{"id":382356,"global_id":"medizinonline.com\/fr\/?id=382356","global_id_lineage":["medizinonline.com\/fr\/?id=382356"],"author":"17458","status":"publish","date":"2024-05-19 00:41:27","date_utc":"2024-05-18 22:41:27","modified":"2024-05-19 00:41:27","modified_utc":"2024-05-18 22:41:27","url":"https:\/\/medizinonline.com\/fr\/event\/42-arbeitstagung-der-chirurgischen-arbeitsgemeinschaft-endokrinologie-caek\/","rest_url":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/events\/382356","title":"42. Arbeitstagung der Chirurgischen Arbeitsgemeinschaft Endokrinologie (CAEK)","description":"","excerpt":"","slug":"42-arbeitstagung-der-chirurgischen-arbeitsgemeinschaft-endokrinologie-caek","image":false,"all_day":true,"start_date":"2024-11-07 00:00:00","start_date_details":{"year":"2024","month":"11","day":"07","hour":"00","minutes":"00","seconds":"00"},"end_date":"2024-11-08 23:59:59","end_date_details":{"year":"2024","month":"11","day":"08","hour":"23","minutes":"59","seconds":"59"},"utc_start_date":"2024-11-06 23:00:00","utc_start_date_details":{"year":"2024","month":"11","day":"06","hour":"23","minutes":"00","seconds":"00"},"utc_end_date":"2024-11-08 22:59:59","utc_end_date_details":{"year":"2024","month":"11","day":"08","hour":"22","minutes":"59","seconds":"59"},"timezone":"Europe\/Zurich","timezone_abbr":"CET","cost":"","cost_details":{"currency_symbol":"","currency_code":"","currency_position":"prefix","values":[]},"website":"https:\/\/www.caek-arbeitstagung.de","show_map":true,"show_map_link":true,"hide_from_listings":false,"sticky":true,"featured":true,"categories":[{"name":"Chirurgie","slug":"chirurgie","term_group":0,"term_taxonomy_id":89,"taxonomy":"tribe_events_cat","description":"","parent":0,"count":126,"filter":"raw","id":89,"urls":{"self":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/categories\/89","collection":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/categories"}},{"name":"Endocrinology","slug":"endocrinology","term_group":0,"term_taxonomy_id":99,"taxonomy":"tribe_events_cat","description":"","parent":0,"count":68,"filter":"raw","id":99,"urls":{"self":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/categories\/99","collection":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/categories"}},{"name":"Gastroenterology","slug":"gastroenterology","term_group":0,"term_taxonomy_id":100,"taxonomy":"tribe_events_cat","description":"","parent":0,"count":104,"filter":"raw","id":100,"urls":{"self":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/categories\/100","collection":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/categories"}},{"name":"General practice","slug":"general-practice","term_group":0,"term_taxonomy_id":90,"taxonomy":"tribe_events_cat","description":"","parent":0,"count":748,"filter":"raw","id":90,"urls":{"self":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/categories\/90","collection":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/categories"}},{"name":"Pharmacology","slug":"pharmacology","term_group":0,"term_taxonomy_id":110,"taxonomy":"tribe_events_cat","description":"","parent":0,"count":614,"filter":"raw","id":110,"urls":{"self":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/categories\/110","collection":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/categories"}}],"tags":[{"name":"Featured","slug":"featured","term_group":0,"term_taxonomy_id":77250,"taxonomy":"post_tag","description":"","parent":0,"count":351,"filter":"raw","id":77250,"urls":{"self":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/tags\/77250","collection":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/tags"}},{"name":"Featured Home","slug":"featured-home","term_group":0,"term_taxonomy_id":116,"taxonomy":"post_tag","description":"","parent":0,"count":351,"filter":"raw","id":116,"urls":{"self":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/tags\/116","collection":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/tags"}}],"venue":{"id":347029,"author":"4","status":"publish","date":"2013-09-20 00:00:00","date_utc":"2013-09-19 22:00:00","modified":"2013-09-20 00:00:00","modified_utc":"2013-09-19 22:00:00","url":"https:\/\/medizinonline.com\/fr\/quel-est-le-risque-de-maladie-coronarienne-chez-les-patients-seropositifs\/","venue":"Quel est le risque de maladie coronarienne chez les patients s\u00e9ropositifs ?","description":"<p><strong>Lors de la session de l&#8217;apr\u00e8s-midi du jeudi 14 f\u00e9vrier 2013,&nbsp; a mis l&#8217;accent sur des domaines sp\u00e9cifiques de la cardiologie lors du Cardiology Update. Comment traiter un infarctus du myocarde p\u00e9riop\u00e9ratoire ? Et quelles sont les derni\u00e8res connaissances sur la fermeture d&#8217;un foramen ovale ouvert pour pr\u00e9venir les attaques c\u00e9r\u00e9brales ? Le risque de maladies cardiovasculaires chez les patients s\u00e9ropositifs a \u00e9galement \u00e9t\u00e9 discut\u00e9.<\/strong><\/p>\n<p> <!--more--> <\/p>\n<p>De nombreux patients qui survivent \u00e0 une attaque c\u00e9r\u00e9brale ne prennent pas leur anticoagulation de mani\u00e8re fiable : deux ans apr\u00e8s l&#8217;\u00e9v\u00e9nement, moins de 50% des patients sont anticoagul\u00e9s, a rapport\u00e9 le professeur Ulf Landmesser, de l&#8217;H\u00f4pital universitaire de Zurich. En cas de fibrillation auriculaire, 91% des thrombus se forment dans l&#8217;oreillette gauche (&#8220;left atrial appendage&#8221;, LAA). Des \u00e9tudes ont distingu\u00e9 quatre types d&#8217;ailes de poulet, de cactus, de manche \u00e0 air et de chou-fleur, qui influencent le risque d&#8217;accident vasculaire c\u00e9r\u00e9bral. Pour fermer le LAA, le &#8220;PLAATO-Device&#8221; a d&#8217;abord \u00e9t\u00e9 utilis\u00e9, puis Amplatzer Devices et le Watchman. Des \u00e9tudes ont montr\u00e9 qu&#8217;apr\u00e8s la fermeture de l&#8217;AAL, le nombre r\u00e9el d&#8217;accidents vasculaires c\u00e9r\u00e9braux \u00e9tait inf\u00e9rieur \u00e0 celui attendu. L&#8217;\u00e9tude &#8220;PROTECT AF&#8221; a montr\u00e9 une diminution des accidents vasculaires c\u00e9r\u00e9braux (mais seulement une r\u00e9duction des accidents h\u00e9morragiques) et de la mortalit\u00e9, mais des \u00e9panchements p\u00e9ricardiques plus fr\u00e9quents (chez 5% des patients). Toutefois, les effets secondaires diminuent consid\u00e9rablement avec la courbe d&#8217;apprentissage. Un watchman qui n&#8217;est pas compl\u00e8tement \u00e9tanche n&#8217;augmente pas le risque d&#8217;accident vasculaire c\u00e9r\u00e9bral tant que la fuite est inf\u00e9rieure \u00e0 5 mm ; en cas de fuite plus importante, les patients sont \u00e0 nouveau anticoagul\u00e9s. L&#8217;essai PREVAIL est actuellement en cours et les r\u00e9sultats devraient \u00eatre publi\u00e9s prochainement.<\/p>\n<p>Le dispositif le plus r\u00e9cent pour la fermeture du LAA est l'&#8221;Amplatzer Cardiac Plug&#8221; (ACP), qui se compose de deux parties : l&#8217;une ferme le LAA, l&#8217;autre, en forme de plaque, scelle l&#8217;entr\u00e9e du LAA. L&#8217;essai ACP a montr\u00e9 une non-inf\u00e9riorit\u00e9 en termes d&#8217;effet et une sup\u00e9riorit\u00e9 en termes de s\u00e9curit\u00e9 pour l&#8217;ACP. Les lignes directrices 2012 de l&#8217;ESC recommandent d&#8217;envisager la fermeture de l&#8217;AAL chez les personnes pr\u00e9sentant un risque \u00e9lev\u00e9 d&#8217;AVC et des contre-indications \u00e0 l&#8217;anticoagulation.<\/p>\n<h2 id=\"mise-a-jour-sur-la-fermeture-du-foramen-ovale-ouvert\">Mise \u00e0 jour sur la fermeture du&nbsp;foramen ovale ouvert<\/h2>\n<p>Le professeur Bernhard Meier, de l&#8217;H\u00f4pital de l&#8217;\u00cele \u00e0 Berne, a mis en garde contre les dangers que peut repr\u00e9senter un foramen ovale ouvert (PFO). Un FOP augmente consid\u00e9rablement le risque en cas de thromboembolie veineuse et constitue, par exemple, un facteur ind\u00e9pendant de mortalit\u00e9 chez les patients souffrant d&#8217;embolie pulmonaire : celle-ci est trois fois plus \u00e9lev\u00e9e que chez les personnes sans FOP. Le FOP est \u00e9galement un inconv\u00e9nient pour la plong\u00e9e sous-marine : les plongeurs atteints de FOP subissent plus de maladies li\u00e9es \u00e0 des accidents de d\u00e9compression que les plongeurs sans FOP. Il existe \u00e9galement un lien entre les migraines et le FOP, ainsi qu&#8217;entre le syndrome d&#8217;apn\u00e9e du sommeil et le FOP. Dans une \u00e9tude r\u00e9alis\u00e9e \u00e0 Berne, 25% des patients souffraient de migraines avant la fermeture du PFO. Apr\u00e8s l&#8217;intervention, 85% des migraines se sont am\u00e9lior\u00e9es (34% ont m\u00eame disparu) ; 9% des migraines sont rest\u00e9es inchang\u00e9es et 6% se sont aggrav\u00e9es. Le FOP est g\u00e9n\u00e9ralement diagnostiqu\u00e9 par \u00e9chocardiographie, mais il est \u00e9galement possible de visualiser le FOP dans un laboratoire de cath\u00e9t\u00e9risme. Le professeur Meier a plaid\u00e9 pour une nouvelle classification des causes des attaques c\u00e9r\u00e9brales : occlusion art\u00e9rielle, embolie art\u00e9rielle, embolies cardiaques, embolies paradoxales (FOP, d\u00e9faut du septum auriculaire, fistule pulmonaire), embolies des veines pulmonaires et attaques c\u00e9r\u00e9brales cryptog\u00e9niques.<\/p>\n<p>Plusieurs \u00e9tudes, dont &#8220;CLOSURE I&#8221;, &#8220;PC&#8221; et &#8220;RESPECT&#8221;, ont montr\u00e9 une r\u00e9duction des accidents vasculaires c\u00e9r\u00e9braux et des accidents isch\u00e9miques transitoires (AIT) apr\u00e8s la fermeture du PFO, m\u00eame si elles n&#8217;\u00e9taient pas significatives en tant qu&#8217;\u00e9tudes individuelles. L&#8217;issue \u00e9tait meilleure apr\u00e8s la fermeture du PFO qu&#8217;apr\u00e8s un traitement m\u00e9dicamenteux. Les indications potentielles de la fermeture du PFO sont notamment l&#8217;attaque c\u00e9r\u00e9brale (&#8220;N&#8217;attendez pas le deuxi\u00e8me !&#8221;, a soulign\u00e9 le professeur Meier), l&#8217;AIT, l&#8217;infarctus du myocarde embolique, l&#8217;embolie p\u00e9riph\u00e9rique, l&#8217;\u00e9v\u00e9nement de d\u00e9compression chez les plongeurs ou encore le mal des montagnes. Le professeur Meier a plaid\u00e9 pour l&#8217;arr\u00eat du traitement antiplaquettaire au bout de six mois apr\u00e8s la fermeture d&#8217;un FOP sans ath\u00e9roscl\u00e9rose, m\u00eame si les neurologues ne partagent pas cet avis.<\/p>\n<h2 id=\"maladies-cardiovasculaires-liees-a-linfection-par-le-vih\">Maladies cardiovasculaires li\u00e9es \u00e0 l&#8217;infection par le VIH<\/h2>\n<p>Le professeur Heiner C. Bucher, de l&#8217;H\u00f4pital universitaire de B\u00e2le, a fait part d&#8217;une nouvelle r\u00e9jouissante : Les patients s\u00e9ropositifs sans abus de drogues sous traitement antir\u00e9troviral (HAART) ont aujourd&#8217;hui pratiquement la m\u00eame esp\u00e9rance de vie que les personnes non infect\u00e9es par le VIH. En cas de &#8220;charge virale&#8221; ind\u00e9tectable, les patients peuvent \u00e9galement mener une vie sexuelle normale sans pr\u00e9servatif dans le cadre d&#8217;une relation stable. Tous les patients s\u00e9ropositifs doivent recevoir une HAART le plus t\u00f4t possible.<\/p>\n<p>Cependant, \u00e0 la suite du traitement, les taux de cholest\u00e9rol et de triglyc\u00e9rides augmentent ; il en r\u00e9sulte une lipoathrophie et une modification de la r\u00e9partition des graisses. Cela entra\u00eene une augmentation de l&#8217;ath\u00e9roscl\u00e9rose et du risque de maladie coronarienne. Les inhibiteurs de prot\u00e9ase de premi\u00e8re g\u00e9n\u00e9ration et l&#8217;abacavir, en particulier, augmentent le risque d&#8217;infarctus du myocarde. Plus les patients prennent d&#8217;antiviraux, plus le risque de maladie coronarienne est \u00e9lev\u00e9. L&#8217;infection par le VIH peut en outre favoriser l&#8217;IRC en raison de l&#8217;inflammation chronique (par exemple, production accrue d&#8217;interleukine 6, activation accrue des cellules CD8+, dysfonctionnement mitochondrial d\u00fb aux m\u00e9dicaments, etc.)<\/p>\n<p>Un autre probl\u00e8me est la gestion sous-optimale des facteurs de risque. De nombreux patients s\u00e9ropositifs souffrent d&#8217;hypertension, mais seulement un tiers d&#8217;entre eux sont trait\u00e9s pour cette maladie ! C&#8217;est pourquoi il y a de plus en plus de patients VIH souffrant d&#8217;insuffisance r\u00e9nale. Avant de prescrire une statine \u00e0 un patient s\u00e9ropositif, il convient de s&#8217;informer sur les interactions possibles. Le site www.hiv-druginterac est tr\u00e8s instructif \u00e0 cet \u00e9gard.<br \/>\ntions.org.<\/p>\n<h2 id=\"traitement-de-linfarctus-du-myocarde-perioperatoire\">Traitement de l&#8217;infarctus du myocarde p\u00e9riop\u00e9ratoire<\/h2>\n<p>&#8220;L&#8217;infarctus du myocarde est la principale complication vasculaire p\u00e9riop\u00e9ratoire&#8221;, a d\u00e9clar\u00e9 le professeur Hans Rickli, de l&#8217;h\u00f4pital cantonal de Saint-Gall, en guise d&#8217;introduction \u00e0 son expos\u00e9. Les facteurs de risque de rupture de plaque p\u00e9riop\u00e9ratoire incluent l&#8217;hypovol\u00e9mie, le manque d&#8217;oxyg\u00e8ne et l&#8217;augmentation du tonus sympathotonique. Une remarque importante : 65% des patients souffrant d&#8217;un infarctus du myocarde p\u00e9riop\u00e9ratoire sont asymptomatiques ! En cas de doute, le protocole de trois heures s&#8217;applique : mesure de la troponine hs au temps 0 et trois heures plus tard.<\/p>\n<p>Les lignes directrices de l&#8217;ESC ne d\u00e9crivent pas la prise en charge de l&#8217;infarctus du myocarde p\u00e9riop\u00e9ratoire. Le traitement doit donc s&#8217;adapter aux circonstances concr\u00e8tes. \u00c9tant donn\u00e9 que le risque de saignement est plus \u00e9lev\u00e9, il est pr\u00e9f\u00e9rable de ne pas recourir \u00e0 la fibrinolyse pour la reperfusion, mais plut\u00f4t \u00e0 l&#8217;ACTP. L&#8217;h\u00e9parine non fractionn\u00e9e est recommand\u00e9e pour l&#8217;anticoagulation.<\/p>\n<p>L&#8217;\u00e9valuation pr\u00e9op\u00e9ratoire des probl\u00e8mes cardiovasculaires est tr\u00e8s importante d&#8217;un point de vue prophylactique. En cas d&#8217;intervention \u00e9lective, il peut \u00eatre int\u00e9ressant de reporter la date de l&#8217;op\u00e9ration et d&#8217;optimiser les facteurs de risque existants (taux de cholest\u00e9rol, angine de poitrine, diab\u00e8te, etc.) pendant le temps gagn\u00e9. Chez les patients \u00e0 haut risque, les b\u00eatabloquants et les statines doivent \u00eatre introduits trois semaines avant l&#8217;op\u00e9ration. Il convient de mettre en balance les avantages et les risques de l&#8217;op\u00e9ration. Le risque n&#8217;est pas le m\u00eame pour toutes les interventions. Il est plut\u00f4t faible pour les op\u00e9rations gyn\u00e9cologiques ou les interventions sur les yeux, par exemple, et plus \u00e9lev\u00e9 pour les interventions sur les gros vaisseaux et les vaisseaux p\u00e9riph\u00e9riques.<\/p>\n<p>La gestion des antithrombotiques doit \u00e9galement \u00eatre planifi\u00e9e \u00e0 un stade pr\u00e9coce. Normalement, il n&#8217;est pas n\u00e9cessaire d&#8217;arr\u00eater la prophylaxie \u00e0 l&#8217;acide ac\u00e9tylsalicylique, sauf en cas d&#8217;intervention neurochirurgicale. Des guides sur la gestion p\u00e9riop\u00e9ratoire sont disponibles sur www.escardio.org.<\/p>\n<p><em>Source : Cardiology Update 2013, Afternoon Session &#8220;Special Topics of Cardiovascular Care&#8221;, 14 f\u00e9vrier 2013, 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