La Revue du praticien
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High grade gliomas are the most frequent and malignant primary brain tumours in adults. Prognosis depends on age, performance status and histological grade. Associated with symptomatic treatments, surgery, radiotherapy and chemotherapy represent the main weapons of the specific multidisciplinary therapy of malignant gliomas. ⋯ Radiation therapy has been shown to improve survival in malignant glioma. The place of chemotherapy is growing not only for anaplastic oligodendrogliomas, more chemosensitive (particularly when they harbor 1p19q codeletions), but also for glioblastomas patients, which have been shown to benefit from radiotherapy plus concomitant and adjuvant temozolomide. This effect was particularly clear for patients with MGMT inactivation in the tumour, confirming here also the impact of molecular biology for future management of gliomas.
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La Revue du praticien · Sep 2006
Review[Non-traumatic pathology of the shoulder: medical treatment].
Recently published meta-analyses emphasized weak methodology of clinical research evaluating medical treatment of non-traumatic shoulder pathology. Experts recommend medical treatment as the first step in the management of rotator cuff tendinopathies, the focus of this review. This step precedes surgical treatment of rotator cuff tear with the objective of recovering passive motion of the shoulder. ⋯ Therefore, the physician prior treatment has to establish a lesion diagnostic, which is necessary to propose an appropriate strategy. Medical treatment includes NSAID, local injections of corticosteroids and physiotherapy with the double objective of a painless shoulder and normal range of motion. In case rotator cuff calcifying tendinitis, medical treatment is specific with first NSAID and local injections of cortico-steroïds, second needle aspiration and third arthroscopic removal, which remains the gold-standard procedure when other treatments failed.
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La Revue du praticien · Sep 2006
Review Comparative Study[Infections caused by multiresistant bacteria].
Bacterial resistance to antibiotics is enhanced by antimicrobial selection pressure by antibiotics and the crossed transmission. Multiresistant bacteria (MRB) are involved in 1/5 of nosocomial infections and the 3/4 of the MRB are meticillin resistant Staphylococcus aureus and extended-spectrum-beta-lactamase-producing Enterobacteriaceae. The epidemic diffusion of these strains is still poorly controlled in our hospitals. The fight against the diffusion of these bacteria requires not only to screen patients harbouring antibiotic-resistant bacteria and respect hygiene measures, but also actions aiming at reducing the weight of selection pressure by antibiotics.