La Revue de médecine interne
-
Seric hyperviscosity syndrome is a medical emergency linked to hyperproteinemia. The clinical diagnosis hinges on a triad of symptoms: mucosal hemorrhages, visual disturbances, and neurological disorders, observed in the most severe cases. ⋯ Laboratory tests predominantly identify the syndrome's etiology, with Waldenström's macroglobulinemia (characterized by a marked IgM peak) being the most common cause, followed by multiple myeloma and cryoglobulinemias. To prevent recurrence, targeted treatment of the underlying cause is implemented following plasma exchange sessions.
-
Aortitis is a rare disease entity of unknown prevalence. Primary aortitis mainly affects the thoracic aorta. They are most often diagnosed on imaging by grade III 18-FDG uptake of the aortic wall on PET, or by circumferential thickening>2.2mm on CT or MRI with late-stage contrast. ⋯ Aortitis secondary to systemic diseases is seen in atrophying polychondritis, systemic lupus and inflammatory rheumatic diseases such as spondyloarthropathy and rheumatoid arthritis. In both ACG and AT, aortitis is a negative factor, characterized by a higher risk of relapse, cardiovascular complications and increased mortality. The management of aortitis is insufficiently codified, and relies on the control of cardiovascular risk factors, with particular monitoring of blood pressure and LDL cholesterol, and on corticosteroid therapy and immunosuppressive drugs, the use of which will depend on the disease associated with the aortitis, the initial severity and comorbidities.
-
Review Historical Article
[Update on the diagnosis and management of functional neurological disorders from Jean-Martin Charcot to 2024].
Functional neurological disorders (FND) represent a major clinical challenge, characterized by neurological symptoms without identifiable organic lesions. Since the initial descriptions by Jean-Martin Charcot in the 19th century, the understanding and management of FND have evolved considerably. This review aims to provide an up-to-date overview of current knowledge on the diagnosis and management of FND, integrating recent advances and multidisciplinary therapeutic approaches. ⋯ The management of FND includes a multimodal approach, combining psychotherapy, physical rehabilitation, and targeted pharmacological interventions. The involvement of emerging technologies such as non-invasive brain stimulation and the use of artificial intelligence tools, opens up new perspectives in patient care. Finally, this review addresses the ongoing challenges related to stigma and the training of healthcare professionals, while proposing avenues for improving the quality of care provided to patients with FND.
-
The Script Concordance Tests (SCTs) are an examination modality introduced by decree in the French National Ranking Exam for medical students in 2024. Their objective is to evaluate clinical reasoning in situations of uncertainty. In practice, SCTs assess the impact of new information on the probability of a hypothesis formulated a priori based on an authentic clinical scenario. ⋯ Instead, the distribution of responses from a panel of experienced physicians is used to establish the question's scoring scale. Literature data suggest that physicians, even experienced ones, like most humans, often exhibit biased intuitive probabilistic reasoning. These biases raise questions about the relevance of using expert panel responses as scoring scales for SCTs.