The rapid growth of the spine during the pubertal spurt requires greater vigilance for the pediatrician at the annual check during this period to detect the occurrence of scoliosis. Before confirming the diagnosis of idiopathic scoliosis, it is imperative to exclude a secondary cause with appropriate history and clinical examination, and in selective cases with additional testing. Any scoliosis detected during growth should be considered potentially progressive and sent to a specialist if it is equal to or exceeds 20° on the X-rays. Radiological changes of more than 5° during a 6 months interval must also motivate an appointment with a specialist. Regular clinical and radiological surveillance, every 6 months, remains imperative to confirm or deny this risk of progression and decide on treatment.
We describe here a case of spondylodiscitis of brucellosis origin in one patient back from Turkey. Some weeks later, her mother, who had accompagnied her in Turkey also developped similar symptoms. A diagnosis of spondylodiscitis due to a contamination by Brucella melitensis was also proposed. Since the control of animal brucellosis in Europe, human cases are rarer. Sporadic cases still observed are mostly travellers back from aerea where animal brucellosis remains endemic. Seroprevalence of a second case of brucellosis among family members of a patient with brucellosis is significantly more elevated than in the general population. This justifies early detection among family members presenting with any medical symptom, in order to avoid chronicity. Early detection among asymptomatic family members is not clearly justified.
Les relations entre poids corporel et anomalies metaboliques ne sont pas univoques. Ainsi, il existe des personnes non obeses metaboliquement anormales (MONW), rarement depistees en raison d'un poids corporel faussement rassurant, et, a l'inverse, des sujets metaboliquement sains bien qu'ils soient obeses (MHO). La topographie (intra-abdominale/hepatique vs sous-cutanee peripherique) et l'activite hormono-metabolique et pro-inflammatoire differente des depots graisseux semblent jouer un role determinant pour expliquer ce paradoxe. Cet article de revue vise a decrire les grands principes de la prise en charge therapeutique des personnes MONW, dans le but de reduire le risque accru de diabete de type 2 et de maladies cardiovasculaires, et de discuter les avantages et inconvenients d'une prise en charge classique de l'obesite chez les patients MHO.
During the past 20 years, therapeutic and rehabilitative modalities in the field of psychosocial rehabilitation have been diversified in becoming more specific. We have the possibility to offer individualized rehabilitation programs as well as in the general field of socio-professional goals as in the clinical field according to the patients' needs and personal assets. The content of these programs associates various forms of specialized medical and paramedical services. The indications are established trough a careful assessment. The rehabilitation unit of the University Department of Psychiatry in Lausanne has developed a multidisciplinary assessment method based on the bio-psychosocial integrative model and the vulnerability-stress model in integrating the level of experience of Wood for the analysis of the psychosocial functioning. This results in a structured assessment program, which leads to a multidisciplinary comprehensive assessment (difficulties versus adaptative resources).
Les lithiases medicamenteuses representent environ 1,5% de l'ensemble des lithiases urinaires, ce qui est loin d'etre negligeable. On en distingue deux grandes categories: d'une part, les lithiases qui resultent de la cristallisation urinaire d'un medicament ou d'un metabolite peu soluble a forte excretion renale; d'autre part les lithiases de composition metabolique apparemment banale, mais qui sont provoquees par les effets metaboliques de medicaments administres pour le traitement de diverses pathologies. Parmi les medicaments qui cristallisent dans les urines et sont susceptibles de former des calculs ou d'enrober des calculs preexistants, l'indinavir, le triamterene et les sulfamides sont les plus frequemments impliques, suivis par la silice utilisee comme epaissisant des biberons chez les nouveau-nes et par divers antibiotiques et antiseptiques. Le diagnostic de ces lithiases repose sur l'analyse des calculs par spectrophotometrie infrarouge ou diffraction des rayons X. Les medicaments inducteurs de lithiases metaboliques sont plus difficiles a impliquer dans un processus lithiasique qui se manifeste souvent longtemps apres le debut du traitement, voire apres l'arret de celui-ci. L'interrogatoiree du patient et l'enquete clinique sont determinants pour juger de la responsabilite du medicament dans le processus lithiasique. Les principaux traitements inducteurs de lithiases calciques sont les supplementations calciques et vitaminiques D ainsi que les traitements prolonges par les inhibiteurs de l'anhydrase carbonique pour glaucome ou epilepsie. Certains traitements peuvent etre inducteurs de lithiases rodiotransparentes comme les medicaments uricosuriques, les laxatifs, l'allopurinol ou les acidifiants urinaires. Lorsqu'un medicament est indispensable au traitement de la maladie pour laquelle il a ete prescrit, l'arret de sa prescription ou le remplacement par un outre produit n'est pas toujours possible. Dans ce cas, il convient de prendre en compte le risque lithogene du traitement et de proposer des mesures prophylactiques adaptees comme une cure de diurese et, pour les produits qui y sont sensibles, une modification du pH urinaire.
Acute severe asthma is defined by the occurrence of an acute exacerbation resistant to the initial medical treatment, complicated by life-threatening respiratory distress due to severe lung hyperinflation. The conventional therapeutic approach is based on oxygen therapy and on the combined treatment of inhaled beta2-agonists at repeated doses and systemic corticosteroids. Inhaled or systemic magnesium sulfate is also recommended. The unresponsiveness to the initial bronchodilating therapy and the development of respiratory distress requiring intubation significantly increases mortality, due to the complications induced by mechanical ventilation. In these situations, a ventilatory strategy, including controlled hypoventilation with permissive hypercapnia, aiming at preventing lung hyperinflation, is indicated. Non-invasive ventilation may be successful in certain patients and represents an effective alternative to intubation. In ventilated patients, helium-oxygen mixtures can be considered as adjunctive therapies. After having reviewed the basic pathophysiological principles, this article will focus on the current medical treatment and of the modalities of mechanical ventilation in acute severe asthma.
La surdite de l'enfant est un reel probleme de sante publique puisqu'elle touche 2 nouveau-nes/1000. Le retentissement du handicap depend de la profondeur de la surdite et du retard diagnostique. Ces 10 dernieres annees, de nouvelles techniques de depistage se sont developpees rendant possible la systematisation des examens. Les tests objectifs simplifies semi-automatises (otoemissions, potentiels evoques auditifs de depistage) sont associes a un interrogatoire et un examen clinique rigoureux pour optimiser le depistage. Le depistage des patients a risques et plus largement le depistage universel pourrait permettre la prise en charge precoce de tous les enfants sourds. Il est particulierement important de souligner le role des parents et des professionnels qui, en reconnaissant precocement les signes cliniques de surdite et en proposant les tests de depistage, pourront permettre d'orienter plus rapidement les patients en consultation specialisee.
Le vieillissement de la population risque d'augmenter de facon significative le nombre de personnes âgees atteintes de troubles psychiques. Celles-ci presentent des besoins de soins specifiques qui pour etre satisfaits necessitent une organisation de soins particuliere. La psychiatrie de la personne âgee est une discipline recente qui rencontre des difficultes importantes pour s'implanter. Si certains pays comme le Royaume-Uni, le Canada, les Etats-Unis, l'Australie et la Nouvelle Zelande ont joue le role de pionniers, d'autres pays, tant parmi les plus developpes que parmi ceux en voie de developpement, se donnent des moyens pour developper des politiques, de programmes et des services specialises, mais peut etre trop lentement. La Suisse s'est dotee de services dans la discipline, tant universitaires que non-universitaires et peut etre fiere de l'exemple qu'elle donne pour le reste de l'Europe. Cependant elle tarde a reconnaitre la specificite de la formation requise pour exercer dans ce domaine. Cet article montre comment cette lacune est en voie d'etre comblee.
Despite the improvement and the diversification of the circuits for care in the city, the number of drug addicts sentenced to prison sentences in the Canton of Vaud in Switzerland has not decreased in recent years. It is therefore imperative for the Prison Medicine and Psychiatry Service (SMPP) to provide a medical follow up which respects as closely as possible the principle of the equivalence of care with the outside environment. This article presents the way in which the SMPP takes its place in the continuity of the therapeutic assistance which drug dependent individuals can take advantage of. In this way, the range of therapeutic protocols in force in the different regimes of detention (preventive detention, custody and the execution of sentence) are examined, whether initial treatment, drug weaning or substitution therapies.
Alendronate and teparatide, recombinant human PTH (1-34) are available treatment for osteoporosis in postmenopausal women. They act through opposite mechanisms of action. Alendronate reduces the remodeling of bone and thus increases secondary mineralization without any change in the amount of bone. Teriparatide, 20 micrograms/day, a bone forming agent would increase the amount of bone through two mechanisms, modeling--formation without resorption, and remodeling--resorption then formation with formation higher than resorption. Theses effects are present at the sixth month.
Coronary artery bypass grafting needs a carefull preoperative screening in order to avoid unexpected adverse events during and after the operation. The purpose of this paper is to present the routine preoperative screening before coronary artery bypass grafting. The Euroscore permits comparison of real mortality compared with expected mortality. The Euroscore allows also quality control in institutions performing open cardiac surgery.
In the field of addiction medicine, presence of multiple morbidity (psychiatric, somatic, social) is frequent. Establishment of a correct psychiatric diagnosis can help,especially in case of treatment failure, to adapt (medical and non-medical) therapeutic strategies. In this article we propose some practical suggestions (clinical, instruments) for establishing a psychiatric diagnosis in addiction medicine. In this fiels, follow-ups in partnership between specialists and general practitioners should be developed. The general practitioner should remain the principal caregiver, guaranteeing the framework, the therapeutic liaison resented by certain patients consulting in general medicine.
UNLABELLEDCardiac angiosarcoma represents a primary cardiac malignancy tumor whose early diagnosis is difficult because of its non specific clinical presentation. We present the case of a 57 years old patient with medium abundance hemoptysis. The chest X ray film and CT scan showed bilateral pulmonary infiltrate without cardiac anomaly. Abdominal echography showed disseminated hepatic tumoral lesions. A transthoracic echocardiography made after apparition of heart failure symptoms found a right atrium cardiac tumor. The hepatic lesion biopsy showed angiosarcoma.CONCLUSIONIn presence of uncommon systemic symptoms like diffuse pulmonary lesions associated with cardiac anomaly, the diagnosis of angiosarcoma should be included.
