Revue médicale de la Suisse romande
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The chronic exertional compartment syndrome (CECS) consists of a disturbance of the muscular function of a compartment related to a rise in the intramuscular pressure of the aforementioned compartment, during an exercise. The most frequent location of this pathology is the leg. ⋯ Among those, the measurement of the intramuscular pressures of all the compartments potentially accused, at rest, during an effort and especially in phase of recovery, represents the determining criteria. The physiopathological mechanisms implied in the syndrome and currently recognized, are also the object of this 1st part.
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Rev Med Suisse Romande · May 2003
Review[Mastectomy and reconstruction: what kind of safety, which attitude?].
Breast reconstruction should be regarded as a significant part of breast cancer treatment. Immediate reconstruction has the advantages of a better cosmetic result, a better illness approach and of avoiding the need of a second major operative procedure. Immediate and early delayed reconstruction does not significantly increase the risk of local or systemic disease recurrence and the type of surgery performed should depend on the further therapy chosen. Skin-sparing mastectomy--a new technique--preserves the skin envelope and should be proposed to patients with central breast cancer.
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Rev Med Suisse Romande · Feb 2003
Review[Can ambulatory networks solve emergency department overcrowding?].
Overcrowding of emergency departments (ED) is on increasing concern and results from (1) patients using ED as their primary source of care, (2) aging of the population, (3) poor coordination between home care services and primary care physicians. Two groups of patients can be targeted to reduce the use of ED services. ⋯ Strong links between home care agencies and primary care physicians are required for the success of these programs and may limit their diffusion in non integrated delivery systems of care. Second, patients with chronic diseases may benefit from disease management programs which have been shown to reduce hospitalizations and cost-saving.
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Rev Med Suisse Romande · Dec 2002
Review[Ambulatory parenteral antibiotics in the treatment of severe pediatric infections].
The indications to parenteral antibiotic treatment in paediatrics are frequent. Antibiotic agents with antimicrobial spectrums and pharmacodynamic properties allowing effective and secure outpatient parenteral therapy are now widely available. ⋯ The physician responsible for conducting such treatment should select patients according to strict criteria and never neglect security and quality issues. In this article, the authors discuss different aspects (general, medical, psychosocial, economic and practical) related to outpatient parenteral antibiotic treatment of severe paediatric infections.
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The assessment of glomerular filtration rate (GFR) is critical for the diagnosis and management of renal diseases in pediatric nephrology. Ideally, it requires the measurement of the renal clearance of a filtration marker. Inulin, an exogenous marker, is the only compound the excretion of which occurs exclusively by glomerular filtration, with no tubular handling. ⋯ Mathematical formulas taking these parameters into account have thus been developed. Among these, the so-called "Schwartz formula" is often used and is a reliable estimate of GFR in children. Finally, radionuclide renal scans can be used to evaluate the separate glomerular function of each kidney.