Revue médicale suisse
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Revue médicale suisse · Dec 2011
[Posterior dislocation of the shoulder, challenges in diagnosis and management].
Posterior glenohumeral dislocation is rare, accounting for less than 3% of all shoulder dislocations. Main etiologies are direct or indirect trauma, seizure and electrocution. ⋯ The purpose of this article is to highlight and clarify the challenges when confronted with posterior dislocation in order to avoid misdiagnosis. Furthermore it aims to propose an adequate and comprehensible management from the initial diagnosis to the treatment.
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In humans, the erect position and bipedal walk is possible because of a balance between pelvic and spinal parameters. The most important pelvic parameter is the pelvic incidence which represents the base on which the spine lies. ⋯ Compensatory phenomenons are possible, but rely mostly on the amplitude of pelvic incidence. Analysis of spino-pelvic parameters and detection of a compensated or uncompensated sagittal imbalance are mandatory before any therapeutic action is undertaken for a degenerative pathology of the spine.
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Despite some progress, the mortality of severe sepsis and septic shock remains high. Immunotherapy directed against inflammatory mediators failed, but new treatments more specifically tailored to individual situations are actively investigated. ⋯ Combined with the clinical course, "PCT" allows to tailor individually the duration of antibiotic therapy in ICU patients. This still contested innovative approach significantly reduces overall exposure to antibiotics.
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In intensive care units, death occurs after a medical decision of treatment limitation in a great majority of patients. In this context, taking care of the patient and his relatives is ethically, practically and emotionally complex. End of life is a well known factor of conflict, burnout and stress among medical and nursing teams in the ICU. The recommendations described in the following article are expected to clarify the roles and practices of the professionals involved in end of life procedures in the ICU.