Cataracte et rétinopathie sténosantes radio-induites

L’exposition professionnelle prolongée aux rayonnements ionisants peut induire des atteintes irréversibles du cristallin et de la macula.

Je vais laisser de côté les formes classiques de cataracte ou de rétinopathie radiques pour m’intéresser à  deux entités spécifiques distinctes pouvant se combiner:

• cataracte sténosante radio-induite (CSRI)
• rétinopathie sténosante radio-induite (RSRI)

J’en parle donc avec d’autant plus d’émotion, que ce sont souvent des confrères cardiologues coronarographistes qui sont touchés. Malheureusement, les pouvoirs publics (qui sont la cause de tout le mal, tout le monde le sait parfaitement…) ont trop longtemps fermé les yeux sur ces pathologies professionnelles.

Le symptôme cardinal est de constater une sténose coronaire significative à un endroit où il n’y en a pas et d’y coller une endoprothèse, si possible active.

Lisons ce témoignage bouleversant qui met en lumière la détresse d’un coronarographiste américain:

Edward Chaid, 68, a semiretired general contractor from Timonium, Md., is among those who have sued. Five years ago, Mr. Chaid decided to get his first physical examination in decades. Just to be safe, his doctor sent him for a cardiac stress test at MidAtlantic, which revealed a small “squiggle” of concern, Mr. Chaid said. He was sent to Dr. Midei to get his arteries X-rayed, and he emerged from the procedure with two stents.

“Dr. Midei said: ‘You sure are lucky. You had 90 percent blockage.’ And the nurse said, ‘Oh yeah, you were blocked in your widow-maker.’ And I said: ‘Thank God. I guess I’m really lucky you got it when you did,’ ” Mr. Chaid said in an interview.

Five years later, another doctor concluded that Mr. Chaid’s blockage had been minimal. “I was really shocked,” Mr. Chaid said. “I’m from a generation where doctors are thought very highly of.”

Malheureusement, la CSRI/RSRI a des répercussions destructrices pour le praticien:

In April 2009, a patient of Dr. Midei’s who was also a St. Joseph employee complained that he had received an unneeded stent and that many other patients had as well. The hospital engaged a panel of experts who reviewed 1,878 cases from January 2007 to May 2009 and found that 585 patients might have received unnecessary stents.

La recherche pour traiter cette terrible maladie est encore balbutiante, faute de reconnaissance et de financements.

On peut donc d’autant plus saluer l’implication d’une firme fabricant des endoprothèses dans la recherche d’une thérapeutique. Elle a ouvert notamment une voie prometteuse vers un traitement innovant par des extraits purifiés de cochon fumé Per Os:

Word quickly reached top executives at Abbott Laboratories that a Baltimore cardiologist, Dr. Mark Midei, had inserted 30 of the company’s cardiac stents in a single day in August 2008, “which is the biggest day I remember hearing about,” an executive wrote in a celebratory e-mail.

Two days later, an Abbott sales representative spent $2,159 to buy a whole, slow-smoked pig, peach cobbler and other fixings for a barbecue dinner at Dr. Midei’s home, according to a report being released Monday by the Senate. The dinner was just a small part of the millions in salary and perks showered on Dr. Midei for putting more stents in more patients than almost any other cardiologist in Baltimore.

Afin de faire avancer la prise en charge de la CSRI/RSRI, et dans un but de promotion de la Santé Publique, je vous propose ce test simple de dépistage qui est à la fois spécifique et sensible:

Dans le cas où vous avez coché 2 fois « oui », vous êtes à haut risque d’avoir une RSRI/CSRI, consultez un confrère ophtalmologue.

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Doctor Faces Suits Over Cardiac Stents, by Gardiner Harris. The New York Times. Published: December 5, 2010.

Shelley Wood. More « unnecessary-stenting » allegations—this time in Texas . theheart.org. [heartwire > Murmurs]; Nov 25, 2010. Accessed at http://www.theheart.org/article/1156973.do on Dec 6, 2010.

67 stents, 28 coronary angiograms, and a crippled healthcare system. Topolog. Posted Nov 01, 2010 at 02:20 PM, EDT by Eric Topol.

Lisa Nainggolan. Another Maryland cardiologist in hot water over unnecessary procedures . theheart.org. [heartwire > MediaPulse]; Sep 2, 2010. Accessed at http://www.theheart.org/article/1118641.do on Dec 6, 2010

Shelley Wood. Federal report linking Dr Mark Midei and Abbott finds « potential fraud, waste, and abuse » . theheart.org. [heartwire > Murmurs]; Dec 6, 2010. Accessed at http://www.theheart.org/article/1160085.do on Dec 6, 2010