Surveillance active des petites masses rénales [Active surveillance of small renal masses]

Small renal masses (SRMs), which are tumors less than 4 cm in diameter, are increasingly discovered incidentally due to the rise in diagnostic imaging. Although many of these masses are benign, managing SRMs remains challenging. Active surveillance (AS) offers a viable alternative to surgery, particularly for patients with high surgical risks or limited life expectancy. AS, validated by various studies, involves close monitoring with regular imaging, enabling delayed surgical intervention if the tumor shows signs of progression. However, the adoption of AS is hindered by the absence of standardized protocols and the growing availability of minimally invasive surgical options

Physiopathologie et prise en charge de l’urticaire chronique [Physiopathology and management of chronic urticaria]

Chronic urticaria manifests as itchy, transient and migrating wheals and/or angioedema lasting more than 6 weeks. It can be classified as spontaneous or inducible by physical factors. It is secondary to mast cell activation due to autoallergy (type I) or autoimmunity (type IIb). While the initial work-up consists essentially in evaluating the presence of biomarkers, it can be completed according to comorbidities and factors identified with history and physical examination. Second generation antihistamines up to four-times the standard dose are the cornerstone of the management. This initial management can be undertaken by primary care physicians. Specialists should be involved in the presence of physical factors, resistance to antihistamines, or atypical lesions

Radiochirurgie des lésions intracrâniennes bénignes. Indications, résultats et perspectives [Radiosurgery of benign intracranial lesions. Indications, results , and perspectives]

Stereotactic radiosurgery (SRS) is a non-invasive technique that is transforming the management of benign intracranial lesions through its precision and preservation of healthy tissues. It is effective for meningiomas, trigeminal neuralgia (TN), pituitary adenomas, vestibular schwannomas, and arteriovenous malformations. SRS ensures high tumor control rates, particularly for Grade I meningiomas and vestibular schwannomas. For refractory TN, it provides initial pain relief > 80 %. The advent of technologies such as PET-MRI, hypofractionation, and artificial intelligence is further improving treatment precision, but challenges remain, including the management of late side effects and standardization of practice

Beyond Instrumentalization: Far-Right Women’s Appropriation of Feminism in France

Femonationalism, or the selective use of feminist discourses to advance far right causes, has often been analyzed through the lens of party politics. Shifting the focus to grassroot activists, this article studies a group of far-right female activists in France organized as a women-only collective of “identitarian feminists” to explore how these grassroot activists articulate anti-feminist frames while also appropriating selective aspects of feminism. The study relies on three types of empirical data: a long-term digital observation of the collective, a critical analysis of documents, and ten semi-structured interviews. These data reveal that these activists diverge from traditional antifeminism and instead reflect a femonationalist appropriation of feminism. This appropriation can be seen in three interconnected frames used by the collective in the fight against street harassment: an opposition to intersectional feminism, the use of postfeminist frames, and the racialization of sexism

Pneumologie : ce qui a changé en 2024 [Pneumology : what's new in 2024]

In 2024, several important innovations have enriched the management of respiratory diseases, including pulmonary hypertension, tuberculosis, COPD, and obstructive sleep apnea syndrome (OSAS). Notable advancements include the introduction of sotatercept in Switzerland for pulmonary arterial hypertension and mediastinal cryobiopsies, reflecting a shift toward more personalized medicine. Meanwhile, biologic therapies for COPD offer promising perspectives, and a potential path is emerging for shortening the treatment of certain forms of tuberculosis. These developments open the door to new therapeutic options, with the hope of enhancing care and delivering meaningful clinical benefits to patients

Endocrinologie : ce qui a changé en 2024 [Endocrinology : what's new in 2024]

In this article, we look at a selection of recent developments in various areas of endocrinology. We focus on advances in endocrine pharmacotherapy and endocrine surgery, addressing several areas: a) the thyroid safety of Glucagon-Like Peptide-1 (GLP1) analogues; b) the efficacy of adrenal surgery for mild autonomous cortisol secretion; c) crinecerfont in the management of congenital adrenal hyperplasia in adults and children; d) paltusotin as a novel oral therapy for acromegaly and e) TransCon PTH (palopegteriparatide) as a novel therapy for chronic hypoparathyroidism

Energy Loss Index and Dimensionless Index Outperform Direct Valve Planimetry in Low-Gradient Aortic Stenosis.

Background/Objectives: Among patients with suspected severe aortic stenosis (AS), discordance between effective orifice area (EOA) and transvalvular gradients is frequent and requires a multiparametric workup including flow assessment and calcium-scoring to confirm true severe AS. The aim of this study was to assess direct planimetry, energy loss index (Eli) and dimensionless index (DI) as stand-alone parameters to identify non-severe AS in discordant cases. Methods: In this prospective cohort study, we included consecutive AS patients > 70 years with EOA < 1.0 cm <sup>2</sup> referred for valve replacement between 2014 and 2017. AS severity was retrospectively reassessed using the multiparametric work-up recommended in the 2021 ESC/EACTS guidelines. DI and ELi were calculated, and valve area was measured by direct planimetry on transesophageal echocardiography. Results: A total of 101 patients (mean age 82 y; 57% male) were included. Discordance between EOA and gradients was observed in 46% and non-severe AS found in 24% despite an EOA < 1 cm <sup>2</sup> . Valve planimetry performed poorly, with an area under the ROC curve (AUC) of 0.64. At a cut-off value of >0.82 cm <sup>2</sup> , sensitivity and specificity to identify non-severe AS were 67 and 66%, respectively. DI and ELi showed a higher diagnostic accuracy, with an AUC of 0.77 and 0.76, respectively. Cut-off values of >0.24 and >0.6 cm <sup>2</sup> /m <sup>2</sup> identified non-severe AS, with a high specificity of 79% and 91%, respectively. Conclusions: Almost one in four patients with EOA < 1 cm <sup>2</sup> had non-severe AS according to guideline-recommended multiparametric assessment. Direct valve planimetry revealed poor diagnostic accuracy and should be interpreted with caution. Usual prognostic cut-off values for DI > 0.24 and ELI > 0.6 cm <sup>2</sup> /m <sup>2</sup> identified non-severe AS with high specificity and should therefore be included in the assessment of low-gradient AS

Accouchement vaginal et cicatrices utérines d’origine gynécologique : revue narrative [Trial of labor and gynecological uterine scars : a narrative review]

The increasing number of women of childbearing age with gynecological uterine scars presents a significant clinical challenge. -Planning the route of birth for a subsequent pregnancy necessitates -careful consideration and should be the subject of an informed -discussion. Unfortunately, the heterogeneity of data in the literature with regards to gynecological uterine scars makes this choice -debatable. Although the use of less invasive surgical procedures in this context is on the rise, there is currently a lack of robust data on their obstetric repercussions. This article -explores risk factors for uterine rupture in the view of gynecological uterine scars and -provides pragmatic recommendations for clinicians