Revue De Medecine Interne最新文献

英文中文

Supercalifragilisticexpialidocious ! [一名44岁女性严重贫血]。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-01-01 DOI: 10.1016/j.revmed.2025.08.004

Marie Meignien , Romain Euvrard , Yoann Roubertou , Mael Richard , Natacha Grienay-Poletto , Quitterie Reynaud , Raphaele Nove-Josserand , Claire Grange , Isabelle Durieu , Halil Yildiz

引用次数: 0

« Faut-il arrêter l’anticoagulation chez un patient avec négativation de la biologie antiphospholipide » ? : le contre “抗磷脂抗体呈阴性的患者是否应该停止抗凝治疗？”[骗术]。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-01-01 DOI: 10.1016/j.revmed.2025.07.008

Thomas Foret , Stéphane Zuily

引用次数: 0

Parcours de soins jusqu’au diagnostic dans la fibromyalgie et les rhumatismes [纤维肌痛和炎症性风湿病诊断的护理途径：采用比较混合方法研究的以患者为中心的方法]。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-01-01 DOI: 10.1016/j.revmed.2025.09.004

Magda Harim , Alexandra Kachaner , Alice Combier , Anne-Priscille Trouvin , Jérôme Avouac , Marie-Aude Piot , Brigitte Ranque

Background

Many doctors have a complicated relationship with patients with fibromyalgia (FM), whereas they feel more comfortable with patients with well-defined clinico-biological illnesses. The aim of the study was to compare the care pathways as experienced by patients with FM or those facing well-defined rheumatic diseases.

Methods

Consecutive participants diagnosed with FM, spondyloarthritis (SpA), or rheumatoid arthritis (RA) were prospectively recruited from a tertiary outpatient center. Utilizing a semi-structured guide, participants were interviewed. A quantitative analysis compared medical pathway characteristics, and a qualitative analysis explored their experiences.

Results

Nineteen participants with FM and 18 with PR or SpA were included. Patients with FM exhibited increased consumption of medical care, a stronger impact on their daily lives, and a diagnostic delay that was seven times longer. All participants reported an overwhelming experience of pain and a perceived lack of credibility regarding this pain. An altered doctor-patient relationship was more prevalent among participants with FM, who expressed pessimism, feelings of rejection, and an increased need for attentive listening.

Conclusion

Compared to usual rheumatic diseases, fibromyalgia is characterized by a prolonged diagnostic latency and faces a lack of acknowledgment, leading to a distortion in the doctor-patient relationship. However, whatever the underlying disease, patients report a lack of consideration of their pain, as long as it is unexplained.

背景：许多医生与纤维肌痛（FM）患者的关系复杂，而他们对有明确临床生物学疾病的患者感觉更舒服。该研究的目的是比较FM患者和那些面临明确风湿病的患者所经历的护理途径。方法：前瞻性地从三级门诊中心招募确诊为FM、脊椎关节炎（SpA）或类风湿性关节炎（RA）的连续参与者。利用半结构化指南，对参与者进行了采访。定量分析比较医学路径特点，定性分析探讨经验。结果：FM患者19例，PR或SpA患者18例。FM患者表现出医疗护理消耗增加，对日常生活的影响更大，诊断延迟时间延长7倍。所有参与者都报告了一种压倒性的疼痛体验，并且对这种疼痛缺乏可信度。在FM患者中，医患关系的改变更为普遍，他们表现出悲观、被拒绝的感觉，并且更需要认真倾听。结论：与常见的风湿病相比，纤维肌痛的特点是诊断潜伏期长，缺乏认识，导致医患关系扭曲。然而，无论潜在的疾病是什么，患者报告缺乏考虑他们的疼痛，只要它是无法解释的。

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引用次数: 0

Chez les patients ayant un accident vasculaire cérébral ischémique, dont le début des symptômes remonte entre 4,5 et 24 heures, présentant un parenchyme cérébral récupérable évalué par TDM de perfusion, et sans plan de thrombectomie, est-ce que l’altéplase permet d’améliorer l’indépendance fonctionnelle à 90 jours, comparativement au traitement standard, tout en étant sécuritaire ? 在缺血性卒中患者中，症状发作时间在4.5 - 24小时之间，灌注CT评估可挽救的脑组织，没有取栓计划，与标准治疗相比，阿替普酶是否在安全的情况下改善90天的功能独立性？]

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-01-01 DOI: 10.1016/j.revmed.2025.11.001

Luc Lanthier , Emmanuelle Lapointe , Alexandre Mutchmore , Marc-Émile Plourde , Michel Cauchon

引用次数: 0

Diagnostic d’une hémolyse non auto-immune chez l’adulte 成人非自身免疫性溶血的诊断

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2025-12-01 DOI: 10.1016/j.revmed.2025.08.001

Marc Ruivard , Marc Michel , Loïc Garçon

The diagnosis of hemolysis is still based on straightforward biochemical parameters: haptoglobin (the most sensitive), lactate dehydrogenase (LDH), and unconjugated bilirubin. Anemia is not always present. Reticulocyte counts typically exceed 120 × 10⁹/L, except in cases of associated vitamin deficiency or during the very early phase of acute hemolysis. When the Direct Antiglobulin Test is negative, a non-autoimmune cause of hemolysis should be considered. A thorough history, careful physical examination, and meticulous review of the peripheral blood smear help to rule out major emergencies such as malaria, thrombotic microangiopathy, severe infections, delayed hemolytic transfusion reaction, or toxic hemolysis. In the absence of a mechanical valve or other intravascular device that could induce hemolysis, second-line laboratory tests should be pursued: hemoglobin phenotyping, eosin-5’-maleimide (EMA) binding test, screening for paroxysmal nocturnal hemoglobinuria (PNH), and enzymatic assays. These tests usually lead to the diagnosis of most corpuscular non-autoimmune hemolytic anemias, including hemoglobinopathies (such as sickle cell disease, thalassemia syndromes, hemoglobin C disease, or unstable hemoglobins), membranopathies (such as hereditary spherocytosis or stomatocytosis), and enzyme deficiencies. The diagnosis of rare causes of hemolysis should be considered at a later stage or in specific contexts, such as alcoholism (Zieve's syndrome), advanced cirrhosis (spur cell anemia), or acute hemolysis in a young patient (Wilson's disease).

溶血的诊断仍然基于直接的生化参数：触珠蛋白（最敏感的）、乳酸脱氢酶（LDH）和未结合的胆红素。贫血并不总是存在。网织红细胞计数通常超过120×109/L，除非在相关维生素缺乏或急性溶血的早期阶段。当直接抗球蛋白试验结果为阴性时，应考虑溶血的非自身免疫性原因。全面的病史、仔细的体格检查和细致的外周血涂片检查有助于排除重大紧急情况，如疟疾、血栓性微血管病、严重感染、迟发性溶血输血反应或中毒性溶血。在没有机械瓣膜或其他可诱导溶血的血管内装置的情况下，应进行二线实验室检查：血红蛋白表型、伊红-5′-马酰亚胺（EMA）结合试验、阵发性夜间血红蛋白尿（PNH）筛查和酶分析。这些检查通常可诊断大多数红细胞性非自身免疫性溶血性贫血，包括血红蛋白病（如镰状细胞病、地中海贫血综合征、血红蛋白C病或不稳定血红蛋白）、膜病（如遗传性球形细胞增多症或口细胞增多症）和酶缺乏症。罕见原因的溶血的诊断应在后期或特殊情况下考虑，如酒精中毒（Zieve综合征）、晚期肝硬化（马刺细胞贫血）或年轻患者的急性溶血（威尔逊病）。

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引用次数: 0

C’était pas facile, pas fastoche, purement finaud, pas futile ! [一例54岁男性多发性血栓]。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2025-12-01 DOI: 10.1016/j.revmed.2025.07.002

Quentin Delcros , David Boutboul , Benjamin Thoreau , Nicolas Gendron , Florence Delestre , Laure Delaval , François Lefrère , Tali-Anne Szwebel , Julien Charpentier , Luc Mouthon , Dominique Helley , Nathalie Costedoat-Chalumeau , Marguerite Vignon , Pierre Antoine Castan , Alexis Dechosal , Y. Moutapam-Ngamby-Adriaansen , L. Pierson

引用次数: 0

Hémorragie digestive due à une probable interaction médicamenteuse warfarine/oseltamivir : à propos d’un cas clinique [可能由华法林/奥司他韦药物相互作用引起的胃肠道出血：1例报告]。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2025-12-01 DOI: 10.1016/j.revmed.2025.09.008

Jonathan Abisror , Roya Asgari , Quentin de Baynast , Christine Le Beller , Nicole Karam , Brigitte Sabatier , Thibaut Caruba

Introduction

Bleeding while on vitamin K antagonist therapy is one of the main causes of iatrogenic hospitalization. There are few reports of a drug-drug interactions resulting in a serious bleeding complications between warfarin and oseltamivir.

Case report

We report the case of a 64-year-old woman hospitalized with anemia. She was on warfarin for mechanical heart valve prostheses (usual international normalized ratio, INR: 2.5–3.5) and had moderate renal insufficiency. Treatment with oseltamivir for influenza was introduced, leading to a rapid increase in the INR value within less than a week and a recurrence of digestive bleeding. Symptomatic management (antagonization with vitamin K and prothrombin complex concentrate) led to correction of the overdose.

Conclusion

When oseltamivir is introduced in a patient receiving warfarin, we suggest close monitoring of the INR, especially in the case of renal insufficiency, from initiation to the elimination of the oseltamivir (3 days after discontinuation).

在服用维生素K拮抗剂治疗时出血是医源性住院的主要原因之一。很少有药物-药物相互作用导致华法林和奥司他韦之间严重出血并发症的报道。病例报告：我们报告一例64岁妇女贫血住院。患者使用华法林治疗机械心脏瓣膜假体（国际标准比值，INR: 2.5-3.5），肾功能不全中度。采用奥司他韦治疗流感，导致INR值在不到一周的时间内迅速上升，并再次出现消化出血。症状管理（与维生素K和凝血酶原复合物浓缩物拮抗）导致纠正过量。结论：当接受华法林治疗的患者引入奥司他韦时，我们建议密切监测INR，特别是在肾功能不全的情况下，从开始到停用奥司他韦（停药后3天）。

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引用次数: 0

Ataxie, surdité et diplopie [共济失调，耳聋和复视]。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2025-12-01 DOI: 10.1016/j.revmed.2025.10.008

Elsa Kaphan, Lucie Derrida, Gilles Kaplanski, Pierre-André Jarrot

引用次数: 0

Une complication rare de la corticothérapie [皮质类固醇治疗的罕见副作用]。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2025-12-01 DOI: 10.1016/j.revmed.2025.08.005

Julia Moiselet , Kévin Devé , Irène Machelart , Sarah Redl , Alexia Hourdillé , Iñaki Zuazo , Jean-François Viallard , Visal Keo

引用次数: 0

Difficultés et enjeux pour une meilleure connaissance et reconnaissance de la médecine interne française [更好地理解和认识法国内科的挑战和问题]。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2025-12-01 DOI: 10.1016/j.revmed.2025.11.006

Pascal Sève , Philippe Morlat , Laurence Bouillet , Anne Bourgarit , Brigitte Ranque , Christophe Leroux , Christian Lavigne , Quitterie Reynaud , Odile Rauzy , Kevin Chevalier , Nathalie Costedoat-Chalumeau , Luc Mouthon

引用次数: 0

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