La stimulation magnétique transcrânienne répétée : une piste thérapeutique pour les maladies neurocognitives ?

Considering the limited effectiveness of drugs treatments in cognitive disorders, the emergence of noninvasive techniques to modify brain function is very interesting. Among these techniques, repetitive transcranial magnetic stimulation (rTMS) can modulate cortical excitability and have potential therapeutic effects on cognition and behaviour. These effects are due to physiological modifications in the stimulated cortical tissue and their associated circuits, which depend on the parameters of stimulation. The objective of this article is to specify current knowledge and efficacy of rTMS in cognitive disorders. Previous studies found very encouraging results with significant improvement of higher brain functions. Nevertheless, these few studies have limits: a few patients were enrolled, the lack of control of the mechanisms of action by brain imaging, insufficiently formalized technique and variability of cognitive tests. It is therefore necessary to perform more studies, which identify statistical significant improvement and to specify underlying mechanisms of action and the parameters of use of the rTMS to offer rTMS as a routine therapy for cognitive dysfunction.     

Le risque allergique des produits diététiques et médicinaux

The consumption of dietary foods and the use of medicinal plants are constantly increasing. Certain foods and dietary supplements are used for their particular natural character, for their vegetal nature and their richness in vitamins and for the fact that they are “biological” products. Phytotherapy, considered to be medicine of the past, is likewise now considered to be a “medicine of the future”, in part because of the numerous active principals remaining to be discovered in plants. There are many reasons for this trend: the idea of returning to a more natural life (for some, to a primitive past); the search for a better gustative quality of food; for the prevention of and the fight against diseases thought to be related to pollution caused by synthetically-produced chemicals; for conservation or amelioration of the physical form of food; etc. At an individual level, the fact that plants are the source of a large number of products actually in use should cause allergists to be alert, because the risk of pollen and non-pollen allergies is well-known. This review will cover the well-known and accepted risks of allergy to products from beehives, to newly discovered foods (in particular, to ancient cereals), to new foodstuffs, and to medicinal plants, especially exotic ones. The aim is not to alarm consumers but to show them that the evolution of our behaviour goes hand-in-hand with the evolution of the risk of new allergies, meaning that control and vigilance are required. People allergic to pollen and to moulds should use dietary products of plant origin and medicinal herbs with prudence.     

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.     

Attentes en éducation thérapeutique des patients atteints de purpura thrombopénique immunologique et des soignants

IntroductionImmune thrombocytopenia (ITP) durably affects quality of life in patients. Patient education aims at improving their self-care and psychosocial skills, allowing them be more autonomous, to prevent avoidable complications, and to maintain or improve quality of life. The aim of this study was to assess patients’ and caregivers’ expectations regarding patient education in ITP.MethodITP Patients and caregivers were asked about topics that should be addressed in a patient education program through a digital anonymous survey. Their responses were analyzed both qualitatively and quantitatively. A double-blind keyword attribution of the answers was carried out by two physicians and then faced until consensus was found.ResultsThirty-eight ITP patients were included: 68% were less than 50 years old and 84% had chronic ITP. On the other hand, twenty-five caregivers were included. Caregivers raised more topics related to the cognitive domain than patients. The psychoaffective and motivational topics tended to be more represented in patients’ responses. Only 53% of topics were mentioned by both patients and caregivers.ConclusionThese discrepancies emphasize the differences between patients and caregivers’ expectations regarding a patient education program in ITP, and thus the relevance of patient-caregiver co-construction of such programs.     

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.     

Hypertension intracrânienne idiopathique : des mécanismes physiopathologiques à la décision thérapeutique

Clinical features include visual disturbances, headaches, and pulsatile tinnitus that can be associated with reduced quality of life, and a risk of irreversible visual impairment in some cases. Obese women of childbearing age represent the main at-risk population, and the incidence of the disease is increasing because of rising prevalence of obesity worldwide. In addition, an imbalance in sex hormones is reported as a contributing risk factor. The pathophysiology of idiopathic intracranial hypertension involves a disturbance of the evacuation pathway of intracranial fluids caused by the increase in intracranial venous pressure. Brain imaging is useful for diagnosis with several signs including bilateral stenosis of the transverse sinuses that plays a major role in the pathogenesis of the disease by creating a positive feedback loop that increases intracranial venous hypertension and contributes to clinical manifestations. Treatment aims to relieve symptoms and prevent permanent visual impairment. Drug therapies including acetazolamide and topiramate have moderate effectiveness. Among invasive treatments, transverse sinus stenting seems to be the most interesting option to consider in drug-resistant patients. Weight loss remains essential to achieve a sustainable improvement by reducing central venous pressure. Future randomized trials are expected to reach a consensus on this treatment.