Presse Med
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The HER2 gene or c-erb B2 or neu is amplified in 15-25% of breast cancers. This amplification is associated with an aggressive course of disease. The trastuzumab is a monoclonal antibody targeting the extracellular domain of HER2. This is the first targeted molecule designed to treat breast cancer. In the firstline metastatic disease, trastuzumab in combination with chemotherapy significantly improved survival of patients with HER2-positive disease. In the adjuvant setting, trastuzumab has been evaluated in several randomized trials. ⋯ In the contemporary medical literature, several strong arguments confirm the benefit in survival of trastuzumab administered concomitantly with a taxane-based chemotherapy and with concurrent radiotherapy, and for a period of 1year. Trastuzumab was well tolerated. Only 2% or less of patients experienced a serious cardiac toxicity, but it was reversible in most of the time.
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Multicenter Study
[Cost awareness at emergencies: multicentric survey among prescribers].
Regular increasing of health-care expense brought about the development of medical implication in prescription control and the will to give more responsibility to prescribers. Emergency departments account for a large part of hospital expenses. This study was carried out to evaluate cost awareness among French emergency physicians. ⋯ Physicians had a poor understanding of prescription costs at the emergencies, especially regarding high-cost drugs. Much progress is required to integrate the cost-containment problem in daily prescriptions at the emergency department.
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Opioid maintenance treatments (OMT) reduce illicit opiate use and its associated risks. They are often prescribed on a long-term basis. Physiological changes induced by long-term OMT may cause hyperalgesia and cross-tolerance to opioid agonists, which suggests that the dosage of analgesic treatment should be modified in cases of acute pain, especially when an opioid-based analgesia is required. ⋯ With buprenorphine, non-opioid analgesics should be introduced first, if possible. If this strategy is inefficient or contraindicated, a temporary or definitive switch to methadone should be considered. In the case of methadone-based OMT, opioid analgesics should be added directly and the dosage should be adapted according to the level of pain reported by the patient.
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Guillain-Barré syndrome (GBS) is an acute polyneuropathy with a variable degree of weakness that reaches its maximal severity within 4 weeks. The disease is mostly preceded by an infection and generally runs a monophasic course. Both intravenous immunoglobulin (IVIg) and plasma exchange (PE) are effective in GBS. ⋯ This study is currently going on. The international GBS outcome study (IGOS) is a new worldwide prognostic study that aims to get further insight in the (immune)pathophysiology and outcome of GBS, both in children and adults. Hopefully these and other studies will further help to improve the understanding and especially the outcome in patients with GBS.
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Anaphylaxis is the most serious form of the IgE-dependent food allergy, with lethal risk. The incidence is sharply rising. ⋯ The actual management of anaphylaxis does not fit with the International Guidelines. Anaphylaxis treatment protocols according to the international criteria should be applied in ED. Risk reduction strategies cannot rely only on the self-administration of epinephrine by the patient and should put forward a better efficiency of all first-aid care providers. A targeted educational intervention should be developed to improve the care of emergency medical services providers. They should have self-injectable-epinephrine available and should be coached to use it properly.