La Revue de médecine interne
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Since the development during the sixties of the pioneer pain clinics in the United-States, the need of a pluridisciplinary approach of the chronic pain patient has progressively compelled recognition. The principles of organization of this new care units--the pin center--are now clearly determined. It has become classic to compare acute pain as a warning symptom with chronic pain as an illness in itself with its constellation of psychosocial factors. ⋯ Neurophysiological, neuropsychological and behavioral differences legitimate the acute/chronic distinction. We will consider the following items: the types of patient, the multidisciplinary model, the team functioning, the initial consultation, the multidisciplinary synthesis discussion, the somatician role, the psychiatrist role and the possible disadvantages. Beside the care mission, multidisciplinary pain centers also have a key role in clinical research and teaching.
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A 17 year-old young man developed two episodes of acute pancreatitis, separated by a 2 year interval and associated with isotretinoin therapy. In 1989, vesicular sludge without lithiasis was evidenced and in 1991, gall bladder stones were found by cholecystectomy. ⋯ It is interesting to note that far away from the use of isotretinoin, the patient suffered from another episode of acute pancreatitis without any coagulation disorder. The involvement of Roaccutane in cellular differentiation is discussed as well as its causal association with acquired dysfibrinogenemia and transient thrombocytopenia.
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Infections due to Yersinia enterocolitica are usually limited to the bowel. When infection is generalized, the role of iron overload and iron chelation has been discussed. We report the case of a 55 year-old patient with sideroblastic anemia who received repetitive transfusions and deferoxamine for 4 years and heme arginate for 2 months, and who was admitted in our institution for Yersinia enterocolitica sepsis. Treatment by third-generation cephalosporins and aminoglycosides has allowed favorable outcome.
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Review Case Reports
[Unresectable giant hepatic hemangioma and Kasabach-Merritt syndrome].
The Kasabach-Merritt syndrome was first described in children with cutaneous hemangiomas, but it can exceptionally be associated with visceral hemangiomas, especially in adults. Clotting and fibrinolysis within the hemangioma are thought to cause the coagulopathy observed in the so-called Kasabach-Merritt syndrome. ⋯ But in the adult, the only radical alternative is surgical excision if technically feasible. We reported here the case of a 43 year-old woman with a giant unresectable hepatic hemangioma complicated with a Kasabach-Merritt syndrome.