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Introduction Tout patient souffrant d’une insuffisance renale severe est confronte a un bouleversement de son quotidien necessitant un changement de comportement, adoption d’un mode de vie sain et observance de schemas therapeutiques. Il est crucial de proposer un accompagnement efficace et humain qui permet de s’impliquer. Description Le service avant de lancer un projet de co-construction a donne la parole aux patients. De nouvelles evaluations de la compliance therapeutiques basees sur la participation et l’engagement des patients et mesurees par le Patient Activation Mesure (PAM) sont a l’aube d’un changement de paradigme. Methodes Etude quantitative par questionnaire auto-declare, propose aux patients repartis en 3 categories : insuffisants renaux stade 3B-5, dialyses, ou greffes renaux d’un service de nephrologie. Le questionnaire est anonyme et comportait 33 items. Les besoins dans le cadre de l’autogestion ont ete evalues par 4 questions. Les resultats sont accompagnes de tests statistiques (t de Student et le Chi2). Le seuil de signification est p Resultats Au total, 510 questionnaires ont ete analyses entre juin et aout 2019. Taux de remplissage a 91 %. Les relations humaines sereines et respectueuses sont les plus importantes (80 %) et conditionnent l’implication du patient suivent la qualite et la securite dans les soins (66 %), l’education et l’autonomie (47 %). Pres de 20 % ont coche l’ensemble des besoins. On n’observe pas de difference statistiquement significatives pour ces 3 groupes selon le stade de l’IRC (p = 0,64). Les patients greffes comprennent mieux les enjeux de l’autogestion et sont plus motives a s’engager que les patients IRC 3B-5 et les patients dialyses. L’âge, le niveau socioprofessionnel et les comorbidites impactent fortement le score PAM ( Tableau 1 ). Conclusion Ameliorer la prise en charge demande aux soignants d’aider les patients a identifier les enjeux, les impliquer en les ecoutant, favoriser l’autonomie et activer leur motivation par des relations humaines et respectueuses.

Ergospirometry was performed on 51 patients before their discharge from hospital, that is between the seventh and tenth days after myocardial revascularization by cardiac bypass surgery. The aim of our study is to show that this type of measurement can be performed with reasonable safety and that it gives an accurate assessment of the patient's ability to withstand exercise. It employs a metabolic approach: study of oxygen consumption (V'O2), carbon dioxide release (V'CO2), the respiratory quotient (RQ), the minute ventilation (V'E) and the respiratory equivalent for oxygen (REO2). The patients withstood a mean load of 82 +/- 17.7 watts for a mean V'O2 of 1.186 +/- 0.258 l/min STPD and a mean V'E of 46.5 +/- 10 l/min BTPS. Changes in respiratory and metabolic parameters as a function of load are discussed, as is the advice that can be given to the patient regarding physical rehabilitation.

Three patients who had undergone an orthotopic cardiac transplantation followed a course of supervised intermittent physical training (60 to 80 per cent of the maximum load) involving three weekly sessions of thirty minutes, for a period of 150 +/- 80 days. During maximal effort, we observed increases of 50 per cent in the load in watts (0.05 less than p less than 0.1), 40 per cent in oxygen consumption (0.1 less than p less than 0.2), 10 per cent in heart rate (p = 0.5) and 21 per cent in systolic blood pressure (0.7 less than p less than 0.8). The respiratory equivalent for oxygen decreased by 21 per cent (0.025 less than p less than 0.05) and the respiratory quotient by 5 per cent (0.4 less than p less than 0.05). For a given submaximal effort (30 watts) the following decreases were observed: 9 per cent in oxygen consumption (V'O2) (0.1 less than p less than 0.2), 32 per cent in the minute ventilation (V'E) (0.05 less than p less than 0.1), 22 per cent in the respiratory equivalent for oxygen (REO2) (0.025 less than p less than 0.05), 8 per cent in the respiratory quotient (RQ) (0.2 less than p less than 0.3) and 11 per cent in the heart rate (HR) (0.1 less than p less than 0.2). The systolic blood pressure (SBP) increased by 6 per cent (0.2 less than p less than 0.3). No changes were observed in these parameters in the postoperative follow-ups (10 to 24 months) of two patients who did not undergo physical training. Physical training is, therefore, necessary in the process of physical readaptation of patients after orthotopic cardiac grafts.

The authors report a case of a Buschke-Loewenstein tumor located at the anus. Initial treatment with Bleomycin was remarkably effective. A recurrence 3 months later did not respond any more to Bleomycin. Multiple surgical resections were performed in association with this form of chemotherapy.