Presse Med
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IN UTERO CARE: The definition of pain proposed by the International Association for the Study of Pain is not adapted to the newborn or to the fetus because it assumes recognition and verbal expression of an unpleasant experience. Neonatologists have however demonstrated that full term and highly premature infants experience pain. In addition, the health of these infants improves with proper management. ⋯ In the short-term, fetal pain causes changes in behavior, hemodynamics and hormonal functions but the long-term consequences remain unknown. ANTENATAL ANALGESIA: As no validated data on assessment of pain in the fetus are available, prevention becomes primordial in all at risk situations (pregnancy termination beyond 24 weeks gestation, in utero interventions). Morphine derivatives (sufentanil) would be the analgesic of choice for antenatal pain.
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Review
[What possible treatments for liver cirrhosis patients with a small hepatocellular carcinoma?].
UNDERLYING LIVER DISEASE: Most cases of hepatocellular carcinoma (HCC) develop in subjects with an underlying chronic liver disease, primarily hepatitis C infection. The underlying liver disease greatly limits treatment possibilities due to the restrictions on surgery or the risk of recurrence even when surgical resection, chemoembolization or alcoholization appears to be successful. ⋯ Access is however sometimes limited, leading to partial destruction and risk of local recurrence. When the patient's liver functions are compatible with surgery, resection of the tumor and its adjacent portal segment has been found to be effective against tumors measuring 3 to 5 cm.