RESUMO
This article features a selection of ten topics chosen, reviewed, and commented for you by chief residents at the Department of Internal Medicine at Centre hospitalier universitaire vaudois (CHUV). This selection synthesizes the novelties and essential reminders of 2023 in internal medicine. By analyzing the standout publications of the year, it offers an overview of progress in diagnosis and patient management within the hospital and their transition to outpatient care. From oral anticoagulation to community-acquired pneumonias, encompassing the management of heart and kidney failure, each key aspect is explored. This compilation provides practitioners with an essential resource to remain at the forefront of current developments, thereby stimulating more informed and effective care for patients.
Cet article propose une sélection de dix sujets choisis, revus et commentés pour vous par les cheffes et chefs de clinique du Service de médecine interne du Centre hospitalier universitaire vaudois (CHUV). Cette sélection synthétise les nouveautés et rappels essentiels de 2023 en médecine interne. En analysant les publications phares de l'année, elle offre une vue d'ensemble des progrès dans le diagnostic et la prise en charge des patients intrahospitaliers et leur transition ambulatoire. De l'anticoagulation orale aux pneumonies communautaires en passant par la prise en charge des insuffisances cardiaque et rénale, chaque aspect clé est exploré. Cette compilation fournit aux praticiens une ressource essentielle pour rester à la pointe des développements actuels, stimulant ainsi des soins plus éclairés et efficaces pour les patients.
Assuntos
Assistência Ambulatorial , Médicos , Humanos , Coração , Hospitais , Medicina InternaRESUMO
BACKGROUND: Renal arteriovenous fistula (rAVF) is a rare complication after a total nephrectomy, with only 72 cases reported in the last literature review published in 1997. AVF has never been described in a renal transplant recipient, and the possible consequences of hemodetournement on the graft function are unknown. METHODS: We hereby reported the first case of rAVF occurring in a renal transplant recipient and analyzed all cases of postnephrectomy rAVF reported between 1997 and 2017. RESULTS: A 75-year-old woman who underwent a right nephrectomy and kidney transplant 16 years earlier, and complaining of mild exercise dyspnea, was discovered with a lumbar continuous murmur. Echocardiography showed a moderate to severe dilatation of the left ventricle, with a decreased ejection fraction. Serum creatinine was slightly raised but returned to normal value with hydration. An injected computed tomography scan demonstrated a communication between the stump of the right renal artery and inferior vena cava. Total occlusion of the rAVF was obtained with Amplatzer plug and coils placed in the distal renal stump, just upstream of rAVF. Exercise dyspnea disappeared immediately, and regression of left ventricular dilatation was objectified at 6-month echocardiography follow-up. CONCLUSIONS: Postnephrectomy rAVF is rare, frequently diagnosed late, and may be responsible for high-output heart failure by left-to-right shunt, with abdominal/lumbar bruit being the only manifestation. Renal complications concern 15% of the patients. Endovascular procedure is nowadays the treatment of choice. Occluding rAVF permits cardiac hemodynamic features and heart failure symptoms resolution.
RESUMO
Alcoholic steatohepatitis is a severe and frequent manifestation of alcoholic liver disease which is associated with high mortality. This poor outcome is strongly influenced by several aspects of the disease, including the absence of medical treatment with proven benefit other than steroids, the elevated risk of infections, the ineffectiveneness of proregenerative strategies, the high prevalence of concomitant malnutrition, and the elevated rate of alcohol relapse during follow-up. All these parameters should be considered as major therapeutic targets in the near future in order to improve the management and outcome of these patients.
La stéatohépatite alcoolique, forme grave et fréquente de la maladie alcoolique du foie, reste associée à un taux élevé de mortalité. L'absence d'alternative efficace au traitement médical par prednisone, le risque élevé d'infections, l'inefficacité de stratégies visant à promouvoir la régénération, la présence concomitante d'une malnutrition grave et le taux non négligeable de rechutes alcooliques lors du suivi sont tous des facteurs qui affectent le pronostic et constituent des défis thérapeutiques pour tenter d'améliorer à l'avenir la prise en charge de ces patients.
