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Resume Introduction L’aval des urgences represente une part importante des hospitalisations dans les services de medecine interne. L’objectif de cette etude est de caracteriser les patients et l’organisation d’un echantillon de services de medecine interne metropolitains ayant cette activite. Materiel et methodes Entre le 29 juin et le 26 juillet 2015, les services du groupe SiFMI (situations frequentes en medecine interne) volontaires, ont recueilli prospectivement dans des e-questionnaires anonymises les caracteristiques de tous les patients admis via les urgences sur une periode de 7 jours consecutifs. Resultats Dix-huit services de medecine interne, totalisant 1100 lits et 33 530 sejours annuels, dont 56 % (25–95 %) d’aval des urgences ont inclus 365 patients en provenance des urgences. D’âge moyen de 68 ans, 54 % de femmes, 44 % des patients etaient polymediques avec un score de Charlson moyen egal a 2,6. Les principales causes d’hospitalisation a cette periode etaient infectieuses (29 %) et neurologiques (17 %). La duree moyenne de sejour etait egale a 9,2 (±8,2) jours. De taille et d’organisation variable, l’equipe medicale de ces 18 services etait constituee en valeur mediane de 4,5 [2,75–6,25] equivalents temps-plein seniors, dont 86 % internistes. Tous les services sauf un accueillaient des internes pour 60 % de medecine generale. Conclusion Cette etude met en evidence la variabilite des organisations et des pathologies prises en charge en aval des urgences dans les services de medecine interne. Ceci place la medecine interne comme une specialite avec une capacite de prise en charge integrative/globale des patients permettant d’offrir un vaste champ d’apprentissage aux medecins en formation.

Patients admitted from emergency units represent a large portion of the population in internal medicine departments. The aim of this study is to identify characteristics of patients and organization of these departments.Between June 29th and July 26th 2015, voluntary internal medicine departments from the SiFMI group prospectively filled anonymized internet forms to collect data of each patients admitted in their ward from emergency units, during seven consecutive days.Three hundred and sixty-five patients from emergency departments were admitted in 18 internal medicine inpatients departments, totalling 1100 beds and 33,530 annual stays, 56% of them for emergency units inpatients. Mean age was 68 years, 54% were women, mean Charlson score was 2.6 and 44% of the patients took at least three drugs. Main causes of hospitalization were infectious (29%) and neurological (17%) diseases. Mean length of stay was 9.2 days. The medical team was composed by a median value of 4,5 [2,75-6,25] senior full-time equivalents, 86% were internists. Each department except one received residents, two third of them were from general medicine.This study highlights a high organizational variability among internal medicine departments and patients, and sets internal medicine as a specialty with a great capacity to achieve an integrative/comprehensive management of patients and to offer a comprehensive basis for physicians in training.

Results 16 patients (12H, 4F) with a median age of 41 years [2961] were included. Patients were Sefarad Jews (n=9), Turkish (n=2) and Arabic (n=5). Seven of them had a familial history of FMF, none had a familial history of auto-immune diseases. Their FMF was symptomatic during childhood except for two patients; most of them had colchicine. They displayed various type of vasculitis such as: HSP (n=7), PAN (n=4; two of them with viral B hepatitis), Granulomatosis with Polyangitis (GPA) (n=1), Microscopic Polyangitis (MPA) (n=1) and unclassified (n=3). Their vasculitis was diagnosed at a median age of 32 [5-43]. For one patient the diagnosis of vasculitis was made before the diagnosis of FMF. Patients with PAN mostly displayed weight loss, fever, myalgia, abdominal pain, arthralgia, with evidence of vasculitis of small or medium-sized blood vessels on a skin biopsy (n=3) or renal arterial aneurysms on an angiography (n=1). MEFV sequencing showed: homozygous M694V/M694V mutations (n=2), homozygous E148Q/E148Q mutation (n=1) and double heterozygous M694V/V726A mutation (n=1). The patient with GPA displayed an intra-alveolar hemorrhage with ORL involvement. He had a M694V/ M694V mutation and was the only patient which FMF was diagnosed after the vasculitis. All of 5 patients with HSP displayed a M694V/M694V MEFV mutation. The patient with MPA displayed erythema nodosum, arthro-myalgia, neuropathy, constrictive pericarditis, and cutaneous vasculitis. He displayed a M694V/E148Q MEFV mutation.