Revue De Medecine Interne最新文献

英文中文

Retour sur le congrès de l’ACR Convergence 2024 回归2024年ACR融合大会

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-02-01 Epub Date: 2026-02-09 DOI: 10.1016/j.revmed.2025.12.007

Salomé Duteurtre , Yoann Zadro

引用次数: 0

Portrait de la Pre. Audemard, professeure au CHU de Tours et co-présidente de la 91e édition du congrès de la Société nationale française de médecine interne 父亲的肖像。奥德玛德，图尔大学教授，法国国家内科学会第91届大会联合主席

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-02-01 Epub Date: 2025-12-29 DOI: 10.1016/j.revmed.2025.11.009

Aïcha Kante , Jonathan Sormani , Anaïs Roeser

引用次数: 0

Perfusion sous-cutanée : indications, modalités et tolérance [皮下输注：适应症，实际注意事项和耐受性]。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-02-01 Epub Date: 2025-12-17 DOI: 10.1016/j.revmed.2025.11.002

Robin Arcani , Julia George , Florian Correard , Charlotte Bérard , Patrick Villani , Aurélie Daumas

Subcutaneous (SC) infusion, or hypodermoclysis, is a route of administration involving the injection of fluids or medications into the hypodermis. Historically used and subsequently abandoned due to complications arising from poor technique, it has regained interest since the 1990s, particularly in geriatrics and palliative care. Compared with the intravenous (IV) route, it is less invasive, better tolerated, easier to implement in outpatient settings, and carries a lower risk of serious complications. The pharmacokinetics of the SC route show slightly slower absorption than IV administration, with bioavailability often exceeding 80% for hydrosoluble compounds. Main indications include the preventive or therapeutic management of moderate dehydration, palliative care (analgesics, anxiolytics, antipyretics, antisecretory agents), and some antibiotics (such as ceftriaxone, as well as ertapenem and teicoplanin, with a good level of supporting evidence). In internal medicine departments, the SC route can also be used for furosemide, levetiracetam, and vitamin B12 when no alternative is available. Some vaccines may be administered subcutaneously in patients with contraindications to the intramuscular route. Local adverse events may occur but are generally mild (pain, edema), transient, and infections are rare. Although often used off-label, hypodermoclysis is a safe and practical alternative, particularly suited to elderly or frail patients, and meets current healthcare challenges related to outpatient medicine and hospital overcrowding. Its wider adoption relies on healthcare professional training, standardized protocols, and robust comparative data.

皮下注射（SC）或皮下灌洗是一种给药途径，涉及将液体或药物注射到皮下。它在历史上曾被使用，后来由于技术不佳引起的并发症而被放弃，自20世纪90年代以来，特别是在老年病学和姑息治疗中重新引起了人们的兴趣。与静脉（IV）途径相比，它侵入性更小，耐受性更好，更容易在门诊实施，并且发生严重并发症的风险更低。SC途径的药代动力学显示吸收比静脉给药稍慢，水溶性化合物的生物利用度通常超过80%。主要适应症包括中度脱水的预防或治疗管理、姑息治疗（镇痛药、抗焦虑药、退烧药、抗分泌药）和一些抗生素（如头孢曲松、厄他培南和替柯planin，有良好的支持证据）。在内科，当没有其他选择时，SC路线也可用于呋塞米、左乙拉西坦和维生素B12。有些疫苗对肌肉注射有禁忌症的患者可皮下注射。局部不良事件可能发生，但通常是轻微的（疼痛，水肿），短暂的，感染是罕见的。虽然经常在说明书外使用，但皮下粘连是一种安全实用的替代方法，特别适用于老年人或体弱患者，并满足当前与门诊药物和医院过度拥挤相关的医疗保健挑战。它的广泛采用依赖于医疗保健专业培训、标准化协议和可靠的比较数据。

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引用次数: 0

Une dermatose bulleuse [大疱性皮肤病]。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-02-01 Epub Date: 2025-10-25 DOI: 10.1016/j.revmed.2025.10.001

Jeremy Antoniadis , Tanguy Sajous , Laid Chikhoune , Raphael Cauchois , Karin Mazodier , Romain Muller , Gilles Kaplanski , Pierre-André Jarrot

引用次数: 0

Immunologie de la fécondation, de l’implantation et de la grossesse : Interactions clés et perspectives thérapeutiques [受精、着床和妊娠的免疫学：关键的相互作用和治疗观点]。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-01-01 Epub Date: 2025-12-13 DOI: 10.1016/j.revmed.2025.11.005

Meryam Cheloufi , Noémie Abisror , Amandine Dernoncourt , Arsène Mékinian , Gilles Kayem

The immunology of fertilization, implantation and pregnancy is based on a complex balance between maternal immune tolerance and a controlled inflammatory response. Adaptation of the maternal immune system is essential for the survival of the semi-allogenic foetus, and any imbalance can lead to complications such as implantation failure, early pregnancy loss and obstetric pathologies. Several cell types, including uterine Natural Killer (NKu) cells, macrophages and dendritic cells, play a key role in regulating the maternal-fetal interface. Similarly, the balance between pro- and anti-inflammatory cytokines, as well as the expression of specific HLA molecules, determines the success of gestation. Immunological disorders, such as those observed in endometriosis, adenomyosis and chronic endometritis, alter endometrial receptivity and increase the risk of reproductive failure. In addition, abnormalities in NK cell activation and cytokine profile have been implicated in repeated implantation failure and recurrent pregnancy loss. Although immunomodulatory treatments such as corticosteroids, intravenous immunoglobulins and intralipids are being explored to improve pregnancy outcomes, their efficacy has yet to be confirmed by large-scale studies.

受精、着床和妊娠的免疫学是基于母体免疫耐受和受控炎症反应之间的复杂平衡。母体免疫系统的适应对于半同种异体胎儿的存活至关重要，任何失衡都可能导致植入失败、早孕流产和产科病理等并发症。几种细胞类型，包括子宫自然杀伤细胞（NKu）、巨噬细胞和树突状细胞，在调节母胎界面中发挥关键作用。同样，促炎性和抗炎性细胞因子之间的平衡，以及特异性HLA分子的表达，决定了妊娠的成功。免疫紊乱，如在子宫内膜异位症、子宫腺肌症和慢性子宫内膜炎中观察到的免疫紊乱，改变子宫内膜容受性，增加生殖失败的风险。此外，NK细胞活化和细胞因子谱的异常与反复植入失败和复发性妊娠丢失有关。虽然免疫调节治疗如皮质类固醇、静脉注射免疫球蛋白和脂质内正在探索改善妊娠结局，但其疗效尚未得到大规模研究的证实。

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引用次数: 0

Histoire de la médecine interne en France [法国内科医学史]。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-01-01 Epub Date: 2026-01-06 DOI: 10.1016/j.revmed.2025.11.008

Pascal Sève

引用次数: 0

Morbi-mortality of obese patients with systemic sclerosis: A comparative study 肥胖患者合并系统性硬化症的发病-死亡率：一项比较研究。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-01-01 Epub Date: 2025-05-06 DOI: 10.1016/j.revmed.2025.04.026

Lucile Grange , Benjamin Chaigne , Marion Casadevall , Pascal Cohen , Bertrand Dunogue , Alexis Régent , Luc Mouthon

Introduction

The prevalence of systemic sclerosis (SSc), as well as obesity, has significantly increased in recent decades. To address the lack of data on obese SSc patients, we conducted a retrospective comparative study to assess the prevalence, clinical characteristics, and long-term consequences of obesity in SSc patients.

Methods

We conducted a retrospective comparative study at the Cochin University Hospital's Department of Internal Medicine (Paris) from 2000 to 2019.

Results

Of the 911 SSc patients included, 90 (9.9%) were obese, comprising 79 females and 11 males. The median weight for obese patients was 90 [82–98] kg, compared to 60 [53–67] kg for non-obese patients, corresponding to a median body mass index of 33 [31–37] kg/m² and 23 [20–25] kg/m², respectively. Obese patients exhibited a higher prevalence of cardiovascular risk factors. The median modified Rodnan skin score was significantly higher in non-obese patients than in obese patients (6 [2–16] vs 3 [2–7]; P < 0.05). Organ involvement did not differ significantly between obese and non-obese patients. We observed a lower number of deaths in obese SSc patients compared to non-obese SSc patients (6 [11%] vs. 26 deaths [25%], P = 0.06). Analysis of 30-year Kaplan Meier survival curves did not show significant survival difference between obese and non-obese SSc patients.

Conclusions

This study of obese ScS patients reveals that they have a higher prevalence of cardiovascular risk factors, lower mRSS, less calcinosis, and similar rates of organ damage and mortality compared to non-obese ScS patients.

近几十年来，系统性硬化症（SSc）以及肥胖的患病率显著增加。为了解决肥胖SSc患者数据的缺乏，我们进行了一项回顾性比较研究，以评估SSc患者肥胖的患病率、临床特征和长期后果。方法：我们于2000年至2019年在巴黎科钦大学医院内科进行回顾性比较研究。结果：纳入的911例SSc患者中，肥胖90例（9.9%），其中女性79例，男性11例。肥胖患者的中位体重为90 [82-98]kg，非肥胖患者的中位体重为60 [53-67]kg，对应的中位体重指数分别为33 [31-37]kg/m2和23 [20-25]kg/m2。肥胖患者心血管危险因素的患病率较高。非肥胖患者的修正罗德曼皮肤评分中位数显著高于肥胖患者（6 [2-16]vs 3 [2-7]）；结论：这项对肥胖ScS患者的研究表明，与非肥胖ScS患者相比，肥胖ScS患者心血管危险因素患病率更高，mRSS较低，钙质沉着症较少，器官损伤和死亡率相似。

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引用次数: 0

Lymphocytes T doubles négatifs αβ : quelles orientations étiologiques ? 双阴性αβ T淋巴细胞：病因有哪些考虑？］

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-01-01 Epub Date: 2025-12-02 DOI: 10.1016/j.revmed.2025.11.004

Paul Dalmas , Clara Fontenaille , Sylvie Cointe , Théo Riu , Anaïs Grob , Laetitia Tessonnier , Baptiste André , Lionel Galicier , Frédéric Vély , Nicolas Schleinitz

Introduction

Double-negative T lymphocytes with αβ TCR (CD3⁺CD4⁻CD8⁻TCRαβ⁺) are a population of T cells present in low proportions in the blood under normal conditions. They can be abnormally elevated in various pathological situations.

Case report

A 64-year-old female patient was hospitalized due to a general deterioration of health. Laboratory tests revealed a monoclonal proliferation of double-negative αβ T lymphocytes, representing 28% of T cells (219/mm³). A thoraco-abdomino-pelvic CT scan revealed two suspicious intrahepatic masses, multiple enlarged lymph nodes, and peritoneal nodules. These lesions were hypermetabolic on 18FDG PET scan. A biopsy of the hepatic masses showed histological features consistent with cholangiocarcinoma.

Conclusion

We report a case illustrating how the investigation of a proliferation of double-negative αβ T lymphocytes led to the diagnosis of cholangiocarcinoma. Although a direct link between the two cannot be proven, we hypothesize that tumor antigenic stimulation selected a T lymphocyte clone.

具有αβ TCR的双阴性T淋巴细胞（CD3+CD4-CD8-TCRαβ+）是正常情况下血液中低比例存在的一种T细胞。在不同的病理情况下，它们会异常升高。病例报告：一名64岁女性患者因健康状况普遍恶化而住院。实验室检查显示双阴性αβ T淋巴细胞单克隆增殖，占T细胞的28% （219/mm3）。胸腹盆腔CT扫描显示两个可疑的肝内肿块，多个肿大的淋巴结和腹膜结节。18FDG PET扫描显示这些病变为高代谢。肝肿块活检显示与胆管癌一致的组织学特征。结论：我们报告了一个病例，说明了双阴性αβ T淋巴细胞增殖的研究如何导致胆管癌的诊断。虽然两者之间的直接联系无法证明，但我们假设肿瘤抗原刺激选择了T淋巴细胞克隆。

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引用次数: 0

Les syndromes d’Ehlers-Danlos : diagnostic et parcours de soins de ces maladies complexes et multisystémiques [Ehlers-Danlos综合征：这些复杂多系统疾病的诊断和护理途径]。

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-01-01 Epub Date: 2025-08-30 DOI: 10.1016/j.revmed.2025.08.002

Karelle Benistan , Gabriel Guichou

Ehlers-Danlos syndromes (EDS) are a heterogeneous group of rare and inherited connective tissue disorders characterized by the following clinical triad: joint hypermobility, skin hyperelasticity and tissue fragility. Thirteen subtypes of EDS were described in 2017 by an international consortium: there are 12 subtypes with an identified genetic etiology, and the most frequent hypermobile EDS of which the molecular basis remains unknown. EDS are complex and multisystemic pathologies, with a wide clinical and genetical heterogeneity. Diagnosing EDS is a tough task, and it requires to apply a rigorous method to spot clinical red flags and eliminate differential diagnoses. There is no specific treatment for non-vascular EDS to date, so the care management is symptomatic, multidisciplinary and personalized. This document in the “carrefour des spécialités” section presents the diagnosis pathway and the care management for both vascular and non-vascular EDS.

ehers - danlos综合征（EDS）是一种罕见的遗传性结缔组织疾病，其临床特征为：关节过度活动、皮肤过度弹性和组织脆弱。2017年，一个国际联盟描述了EDS的13种亚型：有12种亚型具有已确定的遗传病因，最常见的过度移动EDS的分子基础仍然未知。EDS是一种复杂的多系统病理，具有广泛的临床和遗传异质性。诊断EDS是一项艰巨的任务，需要采用严格的方法来发现临床危险信号并消除鉴别诊断。目前尚无针对非血管性EDS的特异性治疗方法，因此护理管理是对症、多学科和个性化的。本文档在“血管性和非血管性EDS的诊断途径和护理管理”部分介绍了血管性和非血管性EDS。

引用次数: 0

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

IF 0.9 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Revue De Medecine Interne

Pub Date : 2026-01-01 Epub Date: 2025-07-29 DOI: 10.1016/j.revmed.2025.07.001

Cécile M. Yelnik

引用次数: 0

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