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Complaints in the region of the hips and pelvis are often difficult to classify. This is due to the fact that pain projection and overlapping can occur; therefore, the complete region of the lumbar spine, pelvis and hips must be considered as a single entity in which alterations can result in radiation throughout the whole region. There are many different anatomical structures within the pelvic region so that the function of various muscle components can be impaired and cause pathological alterations to positional relationships of bony structures or even alterations to other soft tissues, such as ligaments, tendons and labra. In terms of differential diagnostics the groin must be seen as the weak point of the peritoneum and vascular system and taken into consideration. Therefore, a detailed and targeted medical history, functional testing and specific examinations and tests are necessary to narrow down the pathology in question and reach a definitive diagnosis. Orthopedic surgeons must know which conspicuous features can lead to which problems and which anatomical structures are likely to be affected by irritation. The results of the clinical examination are the basis for targeted imaging diagnostics and subsequent therapy. 相似文献
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Résumé Deux sous-types de récepteurs cannabino?des (CB-R) sont identifiés à présent, les CB1-R, essentiellement localisés dans le
SNC, et les CB2-R, périphériques. Le Δ9-tétrahydrocannabinol (Δ9-THC) est le composé actif essentiel de Cannabis sativa, l’anandamide
est un ligand endogène, le WIN 55,212-2, le CP55,940, le HU-210, sont de puissants agonistes synthétiques, mais tous sont
non sélectifs CB1/CB2. Chez l’animal, ils induisent l’association caractéristique de quatre sympt?mes: hypothermie, analgésie,
hypoactivité et catalepsie, qui sont annulés par le SR 141716, antagoniste sélectif CB1. L’anandamide présente plusieurs différences
par rapport aux autres agonistes puisque l’hypothermie, l’analgésie et la catalepsie qu’il induit ne sont pas atténuées par
le SR 141716. Un processus cannabino?de semble également intervenir dans la cognition, la mémoire, l’anxiété, le contr?le
de l’appétit les vomissements, la pression intra-oculaire, l’inflammation et les réponses immunitaires. Bien que le Cannabis
ait un usage récréationnel chez l’Homme, rares sont les études qui indiquent un potentiel appétitif chez l’animal. Au contraire,
le Δ9-THC et les autres agonistes ont des effets aversifs dans divers tests. Le SR 141716 altère la perception par les animaux
du caractère plaisant de différentes substances appétitives (nourriture, coca?ne, morphine) et réduit la consommation de sucre,
de bière et d’alcool, suggérant que des mécanismes dépendant des CB1-R pourraient exercer un contr?le permissif sur les processus
motivationnels positifs. Les systèmes cannabino?des ne semblent pas activés dans des conditions basales. Cependant, une étape
dépendant d’une activation tonique des CB1-R a été mise en évidence dans le cas de douleurs chroniques et chez des animaux
confrontés à des stimuli anxiogènes ou à des renforcements très motivants. Des mécanismes CB1 pourraient également exercer
un contr?le tonique sur certains processus cognitifs.
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Résumé La clinique des pratiques addictives des douloureux chroniques est complexe et a longtemps fait l’objet de publications contradictoires.
Une mise au point s’avère d’autant plus nécessaire que le r?le étiopathogénique, de l’abus médicamenteux dans l’aggravation
et la chronicité de certains types de douleurs est largement reconnu. Différents auteurs soulignent que l’évaluation des comportements
addictifs des patients douloureux chroniques pourrait être améliorée, si l’on utilisait les définitions standardisées appliquées
classiquement à la toxicomanie, celle de l’Association Américaine de Psychiatrie (dépendance et abus), et celle de l’Organisation
Mondiale de la Santé (dépendance et usage nocif pour la santé). Le recours à des définitions standardisées (abus, dépendance)
ne peut rendre que plus lisibles les données recueillies. Les comparaisons deviennent possibles et l’examen des études publiées
fournit une approximation de la prévalence de l’abus et de la dépendance médicamenteuse des sujets consultant pour une douleur
chronique (entre 10 à 20%). Mais, l’inadaptation partielle de ces définitions lorsqu’elles sont appliquées à la population
des douloureux chroniques est discutée. Leur inconvénient principal est que les comportements addictifs de la majorité de
ces sujets douloureux chroniques n’entrent pas dans la catégorie de la dépendance ni même de l’abus de médicaments. Cette
évaluation, bien qu’utile, s’avère être réductrice face à la complexité de la psychopathologie des conduites addictives et
de ses intrications multiples avec la pathologie douloureuse.
Summary Addiction in chronic pain patients is a complex topic and the studies published have long been contreversial. Some authors suggested that the use of standardized diagnostic criteria for addiction developped in the population of substance abusers could improve the assessment of addiction in chronic pain patients. Operational diagnostic criteria have been defined by the World Health Organization (for substance dependence and harmful use) and the American Psychiatric Association (for substance dependence and abuse). A review of studies using these criteria indicated that drug dependence or abuse occurred in a minority of chronic pain subjects (10 to 20%). These definitions should be interpreted caustiously when applied to chronic patients and the limitations are discussed. It appeared that the categorical model of substance use disorder could be applied to a subset of chronic pain patients but that clinical observations and quantitative evaluations indicated that a larger subset of addictive behaviors were not captured by this kind of evaluation.
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Introduction
Epiphyseal stress fractures of the second phalanx base of the fingers are predominant in young climbers. The objectives of the study were 1) to determine the incidence of these injuries among young French competitive climbers (9–18 years old); 2) to determine injury risk factors during training.Methods
A questionnaire was sent to French climbing coaches between September 2015 and April 2017.Results
Four injured presenting 5 injuries were collected. The injured seemed to train more than the uninjured, to have a higher level of competition and to compete more per year. In global physical preparation, the injured seemed to work less on their flexibility than the uninjured. During training, the wounded paid less attention to warm-up. During warm-up, the wounded were doing less cardiorespiratory work. In specific upper limb strength training, 45.45% of trainers used the girder and pan Güllich and 72.72% the no foot, known to be at risk of injury.Discussion
The training of injured climbers had known risk factors for overuse injuries and epiphyseal fractures. Furthermore, there was a lack of knowledge among youth and coaches about: 1) the use of risky methods; 2) epiphyseal stress fractures of the fingers and their consequences. To prevent these fractures, training and competitions should be adapted to children and an information campaign should be organized for families and coaches. 相似文献17.
《Réanimation Urgences》2000,9(7):545-549
A study on the legal liability of physicians working for the SAMU and SMUR emergency medical services was carried out based on a retrospective assessment of all the accidents involving the intervention of medical staff, recorded between 1994 and 1999 by the Sou Médical. During this period, a total of 15 claims were made concerning physicians who acted either in a transporting capacity (ten claims) or in a regulatory capacity (five claims). In the majority of cases (12 out of 15 cases), the claim followed legal proceedings. In two other cases, it was submitted after a verbal or written complaint, in one case, it was spontaneously submitted by a physician following the accidental death of a patient during transport, without any complaint being made by the victim's family. The medico-legal repercussions of the 15 accidents reported in the study were only known in 11 cases, as in the remaining cases there were ongoing legal proceedings. None of the 11 cases involved conviction for any of the doctors concerned. In particular, the criminal lawsuits brought against three regulators and three transporters led to closure of the file (two instances) or to dismissal of the case (four instances). In contrast to the high ratio of criminal lawsuits initiated by the patients, in this series of 15 accidents the fact that no doctor was sentenced by the court reflects a degree of partiality on the part of the judges towards the doctors involved in emergency medical service activity. 相似文献
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