Annales françaises d'anesthèsie et de rèanimation
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Update reviewing of chronic postsurgical pain. ⋯ Epidemiology of CPSP is more recognized as it is experienced by 10-50% of individuals after classical operations. CPSP can be severe in about 5 to 10% of these patients. CPSP is a major public health problem still rarely diagnosed and treated. Twenty percent of patients consulting in a pain clinic have a CPSP. The frequency of neuropathic pain is important but the difference in the proportion to CPSP falls between 6-68% and depend on the type of surgery. Clinical risk factors and physiopathology of CPSP are subject of wide development. Human studies allowed better understanding of the neurophysiological as well psychological aspect of the development of CPSP. Finally, the possibility of pharmacological prevention of CPSP seems to have increased in the past years. Nevertheless, there are still many questions that need to be answers about the problem. We should clearly define the optimal characteristics of clinical and experimental studies as this will allow the better understanding of the prevention of CPSP. Anesthesiologists play a crucial role in this development. They are involved in all of the stages of the operative care of patients and play a decisive role in the evaluation of the risk, the development of a preventive strategy, and in the early detection and treatment of CPSP.
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Many substances, drugs or not, can be responsible for acute hepatitis. Nevertheless, toxic etiology, except when that is obvious like in acetaminophen overdose, is a diagnosis of elimination. Major causes, in particular viral etiologies, must be ruled out. ⋯ During acetaminophen overdose, with or without hepatitis or ALF, intravenous N-acetylcysteine must be administered as soon as possible. In the non-acetaminophen related ALF, N-acetylcysteine improves transplantation-free survival. Referral and assessment in a liver transplantation unit should be discussed as soon as possible.
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Ann Fr Anesth Reanim · Jun 2013
Review Case Reports[Fever and jaundice... and if it was a leptospirosis. About a case of L. interrogans Icterohaemorrhagiae in Northern France].
Leptospirosis is an anthropozoonose, an animal disease transmissible to humans, caused by a spirochete of the genus Leptospira that lives mainly among rodents but also in wetlands. It occurs worldwide, particularly in Asia, Latin America and Africa. In Europe, the incidence is small (except in France and Great Britain, where its frequency has increased in recent years) but the frequency may be underestimated. ⋯ However 5-10% of symptomatic patients have a severe multisystem defaillance. Nearly a century after the discovery of the causative agent, this zoonosis remains a public health problem, zoonosis priority in terms of virulence, its reporting is mandatory in our country. We report the case of a severe form of hepatonephritis due to water contaminated with Leptospira observed in Northern France.