Presse Med
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The principal aim of therapeutic management of the child, adolescent and adult with type I diabetes is to avoid severe hypoglycemia and long-term complications, by maintaining blood glucose concentrations and thus glycated hemoglobin levels (HbA1c)-dose to the normal range. However, the therapeutic constraints should not decrease the quality of life and well-being of patients. Therefore, the purpose of the present study was to evaluate by a questionnaire the well-being of our autonomous diabetic adolescents and young adults in relationship with their HbA1c levels and other characteristics. ⋯ Well-being was mainly associated with HbA1c levels; it improved with better glucemic control.
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In diabetic patients, blood glucose should be controlled to a level which prevents acute metabolic complications, forestalls the development of micro and macroangiopathic complications and remains compatible with good quality of life. Recent interventional trials in both insulin-dependent and non-insulin-dependent patients have helped identify this target glucose level. ⋯ The ideal system includes patient education, renewed training for general practitioners who care for most of the non-insulin-dependent as well as a large number of insulin-dependent diabetic patients in France, close follow-up with regular consultations (calling upon specialists when therapeutic adaptations are required) and an organized system of nursing care by specially trained caregivers. The extra cost of this combined organization is to be balanced against expenditures for complications of diabetes.
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Case Reports
[Poisoning with "poppers", a rare cause of methemoglobinemia observed in emergency cases].
Methemoglobulinemia should be entertained as a differential diagnosis in patients with cyanosis. Recently in France there has been an increase in the number of cases of acquired methemoglobulinemia due to inhalation of poppers. ⋯ Poppers are inorganic aliphatic nitrites used for their relaxing effect on smooth muscle and for their aphrodisiac effect. One poorly recognized effect is the development of methemoglobulinemia. Tissue hypoxia results because methemoglobulin cannot bind oxygen, leading to a brown or blue coloration of the blood. Methemoglobulin usually results from exposure to a wide variety of oxidizing compounds including certain drugs. Methylene blue is the specific treatment for symptomatic methemoglobulinemia. These four cases emphasize the toxic effect of products sold in sex shops and calls attention to the life-threatening risks involved.
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Renal vein thrombosis, long recognized as a classical complication of acute pyelonephritis, has become exceptional since the advent of antibiotics. ⋯ Renal vein thrombosis remains a severe though uncommon complication of acute pyelonephritis. Computed tomography with iodine, contrast agent or duplex Doppler allows noninvasive diagnosis.
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Comparative Study
[Initial evaluation of thoracic injuries. Comparison of pulmonary radiography and x-ray computed tomography].
To investigate the contribution of computed tomography scan (CTS) to the initial évaluation of chest trauma. ⋯ CTS adds significantly to the evaluation of chest trauma by allowing prompt, accurate assessment of lesions. In this study, over 50% of these lesions required specific treatment during the ICU stay.