Dix a quinze pour-cent des oesophagites ne sont pas cicatrisees apres 8 semaines d'un traitement antisecretoire efficace (inhibiteurs de la pompe a protons (IPP) ou fortes doses d'anti-H 2 ). La resistance au traitement est liee a un effet antisecretoire insuffisant associe a la severite des anomalies physiopathologiques (insuffisance des facteurs de defense - acroissement des facteurs d'agression). La plupart des oesophagites resistantes cicatrisent avec un accroissement des doses d'IPP. Cependant la caracterisation des mecanismes pathogeniques susceptibles d'expliquer la resistance est souvent necessaire pour deboucher sur un traitement plus adapte (medical ou chirurgical). Enfin, et en l'absence de symptomes, la persistance de lesions minimes peut etre toleree dans la mesure ou l'aggravation des lesions est rare et ne s'accompagne pas de recidives.
La surcharge ponderale, hormis les comorbidites et la mortalite qui y sont associees, deteriore fortement la qualite de vie. Cet article est une analyse de la qualite de vie des 226 premiers obeses morbides (BMI > 40 kg/m 2 ) se trouvant a plus de dix-huit mois apres une chirurgie de type bypass gastrique sur les 448 effectuees a ce jour dans notre service. Nous avons de plus etudie l'apport supplementaire d'une chirurgie reconstructive, souvent necessaire, chez ces operes presentant un exces cutane Important. La qualite de vie est amelioree cher 85% des patients, et ceci surtout dans le domaine de l'estime de sol et de l'activite physique. La chirurgie reconstructive permet d'ameliorer encore la perception individuelle de satisfaction dans sa vie quotidienne. La mesure de la qualite de vie est donc primordiale dans l'evaluation de la reussite d'une chirurgie de l'obesite, et ceci en complement d'autres criteres comme la perte ponderale ou la diminution des comorbidites. Par ailleurs, la chirurgie reconstructive, offre un benefice supplementaire dans l'amelioration de la qualite de vie, et devrait etre proposee, des que le poids est stabilise.
La diverticulose est la pathologie colique la plus frequente des pays industrialises. La majorite des patients atteints de diverticulose colique sont et resteront asymptomatiques. Environ 25% des patients developperont une diverticulite. La presentation clinique typique est caracterisee par des douleurs abdominales en fosse iliaque gauche, accompagnees d'un etat febrile et de troubles du transit. Le CT-scan est l'examen de choix pour confirmer le diagnostic et rechercher des complications potentielles telles qu'abces, fistule, obstruction ou perforation. L'antibiotherapie, associee a la chirurgie lors de complications, est le traitement de choix. La diverticulose peut aussi dans 15% des cas se compliquer d'une hemorragie. Pour les patients de moins de 65 ans, il s'agit de la cause la plus frequente d'hematochesie. Celle-ci s'arrete spontanement dans 70-80% des cas. Le traitement de l'hemorragie diverticulaire s'effectue par hemostase endoscopique, embolisation arterielle ou chirurgie.
Les bursopathles des membres Inferieurs ont souvent une cause mecanique, en particulier lors de la pratique du sport et en presence de troubles statiques, des avant-pieds notamment. A la hanche, les bursopathles se confondent souvent avec une tendinopathie par surcharge des muscles gluteaux a l'origine d'une periarthropathie de hanche. Parmi les autres causes de bursopathles, il faut mentionner les rhumatismes inflammatoires, en particulier la PR, les rhumatismes microcristallins (depots de cristaux d'urate de sodium ou depots d'apatite) et les Infections qui sont a rechercher chez des patients presentant des facteurs predlswsants (diabete, excoriation cutanee, etc.). Le traitement des bursopathies des membres Inferieurs est avant tout conservateur. Il est exceptionnel que l'on doive recourir a la chirurgie mais ceci est parfois le cas lorsqu'il s'agit d'ameliorer des conflits d'ordre mecanique.
En dehors de ses effets sur la pression arterielle l'angiotensine Il est susceptible de jouer un role important dans la pathogenese de l'atherosclerose, ceci par plusieurs mecanismes : elle accroit le stress oxydatif dans la paroi arterielle, Induisant ainsi une dysfonction endotheliale et une augmentation de l'oxydation des LDL; elle a un effet pro-inflammatoire et procoagulant au niveau de la vasculature; elle favorise l'hypertrophie et le remodelage vasculaire. Il y a une bonne evidence aujourd'hui qu'il y a interet a bloquer le systeme renine-anglotensine chez les malades a haut risque cardiovasculaire.
Le changement des habitudes alimentaires et la diminution de l'activite physique sont largement responsables d'une epidemie d'obesite dans la population pediatrique. Une des consequences de ce developpement dramatique est l'augmentation de l'Incidence du diabete de type 2 (DT2), autrefois seulement connu chez l'adulte. Des facteurs environnementaux et genetiques contribuent a la physlopathologie du DT2. Les minorites ethniques sont plus a risque de developper un diabete que les Caucasiens. Le traitement comprend une modification du style de vie avec une augmentation de l'activite physique et une alimentation equilibree dans le but de stabiliser ou perdre du poids. En deuxieme ligne, une pharmacotheraple par metformine peut etre envisagee. Pour faire halte a cette menace a la sante publique, une prevention primaire de l'obesite est primordiale.
Chronic pain represents an etiological enigma and a therapeutic dead-end for medicine and for the patient. Social sciences, in particular its analysis of patients narratives, offer a new perspective of this problem. Predominant themes include the discrepancy between the biomedical and the patient's discourse, the patient's difficulties in trying to take into account the medical perspective for his pain, the lack of an adequate language of pain, the need for a meaning of pain, the role of culture in shaping the patient's presentation as well as the medical system's response to pain. Acknowledging the patient's subjective experience confirms its legitimacy. Exploring the patient's social, cultural and personal world allows access to multiple interpretations for his symptom, offering possibilities for negociation of a satisfactory meaning.
Both sedentarity and loneliness are two important aspects to be considered among elderly who fall. One third of Swiss citizens do not practice any regular exercise. In Geneva, sedentarity is even mote prevalent and concerns 57% of men and 70% of women. Remaining in good physical shape has a major impact on physical and psychological health. The Geneva University Hospital' MOBEQ program (rehabilitation program to enhance mobility and balance in geriatric in-patients) has developed innovative moderate interventions involving exercise such as Tai Chi and dance. Early results show both significant improvements in physical performance and motivation to pursue to this type of physical exercise. To ensure continuity of regular exercise after discharge, networking with various outside partners has been developed.
Behavioral disturbances (BD) occurring in very old patients suffering from cognitive impairment frequently disturb their next of kin or the neighbors whether they live in the community or in a nursing home, and often justify their hospitalization in geriatric psychiatry. In hospital settings, BD increases length of stay insofar as both nursing homes and home care services are reluctant to take patients back unless there BD have disappeared or are stabilized at socially acceptable levels. The management of BD remains a permanent challenge for the relatives as well as for health care professionals, thus the need for a quantitative,. prospective approach such as the one presented here.
The Bus Sante survey interviewed 2,355 Genevan menopausal women about their use of hormone replacement therapy (HRT) between 1993 and 2002. The percentage ever having used HRT rose from 35% in 1993 to 67% in 2002 for women who had a natural menopause (n=2,145), and rose from 39% in 1993 to 75% in 2002 for women who had an artificial (surgical) menopause. The percentage of current HRT use rose from 25% in 1993 to 48% in 2002 among women with a natural menopause, and rose from 32% in 1993 to 50% in 2002 among women with an artificial menopause. Among ever HRT users, the mean age when HRT began was 51 yrs, with no change between 1993 and 2002. Among women no longer using HRT, the mean age at discontinuation was 56 yrs in 1993 and 58 yrs in 2002, suggesting a slight increase in duration of HRT use, but there was no statistically significant trend.
The use of the oral hormone replacement therapy (HRT) in post-menopausal women in order to prevent coronary heart disease has come to a definitive stop after the publication of the results of the Women Health Initiative (WHI) large randomised controlled trial. In the United States the social history of estrogens started 40 years ago, when the use of replacement sexual hormones has been proposed as a tool to keep a good heart and vascular health together with the most attractive features of the feminine. Observational evidence from epidemiologial studies had contributed to this idea, even if their interpretation had been influenced by the social context which had been highly favourable to the use of estrogens. The WHI trial does not provide all answers about the use of estrogens in the prevention of cardiovascular disease in postmenopausal women but it reminds us that the greatest caution is warranted before submitted large population to chemoprevention. Specially when there are non-pharmacological measures (lifestyle modification) that works.
The prevalence of dementia increases with aging and longevity and affect 30% of the subjects aged 85 and older. Health economical aspects must be considered from now. Diagnosing and treating dementia represent only 3% of health expenditure while the nursing home caring costs reach 67%. In addition, neither the caregivers informal caring nor the socio-economic cost effective consequences are well identified. Furthermore. specific treatment of dementia (i.e. Acethylcholinesterase Inhibitors) delays the progress of the disease and the related disabilities which are much more costly.
Systemic approaches and family therapies offer an important framework for the implication of significant others to the therapeutic process in addiction medicine. Other valuable concepts are also becoming available to improve the network of relatives, partners, or friends to become a resource and to promote self-help and self-change through community activities. In order to enhance family participation as soon as possible, psychoeducation and motivational interviewing provide useful tools. It remains important for therapists not only to respond to current patient explicit demands, but also to develop preventive actions.
Since January 2002, a new healthcare programme of art-therapy (AR-T-S) is proposed to patients suffering from chronic diseases in order that they may express the experience of the disease through painting, theatre and body expression. These workshops have been created in order to draw upon the patient's own resources so as to have better self-management and improve his/her relationship with the disease and with others.
Any adolescent confronted with a parent who abuses alcohol may face difficult situations which will impact on his development and health. One important risk is the appearance of co-dependency, a situation in which the adolescent takes care of the parent, try to control the alcohol consumption; this can lead to important relational disturbances within the family. It is important to help these adolescent children to extricate themselves out of such situations, to provide him with strong support and thus assist him in finding his own way and making his own choice, whatever the evolution of the parent's alcohol abuse.
Motivational interviewing is a method of communication which focuses on exploring and resolving ambivalence. It centers on the motivational processes within the individual that facilitate change. Its efficacy has been widely demonstrated in the field of addiction as well as in the field of health care among adult. The interest of its use with adolescents is increasing, especially since the research seems to confirm its efficacy also with the youngest population. This article reviews the principles and basic strategies of motivational interviewing, taking into account the adolescent development and briefly examines the existing literature.
In the last years, the comprehension and the therapeutic possibilities for depressive disorders made considerable progress. It is often a chronic disease affecting mainly young adults, twice as frequently women in their childbearing period. The question of the role of the persons surrounding a depressive patient and the help they could get remained a scientific field of little interest in the last years. Clinically, however, it seems obvious that specific help should be provided to these people with a significant result on the compliance to the treatments and the outcome of the depressive disorder in itself.
