Presse Med
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Case Reports
[Continuous intrathecal injection of baclofen in generalized tetanus. A therapeutic alternative].
In France, tetanus is diagnosed predominantly in the elderly due to the absence of vaccination in this population. Mortality remains high and is mainly related to complications secondary to prolonged hospitalization, intravenous administration of benzodiazepines, and at times curares. Baclofen, a selective agonist of GABAB receptors, directly counteracts the effects of the tetanic toxin. ⋯ Continuous intrathecal administration of barclofen appears to be a valuable alternative therapy in tetanus. This new therapeutic modality promises to improve the prognosis of this condition, especially in the elderly.
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Intravenous immunoglobulins have been shown to be effective in the treatment of immunologically mediated thrombocytopenia. Several articles have been published on the positive effect of immunoglobulins in sepsis-related death. We retrospectively studied the effects of intravenous immunoglobulins used during septic shock thrombocytopenia over a 5-year period in a polyvalent intensive care unit. ⋯ Although we were unable to demonstrate a significant difference in the effects of immunoglobulins on platelet level and mortality, the trend during this evaluation was comparable with that reported in the literature. For transfusion, and although the results were not significant, a notion of reduced risk was evident. Prospective trials are needed to confirm these observations.
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A NEURODEGENERATIVE DISEASE: Idiopathic Parkinson's disease is initially due to a selective and specific destruction of the pars compacta dopaminergic neurons in substantia nigra. Since the inaugural description in 1817 by J. Parkinson, therapeutic progress rapidly accelerated mainly due to a better knowledge of the neurobiology of the central nervous system dopaminergic pathways.
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FUNDAMENTAL: Analgesia is a fundamental part of management as it helps avoid the morbid effects of pain itself and improves confidence so the child and his parents can accept more easily the diagnosis and proposed treatment. The World Health Organization has established a classification of analgesics. USE OF PLACEBOS: The placebo effect depends on several factors including anxiety, confidence, and the patient's- and prescriber's-expectations and convictions). ⋯ Local anesthetics improve comfort without compromising safety. Neurogenic pain does not respond to usual analgesics and can be relieved with tricyclic antidepressors for burning sensations or antiepileptic drugs for fulgurant pain. TREATMENT-RELATED PAIN: Iatrogenic pain, by definition, must be systematically anticipated and prevented.