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Malignant hypercalcemia is the main metabolic complication of cancer. Clinical presentation varies from asymptomatic to a medical emergency. The main causes include parathyroid hormone-related protein production and bone metastases, while hypervitaminosis D and hyperparathyroidism are rarer causes. Diagnosis is based on the demonstration of elevated serum calcium and low PTH in the context of known or suspected cancer. Treatment is aimed at correcting hypovolemia by hydration, reducing bone resorption, and treating the underlying cancer. The aims are to improve patients' quality of life, minimize delays in oncological management and reduce mortality associated with this condition., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Efficient management of hospitalized patients requires carefully planning each stay by taking into account patients' pathologies and hospital constraints. Therefore, the ability to accurately estimate length of stays allows for better interprofessional tasks coordination, improved patient flow management, and anticipated discharge preparation. This article presents how we built and evaluated a predictive model of length of stay based on clinical data available upon admission to a division of internal medicine. We show that Machine Learning-based approaches can predict lengths of stay with a similar level of accuracy as field experts., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article

The rapid progression of COVID-19 is an organizational challenge for all hospitals. To secure the patient overflow, the Department internal medicine of the University Hospital of Lausanne increased nurse and medical workforces as well as bed capacity by 65 %, with extraordinary help from other departments. The implemented crisis management stood upon three pillars : a crisis management team, steering documents and internal communication. In this new form, the Department had already taken care of 442 COVID-19 admissions by April 16, 2020. Alongside organizational challenges, clinical issues such as rapid respiratory distress, clinical suspicions with negative PCR and treatment uncertainties in the absence of sufficient evidence were overcome. Despite the peak of the pandemic appearing to have passed, the next phase could be just as complicated., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Peripheral neuropathies are frequent in clinical practice and portend severe functional limitations or neuropathic pain. History taking and clinical examination represent key features to trigger investigations and uncover the underlying affection. For general internal medicine practitioners, initial investigation should include search for alcohol consumption, diabetes mellitus, vitamin B12 deficiency and monoclonal gammapathy. Nerve conduction studies should be limited to patients with atypical presentations and/or without a defined etiology. After treatment of specific etiologies, supportive care includes management of neuropathic pain and physical rehabilitation., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

2013 was full of significant advances in all areas of medicine, which may have an impact on daily practice in general internal medicine. From salt and water restriction in heart failure to transfusion threshold in upper gastrointestinal bleeding and fecal infusion in Clostridium difficile colitis; from new data in resuscitation and persistent questions in palliative care and intensive care medicine, through pneumology, nephrology and endocrinology, the literature has been rich in new considerations. Each year, the residents of the Department of internal medicine of the University hospital of Vaud (CHUV) meet to share their most interesting readings. Thirteen of them are reviewed and commented here.

Cardiovascular diseases remain the first cause of mortality in our country. They are associated with well known risk factors such as diabetes and dyslipidemia. Herein we summarize main results of the CoLaus study regarding, first the prevalence and characteristics of the treatment of these risk factors. Then we present recent discoveries of new genetic determinants associated with these risk factors. Finally, we discuss whether this knowledge changes our current clinical management of our patients.

Sacral nerve stimulation (SNS) became recently an essential therapeutic modality in the treatment of anal incontinence. Indications range from anorectal functional disorders to limited sphincteric lesions. An electrode is inserted through a sacral foramen, generally S3, to stimulate the corresponding nerve root. Patient's selection needs a meticulous multidisciplinary approach. Improved continence of more than 50% is frequently encountered and quality of life is significantly improved after implantation. SNS is a minimal-invasive technique, with very few risks of complications.