Revue De Medecine Interne最新文献

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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

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IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-01-01

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« 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

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IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-01-01

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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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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

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IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-01-01

引用次数: 0

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-01-01

引用次数: 0

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-01-01

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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