Revue médicale de Liège
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Revue médicale de Liège · Feb 2012
Review[Neurostimulation: which place in the treatment of refractory headaches?].
The management of refractory headaches (migraine or cluster headache) is often challenging in clinical practice. Most of the time, these patients are "desperate" and have already tried all existing medications. Many progresses have recently been made in the therapeutic approach of these diseases, especially with the advent of neurostimulation techniques. ⋯ The most effective and best studied methods are occipital nerve stimulation (ONS) and hypothalamic deep brain stimulation (DBS), the latter being however at higher surgical risk. Hence, there is a new hope for patients with refractory headaches. Various clinical trials are still underway.
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Revue médicale de Liège · Feb 2012
[Proven and expected benefits of intravenous lidocaine administered during the perioperative period].
Local anesthetics which inhibit sodium channels are used for neural blockade during infiltration and locoregional anesthesia. Furthermore lidocaine given intravenously acts on other cellular systems and produces multiple properties, some of which are beneficial during the perioperative period. ⋯ This article reviews clinically relevant properties of intravenous lidocaine. Its future perspectives for the prevention of chronicisation of postoperative pain, facilitation of postoperative fast track programs, and prevention of tumoral recurrence are also discussed.
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Revue médicale de Liège · Jan 2012
Review[Obstetrical epidural analgesia and postpartum backache].
Backache is a common problem in the general population. The prevalence of backpain is increased during pregnancy and after delivery. ⋯ All the prospective studies published afterwards (prospective cohort studies and 3 randomized controlled trials) yield the same result: there is no relationship between labor epidural analgesia and long-term postpartum backpain. Pregnant women must be aware of this in order to make an informed and appropriate choice about labor epidural analgesia, the most effective technique for intrapartum pain relief.
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Primary cicatricial alopecias (PCA) result from the inflammatory destruction of the hair follicle, followed by its replacement by a fibrotic streamer. The involvement of multipotent stem cells of the hair follicle is possible through a transdifferentiation pathway. ⋯ PCA are classified as the neutrophilic, lymphocytic and mixed types. Each of these groups gather specific disorders including folliculitis decalvans, dissecting folliculitis of the scalp, erosive pustulosis of the scalp, keloidal acne of the nape, frontal fibrosing alopecia, lichen planopilaris and lupus erythematosus.
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As there is no consensus in the specialized literature, it is often difficult to recognize the ties existing between dementia, delirium and depression. Depression preceding dementia is well-documented. Depressive symptoms during the process of dementia are less well-known. ⋯ Unfortunately, elderly patients can often present two, or even three, of the "3 D's" simultaneously. Untangling the 3 D's has been the subject of several articles. We propose a synthesis as well as our thoughts on the subject from a clinical psychogeriatric standpoint.