Revue médicale suisse
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Drowning is always a serious event, with high morbidity and mortality. Definitions were recently revised and simplified according to Utstein-style. The circumstances and prognosis differ in different age groups. ⋯ The management of drowning victims should be directed to the correction of these 3 elements. An early basic life support and an efficient oxygenation are keys of good prognosis, this one being mainly related to hypoxic cerebral damages. The most frequent complications except anoxic encephalopathy are bacterial pneumonia and ARDS.
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Acute abdominal pain tends not to be treated by surgeons and emergency physicians. However, literature has become clear that analgesics are effective and do not disturb clinical examination, diagnostic process and do not delay surgery. Thus, early treatment of acute abdominal pain is recommended. In the absence of scientific evidence, protocols must be established by each institution and validated by quality process.
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The present therapeutic approach is aimed at controlling central sensitisation that is supposed to be the core of fibromyalgia's physiopathological mechanisms. The tricyclic antidepressants have some effects on sleep and the improvement of physical activities. ⋯ New Dopamine D3 receptor agonists as well as the new anticonvulsivants such as gabapentine and pregabalin are equally promising. However the prescription of any medication should take place within a multidisciplinary approach.
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A balanced inhibition of both serotonin and norepinephrine reuptake is usually evoked to explain the analgesic action of tricyclic and SNRI antidepressants but other mechanisms able to modulate the chronic pain-induced neuroplasticity may occur. Fundamental and clinical experiments are necessary to confirm the traditional monoaminergic hypothesis, to improve the efficacy of SRI and to better define the criteria of choice of antidepressants. These could open on novel therapeutic approaches for the management of chronic neuropathic pains as, for example the medication combination.