Revue médicale de Liège
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Revue médicale de Liège · Dec 2009
Review[Regional analgesia after lower limb orthopaedic surgery].
To provide postoperative analgesia, the anaesthesist has at his disposal a panel of different medications and also regional techniques of neural blockade. Loco-Regional analgesia (epidural or peripheral nerve block), by the use of local anaesthetics, blocks conduction of the painful influx to th central nervous system. Pain relief using peripheral nerve blocks after lower limb surgery represents as good alternative to the epidural analgesia and is superior to controlled analgesia with morphine. ⋯ Analgesia after total knee prosthesis and hallux valgus surgery has considerably evolved. Postoperative analgesia is important in these cases: it facilitates physical therapy and improves patient's rehabilitation and satisfaction, it also shortens hospital stay. The aim of this review is to explain the different techniques of peripheral neural blockade and assess the value of this technique for the postoperative period after these two surgeries.
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Revue médicale de Liège · Jul 2009
Case Reports[Germinoma responsible for central diabetes insipidus].
We report the case of a 20-year-old woman who presented with sudden onset of polydipsia and polyuria. A diagnosis of diabetes insipidus was confirmed and the MRI showed a pituitary stalk enlargement. The patient was treated with Minirin. ⋯ The patient was treated with radiotherapy with a partial response as only a part of the mass disappeared. This case highlights the importance of the clinical and radiological follow-up of central diabetes insipidus, especially when it is of unknown origin. The differential diagnosis will be reviewed.
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Directed against the CD20 antigen on B lymphocytes, rituximab (MabThera) is now incorporated in the first line therapy of symptomatic follicular as well as diffuse large B cell non-Hodgkin's lymphoma and offers superior response and survival rates. 90Y ibritumomab tiuxetan (Zevalin) combines the specificity of rituximab for the CD20 antigen and the therapeutic effect of beta irradiation. Given in monotherapy, it constitutes an interesting alternative therapy for follicular lymphomas in second relapse. Alemtuzumab (MabCampath) recognizes the CD52 antigen and offers encouraging results in chronic lymphocytic leukemia resistant to classical chemotherapy.
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Revue médicale de Liège · Mar 2009
Review Case Reports[Esthesioneuroblastoma: a case report and literature review].
Esthesioneuroblastoma (ENB) or olfactive neuroblastoma is a rare cancer arising from the neuroepithelium of the olfactory epithelium of the nasal cavity. Sinusal, orbital and intracranial expansions are common. The anatomopathological diagnosis will frequently require immuno-histochemical tests and sometimes electron-microscopy as well as genetic testing. ⋯ Treatment will generally associate debulking or curative surgery (with combined rhino-neurosurgical accesses) and conformal stereo-tactic radiotherapy. Chemotherapy was generally reserved for palliative cases; it can be now proposed as neoadjuvant treatment. Most patients will relapse; thus the follow-up will remain ad vitam.
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Cerebral venous thrombosis is a rare cause of stroke. Clinical presentation is not very specific and can be very variable. Imaging establishes the diagnosis in the majority of cases. ⋯ Long term prognosis of cerebral venous thrombosis is generally good and few patients remain handicapped in the long term. Evolution is however unpredictable. Treatment strategies follow three axes: anti-thrombotic treatment, symptomatic measures and treatment of the cause if one is found.