Revue médicale de Liège
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Revue médicale de Liège · Dec 2008
Review[Is it possible to integrate frailty of old person, in surgical procedure?].
Frailty in the elderly is an important factor of morbidity, particularly in the setting of surgery. The various pathologies that can lead to a functional decline are well known. The risk of mortality and morbidity should be assessed as a function of the nature of the surgical procedure and of the disease for which it is required; the factors of severity, the predictable duration of the procedure, and the expected blood losses must also be taken into account. ⋯ Frailty must be integrated into the risk assessment; however, further studies are needed to better determine the impact of that new concept. Undoubtedly, the cognitive and nutritional status are of main importance. A better knowledge of the risks should lead to validate specific interventions that could help to prevent surgical complications, shorten the length of hospital stay, and protect the self-sufficiency of the aged.
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Revue médicale de Liège · Nov 2008
Review[Transdermal buprenorphine: a current overview of pharmacological and clinical data].
Our understanding of the pathophysiologic mechanisms of chronic pain progresses; the complexity of the problem justifies our need for new molecules and new ways of administration that will help to further optimise and better individualize our pharmacologic therapies. Whereas acute pain can be considered an alarm signal, chronic pain constitutes, per se, a syndrome that requires a meticulous selection of the analgesic drug(s). Since pain is permanent, the continuous administration of the analgesic is recommended rather than an on demand administration. ⋯ Buprenorphine also exerts an analgesic action on neuropathic pain. It differs from other opioids by its affinity as a partial agonist on mu and kappa receptors, and as a complete agonist of ORL-1 receptors. Therefore, transdermal buprenorphine will be useful to all physicians having to control severe pain by powerful opioids.
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Pulmonary involvement is rare in Horton's disease. Only few cases have been reported presenting as interstitial infiltration, pulmonary artery vasculitis, pulmonary nodules and granulome formation. Pleural effusion was rarely reported. ⋯ Outcome was favourable with systemic corticosteroid therapy. Pleural involvment in Horton's disease is rare and characterized the absence of specific biological and histological findings. However, pleural effusion may be a presenting manifestation of Horton's disease.
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Revue médicale de Liège · May 2008
Review[Migraine management: current trends and future prospects].
Despite its high prevalence and individual as well as societal burden, migraine remains underdiagnosed and undertreated. In recent years, the options for the management of migraine patients have greatly expanded. A number of drugs belonging to various pharmacological classes and deliverable by several routes are now available both for the acute and the preventive treatments of migraine. ⋯ There is thus still considerable room for better education and for more efficient therapies. In spite of useful internationally accepted guidelines, anti-migraine treatment has to be individually tailored to each patient taking into account the migraine subtype, the ensuing disability, the patient's previous history and present expectations, and the comorbid disorders. In this article we will summarize the phenotypic presentations of migraine and review recommendations for acute and preventive treatment, highlighting recent advances which are relevant for clinical practice in terms of both diagnosis and management.
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Most patients who remain comatose for a few hours after a period of global cerebral ischemia have a poor prognosis. Early identification of these patients is desirable to reduce uncertainty about treatment and non-treatment decisions, and to improve relationships with the family. The absence of pupillary light response and corneal reflexes, absent or stereotyped extension motor response to noxious stimulation (3 days after insult); myoclonus status epilepticus; absence of cortical N20 response on somatosensory evoked potential studies; generalised suppression or burst-suppression EEG and serum neuron-specific enolase above 33 microg/L (sampled 1-3 days after insult) have been shown to predict poor outcome. We here propose an algorithm to help intensive care physicians' clinical decision making in post-anoxic coma.