Revue médicale de Bruxelles
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Most of us live in cities and nature seems beneficial. Unfortunately, invertebrates and vertebrates may be aggressive. We will try here a review of the diseases caused by arthropods and other noxious animals. ⋯ Among invertebrates: leeches, anemons, corals, sea urchins, sponges and mollusca. Noxious or venomous vertebrates will not be forgotten. Basic and practical attitudes are proposed.
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A wide range of invasive techniques are available for pain treatment. Treatment must be adapted to the severity of the underlying disease and the intensity of pain. Very few controlled studies concerning these techniques have been performed, and it is therefore difficult to assess their short and long term efficacy. ⋯ This non exhaustive revue presents the indications, techniques and results of neural conduction blocks as peripheral blocks, Alcock canal block, zygapophysial joint blocks and also central blocks illustrated by epidural and intrathecal injections and finally sympathetic nervous system blocks as celiac plexus block, stellate ganglion block and intravenous blocks for complex regional pain syndromes. The indications, techniques and results of thermal neurolyse (radiofrequency, thermocoagulation), transcutaneous electrical nervous stimulation (TENS) and implant central stimulation are also presented. A multidisciplinary approach is used to evaluate the risk/benefit ratio of these invasive techniques for each patient.
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The presence of a general practitioner (GP) at the hospital emergency ward is a first attempt to answer a society phenomenon, challenging the hospital manager, but related to a more complex and extensive problem. New habits, due to various reasons, eventually move an ever growing proportion of patients from the community GP towards the hospital. The relationships between the patient and the practitioner are collapsing down like those between family members especially in towns. How can we resolve such an evolution politically? To have the city GP inside the hospital as it is already the case in big US cities? or, to favor the central role of the community general practitioner in the medical management of the patients, but in opposition to the present course of events? The first solution would be more expensive than the second one.
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When the term of the patent is completed, medicinal products may be copied. Generic products only refer to "essentially similar specialities". It means that bio-equivalence must be established. ⋯ It should increase the patient's compliance. Actually, the lack of compliance is according to all observers a major issue. Involvingly both doctors and pharmacists should be the best way of improving quality of care for patient's benefit.