Aromathérapie en cancérologie : rationnel, intérêt et limites

En France métropolitaine, près de trois millions de personnes souffrent, ou ont souffert, d’un cancer. Bien que les pathologies cancéreuses soient la première cause de mortalité depuis 2004 et que leur incidence augmente chaque année, le nombre de décès diminue grâce aux actions préventives et aux progrès diagnostiques et thérapeutiques. Le recours à des médecines complémentaires pour accompagner les soins de support en oncologie est devenu régulièrement observé. Néanmoins les patients s’exposent à des effets adverses potentiellement graves : toxicité intrinsèque du produit et interaction avec les traitements du patient. De plus, la question de l’efficacité clinique des médecines complémentaires se pose. Parmi les médecines complémentaires en vogue, on observe une demande grandissante du public pour les produits « naturels », dont les huiles essentielles. Cette thèse est une revue de la littérature scientifique dans le but d’établir : (1) les limites de l’aromathérapie chez les patients souffrant d’un cancer en dressant une liste des huiles essentielles à écarter à cause de leur trop grande toxicité intrinsèque ou des interactions possibles avec les traitements qu’un patient souffrant d’un cancer est susceptible de recevoir. Les interactions pharmacocinétiques, pharmacologiques et découlant d’une additivité des toxicités sont abordées. (2) Les bénéfices potentiels des huiles essentielles dans le cadre de l’accompagnement des soins oncologiques de support à partir des études cliniques disponibles et des pistes intéressantes basées sur l’emploi traditionnel ou de travaux in vitro et sur le modèle animal. Enfin une revue des formules de certains auteurs proposant des livres traitant d’aromathérapie à destination du grand public et des professionnels de santé est présente, accompagnée d’une analyse critique. Les formules répertoriées sont indiquées dans les maux de la sphère digestive, buccale, cutanée, psychiatrique, dans l’accompagnement de la douleur et le traitement de la fatigue

François Humbert (1776-1850), un orthopédiste méconnu au patrimoine historique unique

François Humbert (1776-1850) a créé en 1817 le premier établissement orthopédique de France, en plein essor de l’Orthopédie française. Passionné par les « bossus » et les « boiteux », il prend en charge pendant près de 30 ans des luxations congénitales de hanche et des scolioses. Ses travaux ont marqué son époque aux côtés notamment de Pravaz (1791-1853). Son oeuvre nous est parvenue sous la forme d’ouvrages mêlant textes et schémas, mais surtout de 38 modèles réduits de ses « machines ». Celles-ci ont permis d’appliquer des forces mécaniques sur les déformations de près de trois cents patients, qu’il a traités. Bien qu’il ait été le premier à défendre fermement et à illustrer la notion de curabilité de la luxation congénitale de hanche, son oeuvre est passée rapidement dans l’oubli après sa mort

La collection de machines orthopédiques de François Humbert (1776-1850), médecin meusien, fondateur du premier établissement orthopédique français

The early nineteenth century can be considered as a turning point in orthopaedics. Scientific and technical progress allowed those who were called ‘lame’ and ‘hunchbacks’ to be given new treatments. These new cures were very much based on mechanical appliances, ‘machines’ which consisted of beds and chairs incorporating traction systems. In 1817, in Morley (Meuse department), François Humbert (1776-1850), a country doctor and collector, created the first French orthopaedic institution, which accommodated about three hundred patients. In an establishment far from academic centres, he was the first doctor to examine the possibility of treating congenital hip dislocation, deemed incurable at that time. Supported by a book which explains the operation of his inventions, about forty well-made models constitute an element of communication about this innovative work, well worth better institutional recognition and accessibility to the public. The collection had a turbulent history before arriving in the Barrois museum in the city of Bar-le-Duc. Today, a project of preventive conservation and restoration is being developed through a partnership between the museum and an association. Beyond a project of an exhibition to celebrate the bicentennial of the creation of the Morley institution in 2017, reflection has been initiated concerning the inclusion of this highly specific collection in the museum presentation of the permanent exhibition rooms, in the broader context of the technical and scientific heritage of the Meuse department

All-Inside Bicruciate Ligament Reconstruction Technique: A Focus on Graft Tensioning Sequence

Bicruciate ligament (BCL) reconstructions are challenging procedures. One of the main operative goals is to stabilize the knee in the correct anterior-posterior position. We present an all-inside arthroscopic BCL reconstruction technique using hamstring tendon grafts. Ipsilateral semitendinosus (ST) and gracilis tendons are used for TriLink (Arthrex, Naples, FL) double-bundle posterior cruciate ligament (PCL) reconstruction and contralateral ST tendon is used for GraftLink (Arthrex) single-bundle anterior cruciate ligament (ACL) reconstruction. The use of instruments for retrograde reaming and devices for adjustable cortical suspensory fixation allows for a safe, reproducible all-inside BCL reconstruction by simplifying these difficult steps. To minimize the risk of anterior-posterior malposition, the ACL graft is first tensioned with the knee in full extension, ensuring a neutral anteroposterior positioning of the tibia under the femur. The PCL anterolateral bundle can then be independently tensioned with the knee at 90° of flexion, and the posteromedial bundle at 30° of flexion, while applying an anterior translation to the tibia to reduce the posterior drawer without any risk of overcorrection. The purpose of this Technical Note was to describe an all-inside BCL reconstruction with a specific focus on the graft tensioning sequence

Incidence, risk factors, and outcomes of central venous catheter-related thromboembolism in breast cancer patients: the CAVECCAS study

International audiencePrevious epidemiologic studies investigating central venous catheter (CVC)-related venous thromboembolism (CRT) were conducted in heterogenous cancer populations and data in breast cancer (BC) remain limited. To investigate the Doppler ultrasound (DUS)-CRT incidence, risk factors and outcomes in BC, we designed a prospective, multicenter cohort of nonmetastatic invasive BC patients undergoing insertion of a CVC for chemotherapy. All patients underwent double-blind DUS before, 7, 30, and 90 days after CVC insertion and a 6 months clinical follow-up. Symptomatic DUS-CRT were treated by anticoagulants. D-Dimers, thrombin generation, and platelet-derived microparticles were measured before and 2 days after CVC placement. In DUS-CRT patients, a nested case–control study analyzed the role of thrombophilia. Among 524 patients, the DUS-CRT (14 symptomatic, 46 asymptomatic) cumulative probability was 9.6% at 3 months and 11.5% at 6 months (overall incidence rate: 2.18/100 patient-months). Ten/14 symptomatic DUS-CRT were detected on double-blind DUS before the clinical symptoms, and 3/14 had a simultaneous pulmonary embolism. No clinical thrombotic event subsequently occurred in untreated asymptomatic DUS-CRT. Age >50 years (OR, 1.80; 95% CI, 1.01–3.22), BMI >30 kg/m² (OR, 2.64; 95% CI, 1.46–4.76) and comorbidities (OR, 2.05; 95% CI, 1.18–3.56) were associated with DUS-CRT. No biomarkers was found to predict DUS-CRT. In multivariate analysis, BMI >30 kg/m² (OR, 2.66; 95%CI, 1.46–4.84) and lobular carcinoma histology (OR, 2.56; 95%CI, 1.32–4.96) remained the only significant DUS-CRT risk factors. Thrombophilia did not account for DUS-CRT. Only clinical parameters identified high risk DUS-CRT patients who may be considered for thromboprophylaxis

High Risk of Anal and Rectal Cancer in Patients With Anal and/or Perianal Crohn’s Disease

International audienceBackground & AimsLittle is known about the magnitude of the risk of anal and rectal cancer in patients with anal and/or perineal Crohn’s disease. We aimed to assess the risk of anal and rectal cancer in patients with Crohn’s perianal disease followed up in the Cancers Et Surrisque Associé aux Maladies Inflammatoires Intestinales En France (CESAME) cohort.MethodsWe collected data from 19,486 patients with inflammatory bowel disease (IBD) enrolled in the observational CESAME study in France, from May 2004 through June 2005; 14.9% of participants had past or current anal and/or perianal Crohn’s disease. Subjects were followed up for a median time of 35 months (interquartile range, 29–40 mo). To identify risk factors for anal cancer in the total CESAME population, we performed a case-control study in which participants were matched for age and sex.ResultsAmong the total IBD population, 8 patients developed anal cancer and 14 patients developed rectal cancer. In the subgroup of 2911 patients with past or current anal and/or perianal Crohn’s lesions at cohort entry, 2 developed anal squamous-cell carcinoma, 3 developed perianal fistula–related adenocarcinoma, and 6 developed rectal cancer. The corresponding incidence rates were 0.26 per 1000 patient-years for anal squamous-cell carcinoma, 0.38 per 1000 patient-years for perianal fistula–related adenocarcinoma, and 0.77 per 1000 patient-years for rectal cancer. Among the 16,575 patients with ulcerative colitis or Crohn’s disease without anal or perianal lesions, the incidence rate of anal cancer was 0.08 per 1000 patient-years and of rectal cancer was 0.21 per 1000 patient-years. Among factors tested by univariate conditional regression (IBD subtype, disease duration, exposure to immune-suppressive therapy, presence of past or current anal and/or perianal lesions), the presence of past or current anal and/or perianal lesions at cohort entry was the only factor significantly associated with development of anal cancer (odds ratio, 11.2; 95% CI, 1.18-551.51; P = .03).ConclusionsIn an analysis of data from the CESAME cohort in France, patients with anal and/or perianal Crohn’s disease have a high risk of anal cancer, including perianal fistula–related cancer, and a high risk of rectal cancer