La Revue du praticien最新文献

No significant coronary artery lesion is seen on an emergent coronary angiogram in 5 to 10% of patients with myocardial infarction. These patients are most often female, younger and with less risk factors for atherosclerotic disease. Causes of myocardial infarction with no significant coronary artery stenosis (MINOCA) include plaque rupture, coronary artery spasm and coronary microvascular lesions. MINOCA is diagnosed using clinical (prolonged chest pain) ECG and biological (rise in troponin) data. A coronary angiogram is mandatory to confirm the absence of significant coronary artery lesion. Endovascular imaging is often performed. Cardiac MRI confirms the diagnosis of myocardial infarction and rules out other causes of prolonged chest pain and rise of troponin such as myocarditis and Takotsubo syndrome. Long term follow-up by a cardiologist is necessary.

Facilitating emotional, relational, and sexual education (ERSE) sessions requires expertise, which is possessed by marriage and family counselors (MFC). The Yvelines department has eight public sexual health centers, with a focus on preventive care, health education, and psycho-emotional support. Their team of MFCs leads sessions for 9th grade classes, coordinating with other ERSE stakeholders when possible. The aim is to offer at least one ERSE session to the majority of students in the department in their 9th grade year. These interventions by the department's MFCs follow three main principles: they are free of charge, respectful of each individual and their cultural values, and free of any ideological or religious proselytism. They are carried out in the presence of a member of the local teaching team and follow a codified procedure: after introducing the speaker and the group exchanges' rules, the speaker launches discussions on one or more themes with a view to encouraging students'reflexivity. This activity is facilitated by open-ended questions. The discussed topics are lead by the group and are not imposed by the facilitator, thus respecting the students' level of maturity. After a question-and-answer session, people and places the young can rely on are reminded to them. Topics are numerous and cover biological, psycho-emotional, and legal-social issues. The facilitators have a range of educational tools and group facilitation techniques that can be adapted to each topic and, above all, to each group, depending on their sensitivity and maturity levels, which are jointly assessed by the facilitator and the teaching team.

The management of older adults with cancer represents a major public health challenge due to population aging and the increasing incidence of cancer with age. This management is more complex due to the heterogeneity of older patients, marked by comorbidities, geriatric syndromes, polypharmacy, and frailty that may be exacerbated by anticancer treatments. Despite therapeutic advances, survival among older patients remains lower than in younger individuals, partly due to ageism (limited screening, delayed care, reduced access to innovations, etc.) but also due to frailty (comorbidities, dependence, etc.) that increases with age, requiring a trade-off with cancer in overall management.Frailty assessment is essential to adapt the therapeutic strategy. In geriatric oncology, screening relies in particular on the G8 tool, which helps identify patients who require a comprehensive geriatric assessment (CGA). This assessment provides a multidimensional analysis of functional, mobility, nutritional, cognitive and mood status, comorbidities, and social environment. CGA has diagnostic, prognostic, and interventional value, frequently leading to changes in the initial treatment plan and enabling the implementation of targeted non-oncological interventions.Management should be multidisciplinary, individualized, and dynamic, integrating supportive care, prevention of malnutrition and falls, adapted physical activity, rigorous treatment management, and prevention of iatrogenic complications. Effective communication with patients and caregivers, consideration of the socio-environmental context, and efficient coordination among healthcare professionals are essential to preserve autonomy and ensure the best possible quality of life throughout the care pathway.

The number of older patients with cancer is increasing dramatically. Recently , new anti-tumour therapies have led to significant advances in both curative and metastatic situations, with the arrival of immunotherapies as monotherapy or in combination with chemotherapy or targeted therapies, including antibody-drug conjugates. However, these new treatments have been little evaluated in elderly cancer patients, who are rarely included in therapeutic trials and require numerous adjustments to their intensity due to the increasing underlying frailty associated with age.

According to figures from GLOBOCAN and the European Cancer Information System, nearly 40% of breast cancers occur in women aged 70 and over in France. Breast cancer, the most common cancer in women, has been the subject of several specific studies on the elderly population. As such, it provides numerous examples of the possible and necessary adaptation of strategies according to age, the increased risks of certain treatments, and the efforts to be made with the patients concerned to trigger a participatory reform movement in research, to make it more useful for the growing and already predominant elderly population.  The ASTER 70s clinical study, a phase III randomized trial, illustrate this citizen-led transformation; that addressed the essential question of the benefit of adjuvant chemotherapy for hormone-sensitive (luminal) breast cancer after the age of 70. Published in July 2025 in The Lancet, the public release of this study led to the creation of a national collective to better represent the voices of elderly subjects in cancer research.

The "Assessment - Acute Treatment - Reassessment - Relay" approach is still the basis of acute pain management for adults in the emergency department, and intravenous morphine titration remains the cornerstone of severe pain management. However, new recommendations, incorporating all the latest scientific and contextual developments, have led to challenge its place, and to modify the treatment approach. As a general rule, an initial protocol at triage should be followed by multimodal, individualized management for each patient, taking into account the possibility of induced pain, and analgesic relays after the emergency stay should be adapted to the new benefit/risk balance of opioids (from all classes) especially for ambulatory patients.

Vascular diseases of the liver include damage to arterial and venous vessels, both hepatic and perihepatic. The main venous forms are Budd-Chiari syndrome (BCS), portal vein thrombosis (PVT) and porto-sinusoidal vascular disease (PSVD), defined by the location of the thrombotic obstruction. BCS corresponds to an obstruction of the hepatic veins, PVT to an obstruction of the portal vein with a risk of cavernoma, and PSVD to damage the intrahepatic microcirculation without cirrhosis. These rare diseases mainly affect young adults and cause portal hypertension in the absence of underlying liver disease. Myeloproliferative neoplasms are a common risk factor, among other systemic causes (coagulation disorders, antiphospholipid antibodies, infections, pregnancy) or local causes (inflammation, surgery).