> <!-->0.001), and psychotropic medication use (aOR 2.56; <em>P</em> <!-->=<!--> <!-->0.014). Over 70% of participants provided at least one free-text comment, most often describing emotional fatigue, loss of meaning, bureaucratization, and lack of consideration, while also emphasizing a strong sense of vocation, teamwork, and commitment to patients.</div></div><div><h3>Conclusion</h3><div>Burnout among French internists is frequent and multifaceted, primarily driven by organizational factors. Simplifying medical work, enhancing institutional recognition, and strengthening professional autonomy appear to be the key levers.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 4","pages":"Pages 174-183"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147570981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic radiologique d’une pneumopathie interstitielle","authors":"Samia Boussouar,&nbsp;Alban Redheuil","doi":"10.1016/j.revmed.2026.01.003","DOIUrl":"10.1016/j.revmed.2026.01.003","url":null,"abstract":"<div><div>Diffuse interstitial lung diseases (ILDs) represent a complex and heterogeneous group of pulmonary disorders, requiring a structured, rigorous, and integrated radiologic approach for accurate diagnosis. High-resolution computed tomography (CT) remains the cornerstone examination, enabling precise identification of elementary lesions and their organization into diagnostic imaging patterns that are critical for etiologic classification. This analysis, guided by the most recent international guidelines, relies on strict technical protocols (thin slices, expiratory and prone acquisitions), longitudinal comparative reading, and systematic multidisciplinary discussion. The recognition of progressive pulmonary fibrosis as a distinct clinical entity with significant prognostic and therapeutic implications underscores the need for consistent and reproducible imaging assessment. Emerging tools such as artificial intelligence and photon-counting CT are enhancing early lesion detection, quantitative analysis, and prognostic stratification, allowing for dynamic evaluation of ILD progression and facilitating more personalized therapeutic strategies. This article aims to provide a structured radiologic interpretation framework based on elementary lesions, their distribution, and their organization into imaging patterns, while addressing common diagnostic pitfalls and incorporating the latest international recommendations.</div></div>","PeriodicalId":54458,"journal":{"name":"Revue De Medecine Interne","volume":"47 4","pages":"Pages 213-223"},"PeriodicalIF":0.9,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}