La Revue du praticien最新文献

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.

COMPLICATIONS DE LA MALADIE VARIQUEUSE. La maladie variqueuse est souvent considérée, à tort, comme une pathologie benigne. Les troubles trophiques représentent 10 % des complications de la maladie variqueuse et, dans 1 % des cas, un ulcère de jambe peut apparaître. L'hyperpression veineuse est impliquée, mais il existe égalment des phénomènes pro-inflammatoires responsables de lésions endothéliales chroniques qui favorisent le remodelage et la fibrose tissulaire à l'origine des complications cutanées. Stade ultime de l'insuffisance veineuse chronique et témoin de sa gravité, l'ulcère de jambe est souvent négligé et relégué à des soins infirmiers. Véritable problème de santé publique, générant des coûts importants et une altération significative de la qualité de vie des patients, l'ulcère veineux nécessite une meilleure connaissance et une meilleure prise en charge par les soignants. Par ailleurs, des complications graves et potentiellement mortelles ecistent, telles que l'hémorragie aiguë par rupture de varices et la maladie thromboembolique veineuse. Une amélioration de la prise en charge des varices est nécessaire pour limiter la survenue de ces complications.

Palliative care: SOCIAL AND TERRITORIAL. INEQUALITIES.Palliative care can be provided wherever the patient lives or receives care, considering its environment, in coordination with healthcare professionals, social and medico-social professionals. The way in which palliative care is provided varies from one country to another, depending on resources, cultural values, healthcare systems and policies of each country. There are disparities in access, particularly in rural areas and for vulnerable populations. One of the main limitations to the development of palliative care, after budgetary issues, is the insufficient development of a professional workforce specializing in palliative care. The overseas territories are in a specific situation, with populations suffering from a combination of social and territorial health inequalities. This approach to frailty makes it possible to anticipate and plan for palliative care to meet the future patients' needs. French citizens living in extreme poverty, protected persons, people with psychiatric disorders, elderly, people with disabilities and anyone else with one or more vulnerabilities face situations where they cannot exercise all their rights. The national ten-year strategy on « palliative care, pain management and support at the end of life » places priorities to reducing all forms of inequalities in end-of-life journeys.

Research on napping: WHERE DO WE STAND? Sleep specialists have proposed measures to counter the short- and long-term negative consequences of sleep deprivation, suggesting that the recovery nap could be a "powerful physiological public health tool". This article focus on napping as a "countermeasure" to the current epidemic of sleep debt. We review the restorative functions of naps explored in laboratory studies (alertness, memory, stress, immune function, pain sensitivity) with definite public health ramifications (sleep-related accidents, school and work performance, cardiovascular risk). However, the effect of naps and the nature of the sleep stages concerned have yet to be evaluated - in relation to several factors, notably their duration or the age of the subjects - with a view to optimizing adaptation strategies in populations suffering from chronic sleep deprivation.