Revue médicale suisse
-
The quasi-ubiquitous distribution of vitamin D receptors in the human tissues and the high prevalence of vitamin D deficiency worldwide have generated much enthusiasm about the opportunity of cardiovascular disease prevention through vitamin D supplementation. However, reported associations between vitamin D and cardiovascular disease present important limitations and are prone to confounding and reverse causation. Results from ongoing randomized clinical trials testing the efficacy of vitamin D supplementation to reduce cardiovascular events will not be available before year 2015. This article reviews the epidemiology of vitamin D and provides a brief overview on the relationship between vitamin D and cardiovascular disease.
-
Essential trace elements are inorganic metalloid substances: insufficient intakes cause predictable biological and clinical alterations. Numerous factors contribute to the alterations of iron, iodine, selenium, and zinc status, such as low soil content resulting in low food content, malabsorption, or biological fluid losses. ⋯ Substitution and supplementation studies that respect physiological nutritional doses result in significant clinical benefits: improved immunity and cognitive functions, better wound healing. Supplementation with supra-nutritional doses in subjects or patients with adequate status may result in deleterious cancer and cardiovascular consequences due to their potential toxicity.
-
Revue médicale suisse · Oct 2012
[Endometriosis: an essential differential diagnosis of chronic pelvic pain].
In the context of chronic pelvic pain, endometriosis plays a significant role due to its frequency and its effects on the quality of women's lives. It affects 3-10% of women of reproductive age. The clinical signs are part from chronic pelvic pain, dysmenorrhea, dyspareunia, urinary and digestive symptoms as well as infertility. ⋯ This explains the fact that it takes more time to make the diagnosis of endometriosis. Delay of diagnosis, multiple consultations and complex surgical procedures implicate physical and psychological suffering for the patient with serious complications. For all these reasons, the differential diagnosis of chronic pelvic pain in women should include endometriosis.
-
The concept of fast track surgery (FT) is a multimodal strategy aiming to decrease postoperative pains and chirurgical stress-induced organ dysfunction. The key elements of this program are: information and preoperative education, perioperative hydric balance, optimized analgesia, early oral nutrition and early mobilization of the patients. ⋯ FT program is applicable in open surgery and in laparoscopy and has proven its effectiveness in colorectal surgery. Using this strategy in gynecological surgery, which resembles it in many points, will prove its effectiveness and facilitate its wider implementation.
-
Revue médicale suisse · Oct 2012
[Enteral nutrition: nasogastric tube or percutaneous endoscopic gastrostomy?].
When enteral nutrition is indicated to prevent or to treat a patient with denutrition choosing between a nasogastric tube (NGT) and a percutaneous endoscopic gastrostomy (PEG) is not always an easy decision. In neurological patients with swallowing disturbances or in patients with head and neck tumors, PEG is associated with lower rates of feeding tube dislodgement, while NGT has lower rates or morbidity. A meta-analysis showed that the interruption of nutrition is less frequent with PEG but there is no difference in terms of mortality and aspiration pneumonia between PEG and NGT. The European Society for Clinical Nutrition and Metabolism recommends PEG when enteral nutrition is expected to last more than 3 weeks.