Therapie
-
Familial adenomatous polyposis is a rare genetic disease characterized by the development of colorectal adenomatous polyps. Extracolonic digestive and extra-digestive manifestations can also appear. Inevitably, colorectal cancer occurs if a colectomy is not performed. ⋯ For patients with familial adenomatous polyposis, total colectomy and ileal pouch-anal anastomosis is the recommended procedure for most patients. However, sulindac is useful for patients who have had subtotal colectomy and ileorectal anastomosis, if these patients have only a few rectal stump polyps and accept regular and strict follow-up of the rectal stump. Sulindac is also indicated for patients who have not undergone colectomy because surgery is contraindicated or has been refused.
-
Acute pain can be managed favourably by the use of paracetamol, non steroidal anti-inflammatory drugs, opioids and local anaesthetics, solely or in combination. Sophisticated methods of administration such as nerve blocks or patient-controlled analgesia will improve results. ⋯ The role of opioids in the treatment of chronic non-cancer pain has still not been clarified. Adjuvant drugs are often required.
-
This article reviews the peripheral and central mechanisms of neuropathic pain. The main mechanisms involved in neuropathic pain are: (1) ectopic activities, (2) ephapses, (3) sensitization of nociceptors. Central morphological alterations could also be involved: (1) medullar neuronal reorganization, (2) hyperexcitability of central nervous system nociceptive neurones. The relative resistance of these neuropathic pains to opioid drugs could be related to a decrease in the number of opioid receptors to an amino acid mediator related spinal neurons hyperexitability and to an increase in non opioid peptides such as cholecystokinin.
-
Clinical Trial
[Pharmacokinetic evaluation of a computerized target-controlled infusion system: application to propofol in orthopedic surgery].
PaMo 2.0, a type of software, includes a pharmacokinetic model for propofol in the adult. It allows both administration and monitoring of propofol target-controlled infusions. In order to evaluate PaMo 2.0, a prospective clinical trial compared, at defined infusion times, predicted and measured plasma propofol concentrations, in 28 patients programmed for hip-replacement surgery. ⋯ PaMo 2.0 under-estimated plasma propofol concentrations. The convergence between predicted and measured propofol concentrations was good and not modified in respect of infusion time. This infusion system is suitable for propofol administration, but the integration of Bayesian pharmacokinetic models would greatly improve propofol plasma concentration estimation and regimen adaptation to each patient.