Revue Du Praticien最新文献

CHALLENGES OF LONG-TERM FOLLOW UP FOR HODGKIN LYMPHOMA SURVIVORS. Challenge of Hodgkin lymphoma care is to obtain a high level of curability and minimize acute toxicities and long-term complications of chemotherapy and radiotherapy. A specific long-term multi-disciplinary follow-up should be organize with an important place of general practitioners. The follow-up concerns the risk of second cancer especially breast cancer and treatment-related cardiovascular diseases. In addition, a careful attention concerns some possible negative effects of the disease and treatments on psychosocial status and quality of life of Hodgkin lymphoma survivors.

Relapse of hodgkin's lymphoma: 2ND AND SUBSEQUENT LINE TREATMENTS. Patients who fail first-line treatment can be cured with salvage chemotherapy followed by intensified therapy and hematopoietic stem cell autotransplantation. This treatment strategy is feasible for patients who are eligible based on their age, with chemosensitive disease and associated comorbidities. There is no standard of care for salvage chemotherapy, but patients who are in complete remission prior to transplantation have the best prognosis. Combinations of salvage therapy, including new molecules, have shown interesting results, but without comparative trials. The use of brentuximab vedotin as a maintenance treatment post autotransplant has been evaluated for patients at high risk of relapse, resulting in a significant improvement in progression-free survival. Allograft is a curative option for postautotransplant relapse; however, immunotherapy with antiPD1 calls into question the role and timing of allograft.

NEW ANTIBIOTICS TO DEAL WITH ANTIBIOTIC RESISTANCE. The current increase in antibiotic resistance exposes to the risk of therapeutic impasse. To deal with this public health problem, developing new antibiotics that are effective (directly or in combination with older drugs) against these multi-resistant bacteria seems important. Over the last 10 years, new drugs (beta-lactams, beta-lactamase inhibitors, cyclin and carbapenems) have been developed against Gram-negative bacteria. A new oxazolidinone, two glycopeptides and a quinolone have been developed against Gram-positive bacteria. Their use must absolutely be controlled to avoid resistance mechanisms emergence.

Sleep in intensive care: A CRUCIAL BUT LITTLE-KNOWN ISSUE. Polysomnography is the best tool to study sleep in intensive care unit (ICU), but this recording is complex to perform in such environment. Sleep alterations in ICU patients are specific and include electroencephalographic abnormalities during sleep and wake, rendering sleep scoring more complicated. Severe deficit in deep sleep, rapid eye movement sleep and an important sleep fragmentation are reported by most studies. Sleep cycles are disorganized with many sleep episodes during daytime. Sleep disruptions result from light levels, noisy environment, and 24-hours nurses care. Assisted ventilation, sedation, loss of circadian rhythms also contribute to these disruptions. Biological and neurobehavioral consequences of sleep alterations lengthen weaning from mechanical ventilation and have some deleterious impacts on morbidity and mortality. Procedures to promote sleep have been attempted, with limited results to date. However, recent innovation might help to monitor sleep and help patients to achieve some restorative sleep.

EPIDEMIOLOGY OF CLASSICAL HODGKIN LYMPHOMA. Classical Hodgkin lymphoma is a rare neoplasia but represents one of the most common cancers in adults younger than 40 years old. Epidemiology of Hodgkin lymphoma remains fascinating with specific incidence patterns depending of age, socio-economic status, histological subtypes and Epstein-Barr virus (EBV) tumor status. These findings are in favor of several diseases with different pathogenesis. A better understanding of biological specificities of some Hodgkin lymphoma subgroups such as those presenting by older patients might be helpful to improve treatment strategies and outcome. Currently, no causal agent has been identified. Some risk factors are described, especially genetic ones, but no specific screening or prevention procedure are currently indicated.

ALCOHOL CONSUMPTION AND HIGH BLOOD PRESSURE. Cardiovascular disease is the second leading cause of alcohol-attributable mortality after cancer. The impact of alcohol consumption on blood pressure and the risk of cardiovascular pathologies are still largely underestimated by the general population and health professionals. However, numerous studies have demonstrated a dose-dependent increase in blood pressure, even at consumption levels close to the consumption guidelines (two drinks i.e. 20g per day). The alleged protective effects of low consumption levels are not confirmed, even in women. The binge drinking pattern has a particularly strong impact on blood pressure. The increase in blood pressure due to alcohol is reversible after reduction of consumption. Several pathophysiological mechanisms have been proposed to explain the hypertensive effects of alcohol. The screening of alcohol consumption by health professionals remains largely insufficient, especially in France, even in hypertensive subjects, although intervention is effective. It seems particularly important to reinforce the training of health professionals and the screening of alcohol consumption for primary prevention and also for secondary prevention when hypertension is already established. Scientific societies and federations should reinforce communication on the risks associated with alcohol consumption.