Presse Med
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Desmoid tumors are the second leading cause of mortality in patients with familial adenomatous polyposis who have undergone proctocolemy. Both medical and surgical treatment of these non-metastasizing but locally aggressive tumors are difficult. ⋯ In this critical clinical situation, tamoxifen provided rapid and prolonged effect and was well tolerated.
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ANTIREFLUX SURGERY: Peri and postoperative morbidity is higher with Nissen fundoplication than with a 180 degrees posterior fundoplasty (Toupet procedure) which carries the risk of a compromised result with time. Although a 270 degrees posterior gastric valve may be the best technique, the surgeon's skill looks more important than the procedure used, especially for laparoscopic surgery. Its advantages include reduced postoperative pain, shorter hospital stay and convalescent time.
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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.
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UNCOMMON MALIGNANCY: Adrenocortical carcinoma is a very rare malignancy with poor prognosis. Median survival ranges from 12 to 25 months. Most clinicians recommend aggressive surgical management of either local or recurrent and metastatic disease. ANTICORTISOL AGENTS: Mitotane, the most tested agent against inoperable and metastatic adrenocortical carcinoma, procures overall response rates of 20 to 25%, but recent data do not support its use in the adjuvant setting.