La Revue du praticien最新文献

The World Tourism Organization estimates that between 195 and 375 million people traveled to high altitudes in 2019. The high prevalence of cardiorespiratory diseases in the general population, combined with the increasing number of elderly travelers, suggests that a significant proportion of these individuals may have underlying health conditions. Hypoxia, the main physiological challenge at high altitude, requires adaptive responses from the cardiorespiratory system, which are often impaired in patients with cardiac or pulmonary diseases. This population is at particular risk of decompensation and altitude intolerance symptoms. Therefore, a thorough medical assessment, including evaluation of comorbidities and consultation with a mountain medicine specialist, may be essential prior to high-altitude travel or long-haul flights.

Chronic kidney disease (CKD) in children has an epidemiology that differs significantly from that in adults. Its main causes vary with age with a predominance of congenital anomalies of the kidney and the urinary tract. Early diagnosis is essential to prevent complications affecting growth, cognition, and long-term cardiovascular health, and to avoid, or at least to slow, progression to end-stage renal disease. Specific clinical contexts warrant targeted screening: family history, perinatal abnormalities, at-risk conditions, or suggestive clinical signs. Screening relies on simple tools such as growth charts, dipstick urinalysis, blood pressure measurement, glomerular filtration rate estimation, and renal ultrasound. The general practitioner plays a key role in the early detection of CKD, and in ensuring early referral to pediatric nephrology, helping to preserve nephron mass and improve long-term outcomes.

Vascular liver diseases (VLD) are rare and their diagnosis can be difficult and late, leading to a delay in treatment. Diagnosis is most often multidisciplinary, involving primarily the clinician but also the radiologist and pathologist. In all cases, attention should be drawn to the absence of the usual causes of liver disease; conversely, a context of pathology associated with VLD may be a suggestive factor. The two main ways in which porto-sinusoidal vascular disease is discovered are unexplained abnormal liver tests and portal hypertension (PHT) without cirrhosis. In the case of acute splanchnic thrombosis (mainly portal), the main symptom is abdominal pain. The intensity of symptoms varies greatly, and the diagnosis may be overlooked and established late, at the stage of portal cavernoma and possibly complications of PHT. Budd-Chiari syndrome can mimic any acute or chronic liver disease, with the most common presentation being ascites/hepatomegaly/abdominal pain. Many clinical situations should raise the suspicion of VLD, which is based on dialogue between the clinician, radiologist, and pathologist. Early diagnosis allows for optimal patient management, particularly through anticoagulant therapy and treatment of PHT.

Borderline Personality Disorder (BPD) is common, affecting 2 to 6 % of the general population, with a high prevalence in psychiatric settings. It is characterized by emotional, relational instability and impulsivity, often associated with suicidal behaviors and comorbid disorders (anxiety, depression, addictions). Understanding BPD relies on the concept of relational hypersensitivity, rooted in an altered self-concept. The biopsychosocial approach explains its origins through the interaction between genetic vulnerability and emotional invalidation during childhood, exacerbated by trauma. Treatment primarily involves cognitive-behavioral therapies (CBT), such as Dialectical Behavior Therapy (DBT), which promote emotional regulation and reduce self-harming behaviors. Management should include thorough evaluation and education focused on relational hypersensitivity. Although limited, pharmacological treatments can address specific dimensions of BPD but require cautious prescription.

Small liver vessels disorders are a heterogeneous group of rare diseases that can affect the portal venules, the hepatic sinusoids, the centri-lobular veins, or the hepatic arteries. The most frequent is the porto-sinusoidal vascular disorder (PSVD), which is characterised by damage of the portal venules or sinusoids and may be associated with portal hypertension, in the absence of cirrhosis. Diagnosis is therefore based on a liver biopsy. PSVD is often associated with an extrahepatic condition, most commonly immune-mediated, haematological, or a toxic. Its two main complications are variceal haemorrhage and portal vein thrombosis. The latter must be screened for by imaging every six months. Liver failure, on the other hand, is very rare in this context. It is therefore important to consider the diagnosis of PSVD when there is marked portal hypertension alongside preserved liver function or low liver stiffness, particularly in the absence of an obvious cause of cirrhosis or in the presence of an extrahepatic condition known to be associated with PSVD, as well as in cases of unexplained abnormalities of liver blood tests. The management of PSVD is like that of cirrhosis.

Budd-Chiari syndrome is a rare condition characterized by obstruction of hepatic venous drainage, ranging from hepatic venules to the terminal part of the inferior vena cava. A thorough etiological workup to search for a pro-thrombotic disorder should be systematically performed. The most common cause of Budd-Chiari syndrome is myeloproliferative syndrome, present in more than 40% of cases. The clinical presentation of BCS is highly variable, ranging from asymptomatic patients (3% of cases) to those presenting with fulminant hepatitis. Diagnosis relies on imaging, notably abdominal ultrasound coupled with Doppler.A progressive therapeutic approach, combining medical measures (curative anticoagulation, treatment of the underlying cause, management of portal hypertension complications) and a strategy to restore hepatic venous flow, is recommended, preferably in a specialized center for vascular liver diseases. This strategy has significantly improved patient prognosis, with an overall 5-year survival rate exceeding 80%. The follow-up frequency for BCS patients is biannual, with hepatic imaging recommended, as more than 60% of patients may develop hepatic nodules and are at risk of hepatocellular carcinoma.