{"id":403230,"global_id":"medizinonline.com\/fr\/?id=403230","global_id_lineage":["medizinonline.com\/fr\/?id=403230"],"author":"17389","status":"publish","date":"2024-02-08 18:04:57","date_utc":"2024-02-08 17:04:57","modified":"2024-02-08 18:04:57","modified_utc":"2024-02-08 17:04:57","url":"https:\/\/medizinonline.com\/fr\/event\/sim-jahrestagung-2024-hybrid-2\/","rest_url":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/events\/403230","title":"SIM Jahrestagung 2024 – Hybrid","description":"","excerpt":"","slug":"sim-jahrestagung-2024-hybrid-2","image":{"url":false,"id":33,"extension":""},"all_day":true,"start_date":"2024-03-31 00:00:00","start_date_details":{"year":"2024","month":"03","day":"31","hour":"00","minutes":"00","seconds":"00"},"end_date":"2024-03-31 23:59:59","end_date_details":{"year":"2024","month":"03","day":"31","hour":"23","minutes":"59","seconds":"59"},"utc_start_date":"2024-03-30 23:00:00","utc_start_date_details":{"year":"2024","month":"03","day":"30","hour":"23","minutes":"00","seconds":"00"},"utc_end_date":"2024-03-31 21:59:59","utc_end_date_details":{"year":"2024","month":"03","day":"31","hour":"21","minutes":"59","seconds":"59"},"timezone":"Europe\/Zurich","timezone_abbr":"CET","cost":"","cost_details":{"currency_symbol":"","currency_code":"","currency_position":"prefix","values":[]},"website":"https:\/\/www.swiss-insurance-medicine.ch\/de\/bildung\/tagungen\/jahrestagung","show_map":true,"show_map_link":true,"hide_from_listings":false,"sticky":true,"featured":true,"categories":[{"name":"Arbeitsmedizin","slug":"arbeitsmedizin","term_group":0,"term_taxonomy_id":77253,"taxonomy":"tribe_events_cat","description":"","parent":0,"count":17,"filter":"raw","id":77253,"urls":{"self":"https:\/\/medizinonline.com\/fr\/wp-json\/tribe\/events\/v1\/categories\/77253","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"}}],"venue":{"id":347308,"author":"4","status":"publish","date":"2013-09-19 00:00:00","date_utc":"2013-09-18 22:00:00","modified":"2013-09-19 00:00:00","modified_utc":"2013-09-18 22:00:00","url":"https:\/\/medizinonline.com\/fr\/a-la-pointe-de-la-chirurgie-cardiaque\/","venue":"\u00c0 la pointe de la chirurgie cardiaque","description":"

Le congr\u00e8s annuel de l’American Association for Thoracic Surgery s’est tenu cette ann\u00e9e \u00e0 Minneapolis. Le professeur Thierry Carrel pr\u00e9sente ses points forts personnels.<\/strong><\/p>\n

<\/p>\n

R\u00e9duction de l’anticoagulation apr\u00e8s l’implantation d’une valve aortique m\u00e9canique [1]<\/h2>\n

L’\u00e9tude prospective PROACT de la FDA a examin\u00e9 si une anticoagulation per os moins agressive \u00e9tait plus justifiable que celle recommand\u00e9e par l'”American Heart Association” ou l'”American College of Cardiology”. L’\u00e9tude a \u00e9t\u00e9 men\u00e9e sur des patients ayant re\u00e7u une valve aortique de la soci\u00e9t\u00e9 ON-X. Les r\u00e9sultats de l’\u00e9tude sont pr\u00e9sent\u00e9s dans le tableau ci-dessous.<\/p>\n

Les patients pr\u00e9sentant un risque accru d’\u00e9v\u00e9nements thromboemboliques ont re\u00e7u de la warfarine avec un INR cible de 1,5-2,0 ou 2,0-3,0 \u00e0 partir de trois mois postop\u00e9ratoires. Tous les patients ont re\u00e7u 81 mg d’aspirine et ont \u00e9t\u00e9 autoris\u00e9s \u00e0 surveiller eux-m\u00eames leur INR. Les r\u00e9sultats sont pr\u00e9sent\u00e9s dans le tableau 1<\/strong>.<\/p>\n

Les auteurs concluent que l’INR peut \u00eatre ajust\u00e9 dans la fourchette 1,5-2,0 chez les patients ayant subi un remplacement valvulaire aortique par proth\u00e8se m\u00e9canique, en association avec de l’aspirine \u00e0 faible dose ; cela entra\u00eene une r\u00e9duction significative des \u00e9v\u00e9nements h\u00e9morragiques, sans pour autant augmenter le taux d’\u00e9v\u00e9nements thromboemboliques.<\/p>\n

<\/h4>\n

Administration unique d’\u00e9rythropo\u00ef\u00e9tine \u00e0 haute dose deux jours avant une chirurgie cardiaque [2].<\/h2>\n

Plusieurs \u00e9tudes ont montr\u00e9 que l’administration d’\u00e9rythropo\u00ef\u00e9tine \u00e0 court terme peut r\u00e9duire de mani\u00e8re significative le besoin de transfusions sanguines externes. Les protocoles pr\u00e9c\u00e9dents \u00e9taient bas\u00e9s sur une administration de cinq jours et entra\u00eenaient souvent des probl\u00e8mes d’observance chez les patients trait\u00e9s. Les auteurs ont donc \u00e9tudi\u00e9 l’effet d’un bolus unique de 80 000 UI d’\u00e9rythropo\u00ef\u00e9tine humaine recombinante (HRE) deux jours avant une intervention chirurgicale cardiaque programm\u00e9e. L’\u00e9tude a \u00e9t\u00e9 men\u00e9e de mani\u00e8re prospective et randomis\u00e9e sur 400 patients. Le crit\u00e8re d’\u00e9valuation principal \u00e9tait la n\u00e9cessit\u00e9 d’une transfusion sanguine, le crit\u00e8re secondaire l’incidence des effets secondaires et des complications. Les taux d’h\u00e9moglobine ont \u00e9t\u00e9 d\u00e9termin\u00e9s le premier, le deuxi\u00e8me et le quatri\u00e8me jour. Le groupe HRE a re\u00e7u en moyenne 0,39 concentr\u00e9 \u00e9rythrocytaire contre 1,12 concentr\u00e9 chez les patients t\u00e9moins (p<0,01). La moyenne de l’h\u00e9moglobine au quatri\u00e8me jour postop\u00e9ratoire \u00e9tait de 10,2\u00b10,68 g\/dl dans le groupe HRE contre 9,02\u00b10,92 g\/dl dans le groupe t\u00e9moin (p=0,02). La mortalit\u00e9 et le taux de complications n’ont pas montr\u00e9 de diff\u00e9rence significative. Le protocole simplifi\u00e9 (dose unique) semble efficace et a permis d’\u00e9viter les probl\u00e8mes li\u00e9s \u00e0 une application plus complexe.<\/p>\n

R\u00e9sultats pr\u00e9coces apr\u00e8s implantation d’une valve en aval par transcath\u00e9ter en Scandinavie [3].<\/h2>\n

L’implantation transcath\u00e9ter “valve-in-valve” est de plus en plus utilis\u00e9e comme alternative au remplacement chirurgical des valves en cas de proth\u00e8ses biologiques us\u00e9es. Les auteurs r\u00e9sument l’exp\u00e9rience en Scandinavie entre 2008 et 2012.<\/p>\n

Quarante-neuf patients ont \u00e9t\u00e9 trait\u00e9s dans onze cliniques ; une valve aortique a \u00e9t\u00e9 implant\u00e9e chez 45 patients, une valve mitrale et une valve tricuspide chez deux patients chacune. La majorit\u00e9 des patients ont \u00e9t\u00e9 trait\u00e9s par voie transapicale et la dur\u00e9e moyenne d’observation \u00e9tait de 11 mois. Aucune mortalit\u00e9 n’a \u00e9t\u00e9 observ\u00e9e et le taux de r\u00e9ussite technique \u00e9tait de 95,6%. Les complications graves suivantes sont survenues :<\/p>\n

    \n
  • accident vasculaire c\u00e9r\u00e9bral (2,2%)<\/li>\n
  • infarctus du myocarde p\u00e9riproc\u00e9dural (4,4%)<\/li>\n
  • complication d’acc\u00e8s vasculaire (2,2%).<\/li>\n<\/ul>\n

    L’h\u00e9modynamique a montr\u00e9 un gradient de pression moyen entre 4 et 38 mmHg, (moyenne 17 mmHg) et un gradient de pression maximal entre 7 et 68 mmHg (moyenne 30 mmHg). Ce registre multicentrique a confirm\u00e9 que l’approche “valve-in-valve” est une option acceptable pour les patients \u00e0 haut risque et qu’un gradient de pression sous-optimal subsiste chez un nombre consid\u00e9rable de patients. Les cons\u00e9quences \u00e0 long terme de cette h\u00e9modynamique systolique d\u00e9favorable doivent \u00eatre \u00e9tudi\u00e9es plus avant.<\/p>\n

    La fibrillation auriculaire paroxystique (FAP) doit-elle \u00eatre trait\u00e9e \u00e0 l’occasion d’une intervention de chirurgie cardiaque ? [4]<\/h2>\n

    Plusieurs \u00e9tudes prospectives randomis\u00e9es ont d\u00e9montr\u00e9 l’efficacit\u00e9 d’un traitement d’ablation perop\u00e9ratoire en cas de fibrillation auriculaire permanente. La situation est clairement moins claire chez les patients pr\u00e9sentant une fibrillation auriculaire paroxystique. L’hypoth\u00e8se de cette \u00e9tude \u00e9tait la suivante : l’ablation par voie auriculaire gauche n’entra\u00eene pas d’augmentation du risque p\u00e9riop\u00e9ratoire et entra\u00eene une diminution des \u00e9pisodes de fibrillation auriculaire.<\/p>\n

    Plus de 4000 patients ont \u00e9t\u00e9 observ\u00e9s, dont 1044 avec une fibrillation auriculaire pr\u00e9op\u00e9ratoire. 541 patients souffraient de fibrillation auriculaire paroxystique (FAVli) et 50% n\u00e9cessitaient une intervention sur la valve mitrale. Les trois groupes suivants ont \u00e9t\u00e9 compar\u00e9s : patients avec FHVI trait\u00e9s (n=429), patients sans traitement (n=112) et enfin patients sans ant\u00e9c\u00e9dents de FHVI (n=3271). La mortalit\u00e9 \u00e0 30 jours \u00e9tait comparable dans les trois groupes. Les patients qui ont \u00e9t\u00e9 trait\u00e9s ont eu une dur\u00e9e d’hospitalisation plus courte, une incidence et des complications p\u00e9riop\u00e9ratoires plus faibles (24% vs 45%). Le taux d’accidents vasculaires c\u00e9r\u00e9braux \u00e9tait \u00e9galement comparable dans les trois groupes.<\/p>\n

    La r\u00e9alisation d’une ablation des veines pulmonaires par voie auriculaire gauche chez les patients atteints de fibrillation auriculaire n’entra\u00eene pas d’augmentation du risque p\u00e9riop\u00e9ratoire ni de la mortalit\u00e9 p\u00e9riop\u00e9ratoire. Les patients ayant subi une ablation perop\u00e9ratoire ont pr\u00e9sent\u00e9 un taux plus \u00e9lev\u00e9 d’intervalle sans fibrillation auriculaire et un meilleur taux de survie par rapport aux patients non trait\u00e9s. Cette \u00e9tude montre que l’ablation des veines pulmonaires peut \u00eatre une intervention tout \u00e0 fait valable chez des patients s\u00e9lectionn\u00e9s.<\/p>\n

     <\/p>\n

    Source : Congr\u00e8s annuel de l'”American Association for Thoracic Surgery”, 4-8 mai 2013 \u00e0 Minneapolis\/USA<\/em><\/p>\n

     <\/p>\n

    Litt\u00e9rature :<\/p>\n

      \n
    1. Puskas J, et al. : R\u00e9duction de l’anticoagulation apr\u00e8s un remplacement m\u00e9canique de valve aortique : r\u00e9sultats interm\u00e9diaires de l’essai randomis\u00e9 PROACT de la FDA. AATS Abstract-Book, p. 87.<\/li>\n
    2. Weltert L, et al. : Singlehighdose of Erythropoietin twi days before surgery : a simplified short term approach to blood spare. AATS, Abstract-Book, p. 93.<\/li>\n
    3. Ihlberg L, et al. : R\u00e9sultats cliniques pr\u00e9coces de l’implantation transcath\u00e9ter de valve in-valve dans les pays nordiques. AATS Abstract-Book, p. 97.<\/li>\n
    4. Andrei AC, et al : Should paroxysmal atrial fibrillation be treated during cardiac surgery ? AATS Abstract-Book, p. 107.<\/li>\n<\/ol>","slug":"a-la-pointe-de-la-chirurgie-cardiaque","image":{"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356.jpg","id":34538,"extension":"jpg","width":767,"height":294,"filesize":235509,"sizes":{"thumbnail":{"width":320,"height":240,"mime-type":"image\/png","filesize":97925,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-320x240.jpg"},"cnvs-small":{"width":80,"height":80,"mime-type":"image\/png","filesize":12413,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-80x80.jpg"},"cnvs-thumbnail":{"width":300,"height":225,"mime-type":"image\/png","filesize":88312,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-300x225.jpg"},"pk-small":{"width":80,"height":80,"mime-type":"image\/png","filesize":12413,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-80x80.jpg"},"pk-thumbnail":{"width":300,"height":225,"mime-type":"image\/png","filesize":88312,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-300x225.jpg"},"csco-120":{"width":120,"height":46,"mime-type":"image\/png","filesize":11396,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-120x46.jpg"},"csco-120-landscape":{"width":120,"height":90,"mime-type":"image\/png","filesize":19596,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-120x90.jpg"},"csco-120-portrait":{"width":120,"height":160,"mime-type":"image\/png","filesize":28654,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-120x160.jpg"},"csco-120-square":{"width":120,"height":120,"mime-type":"image\/png","filesize":24009,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-120x120.jpg"},"csco-90":{"width":90,"height":34,"mime-type":"image\/png","filesize":6915,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-90x34.jpg"},"csco-90-landscape":{"width":90,"height":68,"mime-type":"image\/png","filesize":12284,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-90x68.jpg"},"csco-90-portrait":{"width":90,"height":120,"mime-type":"image\/png","filesize":17967,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-90x120.jpg"},"csco-90-square":{"width":90,"height":90,"mime-type":"image\/png","filesize":15025,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-90x90.jpg"},"csco-320":{"width":320,"height":123,"mime-type":"image\/png","filesize":58935,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-320x123.jpg"},"csco-320-landscape":{"width":320,"height":240,"mime-type":"image\/png","filesize":97925,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-320x240.jpg"},"csco-320-portrait":{"width":320,"height":294,"mime-type":"image\/png","filesize":118033,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-320x294.jpg"},"csco-320-square":{"width":320,"height":294,"mime-type":"image\/png","filesize":118033,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-320x294.jpg"},"csco-560":{"width":560,"height":215,"mime-type":"image\/png","filesize":150621,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-560x215.jpg"},"csco-560-landscape":{"width":560,"height":294,"mime-type":"image\/png","filesize":200832,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-560x294.jpg"},"csco-560-portrait":{"width":560,"height":294,"mime-type":"image\/png","filesize":200832,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-560x294.jpg"},"csco-560-square":{"width":560,"height":294,"mime-type":"image\/png","filesize":200832,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-560x294.jpg"},"cnvs-small-2x":{"width":160,"height":160,"mime-type":"image\/png","filesize":38313,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-160x160.jpg"},"cnvs-thumbnail-2x":{"width":600,"height":294,"mime-type":"image\/png","filesize":214572,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-600x294.jpg"},"pk-small-2x":{"width":160,"height":160,"mime-type":"image\/png","filesize":38313,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-160x160.jpg"},"pk-thumbnail-2x":{"width":600,"height":294,"mime-type":"image\/png","filesize":214572,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-600x294.jpg"},"csco-120-2x":{"width":240,"height":92,"mime-type":"image\/png","filesize":36332,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-240x92.jpg"},"csco-120-landscape-2x":{"width":240,"height":180,"mime-type":"image\/png","filesize":61028,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-240x180.jpg"},"csco-120-portrait-2x":{"width":240,"height":294,"mime-type":"image\/png","filesize":87493,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356-240x294.jpg"},"csco-120-square-2x":{"width":2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la pointe de la chirurgie cardiaque","description":"<p>Le congr\u00e8s annuel de l\\'American Association for Thoracic Surgery s\\'est tenu cette ann\u00e9e \u00e0 Minneapolis. Le professeur Thierry Carrel pr\u00e9sente ses points forts personnels. R\u00e9duction de l\\'anticoagulation apr\u00e8s l\\'implantation d\\'une…<\/p>\\n","image":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/356.jpg","url":"","address":{"@type":"PostalAddress"},"telephone":"","sameAs":""},"show_map":true,"show_map_link":true,"global_id":"medizinonline.com\/fr\/?id=347308","global_id_lineage":["medizinonline.com\/fr\/?id=347308"]},"organizer":[{"id":347406,"author":"4","status":"publish","date":"2013-09-18 00:00:00","date_utc":"2013-09-17 22:00:00","modified":"2013-09-18 00:00:00","modified_utc":"2013-09-17 22:00:00","url":"https:\/\/medizinonline.com\/fr\/15-a-20-des-lesions-peuvent-evoluer-vers-un-carcinome\/","organizer":"“15 \u00e0 20 % des l\u00e9sions peuvent \u00e9voluer vers un carcinome”.","description":"

      Le professeur Stephan Lautenschlager, m\u00e9decin-chef du service de dermatologie de l’h\u00f4pital municipal de Triemli, nous donne des informations sur l’\u00e9pid\u00e9miologie, les m\u00e9thodes de diagnostic et le traitement de la k\u00e9ratose actinique. En outre, il aborde plus en d\u00e9tail la question de la dangerosit\u00e9 de cette maladie et du risque d’\u00e9volution vers un carcinome spinocellulaire malin.<\/strong><\/p>\n

      <\/p>\n

      Professeur Lautenschlager, la k\u00e9ratose actinique n’est pas encore consid\u00e9r\u00e9e comme un cancer de la peau, quelle est la dangerosit\u00e9 de cette maladie ?<\/strong><\/p>\n


      \n Prof. Lautenschlager :<\/strong>
      \n<\/em> On pense aujourd’hui que les k\u00e9ratoses actiniques font partie d’un continuum de maladies initi\u00e9es par l’exposition aux UV. Il s’agit d’abord d’un dommage lumineux d\u00fb aux UV, puis de la formation de k\u00e9ratoses actiniques, qui peuvent \u00e0 leur tour \u00e9voluer vers un carcinome \u00e9pidermo\u00efde. En raison des modifications cytologiques limit\u00e9es \u00e0 l’\u00e9pith\u00e9lium, les k\u00e9ratoses actiniques sont consid\u00e9r\u00e9es comme des carcinomes in situ selon la doctrine actuelle. <\/p>\n

      Quelle est la pr\u00e9valence de la k\u00e9ratose actinique et quels sont les groupes de population les plus touch\u00e9s ?<\/strong><\/p>\n

      Il est bien connu que les individus ayant une peau claire et complexe ont tendance \u00e0 d\u00e9velopper des k\u00e9ratoses actiniques dans les zones o\u00f9 l’exposition aux UV est \u00e9lev\u00e9e. Ainsi, on les trouve chez environ 50% des adultes en Australie, contre 10 \u00e0 25% sous nos latitudes. Les personnes \u00e2g\u00e9es de plus de 70 ans semblent pr\u00e9senter des pr\u00e9valences encore plus \u00e9lev\u00e9es. Auparavant, les hommes \u00e9taient plus souvent touch\u00e9s que les femmes en raison d’une exposition professionnelle. Cependant, ce rapport s’est \u00e9quilibr\u00e9 au cours des 10 \u00e0 20 derni\u00e8res ann\u00e9es en raison de l’augmentation de l’exposition aux UV li\u00e9e aux loisirs.<\/p>\n

      Quel est le risque de d\u00e9velopper un carcinome malin (spinocellulaire) si l’on souffre d\u00e9j\u00e0 de k\u00e9ratose actinique ? Les chiffres issus de la recherche semblent varier consid\u00e9rablement \u00e0 cet \u00e9gard<\/strong><\/p>\n

      Les k\u00e9ratoses actiniques peuvent rester stables pendant des ann\u00e9es, dispara\u00eetre en partie spontan\u00e9ment ou justement se transformer en carcinomes spinocellulaires. Malheureusement, il n’est pas possible de pr\u00e9dire le moment de la transformation en carcinome invasif ni les formes qui y sont sujettes. On estime que 15 \u00e0 20 % des l\u00e9sions \u00e9voluent vers un carcinome dans les dix ans.<\/p>\n

      Quelles m\u00e9thodes les m\u00e9decins doivent-ils utiliser pour diagnostiquer la k\u00e9ratose actinique ?<\/strong><\/p>\n

      En principe, le diagnostic est clinique, mais il peut exister diff\u00e9rentes formes, qui se pr\u00e9sentent ensuite diff\u00e9remment sur le plan histologique, par exemple des k\u00e9ratoses lich\u00e9no\u00efdes, boweno\u00efdes, pigment\u00e9es et atrophiques jusqu’aux k\u00e9ratoses hypertrophiques de type cornu cutaneum. En particulier, les k\u00e9ratoses \u00e9paissies – dites infiltr\u00e9es – doivent faire l’objet d’une biopsie pour exclure une invasion et donc un carcinome spinocellulaire. Dans les mains d’une personne exp\u00e9riment\u00e9e, une \u00e9valuation au microscope \u00e0 lumi\u00e8re r\u00e9fl\u00e9chie peut en outre s’av\u00e9rer utile.<\/p>\n

      Est-il possible d’\u00e9tablir une distinction diagnostique claire entre la k\u00e9ratose actinique et le carcinome spinocellulaire ?<\/strong><\/p>\n

      Seul un \u00e9paississement indique la possibilit\u00e9 d’un carcinome spinocellulaire.
      \nEn cas de doute, il convient donc toujours de proc\u00e9der \u00e0 une \u00e9valuation histologique. En outre, il convient de noter que l’histologie de l’\u00e9piderme ne permet pas de distinguer une k\u00e9ratose actinique d’un carcinome spinocellulaire et que la biopsie doit donc \u00eatre suffisamment profonde.<\/p>\n

      Quelles autres maladies doivent faire l’objet d’une attention particuli\u00e8re dans le diagnostic diff\u00e9rentiel ?<\/strong><\/p>\n

      Si, plus rarement, une seule modification doit \u00eatre d\u00e9limit\u00e9e, il faut distinguer les k\u00e9ratoses s\u00e9borrh\u00e9iques planes l\u00e9g\u00e8rement pigment\u00e9es ou, le cas \u00e9ch\u00e9ant, les modifications induites par un virus, les carcinomes basocellulaires superficiels ou une maladie de Bowen. Plus rarement, il faut d\u00e9limiter les modifications purement inflammatoires, comme le lupus \u00e9ryth\u00e9mateux disco\u00efde.<\/p>\n

      Il existe une possibilit\u00e9 de r\u00e9gression spontan\u00e9e. Des mesures th\u00e9rapeutiques sont-elles recommand\u00e9es ?<\/strong><\/p>\n

      D’une part, il existe souvent de multiples k\u00e9ratoses actiniques, qui indiquent ce que l’on appelle une carcinose de terrain. Celle-ci multiplie le risque de transformation en carcinome spinocellulaire. D’autre part, les l\u00e9sions progressives ne peuvent pas \u00eatre distingu\u00e9es des l\u00e9sions r\u00e9gressives, c’est pourquoi il existe un consensus parmi les experts pour traiter les k\u00e9ratoses actiniques. Cependant, il n’existe pas encore de consensus sur les mesures th\u00e9rapeutiques \u00e0 prendre pour obtenir le meilleur r\u00e9sultat dans telle ou telle situation.<\/p>\n

      Quelles sont les options th\u00e9rapeutiques m\u00e9dicamenteuses ? Laquelle vous semble la plus efficace ?<\/strong><\/p>\n

      Il existe de nombreuses possibilit\u00e9s de traitement. La d\u00e9cision doit \u00eatre prise en fonction du nombre, de la localisation, du type de peau ainsi que d’autres particularit\u00e9s individuelles du patient. Outre la situation de vie, les comorbidit\u00e9s, l’observance et les pr\u00e9f\u00e9rences des patients doivent \u00e9galement \u00eatre prises en compte. Enfin, l’exp\u00e9rience et la familiarit\u00e9 des m\u00e9decins traitants jouent \u00e9galement un r\u00f4le d\u00e9cisif.
      \nLa cryoth\u00e9rapie est un traitement largement r\u00e9pandu et efficace pour les formes plus isol\u00e9es. Si l’objectif est de traiter la carcinogen\u00e8se de terrain afin de traiter si possible les l\u00e9sions d\u00e9butantes, non encore visibles, la pr\u00e9f\u00e9rence doit \u00eatre donn\u00e9e \u00e0 la th\u00e9rapie photodynamique ainsi qu’au traitement local par imiquimod, fluorouracile topique ou \u00e9ventuellement diclof\u00e9nac aux stades pr\u00e9coces. Un nouveau traitement topique prometteur \u00e0 base de gel de m\u00e9butate d’ing\u00e9nol a r\u00e9cemment \u00e9t\u00e9 approuv\u00e9 en Suisse. On peut supposer que l’utilisation du traitement pendant une courte p\u00e9riode seulement am\u00e9liore nettement l’observance du patient. Pour les cas \u00e9tendus, en particulier lorsque le scalp entier est atteint chez les patients \u00e2g\u00e9s, il faut \u00e9galement penser \u00e0 la possibilit\u00e9 d’un traitement par rayons X, qui entra\u00eene g\u00e9n\u00e9ralement une longue p\u00e9riode de r\u00e9mission, mais n\u00e9cessite g\u00e9n\u00e9ralement six cycles de traitement.<\/p>\n

      Quels conseils les m\u00e9decins doivent-ils donner \u00e0 leurs patients en cas de k\u00e9ratose actinique ?<\/strong><\/p>\n

      Outre l’information sur les signes d’alerte d’un d\u00e9but de transformation en carcinome spinocellulaire, les patients doivent recevoir des instructions pr\u00e9cises sur les mesures de protection solaire. En plus d’une protection solaire textile, la plus grande priorit\u00e9 est l’application r\u00e9guli\u00e8re de produits solaires avec un facteur de protection solaire \u00e9lev\u00e9 \u00e0 tr\u00e8s \u00e9lev\u00e9. Bien entendu, les solariums sont \u00e9galement \u00e0 \u00e9viter.<\/p>\n

      Entretien : Andreas Grossmann<\/strong><\/em><\/p>","slug":"15-a-20-des-lesions-peuvent-evoluer-vers-un-carcinome","image":{"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631.jpg","id":33988,"extension":"jpg","width":767,"height":294,"filesize":84660,"sizes":{"thumbnail":{"width":320,"height":240,"mime-type":"image\/jpeg","filesize":8207,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-320x240.jpg"},"cnvs-small":{"width":80,"height":80,"mime-type":"image\/jpeg","filesize":1865,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-80x80.jpg"},"cnvs-thumbnail":{"width":300,"height":225,"mime-type":"image\/jpeg","filesize":7799,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-300x225.jpg"},"pk-small":{"width":80,"height":80,"mime-type":"image\/jpeg","filesize":1865,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-80x80.jpg"},"pk-thumbnail":{"width":300,"height":225,"mime-type":"image\/jpeg","filesize":7799,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-300x225.jpg"},"csco-120":{"width":120,"height":46,"mime-type":"image\/jpeg","filesize":1915,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-120x46.jpg"},"csco-120-landscape":{"width":120,"height":90,"mime-type":"image\/jpeg","filesize":2611,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-120x90.jpg"},"csco-120-portrait":{"width":120,"height":160,"mime-type":"image\/jpeg","filesize":3163,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-120x160.jpg"},"csco-120-square":{"width":120,"height":120,"mime-type":"image\/jpeg","filesize":2809,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-120x120.jpg"},"csco-90":{"width":90,"height":34,"mime-type":"image\/jpeg","filesize":1567,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-90x34.jpg"},"csco-90-landscape":{"width":90,"height":68,"mime-type":"image\/jpeg","filesize":2008,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-90x68.jpg"},"csco-90-portrait":{"width":90,"height":120,"mime-type":"image\/jpeg","filesize":2372,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-90x120.jpg"},"csco-90-square":{"width":90,"height":90,"mime-type":"image\/jpeg","filesize":2190,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-90x90.jpg"},"csco-320":{"width":320,"height":123,"mime-type":"image\/jpeg","filesize":6207,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-320x123.jpg"},"csco-320-landscape":{"width":320,"height":240,"mime-type":"image\/jpeg","filesize":8207,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-320x240.jpg"},"csco-320-portrait":{"width":320,"height":294,"mime-type":"image\/jpeg","filesize":9495,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-320x294.jpg"},"csco-320-square":{"width":320,"height":294,"mime-type":"image\/jpeg","filesize":9495,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-320x294.jpg"},"csco-560":{"width":560,"height":215,"mime-type":"image\/jpeg","filesize":12835,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-560x215.jpg"},"csco-560-landscape":{"width":560,"height":294,"mime-type":"image\/jpeg","filesize":16820,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-560x294.jpg"},"csco-560-portrait":{"width":560,"height":294,"mime-type":"image\/jpeg","filesize":16820,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-560x294.jpg"},"csco-560-square":{"width":560,"height":294,"mime-type":"image\/jpeg","filesize":16820,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-560x294.jpg"},"cnvs-small-2x":{"width":160,"height":160,"mime-type":"image\/jpeg","filesize":3911,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-160x160.jpg"},"cnvs-thumbnail-2x":{"width":600,"height":294,"mime-type":"image\/jpeg","filesize":17972,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-600x294.jpg"},"pk-small-2x":{"width":160,"height":160,"mime-type":"image\/jpeg","filesize":3911,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-160x160.jpg"},"pk-thumbnail-2x":{"width":600,"height":294,"mime-type":"image\/jpeg","filesize":17972,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-600x294.jpg"},"csco-120-2x":{"width":240,"height":92,"mime-type":"image\/jpeg","filesize":4201,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-240x92.jpg"},"csco-120-landscape-2x":{"width":240,"height":180,"mime-type":"image\/jpeg","filesize":5818,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-240x180.jpg"},"csco-120-portrait-2x":{"width":240,"height":294,"mime-type":"image\/jpeg","filesize":7176,"url":"https:\/\/medizinonline.com\/wp-content\/uploads\/2014\/09\/631-240x294.jpg"},"csco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