Démarche diagnostique et prise en charge thérapeutique de l’hyperthyroïdie

Hyperthyroidism is a frequent clinical situation that can be expressed by various signs and it is generally easy to diagnose. This review proposes to explain the diagnostic approach that affects therapeutic management by separating diseases with homogeneous and nodular thyroid.     

Classification et prise en charge thérapeutique des gammapathies monoclonales de signification rénale

Two categories of renal disorders associated with monoclonal gammopathies are to be distinguished, according to the characteristics of the underlying B-cell clone. The first group of renal diseases always occurs in the setting of high tumor mass with production of large amounts of monoclonal immunoglobulins. The main complication is the so-called myeloma cast nephropathy, which almost invariably complicates high tumor mass myeloma. The second group includes all renal disorders caused by a monoclonal immunoglobulin secreted by a nonmalignant B-cell clone, and currently referred as a “monoclonal gammopathy of renal significance (MGRS)”. This term was introduced to distinguish monoclonal gammopathies that are responsible for the development of kidney damage from those that are truly benign. The spectrum of renal diseases in MGRS is wide and its classification relies on the localization of renal lesions, either glomerular or tubular, and on the pattern of ultrastructural organization of immunoglobulin deposits. Physicochemical characteristics of the pathogenic monoclonal immunoglobulin are probably involved in their propensity to deposit or precipitate in the kidney, as illustrated by the high rate of recurrence of each specific type after kidney transplantation. Early diagnosis and efficient chemotherapy targeting the causal B-cell clone are mandatory to improve renal prognosis and patient survival.     

Prise en charge de la pancréatite aiguë. Revue de la littérature

The management of acute pancreatitis is now fairly codified, with specific recommendations developed by expert groups. These recommendations deal in particular with the minimum initial assessment, recognized severity scores, initial medical management with hyperhydration, preventive anticoagulation, early refeeding, delays in imaging and management of complications. In this work, we have tried to bring together the various recommendations, articles and studies dealing with this subject, based more particularly on European recommendations, in order to guide the management of acute pancreatitis in current practice.     

Prise en charge thérapeutique des métastases hépatiques des cancers colorectaux. À propos de 22 cas

Introduction

Therapeutic management of hepatic metastases of colorectal cancer has progressed during recent years thanks to the development of surgical techniques, chemotherapy, portal embolisation and radiofrequency.

Study aim

To study the rate of resecability and the gain in resecability resulting from other therapies.

Patients and methods

We carried out a retrospective survey including 22 patients treated in our centre for hepatic metastases of colorectal cancer during the last four years.

Results

Six right hepatectomies were performed of which 3 after portal ligature, 2 left lobectomies, 2 central hepatectomies, 4 segmentectomies, 3 enucleoresections, 2 cases were resected after radiofrequency and 3 patients had chemotherapy as palliative treatment for diffuse hepatic metastases. The rate of resecability was 22.7 % and thanks to chemotherapy, radiofrequency and portal ligature this increased to 86.3%.

Conclusion

Our study confirmed that the rate of resecability can be increased by other therapies.