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Resume Les maladies multisystemiques, dont la plupart sont en France prises en charge en medecine interne, touchent par definition plusieurs organes ou tissus. Si les atteintes cutanees ou articulaires sont frequentes, les atteintes neurologiques sont souvent synonymes de gravite. Parmi ces dernieres, les atteintes du systeme nerveux peripherique (par exemple : neuropathies) ou du systeme nerveux central (par exemple : myelites) sont generalement de diagnostic aise, a l’aide de l’expertise clinique et d’examens complementaires adaptes. Les atteintes neuropsychologiques, c’est-a-dire touchant le fonctionnement cognitif, et notamment la memoire, l’attention, les fonctions executives ou les capacites de raisonnement, sont de diagnostic plus difficile, parfois banalisees par les cliniciens. Leurs causes sont souvent multiples et intriquees. Pourtant, ces manifestations cognitives sont cruciales dans le retentissement fonctionnel et le ressenti des patients, et sont etroitement liees a leur qualite de vie. Elles affectent ainsi l’insertion sociale, familiale et professionnelle des patients, et peuvent avoir des retentissements sur le suivi medical ou l’observance medicamenteuse. L’objectif de cette mise au point, sur les troubles cognitifs associes au lupus systemique, de leur physiopathologie a leur prise en charge, est de sensibiliser les medecins internistes aux manifestations cognitives des maladies multisystemiques, a leur prise en charge diagnostique et therapeutique, ainsi que de catalyser les futurs efforts de recherche et de mise en place de parcours de soins pour les patients suivis en medecine interne presentant des difficultes cognitives.

Introduction The neuropsychology of epilepsy has been a major area of study for almost a century and cognitive impairments are an integral part of the new definition of epilepsy. Among such impairments, social cognition (SC) dysfunctions are of relatively recent interest. SC abilities refer to the body of knowledge and processes involved in establishing satisfying and appropriate social interactions. In particular, they allow the recognition of emotions in others, emotional experiences which are suitably adapted to social situations, and the ability to infer mental states in oneself and others. Methods An overeview was conducted of the available data within the literature, with the objective of presenting the SC disorders associated with certain types of epilepsy and the possible risk factors already explored i.e., localisation of epileptic focus , age of onset/duration of the disease, and effects of treatments including surgery. Studies investigating the potential repercussions of these disorders on patients’ daily life have also been included. Results Social cognition disorders are an integral part of the cognitive disorders traditionally described in epilepsy. Indeed, a growing number of studies highlight the increased prevalence of SC disorders in various domains, and some patients appear to be more at risk than others. These disorders could be a major determining factor in the deterioration of patients’ quality of life (QOL), particularly patients’ support and social integration. This highlights the importance of assessing and managing these disorders in patients with epilepsy (PWE). Perspectives in the field of research and clinical practice are also evoked, such as exploring the links between disruptions in SC abilities and treatments, or developing specific tools for assessment and rehabilitation within the context of epilepsy.

The surgical management of the cubital tunnel syndrome has no strict rules to follow. Surgical treatments are various, but none of them has been shown to be superior to the others. This retrospective study presents the clinical results in 73 patients who underwent an anterior subcutaneous transposition of the ulnar nerve, between January 2000 and January 2010, with a minimum 3-year follow-up. Fifty-five patients were assessed with an average follow-up of 65.7 months. McGowan grading system as modified by Goldberg was used to analyse clinical results, preoperatively and at follow-up. The DASH score was used to assess physical function. The average preoperative evolution of symptoms was 16.7 months, and mean period to resolution was 4.7 months. The grade in McGowan grading system as modified by Goldberg significatively improved at follow-up (P=0.0002). Only five patients kept paresthesia. The mean postoperative DASH score was 7.27/100. The satisfaction rate was 96%, and all the patients except one returned back to their occupation. There was neither infection nor complex regional pain syndrome. The anterior subcutaneous transposition leads to very good clinical results, satisfaction and physical function. It is an effective surgical method, without complication in our study, which gives long-term results.

Surgical management of trapeziometacarpal osteoarthritis does not obey to strict rules. The use of interposition implants made of different materials leads to enrichment of surgeon's resources. This prospective study reports the radiological and clinical results of 45 patients treated by total trapeziectomy with polylactic acid interposition implant, with an average follow-up of 31 months. Thirty-seven surgical treatments were carried out after ineffective medical treatment. According to Dell classification, there were five stages II, 30 stages III and two stages IV. Mean age was 66 years. Dominant side was involved in 60%. Thumbs were pain free at 5 months in average and 81% of the patients reported good results (Alnot stages 0 and 1). The average opposition was 9.1/10, the average M1M2 angle was 40°, and the average key pinch strength was 4.4 kg. Six patients suffered from sympathetic dystrophy but neither infection nor local inflammatory reaction was observed. Collapse of the trapezium space was constant and the trapezium space ratio was 76% at the follow-up. Seventy-five per cent of patients returned back to their occupation. The satisfaction rate was 89%. The radioclinical results were very good in our series. The interposition of polylactic acid implant permits to avoid the presumed complications of tendon harvesting, and those of other types of material used in the same indication. Its safety seems excellent.