Revue médicale suisse
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Revue médicale suisse · Aug 2009
Review[Metabolically obese normal-weight individuals and metabolically healthy, but obese, subjects].
The relationships between body weight and metabolic abnormalities are not so simple. Indeed, there are metabolically obese normal-weight (MONW) individuals, who are frequently not detected because of a falsely reassuring body weight, and, in contrast, metabolically healthy, but obese, people (MHO). The different topography and hormonal-metabolic and pro-inflammatory activities of various adipose depots seem to play a major role to explain this paradox. The present review paper aims at describing the main principles of management of MONW individuals, with the objective to reduce the higher risk of type 2 diabetes and cardiovascular disease, and to discuss both the advantages and uncertainties of a classical weight-reducing approach in MHO people.
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The cause of Parkinson's disease remains unknown and no cure or prevention exists so far. Levodopa remains by far the most potent symptomatic therapy, but induces side-effects such as motor fluctuations and abnormal movements, which can somewhat be counterbalanced by optimizing levodopa plasma levels or acting at receptors level with long half-life dopamine agonists. In severe cases, functional surgery with deep brain stimulation can be offered. Some non-dopaminergic symptoms like dementia, freezing, postural instability or dysautonomia do not respond to dopaminergic drugs and need special care.
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Carbon monoxide (CO) is the leading cause of death by poisoning in developed countries. In 2006, 23 deaths and more than 130 hospitalisations related to CO poisoning have been reported in Switzerland. Impairment in oxygen transport through competitive antagonist action on hemoglobin is well known. ⋯ CO intoxications carry a high risk of immediate mortality and long-term neuropsychiatric or cardiac sequelae which justify the need of early diagnosis and treatment. Administration of supplemental oxygen is the cornerstone of treatment of CO poisoning. Hyperbaric oxygen therapy must be considered for the treatment of severe intoxications.
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Slightly displaced clavicular midshaft fracture is currently treated nonoperatively. There is considerable debate about whether acute displaced fractures should be treated operatively. Nonunion rate after displaced fracture has been underestimated for a long time, and malunion clinical impact often minimized. ⋯ However, operating all displaced fractures may lead to overtreatment. Acute operative treatment of midshaft fractures with delayed treatment of established nonunion showed no significant difference in the outcome, but malunion surgical management is technically demanding. Consequently these fractures could be treated surgically, but operative indication should be adapted to patient expectations.