La prise en charge des lésions anopérinéales de la maladie de Crohn: revue de la littérature

The anoperineal Crohn??s disease lesions pose a several problems in diagnostic and therapeutic steps. The frequency of these lesions was around 21 to 23% in the literature [1]. The data in the literature are still insufficient in the absence of studies devoted to this location particularly debilitating. The purpose of this literature review is to highlight the current diagnostic and therapeutic modalities and new recommendations.     

Survenue de cancers au cours de la sclérodermie systémique : facteurs de risque,impact sur la survie et revue de la littérature

IntroductionPatients with systemic sclerosis (SSc) have an increased risk of malignancy. In this study, we aimed to analyze the prevalence of cancer, the risk factors and the impact on overall survival.Patients and methodsWe analyzed clinical (history of cancer, toxic exposition, organ involvement), immunological and treatment data in a monocentric cohort of SSc patients followed between January 2004 and December 2017.ResultsTwo hundred and ten patients with SSc were included. During the follow-up, twenty-one patients (10 %) were diagnosed with malignancies. The underlying malignancies were breast adenocarcinoma (n = 6, 28%), lung cancer (n = 6, 28%), colorectal (colic adenocarcinoma, carcinoid tumor of the appendix), ovarian and cervix uteri, melanoma, kidney and papillary thyroid carcinoma (one of each). The median time between the first visit and the diagnosis of cancer was 4 [2–10] years. The overall survival in SSc patients with cancer was not significantly different from patients without cancer, with median survival during the first quartile (75%) at 12 years for patients with cancer and 11.6 years for those without cancer (P = 0.9). The history of renal scleroderma crisis (HR 10.99, IC95% [1.95–62.07]; P = 0.006) and the presence of anti-topoisomerase I antibodies (HR 5.5, IC95% [1.40–21.67]; P = 0.01) were associated with an increased risk of cancer, whereas the presence of gastroesophageal reflux was inversely associated with the cancer occurrence (HR 0.22, IC95% [0.056–0.867]; P = 0.03).ConclusionThe history of renal scleroderma crisis and the positivity of anti-topoisomerase I antibodies were associated with an increased risk of cancer in SSc patients in this monocentric study.     

Le dépistage ciblé de la pré-éclampsie au premier trimestre de la grossesse au CHU de Toulouse

GoalsPreeclampsia (PE) is a leading cause of maternal and neonatal morbidity and mortality. Early treatment by aspirin has been shown to significantly reduce PE risk before 37 weeks supporting the implementation of first-trimester screening.Subjects and methodsA targeted screening was recently implemented at Toulouse University Hospital for women in their first pregnancy or those with personal or familial history of PE. It uses Fetal Medicine Foundation (FMF) algorithm that combines maternal characteristics, clinical, biophysical and biochemical (PAPP-A, Pregnancy Associated Plasma Protein-A, and PlGF, Placental Growth Factor) data. We describe this first population of pregnant women and compare our results with those of a mini-test that excludes PlGF and biophysical data.ResultsBetween October 2016 and September 2017, 500 women have benefited from this screening. In such targeted population, we identified 3,6 % (n = 18) of women at high risk to develop PE before 34 weeks and 9,6 % (n = 48) of women at high risk to develop PE between 34 and 37 weeks. When we recalculated the risk using the mini-test, only 10 women (56 %) were identified at high risk of early PE.ConclusionFor the first time in France, we report the result of a targeted screening of PE during the first trimester using the FMF algorithm. We describe the screened population and show that it is more efficient than the mini-test.