{"title":"Risques liés au tabagisme en chirurgie générale et digestive","authors":"T. Bège, S.-V. Berdah, V. Moutardier, C. Brunet","doi":"10.1016/j.jchir.2009.10.009","DOIUrl":"10.1016/j.jchir.2009.10.009","url":null,"abstract":"<div><p>Longtemps négligé par les chirurgiens, le tabagisme périopératoire est une donnée importante de la prise en charge des patients en chirurgie générale. Tout d’abord, le tabagisme favorise la survenue de pathologies pouvant conduire à une intervention de chirurgie générale. Ensuite, il a été démontré que les fumeurs ont une augmentation des risques opératoires, avec une majoration du risque de mortalité, de morbidité et un allongement de la durée d’hospitalisation. En chirurgie générale, le risque porte principalement sur les fistules anastomotiques, les infections profondes et les complications pariétales. Enfin, l’importance d’une prise en charge du tabagisme est soulignée par le fait qu’un sevrage préopératoire réduit l’ensemble de ces complications. Le chirurgien doit donc connaître les modalités du sevrage tabagique et ne doit pas hésiter à retarder de quatre à huit semaines une intervention non urgente pour que le patient bénéficie pleinement du sevrage tabagique.</p></div><div><p>Peri-operative smoking history is an important risk factor, which is often under-appreciated by surgeons. In the first place, tobacco use predisposes patients to specific pathologies, which may require surgical intervention. Secondarily, smoking has been shown to increase surgical risks of mortality, morbidity and length of hospital stay. Of particular importance in general surgery is the increased risk of anastomotic leak with fistula formation, of deep infections, and of abdominal wall complications (infection and ventral hernia). If the patient can stop smoking prior to surgery, there is a concomitant decrease in post-operative complications. Surgeons should be familiar with the pharmacologic and behavioral interventions, which may help the patient with smoking cessation and should not hesitate to defer elective surgery for four to eight weeks so that the patient may have the full benefit of smoking cessation.</p></div>","PeriodicalId":56281,"journal":{"name":"Journal De Chirurgie","volume":"146 6","pages":"Pages 532-536"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jchir.2009.10.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28502677","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":"Peut-on combiner la cure d’une hernie inguinale et celle de l’hypertrophie de prostate dans le même temps opératoire ?","authors":"L. Guy","doi":"10.1016/j.jchir.2009.10.003","DOIUrl":"10.1016/j.jchir.2009.10.003","url":null,"abstract":"","PeriodicalId":56281,"journal":{"name":"Journal De Chirurgie","volume":"146 6","pages":"Pages 523-524"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jchir.2009.10.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28523399","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":"Revue de presse","authors":"","doi":"10.1016/j.jchir.2009.10.008","DOIUrl":"https://doi.org/10.1016/j.jchir.2009.10.008","url":null,"abstract":"","PeriodicalId":56281,"journal":{"name":"Journal De Chirurgie","volume":"146 6","pages":"Pages 583-590"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jchir.2009.10.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137201147","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":"Actes de l 'Académie","authors":"","doi":"10.1016/j.jchir.2009.10.011","DOIUrl":"https://doi.org/10.1016/j.jchir.2009.10.011","url":null,"abstract":"","PeriodicalId":56281,"journal":{"name":"Journal De Chirurgie","volume":"146 6","pages":"Pages e1-e22"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jchir.2009.10.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137186083","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":"Méfiez vous du TEP-scan en cas de cancer sur maladie inflammatoire chronique de l’intestin","authors":"T. Bonaventure , D. Goéré , V. Boige , M. Pocard","doi":"10.1016/j.jchir.2009.10.006","DOIUrl":"10.1016/j.jchir.2009.10.006","url":null,"abstract":"<div><p>La tomodensitométrie par émission de positons, couplée à la tomodensitométrie (TEP-TDM) a été proposée comme bilan initial préthérapeutique des cancers digestifs dont l’aspect radiologique est équivoque. La TEP-TDM a également été proposé comme bilan d’évaluation des maladies inflammatoires chroniques de l’intestin (MICI). Nous rapportons ici le cas d’un patient atteint d’une MICI, chez qui a été diagnostiqué un cancer du rectum et dont l’extension tumorale a été surestimée par la TEP-TDM. Il s’agissait d’hyperfixations faussement positives, liées à la MICI. Cette observation souligne l’importance de l’analyse de la TEP-TDM, en fonction des pathologies associées, chez les patients atteints d’un cancer.</p></div><div><p>PET-CT scanning has been proposed as part of the pre-treatment evaluation of GI cancers with equivocal radiologic findings. PET-CT has also been prosposed for the evaluation of patients with chronic inflammatory bowel disease (IBD). We report the case of a patient with IBD and a new diagnosis of rectal cancer; PET-CT overestimated the degree of tumor extension due to false-positive increased uptake in areas of chronic inflammation from IBD. This observation underlines the need for cautious interpretation of PET-CT results for cancer in patients with associated inflammatory illness.</p></div>","PeriodicalId":56281,"journal":{"name":"Journal De Chirurgie","volume":"146 6","pages":"Pages 579-582"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jchir.2009.10.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28502679","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":"La place du patient dans la médecine factuelle","authors":"J. Carretier , A. Bataillard , B. Fervers","doi":"10.1016/j.jchir.2009.10.016","DOIUrl":"10.1016/j.jchir.2009.10.016","url":null,"abstract":"<div><p>Les pratiques médicales ont connu ces dernières années deux évolutions importantes : d’une part, le développement du concept de l’<em>evidence-based medicine</em> (EBM) et, d’autre part, une modification de la relation entre les professionnels de santé et les malades ou usagers du système de santé. Dans cette mise au point, sont discutées, l’hétérogénéité et la variabilité des préférences des patients ainsi que l’importance de la relation médecin–malade qui devrait correspondre à un modèle de décision partagée plutôt que celui de décision paternaliste ou même de décision informée. Ainsi selon le concept moderne, l’EBM ne s’intéresse plus à la seule maladie mais aussi et surtout au malade. L’information est un droit et permet de faire participer le patient à la décision médicale ainsi qu’à la rédaction de recommandations pour la pratique clinique. Ces aspects du rôle du patient sont illustrés par un exemple en cancérologie qui permet aux patients de participer à la décision arrêtée lors des réunions de concertation pluridisciplinaire.</p></div><div><p>Medical practice has undergone a significant evolution over the last decade due to two important factors: (1) the theory and practice of Evidence-Based Medicine (EBM) has become widely established; (2) the relationship between health-care professionals and patients or clients has been profoundly modified. In this review, we discuss the heterogeneity and variability of patient preference and the need to develop a doctor–patient relationship, which facilitates shared decision-making in preference to previous models based on patient information without choice and paternalistic attitudes. Thus, this modern concept of care based on EBM shifts the focus of interest from the disease entity itself to that of the patient suffering from a disease. The patient has a right to information concerning his illness; this information helps the patient to participate in medical decisions through the laying out of clinical practice guidelines. These aspects of the patient's role in care management are illustrated by a national program in the field of oncology which empower the patient in the decisions arrived at by a multi-disciplinary oncology team.</p></div>","PeriodicalId":56281,"journal":{"name":"Journal De Chirurgie","volume":"146 6","pages":"Pages 537-544"},"PeriodicalIF":0.0,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jchir.2009.10.016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28505501","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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