Complications infectieuses à long terme des patients splénectomisés : cohorte rétrospective avec un suivi de plus de 10 ans

Introduction

Although most infections occur within the first 2 years after splenectomy, the relatively short follow-up reported in many studies may underestimate the frequency of infections. The objective of the study was to determine the incidence of infective outcomes and factors associated with infection after splenectomy by studying a group of patients who underwent splenectomy over a 10-year period.

Dépistage systématique d’une thrombose veineuse splénique ou portale après splénectomie

Background

Portal and/or splenic vein thrombosis (PSVT) is common after splenectomy. It can be a life-threatening complication, with a risk of bowel ischemia and portal hypertension. An early diagnosis allows an effective medical treatment and prevents life-threatening complications. There is no consensus regarding the benefit of systematic screening of patients after splenectomy for PSVT. We started in January 2012 a routine screening of PSVT after elective splenectomy. The aim of this study was to assess this policy.

Simulation en santé et médecine interne : quel avenir ?

Simulation-based learning (SBL) is developing rapidly in France and the question of its use in the teaching of internal medicine (IM) is essential. While HAS encourages its integration into medical education, French Young Internists (AJI) set up a working group to reflect on the added-value of this tool in our specialty. Different sorts of SBL exist: human, synthetic and electronic. It enables student to acquire and evaluate technical skills (strengths, invasive procedures, etc.) and non-technical skills (relational, reasoning…). The debriefing that follows the simulation session is an essential time in pedagogical terms. It enables the acquisition of knowledge by encouraging the students’ reflection to reshape their reasoning patterns by self-correcting. IM interns are supportive of its use. The simulation would allow young internists to acquire skills specific to our specialty such as certain gestures, complex consulting management, the synthesis of difficult clinical cases. SBL remains confronted with human and financial cost issues. The budgets allocated to the development and maintenance of simulation centres are uneven, making the supply of training unequal on the territory. Simulation sessions are time-consuming and require teacher training. Are faculties ready to train and invest their time in simulation, even though the studies do not allow us to conclude on its pedagogical validity?     

Analyse docimologique des premières Épreuves classantes nationales informatisées (ECNi) de 2016 : propositions d’amélioration

In June 2016, 8124 medical students in their sixth year of graduation passed the first computerized national ranking exam (CNRE) in France after which they will have to choose what medical specialty they will be practicing all their life. We conducted the first educational assessment of this CNRE according to two criteria: the relevance of the questions and the cognitive domain mainly required to answer these questions. We propose two improvements for the future CNRE: promote student reasoning in the multiple choices questions, reduce to 10 the number of multiple choice questions in the progressive clinical cases and increase by 9 their total number (from 18 to 27), and use a majority of mini-clinical cases for isolated multiple choice questions in order to focus students on reasoning instead of simple knowledge restitution.     

Les interféronopathies de type I. Mise au point et revue de la littérature

Thanks to the tremendous progress of genetics, a new field of inherited inflammatory disorders related to an overproduction of interferon has recently emerged. The so-called type I interferonopathies represent an heterogeneous group of Mendelian diseases presenting with various features starting in childhood, although the diagnosis can also be made later in life. Several clinical and biological characteristics are shared across these patients such as a positive interferon (IFN) signature and neurological and cutaneous involvement, some of which display organ specificity. Treatment is challenging, but IFN-targeting therapies represent a promising option in these severe diseases.     

Long-term observations on the effect of polyadenylic acid in mice of different ages

In order to better life performance, polyadenylic acid (poly (A) ) was given intraperitoneally to CBA/Ca mice for almost a two-year period. This substance, as one of the components of double-stranded polynucleotides (like poly A:U), is known to improve some immune responses of the aging organism. Five approaches (changes in body-weight, adaptation to cold stress, biological half-life of body proteins, mortality and pathology) were applied to test the effects of this substance on life performance. It was found that the beneficial effects of double-stranded polynucleotides cannot be mimicked by polyadenylic acid only, despite its anti-senescence effect, namely, it accelerates the apparent protein turnover, cf., biological half-life. Polyadenylic acid shortens life-expectancy (because of the higher mortality rate of mice). Possible mechanisms of these actions are discussed.     

Compression cardiaque d’origine hydatique

Introduction

Cardiac hydatid disease is uncommon and occurs in 0.5 to 2% of patients with hydatidosis. Isolated intrapericardial hydatid cystic disease is extremely rare.