La Revue de médecine interne
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The clinical efficiency of every therapeutic, medicinal or other, contains a part of not specific effect, or placebo effect, of which the frequency of appearance and the importance, in the treatment of pain, can be particularly raised. The practitioners use often, deliberately either not, this effect to modulate their therapeutic efficiency, or in a diagnostic purpose to investigate the mechanism of a pain; our objective is to analyze, in the light of a review of the recent medical literature, what the understanding of the placebo effect brings to the treatment of pain. ⋯ At term of this review, we will conclude that the use of a placebo has no value of diagnostic test as for the mechanism of the pain; it is neither necessary nor desirable to implement placebo effect in the daily practice because any therapeutics acts by associating specific and not specific effects. The quality of the relation doctor-patient will allow to mobilize not specific factors susceptible to modulate favorably any therapeutic action. For controlled clinical trials, certain methodologies can be envisaged to by-pass the administration of placebo, reducing so ethical constraints bound to their use.
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Review Case Reports
[Hemolytic uremic syndrome as a complication of gemcitabine treatment: report of six cases and review of the literature].
Hemolytic uremic syndrome is a rare condition during gemcitabine therapy. ⋯ Systematic clinical and biological screening of hemolytic uremic syndrome during gemcitabine therapy should allow to better know this complication, to recognize and treat it earlier with a potential positive impact for patients.
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Oncogenic osteomalacia (OO) is a rare paraneoplastic syndrome characterized by severe hypophosphatemia induced by phosphaturic factors which are secreted by some tumors of mesenchymal origin. Fibroblast Growth Factor 23 (FGF-23) belongs to this family. Measurement of FGF-23 might improve the diagnosis of OO. ⋯ We conclude that FGF-23 measurement is likely to be of considerable importance for facilitating early diagnosis of OO.