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Optimiser les objectifs lors de la prise en charge des patients atteints de colite ulcéreuse : Rôle de la calprotectine fécale pour orienter la thérapie d'entretien

Optimiser les objectifs lors de la prise en charge des patients atteints de colite ulcéreuse : Rôle de la calprotectine fécale pour orienter la thérapie d'entretien

Teaser: 

A. Hillary Steinhart, M.D., est membre du service de gastroentérologie du Mount Sinai Hospital/University Health Network, et est professeur de médecine à l'Université de Toronto à Toronto (Ontario).

Résumé
Bien qu'une thérapie d'entretien pour la colite ulcéreuse permette généralement d'obtenir une rémission clinique, de nombreuses études ont montré que les patients en rémission clinique pourraient présenter des degrés variables d'inflammation de la muqueuse. Il semble que les patients présentant le plus haut degré d'inflammation évolutive de la muqueuse, malgré l'absence de symptômes cliniques, sont plus susceptibles de subir une poussée symptomatique à court terme. Chez les patients atteints de CU, le taux de calprotectine dans les selles est associé non seulement à la présence ou l'absence d'inflammation de la muqueuse, mais également au degré de gravité clinique de la CU. Ces observations soulèvent la possibilité d'utiliser le taux de calprotectine fécale pour surveiller de manière non effractive les patients en rémission clinique, et modifier le traitement de ceux montrant une augmentation du taux de calprotectine fécale, et ce, avant la réapparition des symptômes.
Mots clés : colite ulcéreuse, calprotectine fécale, prédiction des poussées, inflammation de la muqueuse, surveillance non effractive.

Colite ulcéreuse : Étude de cas

Colite ulcéreuse : Étude de cas

Teaser: 

Brian Bressler, M.D., M.Sc., FRCPC, est professeur adjoint clini-que de médecine dans
le service de gastroentérologie du St Paul's Hospital, Université de la Colombie-Britannique, à Vancouver (Colombie-Britannique).

Résumé
Un homme de 28 ans est venu nous consulter pour ses selles sanglantes. La coloscopie a mis en évidence une colite ulcéreuse gauche modérément évolutive, affectant une région allant de la marge de l'anus jusqu'au milieu du côlon descendant. Suite à un traitement d'induction avec des 5-AAS par voie orale et rectale, le patient est maintenant en rémission. Une éducation adaptée au patient lui a permis de réaliser que le meilleur moyen pour lui de rester en rémission était de continuer le traitement médicamenteux.
Mots clés : colite ulcéreuse, 5-aminosalicylate, respect du traitement médicamenteux, surveillance de la dysplasie, inflammation du rectum.

Les phtalates dans les 5-AAS : Orienter le choix thérapeutique et minimiser les risques

Les phtalates dans les 5-AAS : Orienter le choix thérapeutique et minimiser les risques

Teaser: 

Geoffrey C. Nguyen, M.D., Ph. D., est professeur de médecine adjoint au Centre for Inflammatory Bowel Disease du Mount Sinai Hospital, Université de Toronto, Toronto (Ontario).

Résumé
Les 5-aminosalicylates (5-AAS) représentent le traitement de première intention pour les patients atteints de colite ulcéreuse (CU) légère à modérée, en raison de leur efficacité prouvée et de leur profil d'innocuité, même pour les femmes enceintes. Cependant, une préparation de 5-AAS possède un revêtement contenant du phtalate de dibutyle (DBP). Bien que, chez les rongeurs, le DBP puisse entraîner des troubles du développement reproducteur et d'autres anomalies congénitales in utero, on ne sait pas si le DBP provoque des anomalies foetales importantes sur le plan physiologique chez les humains. La Federal Drug Administration a modifié la classification des 5-AAS contenant du DBP en les faisant passer de la classe B à la classe C durant la grossesse, afin de refléter le degré plus grand d'incertitude concernant l'effet du DBP chez les humains. Le message le plus important destiné aux femmes enceintes atteintes de CU consiste à prendre les médicaments contre la CU afin d'empêcher une rechute de la maladie, qui pourrait entraîner le plus d'effets indésirables sur la grossesse. Cependant, les médecins doivent discuter avec les jeunes femmes prenant des 5-AAS contenant du DBP des bienfaits et des risques de prendre une autre préparation de 5-AAS sans DBP.
Mots clés : phtalates, 5-aminosalicylate, colite ulcéreuse, phtalate de dibutyle, grossesse.

Le patient venant de recevoir un diagnostic de colite ulcéreuse : Prévoir les questions et personaliser les réponses

Le patient venant de recevoir un diagnostic de colite ulcéreuse : Prévoir les questions et personaliser les réponses

Teaser: 

James Gregor, M.D., est membre du département de gastroentérologie de l'Université Western Ontario, London (Ontario).
Co-auteurs : John Howard, M.D., Nitin Khanna, M.D. et Nilesh Chande, M.D.
sont membres du département de gastro-entérologie du London Health Sciences Centre (Université Western) London (Ontario).

Résumé
L'un des atouts les plus importants dans la prise en charge des patients atteints de colite ulcéreuse consiste à avoir des patients bien informés. L'expérience clinique montre que la plupart des patients ont des questions similaires lors de leur diagnostic. En anticipant ces questions et en les adaptant à la gravité et l'étendue de la maladie d'un patient, il est possible non seulement de simplifier le suivi, mais également de réduire la confusion et d'augmenter les bienfaits apportés par la pléthore de renseignements disponibles au 21e siècle. D'après notre expérience locale, nous avons défini les 10 questions les plus couramment posées par les patients et modifié les réponses, au besoin, pour qu'elles soient mieux adaptées aux patients atteints de rectite ou proctite ulcéreuse, de colite ulcéreuse gauche ou de pancolite.
Mos clés : colite ulcéreuse, patient, questions, classification, prise en charge.

Whose Decision is it Anyway?

Whose Decision is it Anyway?

Teaser: 

Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Baycrest Geriatric Health Care System; Professor of Medicine, University of Toronto, Toronto, ON.

Abstract
One of the most challenging and at the same time hopefully rewarding activities is to be the substitute decision maker (SDM) for someone important to you such as a parent. The assumption is by designating a child or children to be one's substitute they will make the right decisions and keep your wishes or best interests at the centre of the decision-making. This unfortunately is not always the case and for a variety of reasons some of which are just a misunderstanding of the legislation and the meaning of the Health Care Consent Act some SDMs start making decisions based on their personal preferences and biases and not of the person they are meant to represent. This can lead to varying degrees of conflict sometime so serious that health care professionals may explore the steps that might be needed to remove the SDM from the role and find a more appropriate substitute. This is not something one likes to do and with proper explanation it usually can be avoided. The most important point is that the patient must always be the centre of the decision-making process.
Keywords: substitute decision-maker, capable patient, consent, Public Guardian.

Top Ten Tips for Atopic Tots

Top Ten Tips for Atopic Tots

Teaser: 

Katia Faustini, Faculty of Medicine, McGill University, Montreal, Quebec.
Joseph M Lam, MD, FRCP(C), Clinical Assistant Professor, Department of Pediatrics, Associate Member, Department of Dermatology and Skin Sciences, University of British Columbia.


Abstract
Atopic dermatitis is the most common inflammatory skin condition affecting children. Given the complex waxing and waning nature of this common dermatologic condition, patient education and frequent family physician involvement, is the key to proper long term management. While topical steroids have long been accepted as the standard therapy in management of eczema, concern over its side effects by both family doctors and patients greatly impact compliance. Topical steroids are safe and efficacious if used properly. This article examines the top ten things to know about atopic dermatitis in order to properly and safely manage this chronic disease.
Keywords: atopic dermatitis, inflammatory skin condition, topical corticosteroids.

Ear Lesions That Recur Every Spring

Ear Lesions That Recur Every Spring

Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.

Mainpro+® Overview
Teaser: 

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Juvenile spring eruption is a photodermatosis that is considered a localized variant of polymorphic light eruption. This condition appears on the light exposed areas of the ears and is primarily found in boys and young males in early spring or summer. The exact pathogenesis of juvenile spring eruption is not clear. The symptoms usually clear within 2 weeks, but recurrences are common under similar climatic conditions. The diagnosis of juvenile spring eruption is made clinically and investigations are not required. Treatments include avoidance of sun exposure, emollients, potent topical corticosteroids, and antihistamines.
Keywords: juvenile spring eruption, photodermatosis, polymorphic light eruption, spring, ears.

An Unusual Case of Large B-cell Lymphoma of the Sinonasal Tract in a Ninety Year Old Woman

An Unusual Case of Large B-cell Lymphoma of the Sinonasal Tract in a Ninety Year Old Woman

Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.

Mainpro+® Overview
Teaser: 

P.K. Shenoy, MD, DLO, FRCS, FACS1, W. Wang, MD2
1ENT Service Chief, Campbellton Regional Hospital, New Brunswick, Campbellton, Canada. 2Pathology Service Chief, Campbellton Regional Hospital, New Brunswick, Campbellton, Canada.

Abstract
Lymphoma accounts for 3 to 5% of malignant tumours, non-Hodgkin's lymphoma (NHL) accounts for 60% of all lymphoma. NHL of the sinonasal tract is an uncommon neoplasm that can be morphologically difficult to distinguish from non-neoplastic destructive lesions or malignant neoplasm. Only Immuno histochemistry could give a definite diagnosis. These represent 1.5 to 15% of NHL in the United States,1 2.6 to 6.7% of all lymphoma in Asia.2 B cell phenotype are most frequently found in the Western Hemisphere while T cell lymphomas are found in Asian countries. B-cell lymphoma of sinonasal tract occur in 6th to 8th decade of life and have a better prognosis.3 Review of the literature shows that early diagnosis and prompt treatment with local radiation (XRT) or combined modality treatment (CMT) have shown good prognosis.4
Keywords: non-Hodgkin lymphoma, diffuse large B-cell lymphoma (DLBCL), disease free survival (DFS), overall survival (OS), epistaxis, rapid rhino® (Arthrocare ENT products).

Advances in Alzheimer's Disease Management

Advances in Alzheimer's Disease Management

Teaser: 

CHAPTER 7: Ethical and clinically humane end-of-life care for those living with dementia
by Michael Gordon

 

Editors:
Serge Gauthier, McGill University, Montreal, Quebec, Canada
Pedro Rosa-Neto, McGill University, Montreal, Quebec, Canada
Publisher: Future Medicine
Reviewed by: Michael Gordon, MD, MSc, FRCPC, FACP, FRCPEdin

It is always a pleasure to be able to discuss a new book to a receptive audience when I believe the book has something special to offer. When it comes to reviewing books outside the realm of medicine or the medical sciences, reviews often are reflective of the personal and aesthetic views of the reviewer. There are many books written for professional readers on the fringe of medical science that deal with non-clinical aspects of medicine and many that have translated important medical concepts to the lay audience and others in the form of memoirs and novels of the personal and historical type that add a great deal to the general wealth and richness of medicine and the associated medical sciences.

To undertake an academic text book is always a daunting task. Generally if experts and specialists in the field cannot write such a book without the help of others and currently the idea of editors securing experts to write the relevant chapters is a well-accepted methodology for achieving that goal. That being said it becomes the responsibility of the editors to make sure that those that they recruit to write the relevant chapters have the academically sound and clinically and research-based capability of doing so and on top of that have the writing skills to achieve their goal. Moreover, for the chapters to hang together in one strives to have some degree of congruence in the writing approaches and styles, while at the same time promoting the particular capabilities of the writers of each chapter. At the end it is hoped that the chapters hang together into a whole that attracts the reader and provides a perspective on the subject and each of its varied components that would be hard to achieve if the reader decided to explore each of the subject chapters separately without the benefit of them being collated, edited and reference into one easily accessible book.

I am therefore pleased and honoured to not only present the book to subscribers of HealthPlexus.net, Advances in Alzheimer’s Disease Management edited by Serge Gauthier and Pedro Rosa-Neto but to have been one of the contributors. At a time when the knowledge surrounding Alzheimer’s disease and other dementias is on the one hand expanding rapidly from the scientific perspective, for the practicing physician and patient living with dementia and their families, the challenges seems to be overwhelming. There seems to be a huge disconnect between the understanding and scientific progress of the causes in many domains of enquiry and the actual clinical impact that all this new knowledge currently has that physicians in the front lines of care can utilize clinically.

In medicine however, one never knows what key will be the one that opens the door we are all looking to enter. At any given time all we can do is to try and figure out using the best clues and evidence available to know what secrets lay behind that door. The readily accessible E-book format in which Advances in Alzheimer’s disease management is produced allows for a relatively low cost alternative to the usual costs of hard copy texts. The content of the book covers all the main challenging concepts and recommended or best-practices as they exists currently. Obviously in time, perhaps a very short time, some of these will change but for those in the field we all know that many of the concepts and practices have not changed in many years.

The table of contents includes the following subjects by the authors listed next to the chapter titles, with mine at the end. I have been given permission to reproduce my chapter, Ethical and clinically humane end-of-life care for those living with dementia on the HealthPlexus.net website so that subscribers can get a taste of the e-book itself.

1) Genetics of Alzheimer’s disease by Jayashree Viswanathan, Hilkka Soininen & Mikko Hiltunen;
2) Diagnosis of Alzheimer’s disease by Pedro Rosa-Neto, Jared Rowley, Antoine Leuzy, Sara Mohades, Monica Shin, Marina T Dauar and Serge Gauthier
3) Available symptomatic antidementia drugs by Marie-Pierre Thibodeau and Fadi Massoud
4) New drugs under development for Alzheimer’s disease by Lezanne Ooi, Kirubakaran Shanmugam, Mili Patel, Rachel Debono and Gerald Münch
5) Management of agitation and aggression: controversies and possible solutions by Clive Ballard and Anne Corbett
6) Guidelines for the diagnosis and treatment of Alzheimer’s disease by Serge Gauthier and Christopher JS Patterson
7) Ethical and clinically humane end-of-life care for those living with dementia by Michael Gordon

For those interested in ordering the book, this can be done through the following links:
The direct URL for the book is:
http://www.futuremedicine.com/doi/book/10.2217/9781780840840

For those who are interested in finding more information about the book/our e-book series, the email address is:
info@futuremedicine.com
For those who wish to place an order, the email is:
sales@futuremedicine.com

A Practical Review of the Diagnosis and Management of Small Renal Masses

A Practical Review of the Diagnosis and Management of Small Renal Masses

Teaser: 

Stanley A. Yap,1 Shabbir M.H. Alibhai,2,3Antonio Finelli,1
1Division of Urologic Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada. 2Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada. 3Department of Medicine, University of Toronto, Toronto, ON, Canada.


Abstract
The incidence of small renal masses (SRMs) has risen steadily over time, and SRMs now represent the majority of newly diagnosed renal lesions. Approximately 80% of newly diagnosed SRMs will be malignant. However, identifying a benign versus malignant lesion non-invasively can be difficult since no distinct imaging characteristics or growth patterns exist between the two. We have witnessed concurrent improvements in treatment strategies for small, localized tumors and have gained a better understanding of their natural history. Along with these changes there has been a shift in the manner in which we diagnose and treat SRMs. Although surgery remains the standard of care, we can now offer a variety of therapies individualized to the patient.
Keywords: kidney cancer, small renal mass, diagnosis, treatment.