Presse Med
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Review Comparative Study
[Obesity, immune resistance and metabolic complications: what morbid obesity can teach the doctor].
Abdominal -- and not peripheral -- obesity induces insulin resistance. Morbid obesity is not always accompanied by either diabetes mellitus or metabolic syndrome. ⋯ This explains the relative rarity of diabetes in morbid obesity. Patients with morbid obesity are at greater risk of developing mechanical complications (e.g. cardiac, pulmonary, or locomotor system, or sleep apnea) than metabolic complications or cardiovascular heart disease.
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Fungal urinary tract infections (funguria) are rare in community medicine, but common in hospitals where 10 to 30% of urine cultures isolate Candida species. Clinical features vary from asymptomatic urinary tract colonization (the most common situation) to cystitis, pyelonephritis, or even severe sepsis with fungemia. The pathologic nature of funguria is closely related to host factors, and management depends mainly on the patient's underlying health status. ⋯ The antifungal agents used for funguria are mainly fluconazole and amphotericin B deoxycholate, because other drugs have extremely low concentrations in urine. Primary and secondary preventions are essential. The reduction of risk factors requires removing urinary catheters, limiting antibiotic treatment, and optimizing diabetes mellitus treatment.
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Review
[New ethical issues around dialysis. To dialyze or not to dialyze, that is not the question].
Although a physician's first ethical duty is to master the relevant techniques, it is not enough for kidney specialists to know the major principles of dialysis and apply them to all patients with kidney failure. Historically a truly ethical promise, dialysis revolutionized the management of chronic kidney disease by sparing life for the time needed to wait for renal transplantation. Constrained by a supply considerably lower than demand, the nephrologists of that time selected patients, treating only the young and relatively healthy. ⋯ What matters is our mission of care - beyond the quantity of life we must improve its quality, especially at its end. To succeed in providing this care is not to know to how begin, limit, space out or shorten sessions. It requires instead that professionals working in nephrology be trained in palliative care for it is their job to provide care to the very end to these very sick patients, outside of palliative care units, which do not seem to have been created for them or adapted to their needs.
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Comparative Study
[Hydatid cysts of the spigelian lobe (segment I) of the liver: clinical and therapeutic particularities].
Hydatid cysts of the spigelian lobe, that is, segment I of the liver, are rare. We analyzed their clinical and therapeutic particularities. ⋯ Segment I of the liver is a rare site for hydatid disease, and a site where vascular and biliary complications are frequent. Its management requires a good knowledge of the vascular anatomy of the liver and wide experience of hydatid cyst surgery and especially of simple surgical procedures.
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Wernicke encephalopathy - most often observed in alcoholic patients - is due to severe thiamine deficiency. ⋯ Wernicke encephalopathy is a rare complication of hyperemesis gravidarum. It should be diagnosed as early as possible to prevent long-term complications.