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Sommaires des Revues - Mayo Clinic Proceedings

Mayo Clinic Proceedings

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20-Year-Old Woman With Postprandial Nausea, Vomiting, and Abdominal Pain  Voir?

A 20-year-old woman who had undergone a corrective spinal operation for scoliosis 6 weeks previously presented with a 3-week history of nausea, vomiting, diarrhea, diffuse abdominal pain, fatigue, and a 6.8-kg weight loss. She stated that the symptoms occurred approximately 20 minutes after eating. The patient reported no melena, hematochezia, fevers, chills, diaphoresis after eating, chest pain, palpitations, shortness of breath, heat or cold intolerance, hair loss, or focal neurologic deficits.

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58-Year-Old Woman With Diarrhea, Weakness, and Memory Loss  Voir?

A 58-year-old woman with a medical history of osteoporosis and Crohn disease presents with her husband for evaluation of chronic diarrhea. Her medications included mesalamine and alendronate, as well as an over-the-counter multivitamin. Recently, Crohn colitis had been diagnosed when colon biopsies revealed scattered colonic inflammation and ulcerations. In addition to unrelenting diarrhea during the months before her presentation, she had experienced a severe functional decline. Six months before her visit, the patient could care for herself and walk several miles at a time without trouble.

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Saddle vs Nonsaddle Pulmonary Embolism  Voir?

To understand the clinical significance, hemodynamic presentation, management, and outcomes of patients presenting with saddle pulmonary embolism (PE).
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My Treatment Approach  Voir?

Our treatment approach for either symptomatic or incidentally found pancreatic cysts continues to improve. The true incidence of pancreatic cysts is not known, and pancreatic cystic neoplasms, especially intraductal papillary mucinous neoplasms, are currently most commonly diagnosed and resected. This is a result of increasing awareness, widespread availability of imaging, and better understanding of the nature of pancreatic cysts as well. Recent studies on molecular analysis and devices such as microbiopsy forceps help us better define and select the treatment approach to alleviate symptoms and to prevent malignant tumors while avoiding unnecessary surgery.

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The Diagnosis and Management of Bipolar I and II Disorders  Voir?

Bipolar disorders, including bipolar I disorder (BP-I) and bipolar II disorder (BP-II), are common, potentially disabling, and, in some cases, life-threatening conditions. Bipolar disorders are characterized by alternating episodes of mania or hypomania and depression, or mixtures of manic and depressive features. Bipolar disorders present many diagnostic and therapeutic challenges for busy clinicians. Adequate management of bipolar disorders requires pharmacotherapy and psychosocial interventions targeted to the specific phases of illness.

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Timing of Intubation in Acute Respiratory Failure Associated With Sepsis  Voir?

To analyze bedside clinicians' perspectives regarding the decision process to optimize timing of intubation in sepsis-associated acute respiratory failure.
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Preeclampsia: The Vasculature Never Forgets, Neither Should We  Voir?

It has long been recognized that pregnancy complications, especially preeclampsia, predispose to cardiovascular disease (CVD) and may increase mortality1 decades after the index pregnancy.2-5 The risk is heightened when preeclampsia occurs early in pregnancy, results in preterm delivery, or leads to small-for-gestational-age infants.3 The amplified risk of clinical CVD in women with a history of preeclampsia has gained more recognition, and the American Heart Association recently designated preeclampsia as a CVD risk factor.

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Carotid Artery Intima-Media Thickness and Subclinical Atherosclerosis in Women With Remote Histories of Preeclampsia: Results From a Rochester Epidemiology Project-Based Study and Meta-analysis  Voir?

To measure carotid artery intima-media thickness (CIMT), a marker of subclinical atherosclerosis, in postmenopausal women with and without histories of preeclampsia and to synthesize these results with those from prior studies of CIMT performed 10 or more years after preeclamptic pregnancies.
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When Patients and Their Families Feel Like Hostages to Health Care  Voir?

Patients are often reluctant to assert their interests in the presence of clinicians, whom they see as experts. The higher the stakes of a health decision, the more entrenched the socially sanctioned roles of patient and clinician can become. As a result, many patients are susceptible to “hostage bargaining syndrome” (HBS), whereby they behave as if negotiating for their health from a position of fear and confusion. It may manifest as understating a concern, asking for less than what is desired or needed, or even remaining silent against one's better judgment.

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46-Year-Old Man With Lower Back Pain  Voir?

A 46-year-old man originally from Vietnam with no known long-term medical conditions presented to a primary care clinic for evaluation of gradually progressive, left-sided, lower back pain accompanied by resolving flulike symptoms. He had a history of episodic back pain dating to his mid-20s, but the cause had never been determined. Unlike his prior episodes, on this occasion he first noticed the discomfort after what he thought was a flulike illness, characterized by fevers, chills, myalgia, malaise, and headache, as well as a 6.8-kg unintended weight loss.

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Botulinum Toxin in Parkinson Disease Tremor  Voir?

In essential tremor and Parkinson disease (PD) tremor, administration of onabotulinumtoxinA via a fixed injection approach improves the tremor, but many patients (30%-70%) develop moderate to severe hand weakness, limiting the use of onabotulinumtoxinA in clinical practice.
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Electrical Neuromodulation of the Respiratory System After Spinal Cord Injury  Voir?

Spinal cord injury (SCI) is a complex and devastating condition characterized by disruption of descending, ascending, and intrinsic spinal circuitry resulting in chronic neurologic deficits. In addition to limb and trunk sensorimotor deficits, SCI can impair autonomic neurocircuitry such as the motor networks that support respiration and cough. High cervical SCI can cause complete respiratory paralysis, and even lower cervical or thoracic lesions commonly result in partial respiratory impairment.

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Clinical Features, Etiologic Factors, Associated Disorders, and Treatment of Palmoplantar Pustulosis  Voir?

To further characterize clinical characteristics, etiologic factors, associated disorders, and treatment of palmoplantar pustulosis (PPP).
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64-Year-Old Woman With Weakness and Fall  Voir?

A 64-year-old woman presented to the emergency department (ED) after a ground-level fall at home when she attempted to get up from her chair to reach the phone. Her medical history included moderate chronic obstructive pulmonary disease (forced expiratory volume in the first second, 57%), stage 3A chronic kidney disease secondary to hypertension (baseline creatinine level, 1.3 mg/dL), morbid obesity (body mass index, 65), insomnia, depression, and anxiety. Her symptoms had begun approximately 2 weeks earlier, with generalized weakness, light-headedness, and fatigue.

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Real-Time Cineangiography Visualization of Cerebral Aneurysm Rupture in an Awake Patient: Anatomic, Physiological, and Functional Correlates  Voir?

Intracranial aneurysms are common and, on a population-based perspective, are a major cause of morbidity and mortality as a result of mass effect or rupture. Cerebral angiography is the primary technique used for the diagnosis of cerebral aneurysms, and the imaging data have additional utility for planning medical, endovascular, or surgical treatments. An extremely rare periprocedural complication of cerebral angiography is rupture of the aneurysm, either as a chance phenomenon or as a result of some physiologic change or mechanical effect.

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69-Year-Old Man With Abdominal Pain and Obstipation  Voir?

A 69-year-old man presented with a 4-day history of progressive, sharp, nonradiating, nonpositional diffuse abdominal pain and obstipation (inability to pass stool or flatus). Associated symptoms included a 1-day history of intermittent nausea without emesis. He reported no fevers, chills, night sweats, melena, hematochezia, weight loss, or altered bowel habits. Of note, he had presented 5 years earlier with similar symptoms, which resolved with conservative management. Otherwise, he had no history of altered bowel habits.

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60-Year-Old Woman With Headache and Fatigue  Voir?

A 60-year-old woman presented with a 6-month history of progressive fatigue and frequent headache. The fatigue was worse in the afternoon and prevented the patient from performing her regular daily activities. She reported occasional blood-tinged urine and hematochezia, and no hematemesis or melena. Her medical history was notable for an unprovoked lower-extremity deep vein thrombosis (DVT) 1 year earlier, for which she had completed 6 months of warfarin therapy. Medications included omeprazole, zolpidem, and a daily calcium/vitamin D supplement.

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Highlights from the Current Issue – Audiovisual Summary  Voir?

Karl A. Nath, MBChB, Editor-in-Chief of Mayo Clinic Proceedings, discusses the Editor's Choice and Highlights articles appearing in the September 2017 issue.
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General Information  Voir?

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Table of Contents  Voir?

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Editorial Board  Voir?

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Embolic Origin of Osler Nodes  Voir?

A 57-year-old man presented with fever, confusion, and left-inferior homonymous quadrantanopia. An apical pan-systolic murmur was heard. Transesophageal echocardiography (Supplemental Video, available online at http://www.mayoclinicproceedings.org) revealed mitral P1 prolapse and a vegetation. Blood culture yielded Streptococcus gordonii. Ceftriaxone was promptly administered. Dental examination revealed periodontal disease.

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A Comment on Driving and Neurologic Impairment  Voir?

The article by Moon et al1 presents interesting observations on determination of fitness to drive for people with various medical conditions. The study benefits from full capture of all referrals in Belgium to a center for evaluation of fitness to drive and car adaptations. From 2013 through 2014, more than 10,000 drivers were referred, of whom 6584 were studied in detail. The largest group of participants had neurologic conditions, which, unfortunately, do not seem to be represented in proportion to the population prevalence, probably because of referral biases to the center.

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Correction  Voir?

In the article titled, “Herpes Zoster Eye Complications: Rates and Trends,” published in the June 2013 issue of Mayo Clinic Proceedings (Mayo Clin Proc. 2013;88(6):562-570), there are errors in the Results section of the abstract, the first sentence of the Results section, and the Conclusion due to an incorrect denominator. The first sentence of the Results section of the abstract should read: Of the 2035 individuals with HZ in any dermatome, 184 (9.0%) had eye involvement. The first sentence of the Results section should read: Of the 2035 patients with confirmed HZ, 184 had 189 episodes of HZ with eye involvement between January 1, 1980, and December 31, 2007.

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Defining Physician Burnout, and Differentiating Between Burnout and Depression—I  Voir?

On the basis of the conclusion that more than 50% of US physicians suffer from burnout, Melnick and Powsner1 and Shanafelt and Noseworthy2 underlined the importance of taking systemic action to reduce the risk of the syndrome by improving conditions under which physicians work. To effectively deal with the issue of job stress, we think that a critical step is to understand burnout as a depressive condition.

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Defining Physician Burnout, and Differentiating Between Burnout and Depression—II  Voir?

Shanafelt and Noseworthy1 in a recent study are to be commended for continuing to raise awareness of physician job stress, but their reliance on fractions of questions from what they indicate to be “potentially standardized instruments” to categorize burnout is unfortunate. Among these, the popular Maslach Burnout Inventory (MBI)2 is a proprietary test, and its use in the table titled “Candidate Dimensions of Well-being for Organizations to Access” is flawed. Not only are the ‘cutoff’ scores proposed by the developers of the MBI wholly arbitrary and devoid of any clinical referent,2 the inventory's user manual also warns that “neither the coding nor the original numerical scores should be used for diagnostic purposes.”2 Nonetheless, several authors have attempted to take the complexity of physician burnout syndrome down to even single-item measures validated against the MBI3 and/or to comment on qualitative differences that describe a “sense of calling”4 in making physician assessments.

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In Reply—Defining Physician Burnout, and Differentiating Between Burnout and Depression  Voir?

We appreciate the interest in our articles1,2 calling for systemic action to reduce physician burnout. We also are grateful for the opportunity to respond to the letters from Bianchi and Schonfeld3 and from Schears.4 Following their recent studies reporting overlap between burnout and depression in schoolteachers,5,6 Bianchi and Schonfeld have authored a barrage of correspondence calling for classification of burnout as a depressive condition. Both they and Schears call for clarification of the diagnostic criteria for burnout and imply that burnout cannot be reliably measured.

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Charles Fletcher, The Centaur Company, and Proprietary Medicine Revenue Stamps  Voir?

Until the 20th century, the sale of medications in the United States was only lightly regulated. Prior to creation of the Food and Drug Administration in 1906 and the Federal Trade Commission in 1914, there were no restrictions on the types of claims that could be made about medication safety or effectiveness, nor were there limitations on the ingredients that marketed remedies could contain. Many opium- and alcohol-containing bottled medicines were widely available in general stores, and could be purchased without a prescription.

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Dos Quatro by Bill Barrett  Voir?

Recognizing the contribution art has had in the Mayo Clinic environment since the original Mayo Clinic Building was finished in 1914, Mayo Clinic Proceedings features some of the numerous works of art displayed throughout the buildings and grounds on Mayo Clinic campuses as interpreted by the author.

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Pancreatic Ductal Adenocarcinoma  Voir?

The image below shows an en bloc resection of the distal pancreas for invasive pancreatic ductal adenocarcinoma, including the spleen and a portion of the transverse colon.
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In Reply—Regarding “Emergencies in Hematology and Oncology,” I and II  Voir?

We thank Dr Morris1 for his comment on acute promyelocytic leukemia (APL). In our attempt to cover the more common hematologic emergencies, omitting a discussion regarding the coagulopathy of APL was an oversight. We agree with Dr Morris that APL-related coagulopathy is a major clinical concern and a condition that can be fatal without the prompt institution of appropriate therapy such as all-trans retinoic acid. We concur with his assessment regarding initiating therapy even before the diagnosis has been confirmed with molecular studies.

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Regarding “Emergencies in Hematology and Oncology”—I  Voir?

I would like to commend Halfdanarson et al1 on their excellent review published in the April 2017 issue of Mayo Clinic Proceedings. Furthermore, I would like to add acute promyelocytic leukemia (APL) to their list of emergency conditions.2 This disease can have a high rate of early mortality if not recognized, despite the effective tools that are available to treat it.

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Regarding “Emergencies in Hematology and Oncology”—II  Voir?

As intensivists particularly involved in the management of oncohematological patients, we read with interest the review by Halfdanarson et al1 published in the April 2017 issue of Mayo Clinic Proceedings. We must above all stress the importance of their publication and the references cited, which are recent for the most part. We also would like to emphasize that all the oncohematological complications identified by the authors are likely to lead to admission to intensive care units (ICUs). Furthermore, the criteria for admitting the patients to an ICU are much broader than those described at the end of the 20th century or the beginning of the 21st century.

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The Effect of Dogs on Human Sleep in the Home Sleep Environment  Voir?

To objectively assess whether a dog in the bedroom or bed disturbs sleep.
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The Childhood Roots of Cardiovascular Disease Disparities  Voir?

A recent national review of the social determinants of cardiovascular disease (CVD) underscored the growing recognition that poor socioeconomic conditions early in life place children at higher risk for CVD as adults. There is growing evidence that chronic elevation of allostatic load as a consequence of high levels of early childhood stress can trigger early atherosclerotic changes in children independently of behaviors. Elevated levels of circulating cortisol have been documented in children as young as 4 years who were raised in highly stressful circumstances.

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In Reply—50 Shades of Brown: Going Beyond the Guidelines in Melanoma Screening With Partner Skin Examinations  Voir?

We thank Dr Zampella and colleagues for their interesting comments on our article. As we pointed out in our review of the literature, in 3 of the studies we included, physicians find thinner melanoma than do patients.1-3 A clear opportunity to improve early detection exists with patient-and-partner education on ABCDEs for melanoma screening. The impact of patient education in melanoma detection was found to have potential benefit in the SCREEN (Skin Cancer Research to Provide Evidence for Effectiveness of Screening in Northern Germany) project from Germany.

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50 Shades of Brown: Going Beyond the Guidelines in Melanoma Screening With Partner Skin Examinations  Voir?

We eagerly read the recent article by Shellenberger et al1 in the May 2017 issue of Mayo Clinic Proceedings. The authors adroitly summarized the current dilemma surrounding melanoma screening, namely, the limited and conflicting evidence, the lack of guidelines, and the implications of these deficits. The authors accurately pointed out that melanoma screening requires a joint effort between dermatologists and primary health care professionals. However, we believe that part of this burden may be shared by the patient and his or her partner.

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Comparison of Unsafe Driving Across Medical Conditions  Voir?

To compare risks of unsafe driving in patients with medical conditions.
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Neurostimulation Devices for the Treatment of Neurologic Disorders  Voir?

Rapid advancements in neurostimulation technologies are providing relief to an unprecedented number of patients affected by debilitating neurologic and psychiatric disorders. Neurostimulation therapies include invasive and noninvasive approaches that involve the application of electrical stimulation to drive neural function within a circuit. This review focuses on established invasive electrical stimulation systems used clinically to induce therapeutic neuromodulation of dysfunctional neural circuitry.

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Mechanical Ventilation: State of the Art  Voir?

Mechanical ventilation is the most used short-term life support technique worldwide and is applied daily for a diverse spectrum of indications, from scheduled surgical procedures to acute organ failure. This state-of-the-art review provides an update on the basic physiology of respiratory mechanics, the working principles, and the main ventilatory settings, as well as the potential complications of mechanical ventilation. Specific ventilatory approaches in particular situations such as acute respiratory distress syndrome and chronic obstructive pulmonary disease are detailed along with protective ventilation in patients with normal lungs.

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Dernière mise à jour : 18/09/2017 : 09:47


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