Presse Med
-
Massive pulmonary embolism is defined by systemic hypotension or cardiogenic shock. Clinically stable patients with right ventricular dysfunction on echocardiography, elevated brain natriuretic peptide or troponin are usually considered as having sub-massive pulmonary embolism, but this definition is not universally accepted. The time-lag to confirm massive pulmonary embolism should be kept as short as possible and every effort should be done to rely on bedside tests and to avoid patient transfer to the radiology department. ⋯ Surgical or catheter embolectomy is nowadays only rarely performed in patients with pulmonary embolism. This method can be undertaken in the few patients with persisting shock despite supportive care and who have an absolute contraindication for thrombolytic therapy. Before new data are available there is no special indication for vena cava interruption in patients with massive pulmonary embolism.
-
Neurostimulation of neuropathic pain is based on surgical implantation of devices for several types of neuromodulatory treatment (stimulation of the spinal cord, cortex, deep brain or thalamus, or occiput). Spinal cord stimulation is a recognized treatment, with a high level of proof. ⋯ Cortical stimulation is effective in 50 to 70% of cases but should be performed only in several specialized centers. Thalamic stimulation, with its efficacy rate of only 30 to 50%, should be reserved for patients for whom the preceding techniques have failed.
-
Genital human papillomavirus (HPV) infection is one of the most common sexually transmitted infections worldwide. Two HPV vaccines are now available in many countries: (i) the first vaccine is quadrivalent and indicated in the prevention of CIN 2/3, cervical cancers, VIN 2/3, VaIN 2/3 and genital warts associated with the HPV types 6, 11, 16 and 18, (ii) the second vaccine is bivalent and indicated in the prevention of CIN 2+ and cervical cancers associated with the HPV types 16 and 18. ⋯ This review is to my knowledge, the most comprehensive and up-to date review to be published in French on HPV epidemiology and related diseases. It will be of great value to educate medical and paramedical personnel on HPV infection and associated diseases and it will be of great help to public health authorities and decision makers when they have to evaluate the convenience of introducing HPV vaccination in a given population.
-
Interindividual variability in pain perception and response to opioids in terms of efficacy and side effects has been long noted. Numerous genes have been proposed as ideal candidate genes for the study of the genetic component of pain and pharmacogenetics of opioids. Despite the inherent complexity in studying pain, it is obvious that several genetic polymorphisms contribute to modulate nociception and the antinociceptive effects of opioids; specifically those involved in pharmacokinetics and the metabolism of opioids (cytochrome P450) and neurotransmitters (catechol-O-methyltransferase), as well as those affecting pharmacodynamics or the drug targets such as the mu-opioid receptor or the unexpected melanocortin 1-receptor.