Revue médicale suisse
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Revue médicale suisse · Nov 2007
Review Historical Article[A history of internal medicine: medical specialization: as old as antiquity].
This article presents a short review of the history of medical specialization and the evolution of internal medicine within the last two centuries. Medical specialization, far from being a recent phenomenon, existed in the Hellenistic world and in Rome. ⋯ The term innere medizin or internal medicine was adopted from German terminology in the 1880's. The Canadian society of internal medicine was formed in 1983 and its main goal is to promote a broad perspective of medical care and to master the complexity in medicine through a generalist approach.
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Revue médicale suisse · Nov 2007
Review[Peripheral neuropathic pain relieved by somatosensory rehabilitation].
The femoral neuralgia is a rather frequent and invalidating clinical disorder. It takes on many clinical forms because of the anatomical variations of the cutaneous branches of saphenous and femoral nerves. The neuroplasticity of the somato-sensory system has now been determined which allows for a better understanding of the techniques of somatosensory rehabilitation. ⋯ The various strategies of somatosensory rehabilitation are mentioned. The authors also present a brief review of the pharmacological treatments of peripheral neuropathic pain. Lastly, the result of the somatosensory rehabilitation of femoral neuralgia (NNT = 1.8) is documented on the basis of a prospective study done on 59 patients.
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Two studies showed that continuous long-term oxygen therapy (> 15 h/d) undoubtedly confers a significant benefit on survival in hypoxemic patients with chronic obstructive pulmonary disease. This treatment should be prescribed to stable patients with a PaO2 < 7.3 kPa or a PaO2 < 8 kPa and either previous episodes of ankle edema, pulmonary hypertension or a haematocrit > 55%. ⋯ However, the Swiss Society of Pneumology does not recommend treating patients with isolated nocturnal hypoxemia, unless they suffer from central apnea and are shown to be responders. The characteristics of the three methods of oxygen delivery for domiciliary treatment are discussed in this review.
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There are many case reports of serious complications and death among obstructive sleep apnea patients (OSA) during general anesthesia or postoperative analgesia. Sedatives and anesthetic agents, pharyngeal anatomy of these patients, opiates given for analgesia, and post operative REM sleep rebound represent potential hazards for general anesthesia in OSA patients. ⋯ A special attention should be given to the symptoms and signs suggestive of OSA during preoperative visits. Screening tests should be performed in patients with suspected OSA and, if positive, a treatment should be initiated.