Presse Med
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GENERAL DATA: There is now considerable evidence that high risk human papillomaviruses (HPV), such as HPV 16, are closely associated with cancer of the cervix. HPVs that are primarily transmitted through sexual contact, are found in over 99% of the cases of invasive cervical cancer. Although most women can be infected during their sexual life, a small minority is at risk for developing cancer. ⋯ Aneuploidy and karyotypic abnormalities are also key events in the tumor progression. A PREVENTABLE DISEASE: Cervical cancer is more than ever a preventable disease. While waiting for clinically applicable vaccination programs, strategies to prevent cervical cancer include 1) improved screening covering the widest possible population and using HPV testing, 2) close management and follow-up of women with precancerous lesions.
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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.