Revue médicale suisse
-
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.
-
New ways of consuming tobacco or nicotine have recently been developed attracting smokers not only because of their novelty but also because they hope that it will decrease their health risks or will help them in smoking banned places. The objective of this paper is to review the current state of knowledge concerning the waterpipe, oral tobacco, nasal snuff, the electronic cigarette and tobacco heating devices. Although some products seem less harmful than cigarettes, we cannot encourage people to use them because we still do not have sufficient scientific data regarding their safety. Moreover, most of these products are addictive and we still do not know if they will play a role in harm reduction.
-
This article discusses the potentially deleterious influence of opioids on cognitive functioning in chronic pain patients. Under stable doses of opioids, cognitive performances in patients are not inferior to those observed in healthy controls. During initialisation and/or adaptation of opioid treatment, a transient inferiority of cognitive performances is observed in chronic pain patients. ⋯ It is emphasized that cognitive dysfunction in chronic pain patients might be due to the attentional cost due to daily pain. Pain reduction by opioids may diminish this cost. Recommendations for driving under opioids are proposed.