La Revue du praticien
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Imaging strategy varies according to the background of acute or persistent low back pain. In case of acute low back pain with associated symptoms of a cauda equina syndrome or any atypical clinical signs PA and lateral radiographs of the lumbar spine are required. ⋯ Secondary, MRI may be performed in case of worsening and persistence of the clinical symptoms or if a specific low back pain is suspected. In case of chronic low back pain, with a severe socio-professional impact or a planed invasive treatment, plain films of the lumbar spine must be obtained, eventually with additional MRI examination.
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La Revue du praticien · Nov 1999
Review Comparative Study[Urticaria and Quincke's edema: etiology, diagnosis, treatment].
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Vaginal delivery especially with dystocia, may result in relaxation or disruption of fascial and ligamentous supports of pelvic organs. The relationship between first childbirth and obstetric trauma is strong but additional pregnancies and deliveries are aggravating factors as well as ageing and hormonal effects of the menopause. ⋯ General practitioners can help at the time of postnatal control by making a full clinical evaluation of pelvic floor damage, referring women for further investigation and asking them about postnatal sexual difficulties. Postpartum perineal physiotherapy is indicated for women at risk: pelvic floor congenital weakness instrumental delivery, postpartum urinary and/or anal incontinence.
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Close collaboration of an informed anaesthetist with the obstetrician, and respect of the security protocols in every anaesthesia must guarantee the well-being of pregnant women. The development of loco-regional anaesthesia for use in labour analgesia and caesarean section has reduced the indications and the mortality related to general anaesthesia. ⋯ Epidural anaesthesia using low concentrations of local anaesthetics allows parturient ambulation. Intrathecal anaesthesia, with combined spinal-epidural technique, is mostly used for caesarean-section and for the early and late labour.