La Revue du praticien最新文献

THE DIAGNOSIS OF SARCOMA REQUIRES TEAM EXPERTISE. Sarcoma is the prototype of the "rare cancer" which suff ers from a sometimes complicated diagnostic pathway. This is all the truer for soft tissue sarcomas for which the clinical signs are not very specific or even falsely reassuring. The key message is that any patient with a suspected sarcoma must be referred as soon as possible to an expert "sarcoma" center belonging to the NetSarc+ network to benefit from the expertise both diagnostically and therapeutically. In the centers of this expert network, the diagnostic phase begins with radiological expertise both on the analysis of tumor semiology and on the taking of specific samples for diagnostic purposes. This precious sample allows the expert pathologist to apply the most accurate techniques to off er a precise diagnosis and determine the grade of malignancy, paving the way for personalized treatment.

SURGICAL MANAGEMENT OF BONE SARCOMAS. Bone sarcoma surgery must be carried out by a specialized team, often multidisciplinary, integrated into the NetSarc+ network. Its main objective is to obtain appropriate margins to limit the risk of recurrence. Technical advances made in the resection and reconstruction of bone sarcomas have improved the quality of life of patients and reduced the amputation rate. Complications (infection, failure of reconstruction) are numerous, and surgical revisions are frequent. Functional after-effects (neurological deficits, chronic pain) are omnipresent and responsible for a disability that is sometimes difficult for the patient to accept. Collaboration between the surgical oncologist and the attending physician is an essential tool during the long-term follow-up of these patients.

SURGERY OF SOFT TISSUE SARCOMA IN ADULTS. Medical strategy and surgery of soft tissue sarcoma are decided within the multidisciplinary tumor board with an appropriate imaging assessment, multiple percutaneous core needle biopsies to confirm diagnosis and a correct staging and risk assessment. Surgery must be carried out by a surgeon specifically trained in the treatment of this disease in an expert center. The standard surgical procedure is an one bloc excision with clear margins, which implies removing the tumour with a rim of normal tissue around it.

WHY AND HOW SHOULD THE RENAL RISK OF PATIENTS WITH TYPE 2 DIABETES BE ASSESSED ? In patients with type 2 diabetes, regular screening for chronic kidney disease is essential, using estimated glomerular filtration rate and the albuminuria/creatinuria ratio. Use of the KDIGO matrix (kidney disease: improving global outcomes) and KFRE score (kidney failure risk equation) enables fine stratification of renal risk, leading to appropriate referral to specialized nephrology consultations. The general practitioner, as a key player, can initiate a lifestyle adjustments and appropriate treatments from the very first signs. This early management can delay the progression to renal failure and reduce cardiovascular risk, thus optimizing specialized resources and patients' quality of life.

TOBACCO IN FILMS AND SMOKING AMONG YOUNG PEOPLE. The presence of tobacco in films and TV series remains widespread, despite its proven impact on the initiation of smoking among young people. In addition to films, platforms massively distribute these images, influencing adolescents, whose risk of starting to smoke is multiplied by two to three after exposure. Social media amplifies this phenomenon. In response to this observation, measures have been proposed: film classification, health warnings, and awareness-raising among film professionals and platforms. However, total censorship is contested in the name of artistic freedom. The challenge is to reconcile public health and creative freedom to achieve the goal of a tobacco-free generation by 2032.

WHY AND HOW SHOULD THE CARDIOVASCULAR RISK OF PATIENTS WITH TYPE 2 DIABETES BE ASSESSED ? Patients with type 2 diabetes have a two to four fold increased risk of developing atherosclerotic disease, heart failure, and atrial fibrillation. Diabetes is also a major risk factor for chronic kidney disease, which in turn, is associated with an elevated risk of cardiovascular disease. The combination of diabetes with other cardiovascular risk factors and/or comorbidities further increases not only the likelihood of major cardiovascular events but also cardiovascular and all-cause mortality. Cardiovascular risk stratification in patients with type 2 diabetes is essential for guiding appropriate management. Several risk scores have been incorporated into the recommendations of various scientific societies, including the SCORE2-Diabetes model.