Revue médicale de Bruxelles
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Huntington's disease is caused by an abnormal CAG expansion within the gene encoding Huntingtin which induces a major cortico-striatal degeneration as well as motor and cognitive impairments. Since the discovery of the present mutation, a number of experimental data have been collected to uncover the physiopathological consequences of mutated Huntingtin expression. Here, we review the therapeutic challenges of Huntington's disease.
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The European Community has named five emergencies as being priorities. These five emergencies are: the cardiorespiratory arrest, the myocardial infarction, the severe polytrauma, the cerebral vascular accident and the severe acute dyspnoea. In this article three of them are discussed. ⋯ Within the first three hours the aim is to get the patient to an emergency department (by means of the SMUR), to evaluate the coagulation values of the patient and to perform a head scan (without the injection of contrast) of good quality. If the patient is not too severely incapacitated (NIH score between 4 and 25), if the head scan does not show a hemorrhagic lesion and if there is no contraindication for thrombolysis, Actilyse should be administered. The time it takes to do all of these acts can not exceed the above mentioned three hours.
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At the end of 2005 the new guidelines for the treatment of cardiac arrest were published. The diagnostic criteria of cardiac arrest were simplified and priority is given to thoracic compressions. The ratio of thoracic compressions to insufflations is 30/2. ⋯ In case of asystole or pulse less electrical activity adrenaline is administered as early as possible. Atropine is used in case of pulse less electrical activity with a ventricular response lower than 60/min. In advanced life support a priority is given to whether or not there are treatable secondary causes (4H, 4T), furthermore controlled hypothermia is installed when systemic circulation is restored and optimal support to all vital functions is given.
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Fibular intraneural cysts are a rare cause of fibular neuropathy. Echography and MRI are helpful in the detection of cysts of the knee. Surgical ablation of the cyst arising from the superior tibio-fibular joint is necessary for a good recovery.
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Carpal perilunate dislocations are rare and underdiagnosed because of an ignorance of the pathology and an inappropriate incidence of radiography. The carpus is composed of two rows of bones and 33 ligaments. These ligaments are fundamental for wrist stability. ⋯ The Witvoët and Allieu classification of the perilunate dislocations is the most used. This classification is composed of three grades. The treatment is usually surgical and has to be realised in a short delay to minimize the important complications.