Clinical Reviews.

[Argirios Argiriou]

Κλινικές ανασκοπήσεις.

[Argirios Argiriou]

Summary points:

Wound management is as important as use of antimicrobials in preventing infection.

Primary closure should be avoided in limb injuries where possible because of increased risk of infection.

For patients considered to be at higher risk of infection, the prophylaxis of choice is co-amoxiclav.

Erythromycin or flucloxacillin should never be used alone prophylactically as Pasteurella infection is usually resistant.

Infected wounds presenting within 12 hours of injury are usually due to Pasteurella multocida.

Patients at particularly high risk of infection are immunosuppressed patients, particularly those with asplenia or cirrhosis or those who have had a mastectomy.


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[Argirios Argiriou]

Summary points:

Trigeminal neuralgia is a rare but characteristic pain syndrome.

Most cases are still referred to as idiopathic, although many are associated with vascular compression of the trigeminal nerve.

A minority of cases are symptomatic of multiple sclerosis or nerve compression by tumour.

The condition is variable and patients may have just one episode.

Most patients respond well to drugs; carbamazepine is usually the first line treatment.

If drug treatment fails or is not tolerated, surgical treatments are available.

Ablative surgical treatments are associated with facial sensory loss, almost no risk of severe complications or death, and a high rate of pain recurrence; microvascular decompression has a risk of severe complications or death, albeit very low, and a lower relapse rate.



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[Argirios Argiriou]

Summary points:

Intermittent claudication is a common condition and in most cases is easily diagnosed.

It is associated with a significantly increased risk of death from cardiovascular disease.

Only a small proportion of patients with claudication require revascularisation.

The main treatment aim is to reduce the risk of mortality from cardiovascular events.

Smoking cessation, control of hypertension and diabetes, and prescription of statins and antiplatelet drugs are key elements for treating the condition.

Exercise, angioplasty, and bypass surgery can improve symptoms of claudication.



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[Argirios Argiriou]

Summary points:

Atopic eczema is an itchy inflammatory skin condition with associated epidermal barrier dysfunction.

The prevalence of atopic eczema seems to be rising, but the factors responsible for this rise are not fully understood.

The pathophysiology of eczema involves systemic as well as cutaneous immune and epidermal dysfunction.

Eczema is a complex trait with significant genetic and environmental influences.

Emollients and topical steroids are the mainstay of treatment for mild to moderate eczema; moderate to severe eczema may require the addition of second line agents such as topical or systemic calcineurin inhibitors, ultraviolet phototherapy, or systemic azathioprine.

A clearer understanding of the genetic basis and pathophysiology of eczema is expected to lead to new improved treatments.



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[Argirios Argiriou]

Summary points:
..........
Emollients and topical steroids are the mainstay of treatment for mild to moderate eczema
.........................

Τί σκευάσματα για να μαλακώνουν και να λιπαίνουν το δέρμα (emollients) προτείνετε στους ασθενείς σας που έχουν έκζεμα;

[mandreou]

Συνήθως κάποια κρέμα με βιταμίνη Α όπως ακουαζολ ή βεπανθόλ ή τις παιδικές κρέμες που χρησιμοποιούν για τον ποπούλη ( ) οι μαμάδες ( ως γνωστό αυτές τα ξέρουν όλα !)

[Gatekeeper]

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[Argirios Argiriou]

Summary points:

Acute organophosphorus poisoning may induce multisystem toxicity leading to severe toxicity and death.

Poisoning is diagnosed on the basis of history and clinical examination; biochemical investigations can have a role for confirming the diagnosis.

Management consists of prompt resuscitation, antidotes as required (particularly atropine, oximes, benzodiazepines), and selective decontamination.

Ongoing monitoring and high quality supportive care are essential.

Healthcare staff treating exposed patients should exercise standard precautions.



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[Argirios Argiriou]

"It is more important to know what sort of person has a disease
  than to know what sort of disease a person has."

      Hippocrates

Summary points:

Irritable bowel syndrome is believed to result from a variety of biological and psychosocial factors.

Irritable bowel syndrome is not a diagnosis of exclusion; a positive diagnosis can usually be made.

The usual medical treatment is often highly unsatisfactory; if psychological factors seem important, these should be dealt with.

Tricyclic antidepressants and some selective serotonin reuptake inhibitors are of value in improving symptoms.

Cognitive behaviour therapy has a strong evidence base for its effectiveness.

Gut directed hypnotherapy is an effective treatment and is especially suitable for more severely affected patients who might be prepared to travel to specialist centres.


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[Argirios Argiriou]

Summary points:


Rape and sexual assault are common, particularly among young women although men and children may also be assaulted.

Perpetrators are usually known to those they assault.

People who have been sexually assaulted often seek medical help but may not disclose the assault.

Management includes treatment of injuries; emergency contraception; prevention of infections, including HIV; and psychosocial support.

Although many people experience psychological symptoms after rape, most recover.

A minority of people after assault have significant and disabling persistent symptoms that require specialist intervention and active treatment.

Collection of evidence may be crucial in identifying and prosecuting perpetrators.

Optimal acute management is the provision of all necessary services in one place and in a sensitive, safe, and forensically secure environment.



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[Argirios Argiriou]

Summary points:

Herpes zoster and postherpetic neuralgia are common causes of debilitating neuropathic pain.

Systemic antiviral agents reduce both the acute pain of herpes zoster and the incidence of postherpetic neuralgia.

Corticosteroids, tricyclic antidepressants, gabapentin, and opioids reduce acute pain and may have additional effects on the reduction of postherpetic neuralgia.

Tricyclic antidepressants, gabapentin, opioids, and lidocaine patches are effective in established postherpetic neuralgia.

Large scale vaccination of children and older adults may have an important impact on the incidence of herpes zoster and postherpetic neuralgia.



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[Argirios Argiriou]

Summary points:

Most patients with acute sciatica have a favourable prognosis but about 20%-30% have persisting problems after one or two years.

The diagnosis is based on history taking and physical examination.

Imaging is indicated only in patients with "red flag" conditions or in whom disc surgery is considered.

Passive (bed rest) treatments have been replaced with more active treatments.

Consensus is that initial treatment is conservative for about 6-8 weeks.

Disc surgery may provide quicker relief of leg pain than conservative care but no clear differences have been found after one or two years.



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[EzeΤΡΟΛ]

1. Imaging is indicated only in patients with "red flag" conditions or in whom disc surgery is considered.

2. Passive (bed rest) treatments have been replaced with more active treatments.

3. Disc surgery may provide quicker relief of leg pain than conservative care but no clear differences have been found after one or two years.

Άκρως ενδιαφέρουσες οι επισημάνσεις, αλλά η εφαρμογή τους σκοντάφτει σε διαχρονικές, ακλόνητες αντιλήψεις της Ελ υπαίθρου:

1. Τί; Δεν θα μου βγάλεις ακτινογραφία; Έλα δώσ'μου το χαρτί, δεν κουβαλήθηκα μέχρι εδώ για να δώ τα μούτρα σου. (Και πάλι καλά που στο ΚΥ δεν υπάρχει αξονικός τομογράφος)

2. Αστειεύεσαι γιατρέ; Και πώς θα μου περάσει η μέση περπατώντας; Θα μου γράψεις μια σειρά ενέσεις να μου τις χτυπήσει η Τασούλα. Ορέ, δεν ξέρει τίποτα ετούτος εδώ!

3. Τί λες τώρα, γιατρέ; Εγώ έκανα εγχείρηση στη μέση στο Διαβαλκανικό πριν από 5 χρόνια και από τότε δεν με ξανάπιασε, χαλάλι τα λεφτά που έδωσα!

[Αδαμάντιος Σκούφαλος]

1. Τί; Δεν θα μου βγάλεις ακτινογραφία; Έλα δώσ'μου το χαρτί, δεν κουβαλήθηκα μέχρι εδώ για να δώ τα μούτρα σου. (Και πάλι καλά που στο ΚΥ δεν υπάρχει αξονικός τομογράφος)

2. Αστειεύεσαι γιατρέ; Και πώς θα μου περάσει η μέση περπατώντας; Θα μου γράψεις μια σειρά ενέσεις να μου τις χτυπήσει η Τασούλα. Ορέ, δεν ξέρει τίποτα ετούτος εδώ!

1. "Τι; Δεν έχετε αξονικό; Ήθελα να ήξερα τι ρόλο παίζει αυτό το Κ.Υ. και δεν το κλείνετε!" Το σχόλιο αυτό άκουσα από Αθηναίο του οποίου ο συγγενής είχε διακομιστεί στο Κ.Υ. μετά από τραυματισμό στο κεφάλι συνεπεία τροχαίου ατυχήματος, όταν τον ενημέρωσα ότι θα διακομιστεί στο νοσοκομείο για αξονική! (Μεταξύ μας: Που να του έλεγα ότι ούτε καν ακτινολογικό δεν διαθέτει το Κ.Υ.! Που δεν διαθέτει! Χε.χε.χε..)

2. Μου αρέσει που πολλοί διανύουν 20 χιλιόμετρα σε καρόδρομο (ντάκα ντούκα με την ανάρτηση του αυτοκινήτου) για να ρθουν στο Κ.Υ. (αν στο χωριό τους δεν υπάρχει Τασούλα) για να κάνουν την περίφημη ενδομυϊκή αντιφλεγμονώδη ένεση που τους συνέστησε ο καλός (όπου καλός=πληρωτός) γιατρός, γιατί όπως τους είπε στην ακτινογραφία που έκαναν στη μέση "ένας σπόνδυλας έχει φύγει από τη θέση του" (η λογική απορία που γεννάται, όμως μέχρι τώρα δεν έχω βρει το κουράγιο να τη διατυπώσω, είναι "και που πήγε ο σπόνδυλας που έφυγε;"*). Προφανώς οι ενδομυϊκές ενέσεις θα βοηθήσουν στην επανάκαμψη του αγνοούμενου - άσωτου σπόνδυλα.

*Μήπως να τους έλεγα να ψάξουν στο δρόμο - καρόδρομο μήπως κάπου παράπεσε ο σπόνδυλας;