La Revue du praticien最新文献

FRANCE'S FIRST "PESTICIDES AND PEDIATRIC PATHOLOGIES" CONSULTATION. The "Pesticides and Pediatric Pathologies" department of the Regional Center for Occupational and Environmental Diseases of Hauts-de-France (CHU Amiens-Picardie, France) was set up on October 1 2023, to support children (and their families) suffering from leukemia, brain tumors, hypospadias or cleft lip and palate whose parents have been professionally exposed to pesticides. This support includes assistance in dealing with the Fonds d'indemnisation des victimes de pesticides (Pesticide Victims Compensation Fund).

MECHANICAL CIRCULATORY SUPPORT AND REPLACEMENT IN HEART FAILURE. Technological developments have led to a panel of mechanical devices making possible circulatory support and cardiac replacement in patients with heart failure. Some devices (namely extracorporeal membrane oxygenation or ECMO) allow short-term support in patients with acute heart failure and improve the prognosis. Other devices (left ventricular assist device and total artificial heart) are designed for long-term use in patients with advanced heart failure; although heart transplantation remains the gold standard for these patients, mechanical support devices may keep patients alive until transplantation or become destination therapy if transplantation is contraindicated. The optimal use of mechanical circulatory support needs a strong organizational network of specialized multidisciplinary centers.

PREVENTING DENTAL ANXIETY IN ADULTS AND CHILDREN. In 2014, according to INSEE, dental anxiety affected 7% of the French population. Severity of anxiety can range from minor to severe, minor anxiety manifesting for patients as physical symptoms without compromising dental care to severe anxiety by avoiding dental consultation and compromising dental care. This article explains the problems associated with dental anxiety and suggests ways in which practitioners can help their patients to come to the dentist for dental care, in particular by using cognitive-behavioural therapies.

DEFINITIONS AND EPIDEMIOLOGY OF VARICOSE VEIN DISEASE. Chronic superficial venous disorders are a frequent reason for medical consultation. Depending on the study, between 20% and 60% of the general population suffer from varicose veins of the lower limbs. The socio-economic cost of venous disease is considerable, accounting for between 1% and 3% of national healthcare budgets. The factors leading to the formation of varicose veins and the pathogenesis are not clearly elucidated, but two factors have been identified: weakness of the venous wall and hemodynamic disorders. Symptoms and clinical signs are highly variable, ranging from aesthetic dissatisfaction to leg ulcers. The CEAP classification (clinical, etiological, anatomical, pathophysiological) enables the practitioner to precisely define chronic venous disease, providing a precise diagnostic description as well as enabling the patient to be monitored over time. Various quality-of-life scales have also been developed.

DIAGNOSIS OF VARICOSE DISEASE. Varicose vein disease corresponds anatomically to an alteration of the venous wall and/or the valve system of one or more superficial veins, or segments of these veins, and is characterized by reflux causing venous hypertension. The clinical signs, precisely described by the CEAP classification (clinical, etiological, anatomical, pathophysiological), include aside asymptomatic forms, telangiectasias, varicose veins, edema, and skin disorders up to the stage of leg ulcers. The functional signs, also very variable and sometimes absent, are not limited to leg heaviness. Non-specific, they are mainly characterized by their timing and mode of occurrence. Duplex ultrasound (DU) examination allows to confirm the existence of venous reflux, to specify its extension, to measure the diameter of the pathological veins and to analyze their wall remodeling. DU is essential to precisely characterize the varicose disease to define the therapeutic modalities to be considered. Its results are recorded on a venous cartography which graphically represents all the echo-anatomical and hemodynamic data collected. In the event of varicose disease, a specialized medical consultation is necessary to offer therapeutic care adapted to the specific problem of each patient.

RENAL COLIC MANAGEMENT. Renal colic is a common reason for consultation or emergency room visit. In most of the cases, it is caused by the migration of a urinary calculus and the resulting ureteral obstruction. In 2022 French learned societies has published good practice recommendations on the management of urinary calculi and lithiasis.