Revue medicale suisse最新文献

Physical exercise is an integral part of a healthy lifestyle. It contributes to a reduction in the incidence of cardiovascular events and related morbidity and mortality, particularly through its beneficial effects on blood sugar, lipid, and blood pressure profiles. Physical exercise is among the lifestyle and dietary measures recommended for all individuals, whether they are at cardiovascular risk or not, for both primary and secondary prevention. The purpose of this article is to review the current physical exercise recommendations and potential cardiovascular benefits in specific situations.

High-output stoma, which often occurs after ileostomy, results in substantial enteric losses that can lead to dehydration, electrolyte disturbances, and malnutrition. Management requires a multidisciplinary approach including rehydration, tailored nutrition, and therapies aimed at reducing stoma output. First-line management is restoration of intravascular volume with sodium-containing fluids, followed by evaluation and treatment of underlying causes such as infection or partial stricture. Regular monitoring of stoma output and urine output is essential to prevent long-term complications such as renal failure. Control of the condition is, in the majority of cases, achieved through rehydration, dietary measures, and antisecretory/antimotility agents.

Superficial siderosis is a rare neurological evolutive condition that encompasses two distinct entities classified according to their cortical or infratentorial localisation. The disease is caused by the neuronal destruction of the central nervous system linked with hemosiderin deposits. The aetiology is a sustained low-intensity bleeding located at the supratentorial subarachnoid space for the cortical superficial siderosis or from the subarachnoid space for the infratentorial superficial siderosis. The triad sensorineural hearing loss, cerebellar ataxia and pyramidal signs should suggest infratentorial superficial siderosis. The diagnosis is made using central nervous system MRI. The management relies on the identification and surgical correction of the bleeding source. The benefit of medical treatment is discussed.

Alcohol-associated hepatitis, the new term that has replaced "alcoholic hepatitis", is the most severe form of alcohol-related liver disease, with a 1-month mortality of 30 to 50% in severe cases. The diagnosis is now mainly clinical, with liver biopsy reserved for atypical presentations. The MELD (Model for End-Stage Liver Disease) 3.0 and the Lille score calculated from day 4 allow for dynamic prognostic stratification. In eligible patients, prednisolone at a dose of 40 mg/day for 28 days remains the standard treatment. Nutritional and addiction management are major determinants of survival, while early liver transplantation, without an arbitrary abstinence period, is a rescue option for carefully selected non-responders.

Progressive multifocal leukoencephalopathy (PML) is not limited to HIV. In polymedicated or immunomodulated patients, PML can present with subacute cognitive, language, or motor deficits. For general practitioners, the key is to consider PML, review at-risk medications, arrange urgent brain MRI and lumbar puncture, and refer to neurology. This article provides a practical approach focused on recognition, initial workup, and coordination with hospital teams, illustrated by a case.

In 2025, significant progress has been made in the management of cardiovascular diseases. The introduction of the IMPS (Inflammatory Myopericardial Syndrome) concept has positioned cardiac MRI as a central diagnostic tool. In the management of dyslipidemia, lipoprotein (a) measurement has become a key component of cardiovascular risk assessment, while bempedoic acid is emerging as an effective treatment option for statin-intolerant patients. The Pregnancy Heart Team now provides a structured care pathway for cardiac patients before, during, and after pregnancy. Prevention plays a crucial role, supported by the growing awareness of the close link between mental health and cardiovascular health.

Thrombotic microangiopathy (TMA) is a medical emergency. Recognizing and identifying the pathophysiological mechanism is crucial for quickly initiating appropriate treatment and reducing morbidity and mortality. Thrombotic thrombocytopenic purpura (TTP) should systematically be considered among the causes of TMA. Two scores (French and PLASMIC) can be used upon patient admission. If the probability of TTP is high, the treatment should be initiated without waiting for diagnostic confirmation. This article presents several cases of TMA and their respective management.