La Revue du praticien
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This review discusses current therapeutic options for leg ulcers. Compression therapy remains the first-line treatment for venous ulcers, with the use of an external pressure of 30 to 40 mmHg at the ankle (0.8 < ABPI < 1.3). Superficial vein surgery does not improve healing rates of venous ulcers; however it has been shown to reduce ulcer reoccurrence in the context of a competent deep venous system. ⋯ Systemic antibiotics should be considered only if the ulcer presents clinically significant infection (spreading erythema, cellulitis, purulent exudates and fever). Choose a type of dressing depending on the phase of healing and on particulars situations (infection, hemorrhagic, malodorous wounds, dermatitis of surrounding skin). In addition to conventional therapeutic options, patient education and lifestyle interventions should not be forgotten.
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Overwhelming post-splenectomy infection (OPSI) is a long-term risk in asplenic patients, which may be controlled by appropriate preventive measures. Specific guidelines have been developed to reduce its incidence. These guidelines include immunizations, antibioprophylaxis, and education. ⋯ Antibioprophylaxis during 2 to 5 years following splenectomy in children, and 2 years in adults is recommended. Furthermore, long-term education is mandatory. Application of preventing measures is effective and patient's education remains the cornerstone of prevention.
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Myasthenia gravis is a rare, auto-immune neuromuscular junction disorder. Prevalence rates is about 50/1,000000. The disease results from circulating auto-antibody attacks against post-synaptic targets (acetylcholine receptor [AChR] in 80% cases) on the endplate region of the postsynaptic membrane. ⋯ Myasthenia gravis treatment is based on oral form of cholinesterase inhibitors, corticosteroids and other immunosuppressive drugs in severe forms. During myasthenia crisis, intraveinous immune globulines or plasma exchanges can be used. Thymectomy is proposed in case of thymus abnormality.