Presse Med
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We have to trust the patient. Pain is undertreated. Inadequate treatment has adverse consequences. ⋯ They are responsive to opioid analgesia. They need baseline opioids ("opioid debt"), mostly a well-stabilized OST. They require higher doses, more frequent dosing and longer opioid administration.
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Autonomic nervous system (ANS) modulates the function of all body organs through both parasympathetic and sympathetic fibers. Orthostatic hypotension is frequently observed in the course of central nervous system diseases including cortical (stroke, epilepsy, dementias), neurodegenerative (Parkinson's disease, multisystem atrophies) and spinal cord diseases. In some cases, the mechanism of orthostatic hypotension associated with central nervous system diseases involves a dysfunction of peripheral ANS fibers.
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Hypotension is defined by a low blood pressure either permanently or only in upright posture (orthostatic hypotension). In contrast to hypertension, there is no threshold defining hypotension. The occurrence of symptoms for systolic and diastolic measurements respectively below 90 and 60 mm Hg establishes the diagnosis. ⋯ Hypotension is a rare manifestation of pheochromocytomas, especially during surgical removal when the patient has not been prepared with calcium inhibitors. Every flush with hypotension should suggest a carcinoid crisis, which is very sensitive to subcutaneous somatostatin analog. An accurate etiological diagnosis should allow treat efficiently endocrine hypotension without inducing hypertension in supine posture.
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To analyse the factors influencing the time of admission of patients presenting an acute ischaemic stroke (AIS) to the emergency department. ⋯ In the event of a suspected stroke, these results favour contacting the emergency medical call centre and immediate transfer of the patient to an appropriate hospital establishment without waiting for prior medical intervention.