La Revue du praticien
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Liver injury is the main feature of paracetamol poisoning. Early administration of N-acetylcysteine is an effective antidotal treatment. ⋯ Salicylate poisoning should be systematically suspected when several of the following features are observed in a poisoned patient: tinnitus, deafness, hyperventilation, respiratory alkalosis, metabolic acidosis. Diagnosis is readily confirmed by measuring plasma salicylate concentration.
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A stress fracture is a very localized change in bone remodeling occurring in a normal bone that is subjected to an unusual repeated cyclic loading. It is a common fracture in military recruits and recreational or competitive athletes. A typical medical history and a local bone tenderness at physical examination suggest the diagnosis that is confirmed by a local "hot" spot on the radionuclide bone scan. ⋯ Radiographs show the fracture line or a bone sclerosis as the result of fracture healing. Although every bone may be involved, depending on the type of the physical activity, metatarsals and calcaneus are the most frequent locations in the foot. The treatment of a stress fracture in the foot consists in a 4 to 6 nonweight-bearing immobilisation followed by a graduated return to march and sport.
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Tendinitis of the foot is frequent and is generally due to mechanical overload or inflammatory rheumatic disorders. It most often involves the posterior tibial tendon when obesity and calcaneus valgus combine to contribute to mechanical overwork, or in the early stages of rheumatoid arthritis. ⋯ The long-term risk is of a sinking internal arch and a fixed calcaneus valgus. A simple but effective treatment is the correction of the calcaneus valgus, but surgical arthrodesis may be necessary.