Revue médicale de Bruxelles
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Most of us live in cities and nature seems beneficial. Unfortunately, invertebrates and vertebrates may be aggressive. We will try here a review of the diseases caused by arthropods and other noxious animals. ⋯ Among invertebrates: leeches, anemons, corals, sea urchins, sponges and mollusca. Noxious or venomous vertebrates will not be forgotten. Basic and practical attitudes are proposed.
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A wide range of invasive techniques are available for pain treatment. Treatment must be adapted to the severity of the underlying disease and the intensity of pain. Very few controlled studies concerning these techniques have been performed, and it is therefore difficult to assess their short and long term efficacy. ⋯ This non exhaustive revue presents the indications, techniques and results of neural conduction blocks as peripheral blocks, Alcock canal block, zygapophysial joint blocks and also central blocks illustrated by epidural and intrathecal injections and finally sympathetic nervous system blocks as celiac plexus block, stellate ganglion block and intravenous blocks for complex regional pain syndromes. The indications, techniques and results of thermal neurolyse (radiofrequency, thermocoagulation), transcutaneous electrical nervous stimulation (TENS) and implant central stimulation are also presented. A multidisciplinary approach is used to evaluate the risk/benefit ratio of these invasive techniques for each patient.
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A good knowledge of clinical presentation and of risk factors for pulmonary embolism is mandatory to improve adequate clinical suspicion. Some recent improvements in diagnostic strategy have to be emphasized. A low D-dimer level has a good negative predictive value to rule out pulmonary embolism. ⋯ In case of non diagnostic scan, serial non invasive search for deep vein thrombosis in the limbs is recommended by some experts at least in patients with good cardio-respiratory reserve, pulmonary angiography being recommended otherwise. Spiral CT allows direct demonstration of clots, being hardly less sensitive than pulmonary angiography except for subsegmental emboli. Future perspectives include the use of spiral CT as first choice procedure, as well as magnetic resonance imaging.
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For more than 25 years, quantitative approaches were applied to evaluate the outcome of diagnostic and therapeutic strategies. Decision analysis is but one quantitative approach that guides therapeutic decisions. ⋯ It uses a model represented by a decision tree that helps the clinician tot quantify the outcomes. Followed by sensitivity analysis, it may provide a robust basis for the final decision.