Presse Med
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A CHALLENGING SITUATION: A number of patients experiencing chronic noncancer pain are unsatisfied with standard treatment modalities. This raises the question of whether there may be a place for strong opioids in the management of these patients. ⋯ However, opioids may be ineffective in others and intolerable side effects, heightened pain and functional impairment as well as drug addiction may also occur. A PROMISING SOLUTION: Finally, strong opioids do not appear to be the issue to all intractable chronic nonmalignant pain states, but they may be a possible issue to a subset of selected and informed patients who agree on the goals of the treatment and accept regular monitoring.
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Ischemic neuropathy is an uncommon and poorly-understood condition affecting the peripheral nervous system. Most cases involve the upper limbs and occur after vascular surgery. ⋯ Ischemic neuropathy of the lower limbs is generally observed after aortoiliac surgery. Occurrence after aortic dissection is exceptional. Most cases show a distal localization and are painful with little motor deficit. They must not be confused with global ischemia of the lower limb or radiculopathy. Early revascularisation is crucial for complete recovery.
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HYPERLIPIDEMIA: HIV-1 protease-inhibitors therapy is associated with increased levels of triglycerides, LDL-cholesterol and Lp(a). But the understanding of hyperlipidaemia occurring in patients treated with HIV-1 protease-inhibitors is not easy since HIV infection itself is associated with lipid abnormalities and since HIV-1 protease-inhibitors therapy is also responsible for the development of a lipodystrophy syndrome (insulin resistance) which may influence lipid metabolism. However, many data indicate that HIV-1 protease-inhibitors therapy itself modifies significantly lipid metabolism.
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NATURAL HISTORY: Alcoholism is a common cause of chronic calcifying pancreatitis. Abdominal pain, weight loss and acute complications are the early manifestations. Besides chronic pain, about 80% of the patients develop acute pancreatitis, pseudocysts, compression of the main bile duct, serous effusion or digestive bleeding during the first five years of the disease course. Painful episodes are more frequent after 5 to 10 years, with a risk of jaundice and persistent pseudocyst formation.
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Review Case Reports
[Acute respiratory distress syndrome after antineoplastic chemotherapy. Probable role of gemcitabine].
A 4-week interval between radiotherapy and gemcitabin chemotherapy is recommended due to the risk of severe radiosensitization. Gemcitabin can also have severe lung toxicity late after or without prior radiotherapy. ⋯ About 20 cases of severe lung toxicity due to gemcitabin have been reported in the literature, occurring late after radiotherapy or without radiotherapy. Corticosteroid therapy, whether given for prevention or cure, is not always effective. Four of these cases had a fatal outcome. The development of brief mild episodes of dyspnea is considered to be common after delivery of gemcitabin. If unexplained dyspnea persists for more than a few hours, severe lung toxicity is highly likely and gemcitabin should be interrupted.